NYAPRS Note: A revised version based on recent clarifications.
NYAPRS NYS 2013-4 Budget Highlights January 22, 2013
No Community Cuts or COLAs
State Hospital Downsizing and Community Reinvestment
Health Home Infrastructure IT Enhancement
Health Home Enhancements for 'At Risk' Individuals
Expansions in Community Housing, including for Adult Home Residents
Behavioral/Physical Health Integration Initiatives
Prescriber Prevails Repeal and 'Goldcard' Alternative Proposed
Medicaid Managed Care Ombuds Program Boost
NYAPRS Note: Governor Cuomo's 2013-4 budget proposal to address a $1.3 billion budget gap without raising taxes or fees contains a promising agenda for our state's mental health community.
Positive: No community cuts, state hospital downsizing and reinvestment, more OMH and MRT housing, creation of Incident Review panels, permanent exemption from restrictive practitioner licensing standards, creation of an enhanced health home care coordination track for at risk individuals, IT help for some health home network members, BH/physical care integration initiatives, expansion of Medicaid managed care ombuds advocates
Negative: No COLAs
Uncertain: repeal of recent prescriber prevails protections provisions.
Here's what we know so far...more details we get them.
Next Tuesday's NYAPRS Legislative Day will highlight our positions in support of enhanced access to adequate and appropriate, voluntary services and supports. For more information, please see attachments.
OFFICE OF MENTAL HEALTH BUDGET
Community Services Funding
Community Services Funding: On the one hand, it contains no cuts to the community mental health safety net that includes rehabilitation, residential, peer run, clubhouse, treatment, care management and related support services. On the other hand, there is no proposed Cost of Living Adjustment despite years of having to do more with less, saving the state $53.4 million this year and the next.
NYAPRS: Given that OMH's budget if 'flat', meaning it has to fund previously committed expansions like housing and the sex offender program and any new initiatives out of last year's budget level, that's a very welcome outcome and something that NYAPRS members have been pushing.
OMH Community Housing: The budget proposal calls for 'the development of 1,000 supported housing units for residents of nursing homes (including 400 by the end of 2014), 4,000 supported housing beds for individuals in adult homes (including 1,400 by the end of 2014), and 3,400 beds for the homeless housing program in New York City
(including 634 by the end of 2014).
Prison Diversion: 'The Executive Budget continues funding to divert individuals from prison to treatment programs.'
OMH Local Efficiencies
No details yet. Savings are estimated to be $10 million this year and $20 million next year.
Incident Review Panel: The budget calls for 'the establishment of multi-disciplinary Mental Health Incident Review Panels for serious incidents involving a person with mental illness. This will facilitate timely and comprehensive reviews and provide for the implementation of more immediate corrective actions as needed.
NYAPRS: A very positive recommendation, building on the great value and success of the New York State/New York City Mental Health and Criminal Justice review and report of 2007, that looked at provider fixes not 'patient failures.'
Practitioner Licensing Exempts: "The Executive Budget also proposes to make permanent the current exemption for certain social work and mental health professional licensure requirements of persons employed by a program or service operated, regulated, funded, or approved by OMH, and/or local governmental units or social services districts."
NYAPRS: A very welcome long sought action.
State Operations Funding
OMH Psychiatric Center Regionalization and Restructuring, Reinvestment: The budget proposal refers to a further downsizing of New York's state hospital system. This is estimated to yield $20 million in savings this year and $40 million during the next.
The Budget proposal 'reflects the creation of regional centers of excellence for the diagnosis and treatment of complex behavioral health illnesses. This effort will ensure there will be ample capacity for treating individuals with mental illness who require inpatient services, and the savings related to the State Psychiatric Center regionalization initiative will be reinvested to support the same or greater level of community-based services. This reinvestment will help facilitate earlier and better access to care.' The budget extends Reinvestment authority to next year, a good thing as it would have otherwise expired.
NYAPRS: This is a very welcome direction for New York State, which currently spends more money on less people in more facilities than any other state and appears to respond to a long standing priority for NYAPRS that deinstitutionalization be accompanied by appropriate ramping up of the community system via reinvestment. We will be pushing for a strong person-centered discharge planning approach.
OMH Administrative Staffing and NPS Efficiencies
No details yet. Savings are expected to be $12.9 million this year and the next.
Savings from Reductions in State Worker Fringe Benefits
Estimated at $8.2 million this year and $51.1 million next year.
OMH Efficiencies in Sex Offender Management Treatment Program
No details yet. Savings are expected to be $4.6 million this year and the next.
According to the budget proposal, 'these (new) investments are balanced by savings resulting from improvements in benefits design, more appropriate treatment outcomes, greater controls on pharmaceuticals, and compliance with Federal law that requires spousal support. In addition, the Medicaid program will benefit from the implementation of Federal health care reform through the Affordable Care Act (ACA).'
Streamline Medicaid Administration
The Executive Budget proposes the consolidation of all of the State's Medicaid administration activities into the Department of Health, including Medicaid that is currently housed in the mental hygiene agencies which will 'focus on Medicaid policy and the implications of Medicaid on their constituencies.' All State Medicaid administrative functions (e.g., rate setting, negotiation of managed care contracts, claims processing) will be standardized and consolidated in DOH.
NYAPRS: Will DOH properly manage Medicaid in ways that don't short or inadequately serve people with psychiatric disabilities? How much input will OMH really have?
Reinvestment of Medicaid Savings from Hospital/ER use by Beneficiaries with behavioral health conditions
* No action taken.
NYAPRS has urged that we should build upon services' success in helping to improve outreach, engagement, diversion by using some of these funds to ramp up community behavioral health capacity.
Health Homes: The budget proposes to enhance or expand health home initiatives in two ways:
* $15 million to help health home network providers to enhance their IT capacity to share/review patient information in 'real time.' This is for providers who have not previously received state funding via HEAL grants.
NYAPRS: A great help for smaller agencies to participate in the new electronic healthcare records systems.
* $10 million for a 'Health Homes Plus' initiative to fund enhanced services to 'at risk' individuals 'to ensure continuity of care for these individuals in the community, and to integrate physical and behavioral services.'
NYAPRS: Very welcome, consistent with our recent advocacy.
Integration of Behavioral/Physical Healthcare: $15 million to integrate mental health, addiction and medical care by:
* Eliminating current APG related financial disincentives to integrate care
* Expand collaborative care initiatives that enhance behavioral health assessments and follow up in primary care
NYAPRS: Very positive.
Access to Medications: The budget proposes two measures here:
* a repeal of last year's hard won restoration of prescriber prevails protections for anti-psychotic medications within Medicaid managed care and also, within the Fee for Service system, estimated to save $18.7 million.
* a new 'goldcard' option for approved prescribers who meet certain standards (these appear to include evidence based prescribing, reductions in avoidable polypharmacy, etc) who accordingly will be granted prescriber prevails 'powers' for all 4 previously exempt classes (anti-psychotic, anti-depressant, anti-convulsant and AIDS medications).
NYAPRS: More details needed here.
* an estimated $20 million in new supportive housing meds for Medicaid beneficiaries with high needs, to join about $46 million of previously authorized housing last year that is just coming up now.
NYAPRS: Hopefully, the precursor to the $750 million in affordable housing tied to federal approval of our MRT Waiver.
Medicaid Managed Care Ombuds Program
* $3 million to fund ombuds persons who can protect and promote the rights of Medicaid beneficiaries, starting with those in Medicaid Long Term Care program (Medicaid/Medicare beneficiaries).
NYAPRS: A critical important first step advanced by our friends at Medicaid Matters to protect beneficiary rights as we move to a fully integrated Medicaid managed care system next year.