An Evolving Semi-Monthly Update on Community Behavioral Health in New York
August 25, 2011
Earlier this month, Congressional leaders appointed members to the Joint Budget Committee on Deficit Reduction as required by the Budget Control Act of 2011. The bipartisan and bicameral committee is made up of 6 Democrats and 6 Republicans, and will be Co-Chaired by Senator Patty Murray (D-WA) and Representative Jeb Hensarling (R-TX). The rest of the members appointed to the committee are Senators Max Baucus (D-MT), John Kerry (D-MA), Patrick Toomey (R-PA), Jon Kyl (R-AZ) and Rob Portman (R-OH), along with Representatives James Clyburn (D-SC), Xavier Becerr (D-CA), Chris Van Hollen (D-MD), Dave Camp (R-MI) and Fred Uptan (R-MI).
The Joint Committee may recommend any type of deficit reduction measure it chooses, including spending cuts to Medicaid and Medicare, or tax increases and other revenue enhancements. In doing so, its task is to approve, by November 23, 2011, a $1.5 trillion deficit reduction plan over the next 10 years. Congress then must enact the Committee’s proposals and approve at least $1.2 trillion in savings by December 23, 2011. If it fails to do so, or the President vetoes the bill, then $1.2 trillion in automatic spending cuts would be triggered beginning in January of 2013.
As part of the Budget Control Act, these automatic spending cuts would consist of $55 billion each year from 2013 to 2021 in cuts to defense programs, as well as $55 billion in annual cuts to non-defense programs. While programs like Social Security, Medicaid, CHIP, SSI and veteran’s benefits would be exempt from automatic cuts, Medicare payments to providers could be cut up to a maximum of 2% in each year. However, under the trigger mechanism, many health and human service programs could see steeper reductions.
Conflicting Court of Appeals Ruling Sets Issue on Path to Supreme Court
Two federal courts of appeals have reached opposing decisions on the constitutionality of the individual mandate provision in the Affordable Care Act (ACA). On August 12, 2011, the11th Circuit Court of Appeals in Atlanta ruled that the individual mandate is unconstitutional. Earlier this year, the 6th Circuit Court of Appeals in Cincinnati upheld the individual mandate. These contradictory rulings increase the likelihood that healthcare reform issue will be considered by the Supreme Court in the next session.
Proposed Rule on Explanation of Benefits Rule ReleasedOn August 17, 2011, the Obama Administration proposed a new rule under the Affordable Care Act (ACA) to help plans and individuals better understand their health coverage and other coverage options. The proposed regulations will ensure that insurance companies and group health plans make available to consumers a Summary of Benefits and Coverage in plain, concise language. A uniform glossary of terms commonly used in health insurance coverage, like “deductible” and “co-pay,” will also be made available, and will be posted on the new health care reform website: www.HealthCare.gov and www.dol.gov/ebsa/healthreform.
BHO Implementation Here at Home
The New York State Office of Mental Health (OMH) and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) plan to implement the behavioral health organization (BHO) initiative adopted by the Medicaid Redesign Team in two phases. In Phase I, BHO’s will focus on the monitoring and evaluating length of inpatient hospital stays, readmission rates, engagement in outpatient care and profiling provider performance. During Phase II, BHO’s may or may not become special needs plans or specialized managed care plans for individuals with significant behavioral health needs. Phase I is scheduled to begin on October 1, 2011, with all BHOs (in six regions across the state – one in New York City) scheduled to be fully operational before January 1, 2012. At the most recent meeting of the MRT BH Reform Work Group on August 23, 2011, the group discussed these items, as well as housing and employment issues.
Defending Geriatric Mental Health Services for the Homebound
The Coalition and the Geriatric Mental Health Alliance are meeting with State legislators to inform them about the consequences discontinuing payments for mental health services to the homebound elderly who receive offsite services at home (under the new Part 599 Medicaid regulations). As a result, several community-based agencies across New York State have been forced to cutback or shutdown programs that serve the seniors in their own homes, leaving an estimated 1,000 to 2,000 older people with mental illness at risk of losing or have lost home-based mental health services. This would not only affect the mental wellbeing of seniors, but could be detrimental to their physical health as well. The system itself would be impacted by higher service costs of receiving treatment in nursing homes or inpatient hospitals, rather than in the community. This would be occurring at a time as the Governor’s Medicaid Redesign Team is implementing BHO’s to focus on using outpatient services instead of inpatient care. We are currently asking the State to look for other means of funding offsite services to keep seniors with mental illness in their own homes.
Commissioner Arlene González-Sánchez announced the release of the 2011 Outcomes Dashboard. The Dashboard is part of the Commissioner’s commitment to integrate outcomes management into the operations of the agency and the field. The Dashboard identifies 12 key metrics that reflect agency-wide priorities and includes five new priorities for this year. During the coming months, OASAS plans to reach out to counties and providers to further strengthen collaboration, including the incorporation of county and provider priorities in the 2012 Outcomes Dashboard.
The Fund for Public Health in New York, Inc. (FPHNY) has issued a Request for Information on behalf of the NYC DOHMH (HEAL 17 Grantee) and the New York City Regional Electronic Adoption Center for Health (NYC REACH). The goal of the HEAL grant is to assist mental health providers in successfully adopting interoperable electronic health record systems (EHR) and effectively using these systems to improve the quality and value of the care and services they offer. The two agencies have formed JOIN MH (Joint Opportunities for Integrated Networks in Mental Health). This RFI is the first step in this process.
JOIN MH wants to partner with qualified EHR vendors to achieve widespread adoption of high quality, interoperable EHRs for mental health providers in NYC. They are looking for EHR systems which are sufficiently robust to meet the clinical workflow needs of a broad range of mental health providers, to enable eligible providers to achieve Meaningful Use standards, and to facilitate the coordination of care between primary care and mental health providers through health information exchange.
The Coalition strongly encourages all mental health providers to contact your software vendor and make sure they are aware of this project and respond to the RFI. The deadline for submission of a letter of intent is August 29, 2011. The RFI instructions and response forms can be found at: http://www.fphny.org/whatsnew/rfps.
Samaritan Village has been awarded $920,728 by the United States Department of Veterans Affairs as part of the new Supportive Services for Veteran Families (SSVF) program. The SSVF Program, a critical element of VA’s plan to prevent and end homelessness among Veterans, will promote housing stability among homeless and at-risk Veterans and their families. Through this award, Samaritan Village will serve 200 families.
SUS, Services for the UnderServed, was recently awarded $1,787,000 in new federal and New York City funding by the United States Departments of Veterans Affairs (VA), the United States Department of Labor (DOL), and the New York City Department of Health and Mental Hygiene (NYC DOHMH) to provide care coordination, employment opportunities, and supportive services in housing to homeless veterans in New York City.
On August 24, 2011, SAMHSA honored consumer/peer leaders in recovery from mental and substance use disorders who have successfully advocated for the rights of trauma survivors and promoted the importance of trauma-informed care, as well as the writers and producers at its 2011 VOICE AWARDS. More information can be found at www.voiceawards.samhsa.gov.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: