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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
HAPPY NEW YEAR!                                  December 22, 2009

THE TAIL THAT WAGS THE DOG: The Impact of Insurance on Behavioral Health  - A Coalition Conference

Even as the country waits for the realization of health care reform, New York State is poised to bring about the biggest transformation to the behavioral health sector in 30 years. In 2010, the New York State Office of Mental Health (SOMH) will implement new Article 31 clinic regulations designed to restructure the way the State delivers and reimburses mental health services.

This Coalition conference, to be held on January 14, 2010, is intended to explore all sides of the very complicated issue of insurance, and in particular, managed care.

Please join our keynote speaker, Wendell Potter, a Senior Fellow on Health Care at the Center for Media and Democracy, who after a 20-year career as a corporate public relations executive, left his job as head of  communications for one of the nation’s largest health insurers to try his hand at helping socially responsible organizations— including those advocating for meaningful health care reform— achieve their goals.

In addition, our panel of New York State officials, Troy Oechsner, Deputy Superintendent for Health, State of New York Insurance Department; Gregory Allen, Director, Division of Financial Planning and Policy, New York State Department of Health; Bruce E. Feig,
Deputy Executive Commissioner, New York State Office of Mental Health, will respond to Mr. Potter’s keynote and offer their perspective of how the sector can survive transformation and continue services to all consumers. 

Our afternoon presenters will include a provider panel consisting of the following organizations, the Institute for Community Living, the Puerto Rican Family Institute and the Staten Island Mental Health Society, to discuss their experiences with managed care plans. A panel of Managed Care Organizations, including Emblem Health, ValueOptions and Amerigroup and invited guest OptumHealth, will have an opportunity to respond and lay out their own vision.

For more information and on-line registration go our website »

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Coalition Albany Days 2010

The Coalition will be heading to Albany on February 23rd and 24th for advocacy on some very important issues that will affect the community based behavioral health system in State fiscal year 2010-11 and beyond. Our agenda will include two days of visits with State Legislature and Executive officials on clinic reform, professional licensing, OMIG auditing, State budget issues and more. We encourage members to attend in large turnout, as this year is an especially crucial one given the State’s fiscal status and reforms ahead for us. To register your attendance, members should email: cbianchi@coalitionny.org.

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Local Aid Takes 2 Hits From State Budget Cuts

On December 2, 2009, the State Legislature agreed to a $2.7 billion Deficit Reduction Plan (DRP). The DRP cut 12.5% of all unspent local assistance funding for the New York State Office of Alcoholism and Substance Abuse Services (OASAS) and Office of Mental Health (OMH). This amounts to cuts of $19.3 million for OASAS, and $58 million for OMH. The Coalition has confirmed with OASAS and OMH officials that the agencies should be able to meet the cuts through targeted reductions, administrative efficiencies and delays in the rollout of forecasted housing units. This should minimize the impact of the cuts on community based programs and services. Nonetheless, the long term impact on mental health and substance abuse budgets is very real.

Since the deficit for New York State had originally been estimated at $3.2 billion to $4 billion by the Governor and Comptroller prior to the approval of the DRP, Governor Paterson has announced that the State will hold back on $750 million in payments for school aid and assistance to counties and municipalities. We do not expect the Governor’s cuts to directly affect community based behavioral health services.

Education groups and unions have mounted a legal action against the Governor's unilateral cutbacks. New York City and the State counties may have to take similar actions in order to make sure that in the event of a victory by the education lobby, the cuts do not get redirected to municipalities. While State Senate Democrats continue to criticize the Governor’s legal authority to reduce local payments, Assembly Speaker Sheldon Silver has indicated that Governor Paterson is in the right. The Coalition and our government relations consultants in Albany will continue to monitor the State's messy fiscal situation and report back to you. 

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Protect the Community Safety Net – Albany Rally on January 26

The Coalition and fellow advocates will be going to Albany on January 26, 2010 to rally and meet with State legislators on budget cuts to mental hygiene funding. We need a huge turnout to tell Albany to protect the community mental hygiene safety net. Budget cuts are the worst in decades, mental hygiene funding has suffered 3 rounds of cuts in 2009 and 2010 cuts threaten to be the harshest of all! For more information about buses leaving your area call Mary at NYAPRS at 518-436-0008; Doug at ACL at 518-688-1682; or Bob at MHANYS at 518-434-0439. Hope to see you there!

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OMH Pushes Clinic Reform to After April 1, 2010

On Friday, December 18, 2009, the New York State Office of Mental Health (OMH) formally announced that implementation of clinic restructuring will begin no earlier than April 1, 2010, due to the length of time required to adopt the Part 599 regulations. The Coalition has been an active participant in the clinic reform stakeholder process. We have been working closely with OMH officials on a number of issues. The rates paid by Medicaid Managed Care and private insurance companies do not cover the cost of providing services to consumers. The indigent care pool may pay as little as 50 cents on the dollar for service reimbursement. These circumstances will force providers to cut back on service and limit consumer access to care. In addition, many agencies will no longer be able to afford the employment of full time staff with paid benefits. The Coalition has hired consultants to perform stress tests on a cross section of clinics to report to OMH the real effects of reform as currently proposed. We have also compiled a bulleted list of challenges and problems related to clinic reform.

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NYS Senate to Hold Hearing on OMIG

On Thursday, January 7, 2010, the Senate Standing Committee on Investigations and Government Operations will hold a hearing to explore the prevalence of Medicaid fraud in New York State and the efforts of the Office of Medicaid Inspector General (OMIG) to investigate potential fraud. One issue is whether OMIG can meet the targets set in the December 2009 State Deficit Reduction Plan (DRP). The DRP calls for an additional $150 million in recoupments to be realized by OMIG through a more aggressive Medicaid fraud campaign. This worries us. While testimony is by invitation only, The Coalition strongly encourages our members to attend and show how important this issue is to our field. To register and attend this hearing, please click here. Questions about the hearing should be directed to Kent Sopris at 518-455-2817 or Cari Abatemarco at 518-455-2618.

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Coalition Testifies at OASAS Budget Hearing

On December 17, 2009, The Coalition testified before the Assembly Standing Committee on Alcoholism and Drug Abuse, chaired by Assembly Member Felix Ortiz. We provided testimony on the impact of the 2009-10 Budget on the programs in the Office of Alcoholism and Substance Abuse Services (OASAS). Our testimony included The Coalition's support for an increase in the excise tax on alcohol, and reinvestment of revenue collected into community based prevention and treatment programs. This idea is proposed by Assembly Member Ortiz in bill number A067387. We also recommended that savings accrued from Rockefeller Drug Law reforms be reinvested into long-term support of community based drug treatment programs. This should include an assessment performed by an independent, bipartisan prison closing commission to examine possible savings opportunities from underutilized prisons.

Next year, OASAS licensed Article 822 clinics will undergo a restructuring of the State reimbursement system for services into Ambulatory Patient Groups (APG). Since the transition will have a strong fiscal impact on community based providers of addiction services already practicing in an under-resourced system, we asked the Legislature to ensure that sufficient funding is allocated for payment of services in the new system. Finally, we testified that the current exemption of social workers and other mental health professionals from current licensing should be extended for 4 years. If the current exemption is allowed to sunset on June 30, 2010, there will be significant workforce consequences and limited consumer access to services. For more details, please read our full testimony.

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New Regulations for HIPAA Business Associate Agreements Due Soon

Changes to HIPAA embodied in the American Recovery and Reinvestment Act (ARRA) include some significant changes to the regulations pertaining to HIPAA Business Associates, including that they are now covered directly under the HPAA Privacy and Security Regulations.  The new extension of HIPAA to Business Associates is set by statue to go into effect by February 17, 2010 and regulations are to be issued for implementing the changes. As of this writing the regulations have not yet been issued.

The Coalition has engaged a consultant who will be preparing a Business Associate Agreement (BAA) template which will encompass the new requirements as soon as they are issued.  In addition the new template will include language which will make the BAAs complaint with the Breach Notification provisions in ARRA which went into effect September 23, 2009 with a 180-day enforcement person (until February 22, 2010.)   Stay tuned.

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Around the Water Cooler

The Coalition congratulates Frank Muñoz who was appointed by the New York State Board of Regents as the Deputy Commissioner for the Professions. Frank has been serving as the Associate Commissioner of the Office of Professionals, and has been working with The Coalition and other advocates to reconcile issues around social worker licensing.

The Coalition is pleased to welcome Donna Frescatore to her new position as acting Medicaid Director at the New York State Department of Health (DOH).  She was the Assistant Medicaid Director under Deborah Bachrach.

Michelle Yanche, Staff Director of the Neighborhood Family Services Coalition will leave the organization effective January 1, 2010 to assume the position of Director of Public Policy at Good Shepherd Services, a member of The Coalition. Gigi Li and Sierra Stoneman-Bell will be the Co-Directors of the Neighborhood Family Services Coalition effective January 1. Congratulations to all!

Laurie Corlin, Director of Clinical Services at the Jewish Board of Family and Children's Services (JBFC), a Coalition member, won the Direct Service Award from UJA-Federation. The Coalition celebrates this achievement.

Hamilton-Madison House, a Coalition member, has named Mark Handelman as the agency’s new Executive Director. He will replace Frank T. Modica, who will retire on January 15, 2010, after 34 years as Executive Director.

The Coalition mourns the passing of Dennis DeLeon on December 14, 2009. Dennis was the leader of an influential advocacy group called Latino Commission on AIDS. He also was a former New York City Human Rights Commissioner, and one of the first city officials to publicly announce that he was infected with HIV. His obituary appeared in the New York Times on December 15.

Catholic Charities, a Coalition member, has been featured as a grantee in the New York Times' "Neediest Cases Campaign." Several articles have appeared in the Times that focus on individual consumers who have utilized the services offered by Catholic Charities.

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Senate Reaches 60 Votes Necessary to Close Debate on Health Care Reform

In the wee hours of the morning on December 21, 2009, the Senate voted 60-40 on partisan lines to close debate on national health care reform and overcome a filibuster. The Patient Protection and Affordable Care Act (H.R 3590) is now expected to pass by Christmas. Although all of the details have not yet emerged, the bill does contain reforms that will impact behavioral health care.

The Senate bill offers an essential benefits package that will cover mental and substance abuse services, including habilitative and rehabilitative services. Coverage will be at parity with primary health insurance plans which will be offered in state insurance exchanges. Health insurers would be restricted from discriminating against people with behavioral or physical disabilities, where individuals could not be denied coverage based on pre-existing conditions, nor would insurers be able to limit the length of covered treatment.

The Senate reform bill proposes to expand Medicaid  to individuals at or below 133% of the federal poverty level, and offers subsidies and tax breaks to individuals earning up to 400% of poverty level. In addition, a government run long term care insurance program, which will cover people with severe disabilities, will be authorized. $50 million in grants will be made available for community based behavioral health programs to coordinate and integrate primary and specialty care.

The Congressional Budget Office (CBO) estimates the total cost of the Senate bill at $871 billion over 10 years. However, the bill would also reduce the national deficit by $132 billion over the same period due to new revenues from increased taxes, fees and reductions in government spending, according to the CBO. Should the Senate bill pass, it will then have to be reconciled, in conference committee, with the House's Affordable Health Care for America Act, H.R. 3962, passed back in November. With all the interests at play and bitter partisanship in Congress, the debate is expected to be quite contentious.

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Coalition Signs on to Letter to Congressional Leaders Favoring Certain House Health Care Provisions: Crucial Impact on NYS

States will fare quite differently depending on which provisions remain in the final health care reform bill. If the Senate bill were to be passed as it stands, the bill would cost New York State close to $1 billion annually in added costs for hundreds of thousands of uninsured New Yorkers who will enroll in Medicaid.

Under the House bill, New York would qualify for an enhanced FMAP rate for new Medicaid enrollees, which provides an enhanced FMAP rate to individuals with incomes up to 150% of Federal poverty level (FPL) who are not currently eligible under the State’s current Medicaid system. New York would receive an enhanced FMAP rate from the Federal government for single adults and parents from 85% to 150% of FPL. The Senate bill provides an enhanced FMAP rate to adults up to 133% of FPL who do not currently qualify for Medicaid under the State’s current system. Only about 100,000 individuals in New York State would qualify out of roughly 5 million new enrollees. In response, Governor Paterson has released a statement explaining the State’s fiscal situation under the two bills. The Coalition has also signed on to a letter to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi on this issue. We thank Lauri Cole of the New York Council for Community Behavioral Healthcare for her effort in organizing this appeal.

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Congress Approves 2010 Omnibus Appropriations Bill

Both houses of Congress have finally passed the omnibus appropriations bill for Federal Fiscal Year (FY) 2010. FY 2010 began on October 1, but the appropriation bills to authorize funding were not passed until December 13th in the Senate, and December 10th in the House. Currently, a continuing resolution (CR) is funding Federal programs at FY 2009 levels until December 18. President Obama is expected to sign the bill before the CR runs out. The legislation includes appropriations for behavioral health services.

Mental Health and Substance Abuse Funding:

  • $1.8 billion for the Substance Abuse Prevention and Treatment Block Grant (+$20 million over FY 2009)
  • $421 million in funding for the Mental Health Block Grant (same as FY 2009)
  • $121 million for children’s mental health services (+$13 million over FY 2009)
  • $100 million for Second Chance Act Recovery programming (+$75 million over FY 2009)
  • $45 million for drug courts (+$5 million over FY 2009)
  • $14 million for SAMHSA’s  primary and behavioral health care integration grant program (+7 million over FY 2009)
  • $12 million for the Mentally Ill Offender Treatment Crime Reduction Act (+$2 million over FY 2009)

Housing and Homeless Funding:

  • $1.9 billion for McKinney-Vento Homeless Assistance Grants (+$188 million over FY 2009)
  • $75 million in SAMHSA  homelessness (same as FY 2009)
  • $65 million for Projects for Transition from Homelessness (PATH) (+$5 million over FY 2009)

The Coalition participated in the National Council's Hill Day to advocate for funding of many of these programs. The National Council has compiled a Fiscal Year 2010 Budget Chart with the newest funding levels in the omnibus bill.  

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Professional Learning Center Upcoming Trainings

The PLC is pleased to present several new workshops:

Principles of Psychopharmacology for Dually Disordered Individuals - January 8, 2010 | 9am - Noon

The goal of this presentation is to educate staff from chemical dependency and mental health programs on the principles of psychopharmacology as applied to consumers who suffer from mental illness and substance abuse disorders.  This workshop will be lead by Dr. Petros Levounis, Director of The Addiction Institute of New York.  

     More information and registration »

Motivational Interviewing Series of 5 Workshops - Series begins January 13, 2010 | All sessions run from 9am - Noon

Motivational Interviewing (MI) is an approach to counseling that helps clients enhance their motivation to reduce substance use or to become abstinent in order to reach their personal goals. There techniques are also used to help clients become motivated for mental health treatment and are particularly helpful in working with consumers with dual-disorders.  This workshop will be lead by Laura Travaglini, Coordinator of the Substance Abuse Programs at Columbia University Eastside.

     More information and registration »

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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
5631 Director - Adult Outpatient Mental Health Services
5635 Bi-lingual Clinical Social Worker
5640 Court Representative
5640

Substance Abuse Counselors, HIV/AIDS Scatter Site Housing Program

5655 Bilingual Social Workers, Outpatient Mental Health Clinic
5660 Residence Counselor

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