NYAPRS First Look at NYS Budget Agreement

Here are some quick initial details of the budget agreement reached by the Governor and NYS Legislature that is expected to be approved later this week:

State Hospital Downsizing/Reinvestment: the legislature took away OMH’s ability to close hospitals or wards during this calendar year, retreating back to previous one year in advance notification requirements. No downsizing means no savings means no reinvestment into community services.

In order to block such downsizing, the legislature had to find $20 million to replace the projected savings claimed by the Governor in his budget proposal. Reinvestment authority has been extended till next year.

Although NYS spends far more money for more state hospitals to serve fewer people than the next few states combined, once again labor concerns have blocked a downsizing plan that would have centralized state of the art centers and generated important savings to boost local community mental health services.

Cost of Living Adjustment: No COLA again this year.

Behavioral Health into Managed Care Transition Requirements: The legislature provides numerous expectations of the state as it transitions mental health and addiction services into integrated managed care plans in 2014:

DOH, OMH and OASAS are required to “ensure that any special needs managed care plan... have an adequate network of providers to meet the behavioral health and health needs of enrollees, and shall review the adequacy prior to approval of any special needs managed care plan, and upon contract renewal or expansion.”

Such network shall be deemed adequate if they

  • ensure that any special needs managed care plan shall make level of care and coverage determinations utilizing evidence-based tools or guidelines designed to address the behavioral health needs of enrollees;
  • ensure sufficient access to behavioral health and health services for eligible enrollees by establishing and monitoring penetration rates of special needs managed care plans;
  • establish standards to encourage the use of services, products and care recommended, ordered or prescribed by a provider to sufficiently address the behavioral health and health services needs of enrollees; and
  • monitor the application of such standards to ensure that they sufficiently address the behavioral health and health services needs of enrollees.

These provisions provide critical safeguards towards ensuring that people with serious behavioral health needs get the services and provider expertise they will need as we head into managed care.

Mental Health Incident Review Panels: the legislature supports the Governor’s proposal to establish mental

health incident review panel for the purposes of reviewing in conjunction with local representation, the circumstances and events related to a serious incident involving a person with mental illness.”

“A panel shall be authorized to conduct a review of such serious incident in an attempt to identify problems or gaps in mental health delivery systems and to make recommendations for corrective actions to improve the provision of mental health or related services, to improve the coordination, integration and accountability of care in

the mental health service system, and to enhance individual and public safety.”

It’s important to note that the panels will look at violent incidents TOWARDS people with psychiatric conditions too.

Adult Home Resident Transitions to the Community: The legislature did not carry through earlier proposals to delay the transition of adult home residents with psychiatric disabilities into the community by creating a workgroup that would have taken a year or so to offer a review. Advocates worked very hard in the last week to block such efforts and are heartened that the state will be able to go ahead and approve action on previously awarded contracts to help a first wave of 1,050 residents who have chosen to move and been assessed by a health home or managed long term care program as ready to go.

The legislature also approved 4,500 assisted living program beds for adult homes that have over 80 beds and more than 25% of residents with psychiatric conditions, without a competitive bed process.

It also described how a temporary adult home operator could be brought in to shore up and assure consistency of service for financially troubled homes or those where conditions so warrant it.

Prescriber Prevails: The legislature restored a provision that was won by advocates last year to give prescribers the capacity to see that their patients get antipsychotic medications of choice, even if they are not on a plan’s formulary, following a plan prior authorization review.

NYS SAFE Act Mental Health Reporting: No precise word yet but it looks like our efforts to more tightly define and restrict reporting requirements won’t make it into this agreement. Stay tuned for further efforts.