Liebman, Kudish, Coppola Among NYS Health Care Power 50

NYAPRS Note: Congratulations to MHANYS’ Glenn Liebman, NAMI-NYC’s Matt Kudish and ASAP’s John Copolla for being deservedly selected by City and State magazine as among New York’s top 50 most influential NYS health care leaders. See the attached photo that includes Glenn on the left!

The Health Care Power 50: Recognizing The Most Influential People in New York Health Care

By CITY & STATE  JANUARY 13, 2019

It’s that time of year when many New Yorkers start paying attention to their health – watching their weight, trying new diets and hitting the gym.

But for others, health care is a year-round profession and passion. Medical practitioners spend countless hours tending to their patients. Business and nonprofit executives grapple with rising costs and pursue innovative solutions as they seek to improve and expand care. And policymakers continually craft new strategies to combat epidemics and improve public health.

In this special list, we recognize the 50 most influential health care figures in the world of New York politics. Since we cover politicians on a day-to-day basis, we omitted all but a few officials who are in government, instead identifying those who influence it from the outside.

We reached out to insiders and experts to compile this list, ranking each person based on their accomplishments, economic clout, sway in political and policy matters, ties to powerful politicians and the constituencies they represent.

Glenn Liebman CEO Mental Health Association in New York State

New York is one of two states (along with Virginia) to require mental health education in schools, thanks to the lobbying efforts of Glenn Liebman and his team at the Mental Health Association in New York State – Albany’s pre-eminent lobby group for mental health. The organization is continuing to push for its policy proposals on other fronts in 2019, including cost-of-living increases for mental health care workers employed by nonprofits.

Matt Kudish Executive Director National Alliance on Mental Illness of New York City

Matt Kudish leads the largest affiliate of the National Alliance on Mental Illness, one of the nation’s largest mental health advocacy groups, and has been working since 2017 to expand the organization’s reach and broaden its partnerships. His efforts come as New York City Mayor Bill de Blasio’s administration devotes more attention to mental health care needs through its Thrive NYC initiative, with Kudish applauding the mayor’s recent creation of a mental health crisis task force.

John Coppola Executive Director New York Association of Alcoholism and Substance Abuse Providers

If the opioid epidemic made anything clear, it was the need for more robust care around substance abuse and mental health. John Coppola, who has led the New York Association of Alcoholism and Substance Abuse Providers since its inception, has been beating that drum for decades. He has been vocal about the government’s responsibility to change the way mental health and substance abuse are treated, praising Gov. Andrew Cuomo about his actions to make treatment a priority.

MHW: BH Leaders Identify Opportunities, Challenges for Momentous 2019

Opportunities, Challenges for Field in 2019 Signal Busy Year

For our first issue of the year, we asked our readers for their thoughts on the challenges and opportunities awaiting the field in 2019. Here are some of the comments we received. Many thanks to all who responded.

Mental Health Weekly January 8-15, 2019

Joseph Rogers, executive director of the National Mental Health Consumers’ Self-Help Clearinghouse:

Our challenge is the continuing struggle between organizations that work to promote freedom, dignity and equality, and organizations that work to limit these essential commodities.

Our organization advocates for human rights, so the groups that use every excuse to curtail people’s rights make it tougher to do our work. One example is the Treatment Advocacy Center, which fights to limit freedom and equality for people with serious mental health challenges — and twists the truth to do so, as detailed in an article published by FAIR (“Mindless and Deadly,” May 1, 2001). Adding to the burden is the current administration, which is not supportive of human rights. That we are fighting an uphill battle makes our work even more necessary.

“Don’t waste any time mourning. Organize!”— the immortal words of labor organizer Joe Hill, falsely accused of murder and executed in 1915, in a telegram to activist Big Bill Haywood — is our call to action. We could be discouraged, but instead we are galvanized! We are working in coalition with such organizations as the National Coalition for Mental Health Recovery, and helping support the 2019 Alternatives conference, to make sure our voices are heard in the halls of Congress.

Debra L. Wentz, Ph.D., president and CEO of the New Jersey Association of Mental Health and Addictions Agencies Inc.:

Despite the many significant factors currently impacting New Jersey’s community-based behavioral health system of care — move to fee-for service (FFS), transition to managed care for specialty populations, inadequate rates and electronic records requirements, to name a few — the greatest issue in 2019 will be workforce shortages. The decades-old psychiatrist and nursing shortages become more challenging each year and are exacerbated by certain inadequate FFS rates. Now, staffing shortages extend to all clinicians, and direct care staff as well. The community-based system of care has always been at a disadvantage in recruiting and retaining staff since state departments, educational institutions and the private sector have significantly higher base salaries, and more generous benefit packages. Now, with retailers and other industries raising starting wages, and a minimum wage increase to $15 (by 2024) expected here, recruitment and retention of all staff is increasingly challenging. The impact of the workforce difficulties is magnified by the ever-increasing demand for services at a time when baby boomers are retiring in droves. While agencies and schools can work around the edges of the problem, it can only be fully addressed with significant state investments in the workforce. I will continue to fight for those investments every day.

Linda Rosenberg, president and CEO, National Council for Behavioral Health:

The National Council for Behavioral Health celebrates its 50th anniversary in 2019. To honor the past 50 years, we rededicate ourselves to our singular vision: healthy and safe communities. That means Americans must be able to get quality mental health and addictions treatment when and where they need it. Startling figures show average life expectancy in the United States dropped for the third straight year, driven by increasing overdose deaths and suicides. Lack of access has replaced stigma as the leading barrier to care.

Mental Health First Aid teaches Americans the signs and symptoms of mental and addictive disorders; now it’s up to us to ensure there is capacity. Building on the accomplishments of the past 50 years in science, inclusion and parity, we’ll continue to fight for the Excellence in Mental Health and Addiction Treatment Expansion Act. Extending the Certified Community Behavioral Health Clinic program will allow us to meet growing demand with high quality care. In 2019, we will celebrate those in recovery, but never forget the patients and families still suffering. Everyone must have the opportunity to recover.

Ron Manderscheid, Ph.D., executive director of the National Association of  County Behavioral Health and Developmental Disability Directors and the National Association for Rural Mental Health:

The recent Federal District Court decision in Texas v. Azar will rivet our attention in 2019. This decision invalidates the Affordable Care Act, but fortunately specifies no date for implementation of that decision. Already, Kentucky Attorney General Andy Beshear has initiated a case challenging the decision and has invited other states to join the suit. Kentucky would lose insurance coverage for 1.3 million people and $50 billion in insurance and subsidy payments if the decision stands.

Clearly, the national mental health and substance use care community must organize immediately with other components of the health field to fight the decision and to mobilize needed action in the House and Senate, and in our local communities.

Our twin field crises — opioid deaths and suicides — will demand much attention in 2019. At best, the rate of increase in these conditions is declining. Hence, we need to shore up key treatment systems and also to expand prevention and health promotion activities. In 2019, the linkage between mental illness and opioid addiction will receive much-needed attention.

Inappropriate incarcerations continue for persons with behavioral health and intellectual/developmental disability conditions. National prison and jail reforms may begin to address this problem. We must help to advance this agenda. On balance, 2019 will be a very busy and demanding year.

Paul Gionfriddo, president and CEO of Mental Health America:

With so much political uncertainty on the policy horizon in 2019, it is tempting to say that our greatest challenge as mental health advocate may be in holding onto the gains we made through the Affordable Care Act (ACA), Medicaid expansion, the 21st Century CURES Act, and the Mental Health Parity and Addiction Equity Act. But people concerned about behavioral health policy don’t have the option of just playing defense this coming year. Suicide rates are rising; integration of behavioral health into physical health, educational and workplace systems still has a long way to go; children’s mental health services are woefully inadequate; and we have an ongoing shortage of mental health professionals.

We need to commit to prevention, early intervention and services integration. If we want to improve prospects for recovery by implementing interventions before Stage 4 crises occur, then we need a 2019 agenda that makes mental health screening as ubiquitous as vision and hearing screening, beginning during childhood; improves special education services for children with mental health conditions; fixes rules like 42 CFR Part 2 that prevent effective services integration; promotes workplace mental health innovations; adds more peers to the behavioral health workforce; and stops using jails as custodial care institutions for people with mental health conditions.

Joel E. Miller, executive director and CEO of the American Mental Health Counselors Association:

We continue to see the most important program benefiting the behavioral health needs of all Americans go by the board one step at a time — namely, the dismantling of Obamacare through the courts or executive orders or U.S. Department of Health and Human Services regulations that try to diminish its impact. First, the passage of the ACA was a major milestone in our longstanding efforts to ensure access for all Americans to appropriate, high quality and affordable behavioral health care prevention and treatment services. Many of the prominent features (e.g., essential health benefits, Medicaid expansion) of the ACA were instrumental in establishing the centrality of behavioral health services within the overall U.S. health care delivery system. The key point — we are talking real money. The coverage expansions are real funding invested in advancing behavioral health — not demonstrations or long-term grants. We are talking real, major tangible increases in funding of behavioral health care since the ACA was implemented in 2013. So, let’s be sure we protect the ACA on many fronts.

Second, now we must begin to advance behavioral health and a new message that better behavioral health can transform lives and save money everywhere we can. We behavioral health leaders have allowed other health care stakeholders to frame pivotal debates concerning behavioral health care policy and programs. Beyond Obamacare (which should be improved), our overarching goal should be to secure the primacy of behavioral health, and through new messaging and positioning.

And we better become more aggressive right quick, as the other health care stakeholders have been positioning themselves to fight over the health care reimbursement pie, which will grow much more slowly.

We need to highlight that as much of an individual’s health status is tied to behavior and lifestyle choices, it makes sense that behavioral health providers — such as clinical mental health counselors —would be a much better resource and site to deliver care coordination and chronic and severe disease management than the prevailing model.

So mental health and substance abuse caregivers should be positioned as a key asset in the overall health care sphere! Decision-makers need to recognize this value proposition and position behavioral health within the larger health care landscape.

The behavioral health community should implement a major, collective marketing campaign that includes the importance of health behaviors, the prevalence of disabling behavioral health conditions and the superiority of treatment that is more efficacious than many common physical health treatments today.

If the critics of the ACA are hellbent on stripping away the key components of the law, we better be ready as a “behavioral health movement “to put our parochial ambitions aside, in order to make our case on the primacy of behavioral health under new legislative policies and programs for universal coverage that will be offered up in the 2020 presidential election cycle. That begins right now here in early 2019. People with behavioral health conditions are counting on us.

Brian Hepburn, director of the National Association of State Mental Health Program Directors:

The National Association of State Mental Health Program Directors (NASMHPD) looks forward to 2019 and will continue our emphasis on Beyond Beds, which focuses on building a robust continuum of care that looks beyond only inpatient care. NASMHPD has developed a key series of technical assistance working assessment papers addressing Beyond Beds, which can be found on the NASMHPD website at https://www.nasmhpd.org/content/tac-assessment-papers.

As part of this paper series, NASMHPD emphasizes the need to implement the core elements of crisis services found on www.CrisisNow.com, a resource website developed in partnership between NASMHPD and RI International. In alignment with this emphasis, we were pleased with the recent Centers for Medicare & Medicaid Services (CMS) State Medicaid Letter proposing a new §1115(a) waiver allowing short-term, acute-care inpatient stays in institutions of medical disease,” conditioned on states maintaining their efforts at providing community-based services, including outpatient crisis stabilization services.

NASMHPD will also continue to prioritize the significant effectiveness of Cognitive Therapy for Recovery (CT-R), which has been successfully piloted in six states through the Substance Abuse and Mental Health Services Administration (SAMHSA)–funded and NASMHPD administered Transformation Transfer Initiative. CT-R has been shown to help people who have been stuck in long inpatient stays to ultimately thrive in the community and will be one of the topics of the 2019 Beyond Beds papers.

We are also excited to be jointly working with the International Initiative for Mental Health Leadership (IIMHL) and SAMHSA to hold the 2019 IIMHL conference in September.

We look forward to working with Congress, the CMS and our advocacy allies across the behavioral health field in achieving these important goals in the coming year.

Kim Mills, spokesperson for the American Psychological Association:

The American Psychological Association (APA) will be expanding its advocacy efforts in 2019, working in a bipartisan fashion to protect and expand access to health insurance, address the opioid epidemic, reduce gun violence, increase federal funding for psychological research and graduate education, and ensure that migrant families remain intact and receive necessary health care while awaiting immigration proceedings. Defending the Affordable Care Act against legal challenges will remain a key priority as well.

The APA will continue promoting psychology’s role in such new technologies as artificial intelligence, self-driving vehicles and the internet of things. And the association will focus on the issue of deep poverty in America, looking at how psychology can help understand and address this vexing problem.

John Snooks, executive director of the Treatment Advocacy Center:

Created 20 years ago, the Treatment Advocacy Center remains steadfast in our mission: eliminating barriers to timely and effective psychiatric treatment for people with severe mental illnesses. Recent tragedies have only reaffirmed the need for us to remain focused, even as the dialogue on mental illness shifts toward our view, that failing to prioritize the needs of the most severely ill has dire consequences. The federal government and state legislatures have taken courageous steps toward reform, but until those legislative changes are embraced and implemented everywhere, the most pressing question will persist: How do we structure a treatment system to serve the most difficult to care for and vulnerable among us?

In the new year, the Treatment Advocacy Center will continue to fight for a system where people with severe mental illness are never locked out of care simply because they are too sick to seek it for themselves.

And we will remain vigilant in ensuring that promises made are promises kept — fighting to ensure that good laws are appropriately funded, stopping state laws from becoming barriers to treatment that force the severely ill into jails, emergency rooms, homelessness or suicide; and ending discrimination against people with psychiatric illnesses.

Harvey Rosenthal, CEO of the New York Association of Psychiatric Rehabilitation Services Inc.:

2019 will hopefully bring into action the full force of our combined efforts to aid Americans with the most advanced mental health and addiction-related conditions, but without the growing emphasis on forced hospital and community treatment in lieu of appropriate and adequate outreach, engagement and service efforts.

We now know how to engage and support individuals with even the most pernicious challenges to recover and to improve their health and lives free of avoidable tragic cycles of homelessness, incarceration, frequent re-hospitalizations and suicide.

We are seeing impressive evidence of our ability to do so when policymakers, payers and providers make available a full menu of coordinated and integrated service options across the continuum of treatment and rehabilitative approaches that assure access to peer support and that address the social determinants of health.

But these instances are the exception to the rule, and most Americans are denied the benefits of a fully functioning community service system. They do not have access to homeless outreach, housing first and a full continuum of supportive housing options. They are not offered walk-in psychiatric urgent care or mobile rehabilitation services or peer community engagement, peer bridger, crisis respite and community health worker services.

And they cannot maintain their hope, trust and participation in our services when hard-won relationships with staff are regularly compromised by our inability to pay and retain an adequate and appropriate workforce.

Yet, recent policy trends appear to be more focused on increasing hospital beds and outpatient commitment orders and potentially decreasing choice, right and privacy protections.

Instead, let’s come together in 2019 to raise the bar much higher for what people can achieve and policymakers and providers can and should offer.

One exciting trend: some states are exploring using Medicaid to fund a full range of housing, employment, and peer and family support programs. Let’s work with federal and state Medicaid programs this year to increase funding and access to the full continuum of community services and supports Americans with the most serious conditions need and deserve to recover.

Jennifer Mathis, director of policy and legal advocacy for the Bazelon Center for Mental Health Law:

The past year brought important victories in staving off legislative efforts that would have undermined rights under the Americans with Disabilities Act, gutted the Affordable Care Act and weakened the Medicaid program.

At the same time, however, actions were taken by administrative agencies that will make it harder for people to get needed mental health services. For example, new federal Medicaid regulations cut back on the Affordable Care Act’s protections, allowing the expansion of short-term limited-duration health plans that provide very limited benefits and threaten to undermine protections for people with pre-existing conditions. The Centers for Medicare & Medicaid Services also began approving waivers allowing state Medicaid programs to condition benefits on meeting work requirements without assuring that the services beneficiaries may need to work are available; thousands of individuals have lost health insurance as a result. The Department of Housing and Urban Development suspended rules that required fair housing planning processes to take into account the needs of people with disabilities, including those who need housing in order to transition out of institutions.

We do see opportunities in the coming year, including opportunities to expand competitive integrated employment opportunities through implementation of affirmative action requirements for employment of people with disabilities by federal agencies and federal contractors, as well as efforts to expand the availability of supported employment services for people with psychiatric disabilities. Promoting employment is a bipartisan issue, and there is solid potential to achieve gains in this area even during an era of divided government. We will also continue our litigation and policy work to expand the availability of community mental health services needed to support people with significant psychiatric disabilities to live, work and thrive in their own homes and communities; to enable children with mental health disabilities to succeed in school; and to reduce the needless incarceration of people with psychiatric disabilities.

David W. Covington, LPC, CEOand president of RI International and member of the Interdepartmental Serious Mental Illness Coordinating Committee:

As we begin 2019, the support for an individual in psychiatric crisis in most of the United States is abysmal.

In a recent American College of Emergency Physicians survey, one in five hospitals were currently holding someone in their emergency department more than five days. But there will be very significant and promising developments next year.

The Substance Abuse and Mental Health Services Administration and the Department of Veterans Affairs will report to the Federal Communications Commission on a possible 611 crisis hotline. Under the leadership of Assistant Secretary Elinore McCance-Katz, the Interdepartmental Serious Mental Illness Coordinating Committee will drive its Way Forward recommendations. The Department of Health and Human Services and Centers for Medicare & Medicaid Services will require an assessment of the crisis continuum, with specific attention to inpatient alternatives like crisis stabilization programs, for states that pursue the Medicaid Institutions for Mental Diseases waivers. And the National Association of State Mental Health Program Directors will host a crisis summit at the September International Initiative for Mental Health Leadership conference focused on the development of an international declaration and provide additional tools and supports at the http://www.CrisisNow.com website. Together, these initiatives promise very important first steps for ensuring an effective response to all in psychiatric emergency.

NYAPRS 2nd Look at NYS Budget: Solitary Confinement Reform, Vet to Vet, Prescriber Prevails

NYAPRS Note: Following up on our initial review of what’s in the Governor’s budget of note tour community (see below), here’s a second deeper look that involves  3 areas of interest to NYAPRS and our colleagues. The Governor proposes significant solitary confinement reforms that are most welcome but not on the scale of the HALT bill (see below). He also expands access to rehabilitation and ending cash bail, as well as extending vet to vet peer support from 16 to 62 counties. However, we’ll be once again opposing the proposal to allow health plans and not patients and prescribers to choose the appropriate medications.

Get ready to get on the bus to Albany on February 26th for NYAPRS Annual Legislative Day when upwards of 600 self and system advocates gather to push forward our priorities for the coming year. See below for more details.

Criminal Justice Reforms

Solitary confinement

Governor Cuomo is proposing to:

  • limiting the length of time spent in separation,

  • building dedicated housing units for rehabilitation and integration following a disciplinary sanction

  • expanding therapeutic programming to reinforce positive and social behavior.

  • restricting the length of separate confinement to less than 30 days,

  • creating specialized housing units with out-of-cell programming, and

  • requiring intensive training for staff and discipline hearing officers on implicit bias, interpersonal communication, and de-escalation.

  • gradually decrease the amount of consecutive days an incarcerated individual can spend in traditional SHU confinement.

Budgetary Impact:  Department of Corrections and Community Supervision will see an increase of $84.2 million, $70 million for capital expenses and $14.2 million for 153 new staff to implement increases in program services and supervision of inmates staff

Contrast to HALT Bill

  • There are no restrictions of criteria of who can be placed in solitary

  • RRUs guarantee only 5 hours out of cell per day only four days a week (rather than 7 hours, 7 days a week)

  • The time limit on segregation is 90 days as of April 2021, 60 days by Oct 2021, and then ultimately 30 days by April 2022 (rather than 15 days)

  • The only two special populations that would be barred from SHU are adolescents and pregnant women/new mothers (ie does not include people with mental health needs, elderly people, young people 18-21, people with physical disabilities)

OMH Forensic Services

OMH will hire an additional 40 personnel to “support the growing forensic needs within OMH facilities”

Ending Cash Bail

Currently, New Yorkers who do not present a risk to public safety, but cannot afford bail, are detained while those who may present a risk to public safety can post bail and gain release. Legislation will be submitted with the Budget that will end cash bail so that no one is detained because they cannot afford the cost of bail.

Remove Barriers to Re-entry

Individuals with criminal convictions face significant economic and social barriers to their successful reintegration into society. Legislation advanced by the Budget removes outdated suspensions and bans on driver’s licenses and occupational licenses; prevents the sharing of mugshots that do not have a specific law enforcement need; enhances criminal history reports; expands opportunities for compassionate release, merit release and limited credit time allowances; and reduces financial burdens on those recently released from prison.

Consider Domestic Violence in Sentencing.

There is a strong connection between domestic violence and incarcerated women, with nine out of 10 female inmates having experienced severe physical or sexual violence in their lifetime, according to the Correctional Association of New York. To help address the ongoing harm caused to these survivors by the pain inflicted upon them, the Executive Budget advances the Domestic Violence Survivors Justice Act (DVSJA), which would give judges discretion to lower sentences for survivors of domestic violence whose abuse is determined to be a significant contributing factor to their crime.

Vet Suicide Prevention, Expanded Peer to Peer Support

To combat veteran suicide, New York State will launch a wide-ranging, coordinated initiative involving both private and public sector service providers. The Joseph P. Dwyer Veteran Peer Support Project will be expanded from 16 counties to all 62. State personnel will receive training in how to recognize the warning signs of suicide and how to identify veterans, especially homeless veterans, and connect them with veteran-specific services. The State will also launch a telehealth services pilot program to reach Native American veterans.

Repeals Prescriber Prevails

Amend public health and social services law to reduce inappropriate prescribing by eliminating the prescriber’s right of final determination in both FFS and managed care when the justification for use is not clinically supported.

NYAPRS Note: Here are some initial findings in the just released Executive Budget proposal for 2019-20, compiled in tandem with the Mental Health Association in NYS. While there are a few positives we’ve found so far, we have our work cut out for us as regards the Cost of Living Adjustment (not in budget) and Housing Rate Hike (while $10 million is included, we need a lot more!). All hands on deck till session’s end for both of these!

We are very pleased to see another year of Community Reinvestment funds and increased bridger and related services for adult home residents with psychiatric disabilities, along with enhanced monitoring of health plan compliance with insurance parity requirements.

Criminal Justice: We will be working to secure funds for additional Crisis Intervention Team dollars. We have been given encouragement that the HALT bill that will ban the use of solitary confinement with people with mental, physical and intellectual disabilities, youth, seniors and pregnant mothers will pass both houses this year.

See below for program details of our February 26th Annual Albany Legislative Day. Reserve your seat and make your legislative appointments now! Buses will be leaving from Buffalo, Rochester, Syracuse, Westport, Newburgh, New City, Putnam/Westchester, Binghamton, Long Island and New York City. Stay tuned for more details!

 NYS 2019-20 NYS Budget First Look: No COLA, $10 Million Housing Rate Hike,

$5.5 Reinvestment Allocation; Funding to Enhance Behavioral Health Parity Compliance

Here are some details of prominent mental health funding issues in the newly released 2019-2020 Executive Budget, working in tandem with the Mental Health Association in NYS.

No 2.9% Human Services Cost of Living Adjustment

  • NYAPRS has been working very closely with our colleagues from the mental health and substance use nonprofit sectors to secure a long promised cost of living adjustment (COLA) that we have only seen once in 9 years. The total cost of a human services COLA would be $140 million, $120 million of which would be spread out across OMH, OASAS and OPWDD funded nonprofits.

The Executive Budget did not include a COLA and so, we will work from today to session’s end to get the Governor, Assembly and Senate to include it in the final agreement, starting with yesterday’s Albany news conference.

See our news release at https://www.nyaprs.org/e-news-bulletins/2019/1/14/behavioral-health-advocates-unite-to-press-for-a-cola-today-in-albany  and video excerpts of the news conference that featured Community Access’ Phyllis Fisher at https://www.facebook.com/NYAPRSAlbany/videos/1985937304807667/

Great thanks to MHANYS’ Glenn Liebman for his leadership, NAMI-NYS for the video and our entire coalition for our collaboration. Stay tuned for a regular series of coalition actions over the next few months.

$10 Million Housing Rate Hike

  • The Executive budget provides another $10 million housing hike, as it has for each of the last 5 years. As an active member of the Bring It Home Campaign, NYAPRS will work throughout this session to attempt to significantly increase this number, given the dire conditions faced by our housing providers!

$5.5/11 Million Community Reinvestment Allocation

  • Once more, OMH’s budget includes more funding for community services expansion derived from the closure of additional state hospital beds. The $5.5 million equates to $11 million when annualized. See https://www.omh.ny.gov/omhweb/transformation/ for terrific examples of how the state and local stakeholders have deployed these funds to boost services for people with the most extensive needs.

$10 million for Adult Home Transitional Supports

  • It appears that the budget appropriates an additional $5 million for peer bridger and other transitional supports for adult home residents with psychiatric disabilities which, when added to a carryover of last year’s $5 million comes to a total of $10 million.

$100 million to Replace Mid-Hudson Psychiatric Center

  • “The Budget provides an additional appropriation of $100 million to support the replacement of the Mid-Hudson Forensic Psychiatric Center in Orange County, which includes buildings over 100 years old that are not designed for current standards of care.

$60 million in Capital Funds for Community Based Nonprofit Housing Providers

  • The Budget also includes $60 million to maintain and preserve existing community-based residential facilities that allow people with mental illness to live in the most integrated setting possible.

Behavioral Health Parity

  • The budget includes several million dollars to enhance staff at the Department of Financial Services and the Department of Health to help assure health plans have adequate provider networks and are in compliance with parity requirements. dedicated to network adequacy and reviewing existing health plans to help ensure compliance with parity. 

NYAPRS Note: Get ready to get on the bus for this year’s 22nd NYAPRS Annual Albany Legislative Day! Below please find this year’s priorities and schedule. We’ll be sending out a list of regional bus contacts tomorrow for groups to contact and reserve their seats!

Leg day update.JPG

NYAPRS First Look at 2019 Budget, Get on the Bus to Feb 26 Legislative Day!

NYAPRS Note: Here are some initial findings in the just released Executive Budget proposal for 2019-20, compiled in tandem with the Mental Health Association in NYS. While there are a few positives we’ve found so far, we have our work cut out for us as regards the Cost of Living Adjustment (not in budget) and Housing Rate Hike (while $10 million is included, we need a lot more!). All hands on deck till session’s end for both of these!

We are very pleased to see another year of Community Reinvestment funds and bridger and related services for adult home residents with psychiatric disabilities, along with enhanced monitoring of health plan compliance with insurance parity requirements.

In addition to working on housing rate hikes and the COLA, we will be working to secure additional Crisis Intervention Team dollars. We have been given encouragement that the HALT bill that will ban the use of solitary confinement with people with mental, physical and intellectual disabilities, youth, seniors and pregnant mothers will pass both houses this year.

See below for program details of our February 26th Annual Albany Legislative Day. Reserve your seat and make your legislative appointments now! Buses will be leaving from Buffalo, Rochester, Syracuse, Westport, Newburgh, New City, Putnam/Westchester, Binghamton, Long Island and New York City. Stay tuned for more details!

NYS 2019-20 NYS Budget First Look: No COLA, $10 Million Housing Rate Hike,

$5.5 Reinvestment Allocation; Funding to Enhance Behavioral Health Parity Compliance

No 2.9% Human Services Cost of Living Adjustment

  • NYAPRS has been working very closely with our colleagues from the mental health and substance use nonprofit sectors to secure a long promised cost of living adjustment (COLA) that we have only seen once in 9 years. The total cost of a human services COLA would be $140 million, $120 million of which would be spread out across OMH, OASAS and OPWDD funded nonprofits.

  • The Executive Budget did not include a COLA and so, we will work from today to session’s end to get the Governor, Assembly and Senate to include it in the final agreement, starting with yesterday’s Albany news conference.

  • See our news release at https://www.nyaprs.org/e-news-bulletins/2019/1/14/behavioral-health-advocates-unite-to-press-for-a-cola-today-in-albany  and video excerpts of the news conference that featured NYAPRS’ and Community Access’ Phyllis Fisher at https://www.facebook.com/NYAPRSAlbany/videos/1985937304807667/

  • Great thanks to MHANYS’ Glenn Liebman for his leadership, NAMI-NYS for the video and our entire coalition for our collaboration. Stay tuned for a regular series of member actions over the next few months

$10 Million Housing Rate Hike

  • The Executive budget provides another $10 million housing hike, as it has for each of the last 5 years. As an active member of the Bring It Home Campaign, NYAPRS will work throughout this session to attempt to significantly increase this number, given the dire conditions faced by our housing providers

$5.5/11 Million Community Reinvestment Allocation

  • Once more, OMH’s budget includes more funding for community services expansion derived from the closure of additional state hospital beds. The $5.5 million equates to $11 million when annualized. See https://www.omh.ny.gov/omhweb/transformation/ for terrific examples of how the state and local stakeholders have deployed these funds to boost services for people with the most extensive needs.

$10 million for Adult Home Transitional Supports

  • It appears that the budget appropriates an additional $5 million for peer bridger and other transitional supports for adult home residents with psychiatric disabilities which, when added to a carryover of last year’s $5 million comes to a total of $10 million.

 

$100 million to Replace Mid-Hudson Psychiatric Center

  • “The Budget provides an additional appropriation of $100 million to support the replacement of the Mid-Hudson Forensic Psychiatric Center in Orange County, which includes buildings over 100 years old that are not designed for current standards of care.

 

$60 million in Capital Funds for Community Based Nonprofit Housing Providers

  • The Budget also includes $60 million to maintain and preserve existing community-based residential facilities that allow people with mental illness to live in the most integrated setting possible. 

Behavioral Health Parity

  • The budget includes several million dollars to enhance staff at the Department of Financial Services and the Department of Health to help assure health plans have adequate provider networks and are in compliance with parity requirements. dedicated to network adequacy and reviewing existing health plans to help ensure compliance with parity. 

NYAPRS Note: Get ready to get on the bus for this year’s 22nd NYAPRS Annual Albany Legislative Day! Below please find this year’s priorities and schedule. We’ll be sending out a list of regional bus contacts tomorrow for groups to contact and reserve their seats!

Leg day update.JPG

BH Advocates Call for 2.9% Cost of Living Hike (news conference video)

Behavioral Health Advocates Call for 2.9% Cost of Living Hike (news conference video)

Thanks to our colleagues across the behavioral health spectrum who came together today in support of a 2.9% COLA for the human services workforce in the State Budget.  Thanks also to our speakers---Bill Gettman, CEO of Northern Rivers,  Phyllis Fisher of Community Access, Tina Lee, Director of Public Relations for NAMI-NYS and Jessica Mitchell from Northern Rivers.

Among those present were representatives of the Mental Health Association in NYS, NYAPRS, Community Access, NAMI-NYS, Association for Community Living, MHA of NYC, NYS Coalition for Children's Mental Health Services, Coalition of Medication Assisted Treatment Providers and Advocates, Families Together, Alcoholism and Substance Abuse Providers of NYS and Northern Rivers Family of Services.

Listed below is a link to the Facebook Live video of the press conference, thanks to Matthew Shapiro of NAMI-NYS at

https://www.facebook.com/naminewyorkstate/videos/1053059801571835/

All made a compelling case for support of a COLA in the budget as you can tell from the video. 

We’re particularly grateful for Phyllis Fisher’s testimony about her experience with 12 separate care managers in 12 years. Please listen a 6:18.

Behavioral Health Advocates Unite to Press for a COLA Today in Albany

NYAPRS Note: This morning at 11:30, consumer, family and provider advocates for behavioral health services in New York will join together to call for a 2.9% Cost of living Adjustment in this year’s state budget. Our message will be “we will work from the budget’s release to session’s end to for an investment that will allow us to meet some of the state’s greatest challenges.” Great thanks to MHANYS CEO Glenn Liebman for his strong leadership here and to MHANYS Deputy Director Melissa Ramirez for creating the attached map detailing the statewide response to a recent survey of behavioral agencies that revealed an unacceptable 35% statewide turnover rates and 14% vacancy rates for the behavioral health workforce. Stay tuned for further actions in the coming days and get ready to get on the bus to NYAPRS’ February 26th Annual Albany Legislative Day to push for the COLA and other NYAPRS 2019 advocacy priorities!

N E W S   R E L E A S E 

Behavioral Health Advocates Unite to Press for a COLA to Address the Funding and Workforce Crisis

January 14, 2019                           Contact: Glenn Liebman   518-360-7916                                CEO, MHANYS

With the imminent release of the New York State Executive Budget, advocates for behavioral health services including consumers, families and service providers came to Albany on Monday to urge Governor Cuomo and state lawmakers to include a 2.9% Cost of Living Adjustment (COLA) to address a crisis in funding for not for profit human services agencies that is producing unmanageable vacancy and turnover rates and agency operating challenges that jeopardize their ability to support New Yorkers with mental health and substance use related needs.

Representing both mental health and substance use service providers, they emphasized the overwhelming demand for a strong and stable behavioral health service sector in addressing alarming increases in deaths due to opioid use and suicide, including a growing number of attempts among children under 10 years old, and steadily mounting rates of homelessness and incarceration.

“We come today to urge that a critically needed Cost of Living Adjustment for the behavioral health and broader human services workforce is included in this year’s state budget,” said Glenn Liebman, CEO of the Mental Health Association in NYS (MHANYS).

“We will work from the budget’s release to session’s end to for an investment that will allow us to meet some of the state’s greatest challenges,” he said.

“New Yorkers deserve a strong workforce that supports New Yorkers of all ages in their efforts to recover, build resiliency and manage their health and behavioral health challenges, along with the help of peers and family members” said Andrea Smyth, executive director of the NYS Coalition for Children’s Behavioral Health.

Behavioral health not for profits, developmental disability agencies, foster care agencies, at risk youth programs, child welfare agencies, services for the elderly and children’s mental health agencies would all be impacted by this increase to New York’s hard-pressed human services workforce.

At the news conference, the advocates released a newly compiled survey that pointedly demonstrated the magnitude of their workforce crisis, showing a 35% statewide turnover rates and 14% vacancy rates for the behavioral health workforce.  In New York City alone, the turnover rate was over 45%.

The negative effects of the turnover and vacancy crisis include less services, delayed access to care in the community, risk of inappropriate emergency department use, less effective treatment when trust and relationships needs to be continually rebuilt, staff burnout because of overtime and high caseloads and the reduced ability to pair seasoned staff with new hires.

“None of us are surprised by the results of the survey,” said Bill Gettman, CEO of Northern Rivers Family of Services, one of the largest children’s mental health providers in New York State. “Without support and funding from New York State, our ability to attract and retain quality staff will continue to significantly erode.”

“The average pay for our dedicated workforce is so low that 60% of those working in our human services sector were utilizing or had a family member utilizing some form of public assistance benefit such as Medicaid or food stamps,” said Doug Cooper, Associate Executive Director of the Association for Community Living, who compiled the survey results.

“Every day, our behavioral health nonprofits and their workforce work at every level of society to promote and protect some of our most vulnerable New Yorkers,” said Harvey Rosenthal, CEO of the New York Association of Psychiatric Rehabilitation Services. “We can be found on the streets, in the neighborhood, at community crisis programs, pantries and shelters and domestic violence and sexual assault treatment programs, clinics and rehabilitation programs.”

“Without regular COLAs, our agencies become less and less able to do the mission oriented work that provides support, safety and recovery to New York’s most vulnerable citizens”, said Ellen Pendegar, CEO of the Mental Health Association of Ulster County and MHANYS Board Chair.

Families are also very active members of the coalition. “NAMI-NYS and the families we represent are extremely concerned by the severe lack of funding from the state that has led to community mental health providers inability to hire and retain qualified and caring staff, said Wendy Burch, Executive Director of that National Alliance on Mental Illness-NYS. “We know that continuity of care is essential to successful recovery. “

Over a dozen statewide behavioral health advocacy groups representing thousands of workers and over half a million New Yorkers in the behavioral health service sector are in unison in urging support for a statewide COLA for behavioral health and the broader human services sector.

Speakers:

Glenn Liebman, CEO, Mental Health Association in New York State, Inc. (MHANYS)

Christine Robinson-Cooley, Family Member, NAMI, Capital Region

William Gettman, CEO, Northern Rivers Family of Services

Phyllis Fisher, Community Access

PT: Reform Advocates Pushing Legislation to Limit Solitary Confinement

NYAPRS Note: Criminal justice reform remains a top priority for NYAPRS, especially passage of the Humane Alternatives to Long-Term (HALT) Solitary Confinement Act A.3080B (Aubry)/S.4784A (Sepulveda) that bans the use of Solitary Confinement for people with mental, physical and medical disabilities, seniors, youth and pregnant women. The bill requires that individuals from these groups who do need to be removed from the general population for behavioral or other reasons should be sent to special rehab units and not the box.  The bill passed the Assembly last year and we’ve been getting signals it may well pass the new Senate. The HALT campaign is led by the Campaign for Alternatives to Solitary Confinement. Their site is http://nycaic.org/. Please sign on the campaign at http://nycaic.org/campaign-members/. HALT is, along with housing rate hikes and a COLA, among our top 3 priorities at this year’s NYAPRS Legislative Day on February 26th in Albany.

Look for a new release from our COLA coalition later this morning.

Reform Advocates Pushing Legislation to Limit Solitary Confinement

By Emilie Ruscoe  Politico  January 14, 2019

Prison reform advocates want to lock up the governor. Sort of.

A full-scale replica of a solitary confinement cell will land near the Capitol Tuesday morning as several lawmakers and activists call on Gov. Andrew Cuomo to spend 24 hours in an actual cell so he can fully understand what solitary confinement is like. The head of Colorado's prison system did just that several years ago, leading to his support for reform measures.

Advocates are pushing legislation that would restrict solitary confinement to 15 days. They are also supporting parole reform, pretrial detention reform, ending cash bail and ensuring the right to speedy trial. The governor has made criminal justice reform, including an end to cash bail, a priority for this year's legislative session.

"We hope to provide a much, much safer and more rehabilitative environment for everyone involved," said Doug van Zandt, whose son Benjamin killed himself in solitary confinement at Fishkill Correctional Facility in 2014.

According to data from the New York State Department of Corrections, more than 3,000 people are in solitary confinement on a daily basis in the state's prisons and jails, some for years on end.

More than 120 state legislators have supported previous versions of solitary restriction legislation. A bill passed the Assembly last year but it stalled in the Senate.

This year's version of the bill is sponsored by legislators whose districts are adjacent to Rikers Island: Sen. Luis Sepùlveda (D-Bronx) and Assemblymember Jeffrion Aubry (D-Queens).

Solitary confinement restrictions have been opposed by the Correction Officers Benevolent Association of New York City. COBA officials have characterized the use of solitary as a necessary tool for their work. In 2017, it sued the de Blasio administration over a change in policy restricting the use of solitary on people under the age of 21.

Study: Self-Directed Care Shown to Improve Outcomes and Controlling Costs in Comparison to Traditional Services

NYAPRS Note: Last week, Psychiatric Services posted a landmark study that compared the effectiveness of self-directed care to services delivered traditionally in a rigorous research design. outcomes, service costs, and user satisfaction among adults with serious mental illness. Subjects who received self-directed care showed marked improvements in their health and lives, while significantly reducing avoidable service expenditures.

The NYS Office of Mental Health is piloting this approach with 2 NYAPRS member agencies, Community Access and Independent Living. Bryan Cranna will be discussing the Independent Living initiative at this Wednesday’s NYAPRS Putnam/Westchester Regional forum at Cove Care Center in Mahopac (see next posting).

Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Judith A. Cook, Ph.D., Samuel Shore, L.M.S.W., Jane K. Burke-Miller, Ph.D., Jessica A. Jonikas, M.A., Marie Hamilton, L.C.S.W., M.P.H., Brandy Ruckdeschel, M.Ed., L.P.C., Walter Norris, M.A., Anna Frost Markowitz, M.P.H., Matthew Ferrara, B.A., Dulal Bhaumik, Ph.D.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800337

Over the past two decades, the federal Centers for Medicare and Medicaid Services (CMS) has promoted use of a consumer-directed, “money follows the person,” health care financing approach for use by individuals with a broad range of disabilities. Called self-directed care, this model gives individuals direct control over public funds to purchase health care services, supports, and material goods necessary for them to reside in the community rather than in inpatient or nursing facilities.

Although use of this model to promote the recovery of people with serious mental illness is less common, multiple states are now developing mental health self-directed care initiatives, and interest in this approach is growing. Recently, consumer, advocacy, and service provider communities have called for greater use of self-directed care in mental health, as have federal agencies, including CMS (1), the Substance Abuse and Mental Health Services Administration (2), and the U.S. Department of Health and Human Services’ Office of Disability, Aging and Long-TermCare Policy (3). The purpose of this study was to conduct a randomized controlled trial of a mental health self-directed care program, assessing its effects on participant outcomes, service satisfaction, and service costs.

Objective

Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness.

Methods

Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators.

Results

  • Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between group differences were found in total per-person service costs in years 1 and 2 or both years combined.

  • However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four.

  • The most frequent nontraditional purchases were for transportation (21%),communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%).

  • Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups.

 Conclusions

The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.

Psychiatric Services in Advance (doi: 10.1176/appi.ps.201800337)

This Wednesday: NYAPRS Putnam/Westchester Forum Preps for Legislative Day, Looks at New Service Innovations

NYAPRS Carmel Regional Forum

NYAPRS Note: NYAPRS is kicking off a series of regional forums over the next few months with a January 16 Putnam/Westchester Regional Forum in Carmel that will provide advocacy training, seek local input and prepare for our February 26th Annual Albany Legislative Day.

This year, we’ve added an additional hour long program that takes a deeper look at several new models that are being advanced by local NYAPRS member agencies and NYAPRS itself.

Bryan Cranna from Independent Living will offer a look at their self-directed care pilot that is helping eligible individuals to purchase the goods and services they need to advance their recovery and community life.

Raquelle Bender from the MHA of Westchester will be presenting on their Project INSET pilot that is engaging and supporting adults with extensive mental health challenges who live in the Hudson Valley and may be likely referrals for mandated services.

And I’ll be discussing a Health Home Peer Bridger approach appears to be included in a number of NYS Behavioral Heath HCBS Infrastructure funding proposals.

Registration will be capped at 50 so register today at acarroll@covecarecenter.org.

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