An Evolving Semi-Monthly Update on Community Mental Health in New York
November 23, 2009
State Fiscal Crisis Threatens Community-Based Services
The State Senate and Assembly returned to Albany today for another extraordinary session to attempt to reach an agreement on a deficit reduction plan (DRP). The Senate "gaveled out" mid-afternoon in defiance of Governor Paterson's call for immediate action. On Saturday, November 22, 2009, the Governor released a statement citing that inaction would threaten payments to local governments and service providers.
Democrats in the State Senate are pushing back against the Governor’s proposed DRP, which calls for a 10% cut to all unspent local assistance funding, but have yet to agree on another alternative. Local assistance programs support a number of programs provided by the human services sector, including behavioral health services. Community-based providers are burdened with even greater demand during fiscal downturns, as more people require support (economic difficulties, family difficulties, unemployment, addiction problems, etc.) and private resources shrink.
The DRP also calls for $287 million in cuts to Medicaid. According to our government relations consultants in Albany, the Assembly is willing to pare this number down to $200 million, while the Senate may be in the vicinity of $150 million. However, cuts to the State share of Medicaid expenses, would also forgo revenue from the Federal government. The Federal government now pays for an enhanced share of about 62% of Medicaid costs in New York State as a result of the Federal stimulus program. For example, a $287 million cut to Medicaid by the State would amount to a total cut of $758 million in reduction to services when adding up the State and Federal shares. This would be especially harmful to consumers’ access to services, adding to current problems.
On November 16, 2009, The Coalition released a statement in response to the Governor’s DRP, which was distributed to the entire Legislature. We reasserted that cuts to local assistance programs would gut the social safety net and be harmful to the State’s economic recovery. In addition, we argued that the behavioral health sector is in a state of reform. Changes scheduled for next year, like clinic restructuring and conversion to PROS, will alter the coordination of care and reimbursement systems for community-based behavioral health services. It is projected that the reforms will squeeze funding even tighter, shrink the not-for-profit workforce, and limit consumer access to services. We hope that the Legislature will consider other options that will raise new revenue, such as passing new taxes on alcoholic beverages, authorizing State efficiencies like buying pharmaceuticals and other items in bulk, and tapping reserve funds set aside to aid the State during tough times. These are just a few of the options available.
With State budget cuts looming and a $5 billion deficit to close for next fiscal year, the Bloomberg Administration has authorized more cuts to City agencies. According to a letter sent to agency commissioners from the Office of Management and Budget (OMB), the Department of Health and Mental Hygiene (DOHMH) will be cut by 4% in the current fiscal year (FY 2010) and 8% next fiscal year (FY 2011). The City’s fiscal year runs from July 1 to June 30.
The economic outlook for New York City is grim. The City expects to continue losing jobs through December 2010, meaning that less tax revenues will be collected, while expenses continue to grow. Furthermore, depending on how State legislators decide to cut their budget, New York City could be severely impacted by a loss of State aid. The Coalition will work with City officials on lessening the impact of potential cuts to the City’s community-based behavioral health system. As always, we will get back to you with more details.
The results from votes cast in City Council districts on Election Day 2009 will change the makeup of the Council in 2010. New Yorkers have elected a Council that will be the most diverse it has ever been in its history in terms of race and ethnicity. In addition, of the 51 member Council, 13 seats will be occupied by new members (5 beat incumbents). The Republican minority also gained 2 new seats, making it rise from 3 to 5 members next year. Adding all of this up, we could see a Council with more diverse opinions whose decisions on City policy may not be in agreement with Mayor Bloomberg, as much as the Council was during his first two terms. The Mayor’s third term was won by a slimmer majority then expected on Election Day, winning just under 51% of the vote.
On the committee level, while the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services will most likely still be chaired by Council Member G. Oliver Koppell, while the chairs for Finance and General Welfare will be occupied by two new council members in 2010, as a result of the election of Council Member Bill de Blasio as the Public Advocate, and Council Member David Weprin’s unsuccessful run for Comptroller. The Coalition plans to reach out to the new City Council members, and we strongly encourage our members to do the same.
Phoenix House, a member of The Coalition, has announced its appointment of Deni Carise, Ph.D. as Chief Clinical Officer, effective January 1, 2010. According to President and CEO of Phoenix House, Howard Meitiner, Dr. Carise is at the forefront of substance abuse treatment research, and had contributed significantly to the transformation in treatment approaches worldwide.
Black Veterans for Social Justice, a member of The Coalition, will open 42 newly constructed affordable and supportive studio apartments at Wazobia House, in collaboration with Long Life Information and Referral Network. A ribbon cutting ceremony was held on Friday, November 20, 2009 in Bedford-Stuyvesant, Brooklyn.
Jay Laudato, Director of the Division of Managed Care in the Office of Health Insurance Programs at the NYS Department of Health (DOH), will leave DOH on December 4, 2009. Vallencia Lloyd, Deputy Division Director, will assume the responsibilities of the director of the Division of Managed Care on an acting basis. We wish them both good fortune!
The Coalition congratulates Pamela Hyde, who was unanimously confirmed by the Senate as Administrator for the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Humans Services (HHS). The appointment was announced today by HHS Secretary Kathleen Sebelius.
Drug Law Reform: OASAS Announces Funding for Case Management Services
In response to the need for chemical dependence treatment services (including outpatient services and case management services), the New York State Office of Alcoholism and Substance Abuse Services (OASAS) announced its intent to award up to $4 million in anticipation of increased demand for clinical case management (CCM) services.
OASAS has posted information on its website on how to access funding. For providers in New York City other than Staten Island, a request for proposal will be issued with instructions on how to apply for funding. Eligible LGU’s, including Westchester, Orange, Nassau and Suffolk counties, can access information on planning supplements to secure additional funding. OASAS also plans to issue funding that will address supported housing needs as a result of drug reform. According to State officials, funding will be made available for this fiscal year to provide re-entry housing for parolees. In addition, funding for new permanent housing options should be available in the next fiscal year. As more details become available, The Coalition will keep you informed.
State Submits a Remedial Plan on Adult Homes Decision
As required by the case decided in Federal court by Disability Advocates, Inc. vs. New York State, the State has submitted a plan that proposes funding for 200 units of supported housing a year over 5 years, totaling 1,000 units. This plan would not begin until State fiscal year 2011-2012, and would only cover about a quarter of the individuals who were represented in the suit. Disability Advocates now has until November 24, 2009 to respond to the State’s plan. The State also still has the option to appeal the court’s decision
The case found New York State in violation of the Americans with Disabilities Act (ADA) for failing to provide 4,300 individuals in the most independent setting according to their needs. Instead, these individuals were housed in 28 adult homes throughout New York City. The Coalition had urged the State not to appeal the court’s decision. Rather, we would like to work with the State in collaboration with all stakeholders, to develop a long term planning process to sufficiently address the needs of people with mental illness who currently live in adult homes, and enables them to transition, and live independently, in whatever form of supported housing that suits them.
House Passes a National Health Care Reform Bill with Behavioral Health Standards
On Saturday November 7, 2009, the House of Representatives passed the Affordable Health Care Act (H.R. 3962) by a vote of 220-215. While 39 Democrats voted against the bill, 1 Republican supported it. The Act, if signed into law, would cost $891 billion over 10 years, but would reduce the national deficit by $129 billion over the same period due to reforms created in the bill. Both figures meet President Obama’s goals for a health care reform bill that he would sign into law.
The House bill includes several provisions to improve access to behavioral health services. Among them are the:
In addition, the bill expands Medicaid eligibility to 150% of the Federal poverty level (FPL), and includes coverage for childless adults. It also extends the Medicaid FMAP increase to states through June 2011. The temporary FMAP enhancement was originally funded in the American Recovery and Investment Act (ARRA). As a result, New York State currently receives 62% of its Medicaid expenses from the Federal government (instead of the normal 50%).
On Saturday, November 21, 2009, the Senate voted 60-39 down party lines to begin floor debate on its health care reform bill called the "Patient Protection and Affordable Care Act.” Both parties are now maneuvering within their ranks before key issues and amendments get introduced after the Thanksgiving holiday. The Senate leadership hopes to pass the bill before Christmas recess.
The Senate bill includes several of the provisions contained in the House bill passed on November 7, 2009, to improve access of behavioral health services. For example, all qualified plans must offer essential benefits packages with coverage for mental health and substance abuse disorder treatment services, as well as habilitative and rehabilitative services. Both bills apply mental health parity to individual and small group markets. The Coalition is in the process of analyzing all of the provisions in the Senate’s bill that would impact the behavioral health sector.
The Congressional Budget Office estimated that the proposal would cost $848 billion over 10 years, but would reduce the national deficit by $130 billion. Included in the proposal is a public insurance plan that would compete with private insurers. However, States would have the option to opt out of the public plan by passing legislation. The bill expands Medicaid eligibility to 133% of Federal poverty level (FPL).
CMS Withdraws Rule to Restrict Rehabilitative Services
The Centers for Medicare & Medicaid Services (CMS) has decided to withdraw a proposed rule that would have limited the coverage and payment of rehabilitative services. The “Medicaid Program; Coverage for Rehabilitative Services" Rule (72 FR 45201) proposed to amend the definition of Medicaid rehabilitative services. This, if implemented, would have tightened access to coverage for therapeutic foster care, recreational and/or social activities, personal care, habilitative services and pre-vocational services. A notice of the withdrawal is published in today’s Federal Register. The Coalition was against this proposed rule when it was initially proposed in 2007. In a letter to CMS, The Coalition argued that the proposed rule would restrict services for people with mental disabilities, and eventually increase their need for more expensive emergency services instead. As a devoted supporter of keeping this rule in moratorium for the last 2 years, The Coalition applauds CMS officials for its withdrawal.
Harm Reduction Series Offered by Coalition's Professional Learning Center
Part I - Understanding and Engaging Clients with Co-Occuring Disorders: A Harm Reduction Approach
Date: December 4, 2009
Part II - Techniques of Integrative Harm Reduction Psychotherapy
Date: December 18, 2009
Location: The Coalition of Behavioral Health Agencies,
On Friday, November 20, 2009 the Office of the Medicaid Inspector General posted revised certification forms for Part 521, Provider Compliance Programs due December 31, 2009: http://www.omig.state.ny.us/data/content/view/157/53/
Compliance forms for the Deficit Reduction Act (DRA) were also revised and must be submitted by January 1, 2010: http://www.omig.state.ny.us/data/content/view/156/53/
The OMIG made minor changes to accommodate the use of NPI numbers for those provider who do not have a Medicaid Provider ID. Both forms must be submitted via electronic method only. Providers who have previously submitted an electronic certification have the option of submitting a new certification form but will not be required to do so.
The OMIG has also revised the frequently asked questions about both the Part 521 compliance regulations and the DRA: http://www.omig.state.ny.us/data/content/view/81/206/.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: