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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An Evolving Semi-Monthly Update on Community Mental Health in New York
December 4, 2008

IN THIS EDITION

State Dollars Could be Saved by Restructuring OMH Sex Offender Program

With the State’s budget deficit growing and considerable budget cuts on the horizon, State agencies have been looking for areas in which they can make efficiencies that would not impair their core missions. One area where New York State spends a high amount of money with limited evidence of clinical success is in the civil commitment of sex offenders to inpatient psychiatric facilities in the mental health system.

According to The Coalition’s analysis, in fiscal year 2008-09, the Office of Mental Health (OMH) was allocated $33.3M to run the sex offender program. Currently, about 170 people have been found to have probable cause for civil confinement, but not all of these cases are in the OMH system yet. OMH spends over $600 a day per inmate or $225,000 per year. This is a very costly program, especially where evidence of a psychiatric cure is not clear.

When OMH’s sex offender program was initiated, mental health stakeholders were assured that this program would not place a financial drain on the mental health system. Since its implementation, OMH now faces a rising number of sex offenders entering the mental health system (currently about 11 new people per month), including pre-adjudicated cases that should remain in the custody of the Department of Corrections. Sex offender confinement in the OMH system will require the building of new facilities and increased staffing costs (currently 550 positions are authorized).

In the current economic environment and a post reinvestment world, it is not fiscally prudent to continue with this system as is. Sex offenders could be treated in a setting that is equivalent to an inpatient hospital in terms of security and humane constraint, but less costly in terms of professional staffing and related hospital expenses. Cost savings can be achieved as an alternative to cutting the budgets of community-based mental health services.

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Albany Special Session Ends with No Budget Deal; Advocates Rally Outside of Capitol

The Coalition along with over 1,000 advocates participated in the One New York: Fighting for Fairness rally in Albany on November 18, 2008 to push for alternatives to across the board cuts to human services. We would like to thank all of our members who participated and helped make the rally a huge success. Here is a video clip from Capital News Nine coverage of the event and press conference.

Inside the Capitol, legislative leaders and Governor Paterson were unable to come to an agreement on the Governor’s proposed budget cuts for $2B in FY2008-09 and $3.5B in FY2009-10 and a vote did not take place. The Coalition will now be tracking the following budgetary developments and their effect on behavioral health funding:

  • December 15: Senator Skelos will call the Senate back to Albany for another emergency session to look for ideas to deal with the State’s growing fiscal crisis.
  • December 16: Governor Paterson will release the State’s FY 2009-10 Executive Budget one month earlier than normal to look to close an even greater budget deficit. Paterson has also launched a website for a more open budget process; it can be accessed at www.reducenyspending.gov.

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Outpatient Mental Health and Chemical Dependency Clinics are Exempt from Final CMS Outpatient Hospital Regulation

Our advocacy efforts have made a difference! The final rule for the CMS Outpatient Hospital regulation was posted in the Federal Register on November 7, 2008. In reviewing the final rule, it looks like CMS has made several significant positive changes. Here are the highlights of the final rule:

  • Exemption of free-standing outpatient mental health and chemical dependency clinics
  • No impact on the definition of clinic services
  • Service clarifications in the final rule apply only to hospital outpatient services
  • Does not require the use of Medicare’s rates in the UPL calculation

This is a substantial victory for The Coalition and our community. The Coalition will be working closely with colleagues, both locally and nationally, to advocate for the withdrawal of the rule. We will keep you updated on the full implications of these changes.

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Federal Advocacy to Bring Financial Aid to New York State?

Congress was back for a lame duck session from November 17th-21st, 2008 to negotiate a second economic stimulus package. The Coalition, along with other advocates, was actively working with the New York congressional delegation to add to the stimulus bill a temporary increase in the Federal Medicaid Assistance Percentage (FMAP). We also sought a moratorium on the Center for Medicare and Medicaid Services (CMS) Outpatient Hospital (otherwise known as the Upper Payment Limit or UPL). Talks fell apart on the floor after agreement was not reachable. An increase to FMAP would have enlarged New York State’s Federal share of Medicaid expenses and implementation of the Outpatient Hospital rule (as originally written) would have cost the State about $450M by aligning Medicaid fees and services for outpatient services with those offered by Medicare.

While Congress will likely reconvene on December 8th to negotiate a bailout package for the automotive industry, we do not anticipate that the economic stimulus bill will move until January 2009 when the new 111th Congress arrives in Washington. This will provide an opportunity for us to advance the issue of Medicaid aid to states, via an FMAP increase, and regulatory reform agenda. Currently 6 CMS regulations that would be harmful to community providers are in moratorium until April 2009. We are hopeful for withdrawal or extension of the moratoria, as well as passage of a comprehensive economic stimulus package. Estimates of a new stimulus bill, as reported in the New York Times on December 2, 2008, are now as much as $400-$500 billion.

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Mayor Bloomberg Releases November Financial Plan Cuts; Coalition Testifies at City Council Hearing

The Coalition previously reported that Mayor Bloomberg announced that the City planned to cut 2.5% in City funds in FY 2009 and 5% in FY 2010, impacting the Department of Health and Mental Hygiene (DOHMH) budget by a $10.3M reduction in FY 2009 and $18.9 in FY 2010.

As part of the Mayor’s fiscal year 2010 November financial plan, DOHMH plans to reduce funding to contracted behavioral health providers by $2.7 million. On November 24, 2008, The Coalition and about 80 participants from the public testified on the November budget plan cuts. We stated that while respecting the Department’s intention to meet savings targets from providers that are expected to close in the coming year or are not meeting their performance goals, we thought that that DOHMH should announce which specific providers would be impacted. We would like to thank Councilman David Weprin, Chair of the Finance Committee for holding the public hearing and Councilman G. Oliver Koppell, Chair of the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services for stating at the hearing that The Council will inquire on where the cuts will be targeted.

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The Center Releases User Friendly Medicaid Buy-in Fact Sheet for Working People with Disabilities

The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) program enables working people with mental health and other disabilities to earn more income while preserving their vital health care coverage. It is a critical and severely underutilized opportunity, especially in New York City, for eligible consumers who may want to work, or wish to work more, but are fearful of losing healthcare benefits. In response to very low utilization rates among people with mental illness in New York City, The Center, in collaboration with key stakeholders, is working on dismantling the barriers to the program’s access. To this end, The Center is now releasing a new, easy to understand MBI-WPD fact sheet to enhance program awareness and encourage enrollment. Visit our website to download the fact sheet at:  www.coalitionny.org/the_center/resources. We encourage you to share it broadly with consumers and staff throughout your programs.

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Around the Water Cooler

We wish Alysia Pascaris a very fond farewell as she embarks on a new chapter after 7 years of devoted service to the Coalition as the Director of the Center for Rehabilitation and Recovery.

Coalition professional alumnus Michael Polenberg of Safe Horizon (a Coalition member), and his wife Liza became the proud parents of Leo Morse on November 21st. Leo's already aggressively lobbying president-elect Obama for Under Secretary of Tiny Little Feet and Hands.

Services for the Underserved and Visiting Nurse Services, two Coalition members, were ranked as two of the best places to work in New York City by Crain’s New York Business. The complete list appears in the November 17, 2008 publication.

DOHMH’s new Executive Deputy Commissioner Dr. Adam Karpati visited The Coalition on November 13, 2008, where he met representatives from Coalition members and staff. We look forward to a collaborative and productive relationship.

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New Membership Announcement

The Coalition welcomes our newest member Family Services of Westchester. We are looking forward to their active participation in The Coalition. Since 1954, Family Services of Westchester has been dedicated to strengthening and supporting families and individuals at every stage of the life cycle with a broad range of social and mental health services.

Susan Wayne, President/CEO

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Two Coalition Members Secure Housing Grants

The Coalition congratulates our members, Church Avenue Merchants Block Association (CAMBA) and Neighborhood Coalition for Shelter, who received grant awards from the TD Charitable Foundation’s “Housing for Everyone” program. CAMBA was awarded a $100,000 grant to develop 53-units of affordable and supportive housing in Flatbush, Brooklyn. The building will become home to lower-income residents and formerly homeless individuals from the City’s shelter system, offering on-site case management services, community rooms and a landscaped patio and garden. On a green note, the facility will also utilize energy, waste and water efficient systems to reduce the building’s overall energy consumption. Another Coalition member, Neighborhood Coalition for Shelter was awarded a $25,000 grant to help fund a new Housing Development Coordinator position to identify and develop long-term and transitional housing opportunities for homeless adults with mental illness.

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Coalition Hosting Foothold Technology User Group

On December 10, 2008 from 3-5pm the Coalition will be hosting a special Foothold users group meeting entitled “Best Practices and New Directions in Service Delivery”. The meeting is open to current Foothold users. Please RSVP to Juliette Palmer juilette@footholdtechnology.com. For directions to The Coalition’s offices located at 90 Broad St. 8th Fl. go to our website http://www.coalitionny.org/contact_us/.

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Free Tax Preparation for Working Individuals with Mental Health Disabilities

The consequences of reporting income, and filing a tax return, on benefits can be a real concern to working people with disabilities, Therefore, The Coalition’s Center for Rehabilitation and Recovery, in partnerships with Seedco, is sponsoring an opportunity for individuals with mental health disabilities, who live and work in New York City, to have their taxes prepared and filed for FREE at The Coalition. Please save these dates: February 10, 2009 & February 28, 2009. Registrants will have the opportunity to choose either date for morning or afternoon sessions. Registration preference is on a first come, first served basis. Please look for future updates with more information and how to register on our website: www.coalitionny.org/the_center.

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Coalition and Citibank to Offer Agency Cash Management Seminars

We encourage you to take part in a timely Breakfast Seminar Series, co-sponsored by Citi’s Nonprofit Financial Services Group and The Coalition, on agency cash management. The first seminar called Forecasting Cash Flows with Daniel L. Blumen, CTP, who is a Partner in the Treasury Alliance Group LLC, will be held on Wednesday, January 14, 2009 from 8:30 am – 10:30 am. The second seminar called Helping Clients Forecast Cash with Louise McNulty, Vice President, Citibank N.A., will be held on Wednesday, February 25, 2009 from 8:30 am – 10:30 am. Both seminars will take place at Citi Conference Center – 14th Floor at 153 E. 53rd Street, New York, NY 10022, between Lexington and Third Avenues. Enter at the lower plaza on Lexington Avenue.

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Coalition’s Medicaid Crystal Ball Conference – A Huge Success

On November 20, 2008, The Coalition held an all day conference that was well attended and featured prominent individuals with significant understanding and knowledge of the Medicaid system. The conference, entitled The Medicaid Crystal Ball: Behavioral Health Transformation in New York, opened with Charles G. Curie, MA, ACSW and the former administrator of the Substance Abuse and Mental Health Services Administration (SAMSHA). Mr. Curie delivered a well received keynote address that spoke to future Medicaid funding for behavioral health services, the role of the Center for Medicare and Medicaid Services’ mission in funding health care and how it differs from the behavioral health community’s current thinking on rehabilitation, recovery, evidenced based practice and consumer driven services.  

Michael Hogan, Ph.D, Commissioner of NYS Office of Mental Health and Deborah Bachrach, JD, Medical Director of the NYS Department of Health each responded to Mr. Curie and than engaged in an extremely candid discussion of the more pressing Medicaid policy issues affecting the provider community and the consumers they serve. They were followed by afternoon presentations by Jeffrey Crowley, MPH, Senior Research Scholar at Health Policy Institute, Georgetown University, and Mary Thornton, BSRN, MBA, Principal of Mary Thornton Associates. Mr. Crowley spoke about the impact of Medicaid rule changes and moratoria on community behavioral health services, and Ms. Thornton presented on Medicaid quality of care and compliance issues. Highlights and presentations can be accessed on our website at: http://www.coalitionny.org/news_resources/.

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DOHMH Partnership to Increase Consumer Knowledge of Safe Sex Practices

The Division of Mental Hygiene and the Bureau of HIV/AIDS Prevention and Control of the New York City Department of Health and Mental Hygiene (DOHMH) are partnering to increase consumers’ safe sex practices and encourage their use of male and female condoms.

The Department strongly encourages all adult mental health programs and substance use services to make condoms available to the people they serve. Organizations can request free condoms by calling 311 or visiting online at www.nyccondom.org. The Bureau of HIV/AIDS Prevention and Control also provides a one-hour presentation about male and female condoms to providers and the people they serve on what one should know about safe sex in relationship to STD/HIV prevention, exploring risky behaviors, characteristics of male and female condoms as safe sex tools, how to use condoms, and how to properly store and maintain the products. To schedule a presentation, please contact Crystal Lovelace, Quality Assurance Field Supervisor at (646) 253-5711.

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OMH Proposes Regulation to Extend Age of Eligibility for Children’s Day Treatment

The Coalition has learned that the New York State Office of Mental Health (OMH) proposed a regulation that will increase the age of individuals receiving services in day treatment programs for children. Upon approval of the Commissioner, a day treatment program may continue to serve individuals over the age of 18, but under the age of 22, if it prevents a disruption in the provision of educational services necessary to complete the educational plan. The amendment is non-controversial as it is permissive in nature and should not be considered a mandate or requirement.

This regulation is currently undergoing the public review process. Public comments will be accepted for 45 days after the publication date of November 19, 2008. OMH does not expect individuals to object to the proposed rule. Once the comment period ends, OMH will review public testimony and submit the regulation to the State for final approval. Adoption is most likely to occur in January 2009.

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Social Security Administration Holds Hearing on Traumatic Brain Injuries and Stroke

The Coalition’s last edition of Briefs announced the rollout of Compassionate Allowances, a Social Security initiative to expedite the processing of disability claims for applicants whose medical conditions are so severe that they obviously meet social security standards.

On November 18, 2008, The Social Security Administration, in conjunction with the United States Department of Defense, held a public hearing on Compassionate Allowances at Ft. Myer in Arlington, VA. Senior executives from the Department of Defense and the National Institutes of Health joined Michael J. Astrue, Commissioner of Social Security, to hear testimony from some of the nation’s leading experts on traumatic brain injury, the signature injury of the conflicts in Iraq and Afghanistan, and stroke.

This hearing was the third of four public hearings Social Security plans to hold. Previous hearings dealt with cancers and rare diseases and resulted in the nationwide launch of the Compassionate Allowances initiative in October 2008. See the press release at: www.socialsecurity.gov/pressoffice/pr/compassionate-allowances-1008-pr.htm. Please go to www.socialsecurity.gov/compassionateallowances to read the testimony from many of the traumatic brain injury and stroke experts or to view a webcast of the hearing.

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Direct Express - Social Security Debit Card Released by Treasury Department

A new debit card – Direct Express – is now being offered by the Treasury Department as an alternative to paper checks for Social Security and Supplemental Security Income recipients who wish to receive their benefits electronically. While about 80% of recipients have benefits directly deposited into their bank accounts, for those recipients without bank accounts, the risks and costs associated with receiving and cashing paper checks can be very problematic. Available to individuals receiving Social Security and SSI, the debit card can alleviate concerns regarding paper checks being lost, delayed, or even stolen, and save recipients without bank accounts costly check-cashing services that total up overtime!  Every month, a benefit payment is automatically transferred to a Direct Express account that is accessed at an ATM or merchant that accepts MasterCard debit cards. Signing up is free and no bank account is required. For more information go to:  www.directexpress.org or www.usdirectexpress.com or call 1-877-212-9991.

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Coalition Job Board

Coalition Members advertise staff positions for free on The Coalition’s Job Board!  Here's a sample:

Job #  Job Title
5312 Director of Outpatient Mental Health Clinic
5299

Instructor/Case Manager

5303 Case Manager, Transitional Living Community
5300

Substance Abuse Case Manager

5291

Associate Program Director

5286 Intensive Case Manager

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