NYAPRS First Look at Details of Pending 2014-15 NYS Budget Agreement
By Harvey Rosenthal, Briana Gilmore March 31, 2014
It is expected that state legislators will approve a series of budget bills and agreements today that were reached last week by negotiators for both houses and the Governor.
Overall, we saw a lot of progress in meeting our public policy goals for this session, including $25 million in OMH state hospital reinvestment, just about $120 million in Medicaid pre-investment in advance of next year’s move to integrated managed care, $40 million to aid the community integration of adult and nursing home residents with psychiatric disabilities, over $6 million in supported housing rent stipend hikes and a 2% COLA for direct care workers that begins in the 4th quarter of the upcoming fiscal year (January to March) and annualizes thereafter.
On top of that, we were thrilled to helped lead a late sprint effort that won $400,000 to establish Crisis Intervention Teams here in New York (see below for more).
NYAPRS wishes to express our great gratitude to the Administration and to both houses of the Legislature for making this one of the best budgets we’ve ever seen. We regard this as an expression of how state government has come to view as the importance and value of our community.
Here’s a summary of what we’ve pulled out as of this morning. We’ll have more details and analysis in the next few days.
2% Cost of Living Adjustment (COLA): The 2% COLA advanced by start legislators during the budget hearings was approved…..but won’t start until January 2015 and will only apply to direct care staff, direct support professionals and to foster and adoptive parents who are associated with OMH, OPWDD, OASAS, OCFS, DOH and SOFA. It’s not clear whether these only apply to those making $50,000 or less as had been rumored. Local county governments or direct contract providers will be required to submit a written attestation demonstrating that the increases will only apply to aforementioned staff. The 2% COLA will then extend into the entirety of the following year (April 2015 to March 2016) and will grow to include “clinical staff.”
$25 million in OMH State Hospital Reinvestment Funds: State legislators approved the $25 million in Reinvestment funds that was proposed by the Governor in January. The funds will be used to fund recommendations of the regional Regional Centers of Excellence groups, which will provide for “the expansion of state community hubs and voluntary operated services for adults and children, including, expanding crisis and respite beds, home and community based services waiver slots, supported housing, mental health urgent care walk-in centers, mobile engagement teams, first episode psychosis teams, family resource centers, evidence-based family support services, peer-operated recovery centers, suicide prevention services, community forensic and diversion services, tele-psychiatry, transportation services, family concierge services, and adjustments to managed care premiums.”
$5 million Pilot program to provide job placement training to state employees in the Office of Children and Family Services, The Office of Mental Health, the Department Of Corrections and Community Supervision and the Office for People with Developmental Disabilities who are impacted by the closure or restructuring of facilities in state fiscal years 2012-13, [or] 2013-14, OR 2014-15. The pilot program will be developed and administered by the Office of Employee Relations.
OMH community based service grants were approved for a number of projects, including:
- $400,000 to launch a statewide Crisis Intervention Teams initiative aimed at providing extensive mental health training to local police departments and linking their efforts with mental health workers to reduce tragedies and incarcerations. This was a great victory for a late starting budget effort that was successfully advanced by a coalition of NYC and NYS based advocacy groups, pushed heavily by NYAPRS and guided by the extraordinary assistance of lobbyist Kevin Cleary.
- $1,852,500 for veteran peer-to-peer pilot programs
- $100,000 for a Mental Health First Aid initiative run by the Mental Health Association in New York State:
- $125,000 to fund a Sullivan County Peer Empowerment/Recovery Center
- $350,000 demonstration program for counties impacted during the 2011-12 closure of state-operated hospitals
- $75,000 for a study on the anticipated impact of expanded OMH community reinvestment funded services
- $450,000 for Veterans Mental Health training for psychiatrists, physicians and social workers “to maximize the treatment and recovery from combat related post-traumatic stress disorder, traumatic brain injury and other combat related mental health issues, including substance abuse and suicide prevention” to be implemented by the New York State Psychiatric Association, the Medical Society of the State of New York and the National Association of Social Workers-NYS.
- $600,000 for an Orange County based Mobile Crisis Teams Initiative.
Housing and Supports Related Initiatives
- Rental stipend adjustments to downstate supported housing units in New York City’s 5 boroughs and Nassau, Suffolk and Westchester counties: $6,500,000
- Education, assessments, training, in-reach, care coordination, supported housing and the services for adult home residents with psychiatric disabilities per the recent court settlement: $30 million
- Care coordination, supported housing and other services needed by qualified current and future residents of nursing homes with mental health conditions, including people with MH conditions who are discharged from nursing homes, to implement settlement of 2011 federal litigation: $10 million
Medicaid Behavioral Health Initiatives
It appears that all but $10 million of the state’s proposed $120 million investments to ready us for the transition to integrated managed care were approved. These had been proposed to cover managed care readiness for providers and plans, to preserve Vital Access providers, for an OASAS residential clinical program, for an enhanced health home initiative and $30 million to ramp up 1915.i services like peer and family support, employment and education, rehabilitation and transportation and self-directed care. It appears that the integrated and collaborative care initiative was reduced or cut.
Medicaid Redesign Initiatives
- Capital restructuring grants will be available to providers who are approved to participate in the state’s Delivery System Reform Incentive payment program (DSRIP) for “closures, mergers, restructuring, improvements to infrastructure, development of primary care service capacity, development of telehealth infrastructure, the promotion of integrated delivery systems that strengthen and protect continued access to essential health care services.” The grants will be approved by DOH and the state’s Dormitory Authority, in consultation with OMH, OPWDD and OASAS. Eligible providers for these funds include general hospitals, residential health care facilities, diagnostics and treatment centers, and health and mental hygiene licensed clinics, assisted living programs, primary care providers, and home care providers.
The Legislature created a number of advisory panels and reporting requirements for the Administration, including panels to review DSRIP and Medicaid redesign projects and Health Home allocations that have been approved by DOH. The panels will include legislative representatives and will require quarterly reports to the legislature.
- The DSRIP panel will issue quarterly reports that will analyze progress made towards established goals, on the number and types of providers that were both approved or denied funding, on the state’s monitoring system, on project milestone progress, on project spending and budget, on numbers of beneficiaries served, on the geographic distribution of funds et al.
- The Health Home panel will look at rate adjustments to health homes, the amount of money dispersed from the fund, which providers were awarded such funds, at what level and for what purpose. It will also look at how those funds enhanced member engagement, staff training and retraining, health information technology implementation, joint governance technical assistance.
- DOH must submit copies of Medicaid state plan amendments to Senate and Assembly Health Committee chairs no later than 5 days from submission.
- DOH must also provide detailed reports on the accounting of the state Medicaid Global Cap and related projections.
- Medicaid Waiver Related Savings Reinvestment reports: DOH must post approvals on its website and include details on the description of the proposed services to be provided and information on both the criteria for selection of a contractor or contractors and about the nature of such projects. It will also be required to submit monthly reports on rates and rate adjustments, service utilization and budget impact for spending on a variety of settings including inpatient, outpatient, ER, clinic, nursing homes and other long term care, Medicaid managed care, FHP, pharmacy, transportation, dental, affordable housing, BH Vital Access providers, health home establishment, grants facilitating transition of BH services to managed care, transition of vulnerable populations to managed care, audit recoveries and settlements and demographic information of recipients.
- A Health Information Technology Workgroup will be created to “evaluate the state’s HIT infrastructure and systems, including the all payer database (APD), the state planning and research cooperative system (SPARCS), regional health information organizations (RHIOS), the statewide health information network of New York (SHIN-NY) and to “develop recommendations for the state to move toward a comprehensive health claims and clinical database.”
The workgroup shall include RHIO members, DOH officials, physicians, hospital and FQHC reps and a rep of the Senate Health Committee chairman.
- Rural Transportation: DOH is afforded $2 million to increase access to non-emergency transportation in rural areas.
Several advocacy priorities advanced by Medicaid Matters NY were also approved:
- 4 new members were added to the state’s Medicaid Managed Care Advisory Review Panel (MCCARP): consumers and provider reps from behavioral health and Medicaid/Medicare (duals) communities.
- The budget maintains aid continuing rights, which protects the right to a notice and a hearing before reduction or termination of benefits for seniors and people with disabilities who receive both Medicare and Medicaid.