NY Proposal Expands Community Recovery Services and Supports
Mental Health Weekly; Volume 24 Number 5, 2/3/2014
Mental health providers and advocates in New York state say they are pleased with New York Gov. Andrew Cuomo’s FY 2014–2015 executive budget proposal, released Jan. 23, which calls for increased funding to support supported housing, home- and community-based services waiver slots, peer-operated recovery centers and better integration of physical and behavioral health services. The proposal redirects funds from downsizing state psychiatric facilities to local community mental health systems.
The proposed package of investments includes $25 million to expand community services in anticipation of a reduction in upward of 400 inpatient beds throughout the state. Last summer, state officials announced plans to create regional centers of excellence (RCEs). An RCE model will be regionally based networks of inpatient and community-based services, each with a specialized inpatient hospital program located at its center, with geographically dispersed community services “hubs” overseeing community-based services (see MHW, July 22, 2013).
Cuomo’s proposal supports his Medicaid Redesign plan to redirect $120 million in Medicaid funding to ramp up the state’s local community recovery services in advance of plans to integrate behavioral and medical healthcare and to turn it over to coordinating managed care plans in 2015, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS). “We’re moving to a managed care redesign that will integrate behavioral health and physical health,” he told MHW.
The budget proposes $71.5 million to the Office of Mental Health (OMH) for reinvestment of state hospital resources into the community, downstate supported housing rent increase and community housing supports for adult, nursing home residents.
The OMH funding includes $40 million in community housing and supports for current residents of adult homes ($30 million) and nursing homes ($10 million) with psychiatric disabilities. The proposal features 200 new supported housing units for nursing home residents, and a total of 600 by the end of 2015; 500 new supported housing units for adult home residents, and 1,750 by the end of 2015; and 300 new housing beds for the homeless.
For Medicaid redesign housing investments, the budget proposes an $18.4 million increase in supporting housing.
“The budget basically sends a message that people should be served ideally in the community and that resources [be redirected] from institutions to the community, where people can best recover,” Rosenthal said. “We feel the proposal represents a culmination of issues and priorities we’ve been working on for decades.”
He noted that more than 600 New York consumers, advocates and mental health providers participated in a rally on Jan. 28 in Albany to urge state policymakers and legislators to support increases in the state’s community-based mental health services.
New York state officials intend to use the 1915i <HCBS> option in Medicaid to reimburse states for services and supports that historically have not been available for reimbursement, such as employment, education, peer support, psychosocial rehabilitation, transportation and self-directed care, said Rosenthal.
A mental hygiene budget hearing at the end of February will signal the next part of the budget process going forward, he said. Before the budget is approved April 1 there will be a number of hearings coming up, he said. “We will continue advocating with the state legislature,” said Rosenthal.
Seeking provider increases
Lauri Cole, executive director at the New York State Council for Com- munity Behavioral Healthcare, said that the council is seeking an increase for children’s mental health outpatient clinics. “Many of our members who serve a high percentage of children are in fiscal distress,” Cole told MHW. “We have proposed that the administration and the State Department of Health reset the Child Health Plus rate to be on par with the Medicaid fee-for-service rate.”
Several years ago the state reset the Medicaid Managed Care (MMC) rate to be on par with the fee-for- service rate, Cole said. “At that time, our request to reset the MMC rate was after we learned that many of our members were dropping their contracts with MMC companies due to very low rates,” she said.
Cole added, “We think it is time to rationalize the Child Health Plus rate that is considerably lower than the Medicaid fee-for-service rate. The precedent is there.”
Although pleased with the governor’s budget proposal, Cole said she is concerned that a long overdue cost-of-living adjustment (COLA) for the human services workforce is not included. “The COLA adjustment being delayed puts a tremendous strain on our workforce.” she said. “It’s very difficult to recruit and retain talented, dedicated staff when you can’t pay them what they are worth.” The COLA was originally proposed several years ago but has been delayed a number of times since then, she said.
“We are also working to resolve an issue for our OASAS [Office of Alcoholism and Substance Abuse Services] hospital-based members,” said Cole. Years ago when the rest of the system moved to Ambulatory Patient Groupings and revised rates, hospital-based organizations that provide addiction treatment services were delayed, she said.
“It’s now been three years and the issue is not resolved,” Cole said.
“While we understand NYS and CMS [Centers for Medicare & Medicaid Services] are still working on the State Plan Amendment to resolve this matter, in the meantime these organizations are still being paid the old Legacy rates and are in some cases owed millions of dollars.”
Cole added, “They made the changes and devoted the resources required to bill using APGs, but the green light has not been switched on. We think it is time to resolve this matter.”
The council intends to work hard this session to protect the provisions in the governor’s budget, said Cole. “We intend to see that the implementation of the behavioral health managed care system prioritizes access to care and the availability of a range of behavioral health service options provided by behavioral health agencies who know best how to meet the needs of these individuals,” she said.
“We will fight hard this session to ensure adequate inpatient and community services are available in local communities across the state,” Cole said. “Our priorities will center on access to care and adequate payment for services provided as we move into a managed behavioral health environment.”
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