Public Policy

January 13, 2016

First Look at the NYS 2016-17 Executive Budget Proposal

From:   Tom Templeton, Public Policy Specialist
             Harvey Rosenthal, Executive Director
             New York Association of Psychiatric Rehabilitation Services

Here’s our preliminary look at Governor Cuomo’s budget proposal for the coming FY 2016-17 that offers our community some historic advances as well as several challenges to address in coming months.
The proposal makes unprecedented investments in housing for the homeless and some modest additions in other areas, but does not fully address the unmet need for supportive housing nor the crisis faced by existing OMH housing.
The Governor proposes a series of important criminal justice diversion and re-entry focused reforms and renews his strong commitment to “Raise the Age” of criminal culpability from 16 to 18 years of age. We will continue to seek inclusion of a Medicaid presumptive eligibility initiative to link discharged prisoners with critically needed services and supports.
While the proposed budget continues to make major investments in the Medicaid
Redesign program, it would take down “prescriber prevails” patient protections. The budget includes more OMH Reinvestment dollars and a wonderful boost in funding for children’s mental health services, but does not include any apparent expansion in funding to nonprofits to support their raising the minimum wage.
Ultimately, there’s much to celebrate and plenty of work to do, and we will dedicate ourselves to supporting our members to protect the first and address the second. Stay tuned…. Special thanks to Glenn Liebman at MHANYS for his partnership in parsing this
budget proposal.

Here are more details on the budget proposal as we understand them currently:

HOUSING

Housing for the Homeless
• The Governor makes an historic 5-year, $10.4 billion investment in affordable housing, homeless housing, and homeless services, as follows:
   o $7.8 billion to support 44,000 supportive housing units, 77,000 shelter beds, and other homelessness-related activities
   o $2.6 billion for 6,000 new units of supportive housing and 1,000 new emergency shelter beds.
   o Within 15 years, the Governor’s plan will fund 20,000 new supportive
housing beds across the state.
New York/New York III Transitional and Pipeline Housing Beds
   o 1200 New/New York III units to open this year, along with 800 other residential pipeline beds

Shelter Conditions
   o The State will partner with the NYC and Buffalo Comptrollers to review and inspect shelters in their respective jurisdictions. It is expected that OTDA will also be devoting substantial efforts to improve shelter conditions statewide.
• At this time, there does not appear to be any money allocated to address the crisis caused by steadily rising supported and congregate housing costs that are now about 50% higher than current funding levels. This is a top priority for NYAPRS this year, and we plan to move forward with vigorous advocacy in this area.

CRIMINAL JUSTICE


• The budget creates a most welcome Independent Special Counsel to review cases of police-involved civilian deaths, far too many of which involve people with
mental health conditions.
• It includes a $1 Million commitment to “Raise the Age” of Criminal Culpability from 16 to 18. Further, beginning in August 2016, 16 and 17 year old youth will be housed at Hudson Correctional Facility, currently a DOCCS operated facility that is undergoing transformation to appropriately house and serve younger offenders.
• There’s a continuation of a previous authorization from the Assembly to invest $1 million to expand Crisis Intervention Team initiatives, training, and diversion programs; more details are pending.
• Through a Comprehensive Re-entry Initiative, NY will provide citizens who enter the criminal justice system the opportunity to rehabilitate, return home, and contribute to their communities. Included here are also transitional housing,
employment, and immediate access medical/mental health services.
• There’s $1 million to invest in Alternatives to Incarceration for high-risk, high- need populations and $7.5 million for college-level education programs for incarcerated individuals
• NYAPRS hopes to work with the Administration and plans to continue to advocate for presumptive Medicaid eligibility that will provide true transitional support to those prior to and upon reentry into the community.

OFFICE OF MENTAL HEALTH

New Items

Reinvestment:
• $16 million from further state hospital bed reductions to fund an array of state and nonprofit crisis and respite beds, home and community based services waiver slots, supported housing, mental health urgent care walk-in centers, mobile engagement teams, first episode psychosis teams, family resource centers, evidence-based family support services, peer-operated recovery centers, suicide prevention services, community forensic and diversion services, tele-psychiatry, transportation services, family concierge services, and adjustments to managed care premiums.
Expansion of Children’s Mental Health Services
• An increase of $22.5 million (from $7.5 to $30 million) for crisis intervention, community psychiatric support and treatment, psychosocial rehabilitation services, family peer support services, youth peer training and support services, and services from other licensed practitioners.
No Merger of OMH and OASAS
• While statewide forums were held to explore the impact of a merger between the
2 agencies, there is not proposal here to do so.

Previously Authorized Items


Transitional Supports for Adult and Nursing Home Residents with Mental Health Conditions including:
   o $38 million for transitional supports and supported housing for adult home residents and
   o $12 million for care coordination, supported housing and services for current and future mentally ill residents of nursing homes, and persons with mental illness who are discharged from nursing homes
Mobile Recovery Support and Crisis Team
• $600,000 to provide 7-day a week, after hours clinical and peer recovery support and crisis intervention in collaboration with the mobile mental health teams in the
Hudson Valley

Social Work Exemption


• The budget extends for five more years the current exemption for certain social work and mental health professional licensure requirements of those employed by
a program or service operated, regulated, funded or approved by OMH, OPWDD,
OASAS, DOH, SOFA, OCFS, OTDA, DOCCS, and/or local governmental units or social services districts.


MEDICAID


Medicaid Redesign
The budget documents review the distribution to date of New York’s $8 billion, 5 year Medicaid waiver. In the first two years, $1.7 billion has been awarded under the waiver.
   o $963 million to 25 Performing Provider Systems (PPSs)
   o $280 million for Health Homes and other reform initiatives;
   o $500 million for financially distressed safety net hospitals whose viability is critical to achieving ongoing reforms.
It also refers to the $2.5 billion in capital investments to make infrastructure improvements to stabilize health care providers to further advance transformation
goals. Medicaid Redesign
Pharmacy Proposals to
   o reduce reimbursement rates for certain specialty drugs to align with rates achieved by managed care plans.
   o eliminate the prescriber’s right of final determination, excluding mental
   health medications, when the justification for use is not clinically supported.
Community First Choice
   o The budget proposes the authorization of Advanced Home Health Aides (AHHAs) to perform specified advanced

   home care tasks under the supervision of a licensed registered professional nurse.

WORKFORCE


COLA: The budget includes an estimated.02% Cost of Living Adjustment for OMH, OPWDD and OASAS at a total cost of $12 million
Minimum Wage Hike: The Executive Budget includes provisions to further increase the
minimum wage to $10.50 in New York City and $9.75 in the remainder of the State, effective July 1, 2016, gradually increasing the minimum wage to $15.00 in New York City on December 31, 2018 and across the rest of the State on July 1, 2021. Yet, there are not funds to underwrite the increases to our most deserving and dedicated nonprofit workforce.

Stay tuned for lots more details and make sure you’re reserving your seat to get on NYAPRS buses from across New York to join our push on our February 23rd Albany Legislative Day!



 

See NYAPRS Public Policy Committee in action with footage of this press conference!

Over the past decade, some of NYAPRS' proudest achievements include:

RIGHTS
:

    • Seclusion and Restraint: In 1992, hundreds of NYAPRS members completed surveys for the NYS Commission on Quality of Care and spoke out on behalf of efforts that significantly reduced the use of S&R in state and local hospitals

    • Anti-Stigma Efforts: NYAPRS members have engaged in countless public efforts to protest damaging public stereotypes and to fight bigotry and discrimination.

    • Kendra's Law: NYAPRS members strongly oppose forced treatment, favoring choice and informed consent. In that spirit, we led the opposition to the Involuntary Outpatient Commitment program launched under Kendra's Law in 2000 and successfully fought to extend the legislature's oversight and require independent research that looked equally at the impact of voluntary engagement approaches in 2005.

    • Electroshock Therapy Oversight/Informed Consent: In 2003, NYAPRS successfully convinced both houses of the Legislature to pass ECT Reporting legislation; our forceful public protest to the Governor's subsequent veto paved the way for OMH administrative actions that enhanced state oversight, reporting and protections that promote informed consent.

    SERVICES FUNDING AND DEVELOPMENT:

    • Community Reinvestment Act: NYAPRS members' personal testimonials and "never-say-die" Capitol candlelight vigils played a key role in gaining approval for an initiative that has redirected over $180 million in new community services. Our subsequent strong support helped convince the Governor and the Legislature to approve 3 extensions of this landmark program.

    • Funding for Rehabilitation, Peer Support and Employment: NYAPRS was successful in gaining a $1 million increase for clubhouse programs in 1992, and a $1.3 increase for peer services in 2002. We won several increases in PROS funding and formed a statewide Campaign for Employment that helped bring a $5 million Medicaid Infrastructure Grant (New York Makes Work Pay) to our state.

    • Fighting Cuts: Throughout the past decade NYAPRS members have played pivotal roles in countless successful campaigns to avoid or restore cuts to the community mental health safety net.

    • Cost of Living Adjustment: NYAPRS members played very public roles in the successful effort to gain several multi-year cost of living adjustments for the community mental health workforce.

    • Mainstreaming of Rehabilitation: In 2001, a NYAPRS Medicaid Task Force capped several years of investigation and discussion by determining that a Medicaid-funded psychiatric rehabilitation model should be piloted to promote enhanced funding, valuing and availability of rehab services. This ultimately led to the development of OMH's Personalized Recovery Oriented Services (PROS) initiative.

    SPECIAL NEEDS/POPULATIONS:

    • Adult Home Residents: NYAPRS Public Policy members and staff helped found the NYS Coalition for Adult Home Reform; Harvey Rosenthal was appointed to the Governor's Adult Home Workgroup, which successfully won the development of a new adult home case management/peer specialist model and approval for 2,000 new supportive housing beds.

    • Prisoners with Psychiatric Disabilities: NYAPRS Public Policy members and staff worked in support of establishing a Medicaid Presumptive Eligibility program in 1997-2000, and helped lead MHASC's successful campaign to mandate alternatives to solitary confinement and other reforms supporting prisoners with psychiatric disabilities.

    • Underserved Minorities: NYAPRS helped win the establishment of two Centers of Excellence in Cultural Competence.

    ACCESS to...

    • Transportation: NYAPRS members helped form and lead a NYC/NYS-wide coalition that won passage of the MTA Half Fare Fairness Legislation.

    • Housing: NYAPRS has been an active member in the NY/NY Campaigns and the NYS Campaign for Mental Health Housing that have won funding for community housing for thousands of New Yorkers with psychiatric disabilities.

    • Employment: NYAPRS members helped form and lead a cross-disability advocacy coalition that won approval of the Medicaid Buy-In program in 2002.

    • Entitlements: NYAPRS partnered with our cross disability advocacy partners to successfully defeat proposed SSI COLA cuts in 2003 and 2009.

    • Full Community Integration: NYAPRS members again joined with our cross disability partners to win passage of legislation creating New York's Most Integrated Setting Coordinating Council. Our staff and Board members have played active roles in support of the Council's efforts to produce a NYS Olmstead plan.

    • Mental Health Coverage: Since the mid-1990's, NYAPRS members have been active members of coalitions that ultimately won passage of mental health parity legislation (Timothy's Law).

    • Medication: NYAPRS has long fought to protect full access to Medicaid mental health and related medications.

     

    For more information on NYAPRS Public Policy, please contact our Public Policy Specialist, Tom Templeton at tomt@nyaprs.org.