The 2017—2018 Executive Budget is a mixed bag that includes a few spending
additions in areas of importance to MHANYS, but also some programs that
have not been funded, notably the Executive again deciding to defer any
COLA for the mental health work force till the 2018-19 budget.

The full breakdown is listed below

Workforce:

– The COLA for the mental health workforce was deferred to the 2018-19
Budget
– The Budget invests $17 million to support the direct costs of FY 2018
minimum wage increases for direct care, direct support, and other workers
at not for profits that provide services on behalf of OPWDD, OMH and OASAS.
– $255 investment to support the minimum wage increases for health care
workers that provide services reimbursed by Medicaid on behalf of the
Department of Health. The breakdown is Home Care–$242.7 million, Nursing
Homes–$4.6 million, Inpatient–$0.2 million, Outpatient–$ 4 million and
Transportation $4 Million.

Commentary:

We continue to be disappointed that there was limited money in the mental
health budget allocated for the not for profit workforce. The frustration
is mounting as our members and other community agencies struggle to recruit
and retain a quality workforce while getting almost no increases over the
last decade.

At the same time, the minimum wage increase also impacts the not for profit
workforce. While a for profit entity like McDonalds can pay for higher
wages for an individual by raising prices, there is no similar recourse in
the not for profit sector. As a result quality staff will leave for higher
paying jobs in the service industry. The $17 million increase for direct
support is appreciated but only makes a small dent in a much larger issues.

Also, none of the state’s $255 million to support minimum wage increase in
the health care sector are designated specifically for the mental health
workforce.

Recommendations:

1) It is imperative that the Executive and the Legislature work
together to create a COLA increase for the not for profit workforce. Three
years ago, there was an agreement to add funding to the direct care
workforce in mental health. This year, another such agreement should be
reached to include the entire mental health workforce.

2) There is over one billion dollars in DSRIP funding allocated for
workforce with not for profits in the PPS. We do not know if any of this
funding has been allocated.

We urge the State to utilize this funding to provide one time funding to
not for profits over the two and half years left of the DSRIP program. A
large portion of this $1.1 billion dollars should be utilized for the human
service workforce, many of who are part of existing PPSs

 

Housing

The Executive Budget proposes adding ten million dollars to enhance
services for existing residential program. This funding will help preserve
access and maintain existing housing capacity. The money will be divided
between supported housing and SROs. As in the past few years, the
supported housing dollars will likely go mostly to downstate housing
providers though there is no official word on exactly what the breakdown
will be. The SRO funding will likely be much more expansive to other parts
of the State.

OMH is also planning to reconfigure 140 state operated residential beds
(SOCRS) that are more costly and replace them with funding for 280
supported housing beds in the same geographic area.

Recommendations:

1) We are appreciative of the additions in this year’s housing budget,
but it does not meet existing needs statewide. MHANY S is part of a
campaign with ACL, NYAPRS and NAMI calling for an increase of thirty seven
million dollars a year for the next three years to help shore up funding
for existing supported housing programs.

2) Also, we support funding for more supported housing based on the
retooling of state operated residential beds. However, we would like to see
it costed out to see how much the State is saving in this reconfiguration
and insure that the savings are added to mental health community services.

 

Reinvestment of Services

MHANYS has long been supportive of community based funding. As the State
continues to downsize, we want to insure that any beds that close go
immediately into community support services. OMH has done an excellent job
of spending this money quickly based on community priorities.

We were pleased to see $11 million dollars added in the budget for
reinvestment. Based on the calculations of $110,000 per individual bed, the
projection is that 100 bed will be closing in the next year.

Recommendation:

Continue to insure that this funding is embedded into localities for
community support services for housing, peer support, crisis respite,
children’s services and family engagement.

 

Extension of Behavioral Health Provider Rates till March 2020

The government rates for clinic services will be extended from June 2018 to
March 31, 2020. Those services cannot be reduced by health plans below
existing government rates.

 

State Operated Outpatient Clinic Reform

OMH will undertake a review of all 85 state operated facilities to reduce
any overlap of services and ensure clinics are operating at optimal patient
capacity.

 

Revamp Hutching Children and Youth Services

OMH will evaluate and develop a plan to achieve efficiencies for
administration and care of Hutching’s Children and Youth inpatient services

 

Establish Jail Based Restoration Program for Certain Defendants

Currently, defendants who are deemed incompetent to stand trial are treated
at an OMH inpatient psychiatric hospital until they are restored to
competency and returned to jail to await trial. OMH will work with counties
on a voluntary basis to develop specialized residential treatment units
within their jails.

 

Veterans Mental Health, Suicide Prevention, Mental Health First Aid and
Crisis Intervention Teams

There is no state funding directed to any of these MHANYS priority issue
areas.

Recommendation:

MHANYS has been involved with several reforms over the last number of years
around education and ending stigma of mental illness. We are concerned that
these fundamental programs are not embedded in the State budget through
State local assistance dollars. All these programs are essential to
prevention, early intervention and criminal justice reform. MHANYS will
continue to work with the Legislature and the Executive to insure that
there is funding in the budget for those priority areas.

 

Raise the Age

We were pleased to see the Governor continue his call for supporting the
Raise the Age Initiative.

Recommendation:

MHANYS fully support the Raise the Age legislation. There are so many of 16
and 17 year olds who are treated as adults in the corrections system that
have an underlying mental health and/or substance abuse issue. We need more
preventative and early intervention services to insure that they receive
services and support rather than an entry into the corrections system.

 

HEALTH CARE REFORMS

Medication Access

We are appreciative of the Executive including prescriber prevails language
for Mental Health Medication in State formularies for Medicaid patients and
to ‘include non-formulary drugs, upon demonstration by the prescriber,
after consulting with the managed care provider, that such drugs, in the
prescriber’s reasonable professional judgement, are medically necessary and
warranted’.

Recommendation:

We are very supportive of the prescriber prevails language but also
recognize that people with mental health issues are also much more likely
than the general population to have physical issues as well. To truly
provide comprehensive care, there should be full ‘prescriber prevails’
language for all appropriate drug classes.

 

Health Care Facility Transformation Program

This program provides funding for support of Capital Projects that
facilitate health care transformation activities including merger,
consolidation, acquisition of other activities intended to create
financially sustainable systems of care or preserve or expand essential
health care services. The funding is not for operations. Eligible entities
would be health care providers. Listed among those entities include
licensed mental health clinics. The scope of the project is $500 million
but $30 million is set aside for community based health care providers.

Recommendation:

It is clear from this language that licensed mental health clinics would be
able to participate in this funding. The way the language is written, it is
not clear if community based mental health organizations would be eligible.
Our recommendation is to amend this language to clearly state that
community based mental health organizations are eligible and increase the
funding for community based providers to more than $30 million dollars.

 

Health Care Regulation Modernization

The Governor’s Budget proposes a health care regulation modernization team
for purposes of providing guidance to the Governor towards a fundamental
restructuring of the statutes, policies and regulations that govern the
licensure and oversight of health care facilities and home care to better
align with recent and ongoing changes in the health care delivery system
that are designed to increase quality, reduce cost and improve health
outcomes.

There are significant mental health implications. Among the
responsibilities of the team would be to streamline state agency
certificate of need and other licensure of construction approval process;
creating more flexible rules on licensing and scope of practice for
clinicians and caregivers; streamlining and simplifying the provision of
primary care, mental health and substance use disorder services in an
integrated clinic setting; align care models around home and community
based services consistent with the report issued by the Olmstead
Development and Implementation Cabinet; authorize Commissioner of Mental
Health and Commissioner of Office of Alcoholism and Substance Abuse to
implement time limited demonstration programs to test and evaluate new and
innovative procedures for organizing and delivering health care services.

 

SUMMARY

We have seen some small budget allocations to priority areas of MHANYS
including community support through reinvestment and funding for existing
housing. We are also supportive of the movement to continue prescriber
prevails in place for mental health medications (though we needed for many
other medications as well) as well as the Governor’s continued commitment
to Raise the Age. Also, the Health Care Regulation Modernization Work Group
is intriguing in regard to possibly reducing some burdensome regulations
that needlessly impact the lives of individuals with mental health issues.
We will be working to change the language of the Health Care Facility
Transformation Program to clearly define the community mental health
workforce to insure eligibility for the funding for MHA’s and other
community based organizations.

We continue to raise our concerns about the impact to the workforce of
another year of no enhancements to their base. The workforce in our field
is vastly underfunded and they are so essential to individual recovery. The
minimum wage impact also plays a major role in workforce. *We must
prioritize workforce as a leading issues in the mental health system.*

Please join us and lend your support by coming to the MHANYS Annual Mental
Health Matters Legislative Day on March 8th in Albany. Go to
www.mhanys.org to register.

Glenn Liebman, CEO

Mental Health Association in New York State, Inc.

gliebman@mhanys.org

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