An Evolving Semi-Monthly Update on Community Behavioral Health in New York
April 9, 2012
On March 30, 2012, Governor Andrew M. Cuomo, Senate Majority Leader Dean Skelos and Assembly Speaker Sheldon Silver announced early passage of the budget
Among the brighter parts of the budget is the establishment of the supportive housing development reinvestment fund for high-need Medicaid recipients. This fund will go a long way towards meeting the goals of the Medicaid Redesign Team (MRT). Evidence shows that by providing affordable, stable housing to individuals with complex health and behavioral health conditions, inpatient hospitalizations, emergency room visits and stays in long-term care facilities drop significantly. At the same time, state expenditures on health services fall as high cost services are needed less. While the fund was reduced from the Governor’s original proposal of $75M to $60M, the potential impact of this initiative should not be under estimated. While the remaining $15M was used in this fiscal year to fund other health initiatives, the supportive housing allocation should kick up to the full $75M come next fiscal year. The Coalition will work with state officials on the details of how state savings will be reinvested into housing services, as we advocated for in our Albany advocacy agenda.
We await further details on how the Executive Order to cap executive compensation and administrative spending will be implemented. After much advocacy by The Coalition and our allies, the Legislature balked at passing an alternative to the Governor’s proposal. Please read the article below for more information and analysis.
The Coalition remains watchful about movement in the Legislature to legalize casino gambling in New York State. We will continue to push for investments of new gambling revenue into prevention programs.
Unhappily, the budget did not authorize the creation of a New York State Health Insurance Exchange, but we will advocate for the Governor to issue an Executive Order to do so.
Moving forward, the rollout of Medicaid redesign initiatives and care coordination programs, like Health Homes, continue to occupy much of The Coalition’s government relations activities. In addition, the budget authorized language on the integration of health and behavioral health services, by allowing DOH, OASAS, OMH and OPWDD to identify ways in which health and behavioral health operations can be integrated.
On Monday, April 2, The Coalition attended a meeting with Executive Staff and other advocacy organizations on the matter of Executive Compensation and Administrative Caps. It was organized by the Human Services Council (HSC). Attending from the Governor’s Office was Jeremy Creelan, Counsel to the Governor—head of the office that will implement the Executive Order # 38. Also attending from the Executive was James Introne, Secretary for Health and Human Services, Kristin Proud, Deputy Secretary for Human Services and Lou Raffaele and Dan Shepherd, both from DOB. Phillip Saperia, from The Coalition, and James Lytle, from Manatt, Phelps and Phillips, represented The Coalition.
Absent much detail, the Executive staff asserted that its aim was to avoid creating impediments to most affected nonprofits in the work that they do providing important services to needy and vulnerable State residents.
The Governor’s Office will not use an emergency regulations procedure, so that when the regulations are submitted (potentially April 18), they will be published in the NY State Register and subject to a public comment period. The goal for implementation is January 1, 2013.
The applicable entities are those for-profit and non-profit organizations that contract with 13 State agencies (including the 9 mentioned in the Executive Order), and meet three thresholds: 1) 40% of operating budget is from State contracts, not including capital monies; 2) State contracts must altogether total $500,000 or more; 3) providers must meet both thresholds for two years in a row.
While the $199,000 executive salary cap and the administrative expenditure ceiling of 15% are still in place, the Governor’s office is considering exceptions and waivers that are not fully explicit at this moment. They stated that Executives earning less than $199,000 annually are not included. In some cases Executives will be permitted to justify salaries in excess of $199,000 by meeting IRS standards of comparability or allocating those salaries to other funding sources. For those many providers that rely very extensively on State funds, some hard cap on salaries and administrative expenditures will likely be applied to guarantee that the bulk of State aid goes to care. Agencies receiving a very large percentage of state funding (maybe 75-90%) may find executive compensation subject to a harder cap. The specifics of that cap are yet to be determined.
The State Agencies are meeting and exploring some inter-agency mechanism that will create simple, uniform and objective standards across all of the participating Agencies. They will seek to use information already provided by the CFR and the 990s that providers submit annually.
This is a work very much in progress. We feel that the Executive Staff are working hard to maintain maximum flexibility and reasonableness. Nevertheless, we were left reinforced in our belief that the original hope that the legislature would enact simple and more flexible law and oversight contained wisdom unheeded, leading perhaps to unnecessary and additional burden for already overburdened providers in a time of rapid fiscal shrinkage and program transformation. To read more on this subject, Manatt, Phelps & Phillips have prepared a detailed analysis of the issues outstanding.
The Coalition testified on the Mayor’s FY 2013 Preliminary Budget at a NYC Council hearing on March 19th. The hearing was convened by the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services. In our testimony, we asked the Council to restore the behavioral health initiatives it supports annually, as well as reinstating past cuts to these programs. Since FY 2009, these initiatives below have been cut between 25% and 55%. In FY 2012, the City Council funded the:
The Mental Hygiene Contracted Services PEG at the NYC Department of Health and Mental Hygiene (DOHMH) was partially restored by the City Council in the FY 2012 Budget. This was an initial $4.86M cut that was restored at $2.66M. Funding for this program was not included in the Mayor’s FY 2013 Budget.
On Thursday, March 29, 2012, the House voted to approve the budget proposal put forward by Representative Paul Ryan. It would sharply cut Medicaid and Medicare by converting Medicaid to a block grant program, and Medicare to a voucher program. The first would reduce Medicaid funding for the states, and the second would require seniors to pay more out of pocket for healthcare. Overall the Ryan plan would reduce federal spending by $20 billion. It would also repeal the Affordable Care Act.
Back in February, President Obama released his budget proposal. While it does not propose an overhaul of the Medicaid and Medicare programs, it does propose to cap Medicare spending at a growth rate of GDP + 0.5%, as does the Ryan plan. As for Medicaid, its expansion remains a critical component of President Obama’s healthcare reform agenda under the Affordable Care Act. On Tuesday, April 3, 2012, the President addressed the House’s budget, making sharp comparisons to his own proposal.
Last week, the Supreme held three days of hearings on the constitutionality of the Affordable Care Act. The court will decide in June whether a mandate for coverage and the expansion of Medicaid is constitutional, as well as nuances like is a mandate equivalent to a tax, and can the mandate provision be severed from the rest of the healthcare law. Stay tuned and sitting on the edge of your seat.
20 Ways to Overcome Barriers to Recovery
In this half-day workshop, Dr. Harding will provide a window into at least 20 obstacles that can stand in your way and how to resolve many of them. You will receive a clear set of questions to ask, new ways to rethink problems, and some solutions to remove the roadblocks.
Trainer: Courtenay Harding, Ph.D.
Introduction to Benefits Management—Hurry, Space is Limited!
This introductory training is intended for staff new to the subject of benefits.
Learn the nuts and bolts of benefits management, including the latest changes in the Social Security Administration guidelines by attending this training. It is free, and is being offered in various locations throughout New York City. Participants who attend will have the opportunity to:
Trainers: Margie Staker, CQSW & Patricia Feinberg, MS, Certified Benefits Planner
During his speech at the annual Somos El Futuro conference on March 24, 2012, Governor Andrew M. Cuomo announced that he has nominated Assembly Member Peter M. Rivera to serve as Commissioner of the New York State Department of Labor (DOL). Assembly Member Rivera is currently the Speaker Pro Tempore of the Assembly and presides over the chamber. He has represented the people of the 76th Assembly District in the Bronx since 1992. Rivera will remain in the Assembly through the end of June and his appointment is subject to confirmation by the Senate.
Peter Campanelli, President and Chief Executive Officer of the Institute for Community Living (ICL) announced that he will relinquish his post on June 30, 2013. Peter founded ICL some 26 years ago from a garage in Brooklyn and a dissertation to one of the largest free standing mental health providers in New York City known nationally for the quality of the service provided. Peter is also a highly valued Past President of The Coalition and was a long time member of our Board.
Fatima Goldman, Executive Director/CEO of the Federation of Protestant Welfare Agencies (FPWA), has announced that she will retire in September 2012. Goldman has led FPWA since 2003. She has served as the Executive Director of Brookwood Child Care, the first early childhood services division director for Graham Windham Services for Children and Families and as the Director of Family Day Care for the City's Human Resources Administration. In 2005, she was appointed by the Commissioner of the Administration for Children's Services (ACS) as co-chair of the taskforce on minority governed, community-based child welfare agencies.
Richard Hucke, of Jewish Child Care Association (JCCA) has been promoted to Vice President, and will now lead the Coordinated Community Services Division, providing supervision, management, and administrative direction. Mr. Hucke has been a part of senior management at JCCA's Foster Home Services since 2004, and Deputy Director of Foster Home Services in the Bronx for many years. He originally joined JCCA in February 1994 as a Case Associate in the Foster Home Division.
The National Council announced the 2012 Awards of Excellence and Reintegration Awards honorees, which included Kevin Cleare of CASES for Achievement, and an honorable mention for the Center for Urban Community Services’ (CUCS) Project for Psychiatric Outreach to the Homeless under the category for housing. All of the winners will be congratulated at the Celebration of Excellence at the Hilton Chicago, April 16, 2012, 6 – 9 pm. The Celebration of Excellence will occur during the National Council’s annual conference, which will be attended by Coalition staff members Karyn Krampitz and Jason Lippman. The Coalition extends kudos to the honorees!
The McSilver Institute for Poverty Policy and Research at the NYU School of Social Work presents “New York State Medicaid Redesign and the Affordable Care Act: The Impact on Children and Their Families.” Part One of a two-part series will be held on Wednesday, April 18 from 1:00 – 2:30. The list of speakers include Peter Campanelli and Stella Pappas of the Institute for Community Living (ICL). For more information please visit www.mcsilvier.org or call (212) 998-5937.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample:
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