Resources, supports and workforce necessary in NYS Olmstead plan
Mental Health Weekly
Vol. 23, # 40; Oct. 21, 2013
Amid plans to reform state mental health facilities, New York Gov. Andrew Cuomo released the state’s Olmstead mandate to support community integration efforts, with the intent, say officials, to create a “unified” mental health system, bolster recovery and resiliency efforts and will position state staff into community-based roles.
Advocates say they intend to ensure that sufficient community resources and supports are in place to provide an effective transition for consumers with mental illness from institutions into the community.
In November 2012, Cuomo created the Olmstead Development and Implementation Cabinet that was charged with developing a plan consistent with the state’s obligations under the Supreme Court’s Olmstead v. L.C. decision. The Olmstead Cabinet received input from stakeholder groups across the state, including mental health advocacy organizations.
The subsequent “Report and Recommendations of the Olmstead Cabinet: A Comprehensive Plan for Serving People with Disabilities in the Most Integrated Setting” notes that the state will transition people with disabilities into community developmental centers, psychiatric centers, adult homes and nursing homes. State officials also intend to adopt new Olmstead outcome measures for people with disabilities.
The Olmstead plan highlights the settlement agreement the state reached in July 2013 with plaintiffs in longstanding litigation concerning 23 adult homes in New York City serving people with serious mental illness (see MHW, July 29). The agreement will allow consumers to make an informed choice about where to live. As residents move to
supported housing, they will participate in a person-centered transition planning process.
“In creating its Olmstead plan, New York conducted broad stakeholder outreach and consulted a wide variety of resources, including the experience of other states,” Ben Rosen, spokesperson for the New York State Office of Mental Health (OMH), told MHW. “The OMH has launched a regionally based planning process, wherein local communities, represented by Regional Centers of Excellence (RCE) advisory teams, will help determine the needed services to reduce psychiatric hospitalizations and create community-based support systems.”
“As part of this plan, OMH will reinvest state staff into community-based roles and expand mobile and residential services throughout New York,” Rosen said. “OMH has committed to continuity of employment for our workforce and will redeploy highly skilled staff into the community, where they can have an even greater impact.”
The RCE plan is phased in over three years, allowing community-based services to be adequately developed and implemented as psychiatric centers are reorganized, he said. “A key point of the RCE plan is to create a unified New York state mental health system, breaking the boundaries between the ‘state system’ and other providers whom we license and regulate, including county-operated and voluntary programs,” Rosen said.
Addressing BH needs
The Olmstead plan states that under Medicaid redesign for managed behavioral healthcare, New York will create special-needs Health and Recovery Plans (HARPs): distinctly qualified, specialized and integrated managed care programs for people with significant behavioral health needs, said officials. Mainstream managed care plans may qualify as HARPs only if they meet rigorous standards or if they partner with a behavioral health organization to meet those standards, they said.
HARPs will include plans of care and care coordination that are person-centered and will be accountable for both in-plan benefits and non-plan services. HARPs will interface with social service systems and local governmental units to address homelessness, criminal justice and employment-related issues, and with state psychiatric centers and health homes to coordinate care.
HARPs will include specialized administration and management appropriate to the populations/services, an enhanced benefit package with specialized medical and social necessity/utilization review approaches for expanded recovery- oriented benefits, integrated health and behavioral health services, additional quality metrics and incentives, enhanced access and network standards, and enhanced care coordination expectations.
Advocacy input
The New York State Coalition for the Aging was one of several organizations with input into the development of the plan. Ann Marie Cook, president of the coalition, which includes individuals with mental illness and developmental disabilities, said a major concern at this point involves resources – namely, whether there are enough resources in the community to handle everyone who will be impacted by the plan.
“Older adults want to live in their community of choice,” Cook told MHW. “We saw in the early 1990s, when state mental health institutions closed or were dramatically reduced, that support services needed in the community were not there.” The plan notes that many of the state institutions for consumers with developmental disabilities are downsizing, she said. “We don’t want to muddy the waters, but we want to make sure the support and services are there,” Cook said.
Cook added, “Our organization will continue advocacy and education about the need for home- and community-based services. We will join a consortium of aging organizations looking at the issue.”
New York state could possibly establish a national standard for disability policy and deinstitutionalization, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS). “The governor is building a strong recommendation on disability policy very much tied to Olmstead compliance,” Rosenthal told MHW. He cited such long-awaited reform efforts as Cuomo’s downsizing of state hospitals, the Medicaid redesign plan and the adult-home settlement.
Cuomo had announced on August 6, 2012, that New York has submitted an application for a waiver from the federal government that will allow the state to invest up to $10 billion in savings generated by the Medicaid Redesign Team (MRT) reforms to implement an action plan to transform the state’s healthcare system.
Rosenthal, a member of the Most Integrated Setting Coordinating Council, developed to provide input to the state’s Olmstead planning process, said that the state should take any money it expects to save from Medicaid redesign and other state reform efforts and reinvest it into the community.
“This plan will only work if the state front-loads sufficient community resources to put in place the housing and job supports and transportation reforms necessary to support these required and long-awaited community integration plans,” Rosenthal said.
“We have to watch that the money is fully reinvested and we have to make sure community capacity is in place in advance of people coming into the community,” he said. “The state has agreed to a full investment of the savings.”
Rosenthal said he and other stakeholders are trying to wrap up recommendations by December in advance of the release of the 2014 state budget. “Next year’s budget will be the first indication of commitment the state is making with regard to Olmstead, Medicaid savings from the downsizing of state hospitals and funding from adult homes to move consumers into the community,” he said. “That’s where the rubber meets the road.”
Jennifer Mathis, deputy legal director of programs for the Judge David L. Bazelon Center for Mental Health Law, said the Bazelon Center has not yet reviewed the Olmstead plan in its entirety. “It is encouraging that the state has set some concrete goals for affording individuals with psychiatric and other disabilities the chance to live and work in integrated settings,” Mathis told MHW. “The Olmstead plan is an important step toward promoting community integration, but the plan’s success will depend on how it is
implemented.”