NYAPRS Note: The following testimony was prepared by NYAPRS for the joint legislative budget hearing yesterday on health/Medicaid issues. Harvey will be offering oral testimony at the Mental Hygiene hearing on February 11. In these testimonies we reassert our request that the legislature protect the imperative funding for mental health services and community housing afforded in the proposed Executive budget.
Testimony Before the NYS Legislative
Joint Fiscal Committees
Health/Medicaid Budget Hearing
February 3, 2014
Presented by
Briana Gilmore, Director of Public Policy and Advocacy
Harvey Rosenthal, Executive Director
New York Association of Psychiatric Rehabilitation Services
On Behalf of NYAPRS Members and
The NYAPRS Public Policy Committee
Co-Chairs: Carla Rabinowitz, Ray Schwartz
NYAPRS Board of Directors
Co-Presidents: Steve Coe, Maura Kelley
Thank you to the chairs and members of the respective committees for the opportunity to submit to you the concerns of the tens of thousands of New Yorkers represented by the New York Association of Psychiatric Rehabilitation Services. NYAPRS is a unique statewide partnership of New Yorkers with psychiatric disabilities and the community mental health professionals who support them in over 100 community-based mental health agencies from every corner of the state.
My name is Briana Gilmore, and I work as the Public Policy and Advocacy Director for NYAPRS. The following testimony incorporates the views of the New Yorkers who help to guide the direction and scope of our work. In part, this testimony reflects feedback from hundreds of community members who participated in planning forums last fall in Newburgh, Hempstead, Brooklyn, White Plains, Batavia, Saranac Lake, Binghamton and Syracuse.
You may have seen our members out in great evidence last Tuesday. Throughout that day, the Capitol was filled with over 600 spirited mental health self and system advocates who came to urge their state legislators and Administration officials to advance policies promoting their recovery, rehabilitation and rights.
State mental health policy is a very personal matter for our NYAPRS community. Many of our members, our board members, our staff, and I all share a common personal journey of recovery from a psychiatric disability. We believe this strengthens our ability to speak to you on behalf of the thousands of New Yorkers with psychiatric disabilities and their supporters that we represent.
NYAPRS would like to bring the following Executive budget items to your attention as they relate to the Medicaid beneficiaries whom we work to protect and advocate for:
Medicaid Redesign
Over 700,000 individuals in NYS receive behavioral health (mental health and addiction) services through Medicaid. Roughly one-third of these people have a diagnosis of a serious mental illness. NYS spends nearly $1 billion annually on avoidable hospital readmissions, 70% of which are attributed to persons with diagnosed behavioral health conditions. Thanks to the Administration’s progressive implementation of the recommendations of New York’s Medicaid Redesign Team, of which NYAPRS executive director Harvey Rosenthal is a member, attention to our community members is finally being acknowledged as a significant public health issue that requires greater investment of funding and program redesign.
The 2014-15 Executive Budget allocates $120 million to substantively re-shape our Medicaid system, maximizing community based supports and healthcare integration while providing funding for an array of alternatives to costly hospitalizations. We believe that these investments are critical to state efforts to overhaul our systems to improve the health of hundreds of thousands of New Yorkers and we urge their strong support by these committees and the legislature as a whole.
In doing so, the 2014-15 Medicaid budget reflects the growing understanding that attention to the physical, mental, and social determinants of health for behavioral healthcare consumers saves money and promotes wellness and recovery.
Reinvestment of Medicaid Inpatient and ER Savings Must Be Upheld
The budget redirects $120 million in Medicaid savings attributed to the decreased use of inpatient and emergency settings by Medicaid recipients with behavioral health issues. NYAPRS members strongly support the allocation of this funding into the following imperative service areas:
- $20 million to help managed care plans, health homes and providers prepare for the move to managed care integration
- $15 million for efforts to integrate behavioral and physical health
- $40 million for a targeted Vital Access Provider (VAP) program
- $5 million to establish clinical care in OASAS residential settings
- $10 million for enhanced coordinated care for highest need individuals
- $30 million to ramp up community recovery service capacity in advance of the 2015 move to integrated, managed ‘Health and Recovery Plan’ initiative
These provisions anticipate the increased flexibility within Medicaid that the state is preparing to make the center piece of our behavioral healthcare reforms. Federal standards for Medicaid spending on behavioral healthcare has expanded to meet the needs of individuals who are often burdened with chronic poverty, poor access to culturally competent physical healthcare, inadequate coordination among their various service providers, and unable to access preventive and rehabilitative services.
This budget will allow for increased flexibility and expectations for the Medicaid managed health plans to which behavioral healthcare will be entrusted and integrated in 2015. At the same time, it will enhance state proposals to create new ‘health home networks’ of providers that are being organized to improve coordination and raise accountability. Finally, budget initiatives will allow providers to create innovative needs-based and person-centered service designs to address the multiple, costly needs of beneficiaries with complex medical, mental health and addiction related conditions.
It will allow New York to dramatically increase access to essential benefits that have historically been limited to marginal state grant funding, including crisis and mobile crisis, peer and family supports, rehabilitation, employment and non-medical transportation services will be enhanced with Medicaid funding that will help keep people out of the hospital, and in the community where recovery happens.
Stable housing in a cornerstone of recovery and has been closely tied to improved health and reduced use of costly healthcare settings and placements within homeless shelter and correctional facilities. The budget demonstrates national leadership in increasing Medicaid Redesign Team supported housing funds by $14 million in 2014-15 and an additional $60 million in 2015-16.
Proper distribution of these funds will contribute to further reductions in the use of costly hospitals and emergency services by funding community-based services that are preventive and meet the range of supports needed by behavioral healthcare consumers. Furthermore, it will adequately prepare the Medicaid system for a full integrated transition to managed care.
Accordingly, we urge the legislature to:
- Maintain the commitment to community reinvestment by upholding the proposed $120 million in Medicaid Reinvestment;
- Create provisions in the 2014-15 budget that ensures that savings from future decreases in Medicaid inpatient and ER spending by behavioral health consumers is reserved and reinvested back into initiatives that benefit behavioral health consumers, in accordance with the state’s commitment to implement the recommendations of the behavioral health subcommittee of the Medicaid Redesign Team.
Support the Transition of Adult Home Residents with Psychiatric Disabilities
Included in the Office of Mental Health’s proposed budget is a $30 million allocation to fund 500 units for individuals coming out of adult homes in keeping with a long awaited court settlement. When fully allocated, this will bring the total to 1,750 by the end of 2015.
As the licensing body for NYS adult homes and the overseer of the coordinated health home networks that will be charged with organizing and delivering health and behavioral health care to the transitioning residents, the Department of Health must play a clear and consistent role in supporting good transitions and follow up care.
DOH should achieve all appropriate actions to enforce new state regulations that require adult homes with over 80 residents with psychiatric disabilities to “bring the facility’s mental health census to a level that is under 25 percent of the resident population over a reasonable period of time, through the lawful discharge of residents with appropriate community services to alternative community settings.”
Protect Consumer Rights and Choices in New Medicaid Initiatives
As members of Medicaid Matters New York, NYAPRS supports their vital work in ensuring that all Medicaid programs are implemented with respect to the needs of beneficiaries. We support MMNY’s ongoing priorities, particularly the following issues that are reflected in this year’s Executive budget:
The Medicaid Managed Care Ombudsperson Program will provide individualized, independent assistance for persons new to Medicaid Managed Care. The 2014-15 budget allocates $3 million for the full implementation of this program. NYAPRS expects that the Ombudsperson Program will become a vital mainstay for Medicaid transitions, as it builds upon this Administration’s commitment to ensuring the safety and rights protection of all consumers. We anticipate that proper oversight and funding will be achieved for implementing the Ombudsperson Program. This should not only be for Managed Long Term Care and the downstate dual FIDA program, but also for the 2015 transition of 700,000 Medicaid beneficiaries with behavioral health needs into managed care, including those eligible for a Health and Recovery Plan (HARP) specialty product.
We encourage that the legislature underscore the importance of consumer rights and protections in this year’s final budget. Ensuring the rights of persons seeking and maintaining services through Medicaid Managed Care is noticeably absent from this year’s budget. NYAPRS would like the legislature to include the elimination of exhaustive requirements on managed care appeals, as well as to provide continuing service protections in MLTC plans during a pending hearing. These basic due process provisions, now mandatory within Department of Health regulations, continue to violate the rights, health, and safety of vulnerable New Yorkers.
In addition, NYAPRS has long advocated for the vital “provider prevails” provision, secured last year in Medicaid Managed Care. The Executive budget proposes to eliminate this vital provision, threatening to remove a protection integral to the safety and continuity of care of hundreds of thousands of behavioral healthcare recipients and many more in the wider community. The provider prevails provision not only secures access to name brand drugs where determined clinically appropriate, but also serves to secure the imperative but often tenuous relationship between prescriber and beneficiary; when medications are suddenly changed or unavailable, the resulting stress and confusion inflicted upon beneficiaries reflects negatively on their relationship with providers of services. Disruptions in the care, safety, and health of New Yorkers cannot be the consequence of an overreaching method to save money.
Accordingly, we urge the legislature to:
- Stipulate that the $3 million allocated to the Medicaid Managed Care Ombudsperson Program also be utilized to prepare for the transition of over 700,000 New Yorkers with behavioral healthcare needs into managed care;
- Uphold the due process rights of MLTC plan members by removing exhaustion requirements during an appeals process, and by mandating that service provision be continued when a service termination hearing is pending;
- Preserve vital “provider prevails” protections.
In closing, NYAPRS members have long awaited the type of investments and reinvestments to expand community recovery services and supports that are proposed in the 2014-15 budget. We appreciate the opportunities that the Executive budget provides, and encourage the joint committees to ensure that these historic allocations and provisions receive your strong support.
Thank you for the opportunity to share our community’s concerns and recommendations.