NYS Legislative Budget Proposals: NYAPRS' First Look

NYAPRS Note: The NYS Assembly and Senate have responded to Governor Cuomo's budget proposals for the coming year with their respective one-house bills. Here are some initial findings of interest to NYAPRS members. The legislature and the Governor are now expected to reach final agreement by March 18. More details as we get them...

OMH STATE OPERATIONS

· Both houses reject OMH Centers of Excellence/Hospital Downsizing Plan: The Senate would OMH to submit a report regarding proposed restructuring of state operated facilities by September 1, 2013, with an update every 6 months thereafter.

The hospital downsizing/Centers of Excellence proposal has been a high priority for NYAPRS. New York spends more money on more hospitals for less people than the next 2-3 states combined. The state system must be seen as a treatment not a jobs program. It's an outrage to keep sorely needed public mental health dollars in outmoded facilities when those funds could be used for critical investments in our community based behavioral health service systems on the uncertain eve of their integration within managed care health plans in 2014.

· Reinvestment - The Senate extended authorization for the Reinvestment Program for one year, until March 31, 2014. The Assembly extends Reinvestment for 4 years until 2017. Reinvestment would redirect a portion of the savings from state hospital ward or facility downsizing into boosting community mental health services. However, without any approved closings of wards or hospitals, there's no money to reinvest.

· Incident Review Panels to investigate incidents involving violence to/from people with mental illnesses: both houses would approve this proposal with minor changes.

OMH Aid to Localities

· The Senate proposes $3 million for veteran mental health initiatives, as proposed by Senators Zeldin and Fuscillo

MEDICAID

· Both houses restore 'prescriber prevails' provision for anti-psychotic medications. According to MHANYS,

o "The Assembly has rejected the budget language for eliminating prescriber prevails for Medicaid fee for service as well as rejected the budget's repeal of prescriber prevails for atypical anti psychotics drug class in Medicaid Managed Care.

o The Senate has also rejected the language for eliminating prescriber prevails for Medicaid fee for service as well as rejected the Governor's repeal for prescriber prevails for atypical antipsychotics in Medicaid Managed Care. In addition, the Senate also added prescriber prevails for Medicaid Fee for Service and Medicaid Managed Care for all drug classes."

· Both houses would increase Medicaid managed care payments to behavioral health providers through the APG group methodology, beyond the Governor's proposed end date of 2015 to 2017

· Behavioral Health Integration into Managed Care: both houses set expectations for how our behavioral health services will be transitioned into managed care plans, as suggested by the NYS Council of Community Behavioral Healthcare. These changes will determine the future care and conditions of New Yorkers with behavioral health needs and getting the legislature to closely monitor the process and put into law its own expectations is a critical step forward. The two houses offer slightly differing proposals, as follows:

The Assembly proposes that the NYS Department of Health, Office of Mental Health and Office of Alcoholism and Substance Abuse Services jointly conduct a study on the transition of complex

behavioral health services into managed care plans that will evaluate:

§ the adequacy of rates,

§ the plans' capability to arrange and manage covered services for eligible enrollees

§ the plans' ability to provide an adequate network of providers to meet the needs of enrollees

§ the plans' use of evidence based tools or guidelines when determining the appropriate level of care or coverage for enrollees

§ the plans' ability to provide eligible enrollees with both the appropriate amount and type of services, the plans' quality assurance mechanisms, including processes to ensure enrollee satisfaction

§ the plans' procedures to address the cultural and linguistic needs of the enrollees

§ and any other quality of care criteria deemed appropriate by the commissioners to ensure the adequacy of rates, continuity of care and the quality of life, health, and safety of enrollees during the transition of complex behavioral health services into managed care plans.

The agencies would be required to submit a report on their findings, conclusions and any proposed amendments to pertinent sections of the law on or before August 31, 2016. The report shall also include recommendations to preserve adequate levels of service with focus on quality of care and rate adequacy under managed care plans.

The NYS Senate proposes that DOH, OMH and OASAS jointly establish standards and requirements to:

· ensure that any special needs managed care plan shall 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.

· ensure that plans 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.

DOH, OMH and OASAS would also be required to demonstrate that health plan contractors have demonstrated the ability to effectively, efficiently, and economically integrate behavioral health and health services; have the requisite expertise and financial resources; have demonstrated that their directors, sponsors, members, managers, partners or operators have the requisite character, competence and standing in the community, and are best suited to serve the purposes of this section.

Plans are also expected to demonstrate that they

· make level of care and coverage determinations utilizing evidence-based tools or guidelines designated 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 any such contractor or contractors.

· 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.

Oversight of such contracts with such plans, providers or provider systems shall be the joint responsibility of such state commissioners, and for contracts affecting a city with a population of over one million persons, also with the city's local social services district and local governmental unit, as such term is defined in the mental hygiene law.

In selecting such plans or systems, the commissioners shall:

· ensure that any such plans or systems 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 such plans or systems, and upon contract renewal or expansion.

· ensure that such plans or systems 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 any such plans or systems.

· establish standards to encourage the use of services, products and care recommended, ordered or prescribed by a provider to sufficient address the behavioral health and health services needs of enrollees;

· and monitor the application of such standards to ensure that they aufficiently address the behavioral health and health services needs of enrollees.

The agencies are required to submit a report demonstrating that the above has been followed by June 30, 2016.

OPWDD rates: Both houses find $120 million to restore the Governor's proposed 6% cut to OPWDD providers.