An Evolving Semi-Monthly Update on Community Behavioral Health in New York
April 7, 2011
Ta-Da…Introducing The Coalition Briefs BlogThe Coalition announces a new policy and advocacy blog called “The Coalition Briefs Blog.” You can access it at the following link: http://coalitionny.wordpress.com/. This new resource will allow our members and other stakeholders to keep up-to-date on The Coalition’s advocacy and related policy news. The blog will be an important tool during the upcoming City budget negotiations, as well as in all future state budget plans. We encourage you to visit the blog and sign up to receive “brief” updates.
State Legislators Approve BHOs
Last week, the Senate and Assembly passed legislation to enact the FY 2011-12 Budget. It included language to establish regional behavioral health organizations (BHOs). According to the BHO provisions stated in the law, OMH and OASAS, in consultation with DOH, are jointly authorized to designate regional BHOs to provide administration and management of behavioral health services. However, the legislation also authorizes the BHO to oversee prior approval, coordination and utilization of behavioral health services. These added provisions are broader and potentially more troubling than what was originally proposed by the Medicaid Redesign Team (MRT). The Coalition is in the process of speaking and meeting with state officials to learn more about how the BHO will be implemented, and communicate our concerns.
The budget legislation also allows OMH and OASAS to enter into contracts with BHOs without a competitive bid or RFP process in the initial 2 year phase. New York City will be eligible to establish a limited number of specialized managed care plans and/or integrated physical and behavioral health provider systems no later than April 1, 2013. Under these plans, providers would be paid on a capitated rate basis or other managed care payment methodologies to manage, coordinate and pay for behavioral and medical services.
Behavioral Health Utilization Thresholds Causes Much Concern
State budget legislation passed last week authorizes the enactment of utilization thresholds for OMH and OASAS. This policy was proposed by the Medicaid Redesign Team (MRT) to help reign in Medicaid spending, however it will potentially threaten the care for individuals with mental disabilities who have higher service needs. The MRT proposed thresholds for OMH for annual visits over 30 to be reimbursed at a 25% discount, and 50 at 50% discount. On the OASAS side, the thresholds were set at 65 and 85. After this proposal was released, The Coalition sought language changes in the bill to allow OMH and OASAS some leeway in protecting high need populations. While the exact changes we put forward did not make it into the final bill, the Legislature did make some helpful revisions. OMH and OASAS are authorized to waive utilization thresholds for patients “enrolled in specific treatment programs.” The language also states that annualized reductions for Article 31 clinics shall not be more than $10,900,000, and $13,250,000 for Article 32 clinics (the original language said not less than).
Utilization thresholds may be established on a provider-specific or patient-specific basis. OASAS officials have confirmed that they plan to implement thresholds at the provider level, based on averages. This will allow for better flexibility, rather than limiting services per individual. A formal policy is expected to be released soon. At this moment, we believe that OASAS will not exempt specific populations. With regard to OMH policy, we are still working with them to verify which populations will be kept exempt from utilization thresholds.
Anasazi Software Product Luncheon and Demonstration
Please join Anasazi Software on Tuesday, April 12th at 12:30pm for a luncheon followed by a special presentation from 1:00pm to 4:00pm featuring its Clinician’s HomePage and Doctor’s HomePage products. This presentation will also highlight Anasazi’s PROS development. The event will take place at the Coalition, located in lower Manhattan at 90 Broad Street, 8th Floor.
Anasazi will also contractually commit to attain and maintain certification as a “Complete EHR” for all three Meaningful Use Stages (2011, 2013 and 2015) of the American Recovery and Reinvestment Act of 2009 (ARRA/HITECH), such that Anasazi customers will be eligible for HITECH funding for the entirety of the eligibility period. Anasazi is therefore committed to attaining and maintaining certification of all 25 modules required for a Complete EHR for Stage 1 (2011) and for any additional modules required for a Complete EHR for Stages 2 and 3. Register Online Now >>
On March 28, 2011, The Coalition testified before the City Council’s Mental Health, Mental Retardation, Alcoholism, Drug Abuse & Disability Services Committee, chaired by Council Member G. Oliver Koppell. The hearing covered the Mayor’s FY12 Preliminary Budget as it relates to mental hygiene policy. While mental health and chemical dependency contracts did not receive additional cuts in this budget plan, cuts were carried over from the November Budget Plan. In the Department of Health and Mental Hygiene (DOHMH), Mental Hygiene Contracts are proposed to be cut by $1.8M in FY11 and $4.8M in FY12. These cuts include $2.5 million in reductions to psychosocial clubs and bridger programs in FY 12. Additionally, medically supervised outpatient services and outpatient rehabilitation services are proposed to be cut by $1M in FY12.
In our testimony, The Coalition also backed the restoration of City Council funded programs that support the mental health and substance use needs of New Yorkers who are underserved by the behavioral health system. They include: “Mental Health Contracts,” which was funded at $450,000 in FY11; “Alcoholism/Substance Abuse Voluntary Sector,” funded at $335,000; the “Children Under Five Mental Health Initiative,” funded at $1.25M; and the “Geriatric Mental Health Initiative” at $2M. With the City calling on DOHMH and other agencies to meet an additional 4% cut in the Mayor’s FY12 Executive Budget, to be released at the end of this month, advocacy by The Coalition and its members will be needed even more.
Representative Paul D. Ryan, Chair of the House Budget Committee, released an FY 2012 budget resolution on Tuesday, April 5, 2011, to cut $5.8 trillion in spending over the next 10 years, and taxes by more than $4 trillion. Included in the budget resolution is a plan to block grant Medicaid funding to the states, and eventually privatize Medicare. Both of these proposals would shift healthcare costs to the states and recipients, limiting the amount and quality of care to seniors, people with disabilities and the poor.
Turning Medicaid into a block grant program would be harmful to state Medicaid plans. Many states could use the flexibility of block grants to cut benefits or reduce Medicaid rolls. In addition, the lump sum amounts, while indexed for inflation and population growth, would not be able to keep pace with the cost of projected Medicaid expenses, nor would it allow for enhanced federal funding to states during tough economic times. Representative Ryan also proposes to transform Medicare into a privatized system beginning in 2022, by giving new enrollees a voucher to purchase coverage from a list of private insurance plans. “Additional assistance would be provided to lower-income beneficiaries and people with greater health risks.” Essentially, coverage for seniors would be turned over to health insurance companies, increasing costs and lowering benefits.
In anticipation of this budget resolution, 17 Governors signed a letter to oppose the block granting of Medicaid. Governor Cuomo also wrote his own letter in opposition. Advocates, including The Coalition, have participated in weekly conference calls on federal updates and strategies organized by Lauri Cole of the NYS Council for Community Behavioral Healthcare.
Congressional leaders continue to meet with President Obama to reach a deal on the FY 2011 budget before the current stopgap funding measure expires this Friday, April 8th. If they fail to achieve a consensus before this deadline, or pass another extension, a government shutdown could ensue. The Republicans in the House seek $61 billion in midyear cuts. Senate Democrats have agreed to $33 billion. With this gap unlikely to be bridged, the Republicans proposed a one week extension with $12 billion in spending cuts. President Obama rejected it, as it also featured controversial language on abortion services, healthcare and environmental policy.
This workshop, facilitated by Center Director Dr. Courtenay Harding, will provide concrete and practical tools and strategies for the clinician to help participants, particularly in PROS programs, move forward in reclaiming their lives. Each clinician needs a “little black bag” with tools of the trade stuffed inside to pull out when needed as the person with whom they are working wants to have a clearer head, a healthier body, “a home, a job and a date for the weekend!” This free workshop will take place at the Coalition on April 28, 2011 from 9:30am – 12:30 pm. Register now »
Dr. Peter C. Campanelli, President and CEO of the Institute for Community Living (ICL) was featured in a NY Daily News column that outlined the respective roots of Peter and ICL. Peter also appeared on “The Debrief with David Ushery” show on WNBC to talk about his “April Fool’s Day is No Joke” opinion piece regarding cuts to The Housing Advantage Voucher program.
Services and Programs for Older People (SPOP) presents Dr. Francine Russo to speak on “Sibling Rumble: How Siblings Deal with our Aging Parents—and Each Other.” The program will be held on Thursday, May 19th from 8:00am -9:30am at Skadden, Arps, Slate, Meagher and Flom, LLP at Four Times Square. It includes breakfast and a question and answer period. Tickets are $35 per person. For additional information contact Suzanne Shapiro at 212-787-7120 ext. 135 or at email@example.com.
The Mental Health Association of Westchester (MHA) held a ribbon cutting ceremony to celebrate its move to a new headquarters in Tarrytown, NY. It was attended by Westchester County Department of Mental Health Commissioner Grant Mitchell MD and Joseph D. Kenner, Assistant to the County Executive. Together, they joined Dr. Amy Kohn, MHA’s Executive Director, and Norman J. Michaels, Board President, in cutting the ribbon. A Certificate of Appreciation from The New York State Senate and State Senator Andrea Stewart-Cousins was presented to Dr. Kohn in appreciation of MHA’s contributions to the community.
The New York-based Children's Aid Society has been awarded a $3.5 million grant from the Edna McConnell Clark Foundation to expand its teenage pregnancy prevention program. The Children’s Aid Society was one of 9 nonprofits chosen nationally with innovative programs that work to solve problems confronting low-income youth in America. The Children's Aid Society plans to use this funding to expand services at its Carrera Adolescent Pregnancy Prevention Program. It will be able to serve between 10,000 and 11,000 teens nationwide over the next there years, a growth of up to 50%.
Astor Services for Children & Families has received a $200,000 grant from Robin Hood of New York, a poverty-fighting organization. The money will support an Astor program in the Bronx that "helps children with serious emotional problems transition from the Lawrence F. Hickey Center for Child Development and the Early Childhood Day Treatment Program into public school with ongoing supportive services." Read more in the Poughkeepsie Journal.
The NYS Office of Mental Health (OMH) invites you to join them for an informational webinar to find out how you can get involved in the Regional Multicultural Advisory Committee. OMH’s Bureau of Cultural Competence is restructuring the Multicultural Advisory Committee as a regionalized approach to bring a stronger voice to the NYS Public Mental Health System. As such, they are looking for consumers, families, providers and community agencies that are familiar with and have been successful in serving diverse cultural groups. The “Regional Multicultural Advisory Committee Forum" will take place on April 12th from 10:00a.m.-12:00p.m. Space is limited. Reserve your Webinar seat now at https://www1.gotomeeting.com/register/662897793.
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