On Monday, MHANYS testified at the annual legislative hearing on the
Mental Hygiene portion of the Executive Budget. In the fourteen years that
I have testified, I have never witnessed so much emphasis on workforce from
all sectors. We spent our entire testimony talking about workforce and
emphasizing the downside of deferring the COLA for another year. This
deferral combined with the impact of the minimum wage, the increasing cost
of running programs and the changing expectations of our work force as we
transition into managed care, all have a significant workforce impact.

Our community desperately needs funding to continue to run the programs
that are consistent with the values of keeping people in the community and
not in more expensive institutional settings. I never saw so many
legislators and advocates speak with such a unified voice on this need. We
will continue to demand action for the workforce.

Mental Health Association in New York State, Inc.

Testimony to Joint Legislative Public Hearing on 2017-2018 Executive Budget
Proposal Topic Mental Hygiene

February 6, 2017

Presented by Glenn Liebman, CEO

Thank you very much for the opportunity to testify at today’s Legislative
Budget hearing. My name is Glenn Liebman and I am the CEO of the Mental
Health Association in New York State, Inc. (MHANYS). Our organization is
comprised of 26 affiliates in 50 counties across New York State. Our
members provide community based mental health services to over 100,000 New
Yorkers with mental health challenges.

Our organization is also involved in advocacy, education and trainings. Our
core mission is to advocate for the greater good of the mental health
community and to help eradicate the stigma of mental illness.

This is the 14th year I have had the opportunity to present testimony. Over
these years, especially in more recent years, there has been great progress
made in the fight to end the stigma of mental illness. I want to thank all
of you, especially Assemblymember Gunther and Senator Ortt, because you
listened and you acted. In recent years, there have been some hard earned
successes for people with mental health issues through prevention,
education and public awareness efforts.

Last year the passing of the mental health education bill was a landmark
accomplishment. In the fall of 2018, all students will be taught about
mental health as part of the health curriculum. With one in five children
having a mental health issue including high percentages of depression and
anxiety, this legislation will have an immediate and greatly beneficial
impact.

In the public awareness arena, thanks to the dedicated work of our mental
hygiene chairs and Senator Carlucci, we have the first bill in the country
dedicated to funding for public awareness about mental illness through a
New York State Income Tax check off. It sent an important and immediate
message to the entire State that mental illness is as significant as any
other illness including breast cancer awareness and Alzheimer’s disease.

This year’s introduction by our chairs of a license plate bill to raise
awareness and fight the stigma of mental illness is another wonderful
opportunity to support people with mental illness and their loved ones such
as myself. We hope you are all able to support this legislation.

All of your leadership especially that of Senator Young in 2016 resulted in
the passing of a bill to help reform New York State’s practice of ‘Step
Therapy’ or Fail First. This common sense legislation will provide greater
consumer safeguards and more ability for prescribers to have involvement
with the treatment plan and medication choices.

So thank you for all your great work and support. We also thank Governor
Cuomo for his signing of these important initiatives.

BUDGET ANALYSIS

We have a mixed budget this year as we have had for the last several years
with some new spending but unfortunately some deferrals in spending
including most importantly to Cost of Living Adjustments (COLA) to the
mental health workforce.

Workforce
As I referenced earlier, this is my 14th year of presenting and in all the
years, there has never been a greater need for a well-trained and well
compensated workforce.

Think of it from an agency perspective. You have to run an agency with the
expanding cost of health care and other ancillary costs of running a not
for profit business. You have to deal with the transformation of the mental
health system into Medicaid Managed Care and the new expectations put on
that workforce. Then you are dealing with the impact of the minimum wage
to your workforce. A not for profit is not like McDonalds; you can’t raise
hamburger prices by a nickel to pay for the minimum wage. Without
additional state funding, we would be unable to pay for minimum wage
increases.

According to work done by our colleague Doug Cooper at the Association for
Community Living, we estimate that there would be the need of $50 million a
year for the next six years to help pay for the cost of the minimum wage
increase. Our colleagues in the BFairtoDirectCare campaign have similar
numbers on the Developmental Disabilities side.

That is only one part of the story. The other part of the story is that
there is virtually no additional funding support from New York State. In
Mental Health, we have received only two COLAs in the last decade and one
was .02 percent (a dollar a more a week for most employees). This year
again, sadly, the COLA is deferred.

How many more years can a COLA be deferred before the workforce is
completely decimated?

At some point this logjam has got to end. Our workforce can tell you point
blank that things have never been more difficult in the not for profit
sector.

We are part of the Restore Opportunities Now (RON) campaign that is
comprised of over three hundred and fifty not for profit organizations
across the State that calls for crucial investments and systemic changes in
New York’s nonprofit human services sector. The impact of lack of funding
for the not for profit sector is seen across New York State in poverty
numbers, individuals with disabilities and food insecurity for both
children and adults.

Many of the Governor’s bold initiatives in the State of the State which we
completely support such as expansion of indigent legal services, affordable
housing programs, high quality pre-K for three and four year olds, SNAP
benefit expansion, Fighting Food Insecurity, mental health services for
individuals that are homeless, Opioid Addiction Reform, Veterans Support
and much more, need the support and tireless efforts of the not for profit
sector to succeed.

We must fund living wages that are competitive and keep pace with
increasing cost of living in the future.

From MHANYS perspective, this issue is especially acute in the mental
health sector. The workforce is incredibly mission driven. People know when
they enter the mental health workforce that it is not for the money but it
is for helping vulnerable people get better and move forward with their
lives. Yet, good feelings and mission driven work does not pay the rent or
student loans. We strongly support Medicaid reform and the integration of
health and mental health for people with mental health challenges. However
as progressive as the systems of care may be, you need a sophisticated and
well compensated and well trained workforce to operationalize these changes.

We must have a workforce enhancement if we are able to continue to run
quality programs and support for people with mental health issues to live
in the community.

Recommendation

1) Fund the minimum wage increase through state contracts and
Medicaid reimbursements. Our colleagues in the BFairtoDirectCare Campaign
have shed light on the needs of our community. We support their tireless
efforts and we urge support in the mental health community as well.

2) Through the leadership of the Legislature, there was a COLA for
the mental health workforce three years ago. That was very helpful. We need
your support to insure that there is funding for another COLA for the
mental health workforce.

3) Work with the Executive around workforce funding through the
DSRIP Waiver. The $8 billion waiver, over a five year period, has a
specific set aside of $1.08 billion for workforce and enhanced behavioral
health services.

Much of the money dedicated to behavioral health of the $1.08 has not been
expended. How is that money being utilized and wouldn’t there be an ability
to redesign the waiver to insure that this funding was going to the
behavioral health workforce rather than losing the funding from the waiver?
There is only two years left of this waiver and New York should do
everything possible to follow the language of the waiver that specifically
states, “This funding will support Health Home development, and investments
in long term care, *workforce and enhanced behavioral health services”*

Our colleagues at NYAPRS, The New York State Coalition of Children’s
Services and the New York State Council for Community Behavioral Healthcare
all support this important initiative.

We also know that a very small percentage of the DSRIP dollars have flowed
to community providers. In an account from last week’s DSRIP meeting, less
than two percent of funding has gone to downstream providers. Another way
to incent the workforce is by insuring DSRIP contracts with these providers
for the outcomes necessary to keep people out of the hospital and in the
community.

The workforce is in desperate need of help and support and utilizing the
DSRIP waiver can help provide resources to the sector with no impact to the
State budget and to middle class taxpayers. We urge the Legislature to work
with the Governor on this initiative.

Reinvestment
We are very appreciative of the Governor’s efforts to continue funding for
reinvestment services. There is an additional $11 million in this year’s
budget to close 100 community beds. This $11 million will bring the total
to over $90 million in annualized spending for reinvestment. We are
appreciative of the legislatures’ support for this funding. These critical
service dollars have been used by many of our members across New York State
in providing peer supports, crisis services, family engagement and
employment programs. OMH deserves a great deal of credit for getting this
money out to the communities around New York State

Recommendation
Continue support for reinvestment, but insure a full accounting of how the
money is being spent. There should be a full breakdown of how the money is
being spent for state operated programs versus community mental health
projects.

Housing
We are very appreciative of the Governor’s support for housing subsidies.
This year’s budget includes a proposed $10 million dollars to enhance
services for existing residential programs.

We completely support this funding as many of our members run residential
programs and there is a constant need for program funding. We urge support
for funding across New York State.

Recommendation
We support our colleagues at ACL, NAMI, and NYAPRS in supporting this
enhancement of housing support. We are also seeking an additional $28
million for this year and $38 a year for the following two years to make
these programs whole in their communities.

Veterans Mental Health
We continue to be concerned about the limited amount of funding in the
budget for Veterans mental health. The rates of suicide and post-traumatic
stress in the veterans’ community are much higher than the general
population. We also have to utilize funding to break down the walls of
stigma. Many veterans will not acknowledge that they have a problem. Over
the years, we have had great difficulty in assisting them in receiving
mental health services and much of it has to do with stigma.

Recommendation

1) Continue the success of the Joseph Dwyer Veterans Peer Support
Project by providing funding for additional counties across the State.
Special thanks to Senator Ortt for leading the charge to continue funding
for this vital program. As we were told at our Veterans Rally last year by
a participant from Long Island who said, “Without the help and support of
the Dwyer Program, I wouldn’t be alive today” What a testament to the
program.

2) Work with the State and Legislature to develop a public
awareness campaign for veterans that addresses stigma and mental illness.

Mental Health First Aid
Mental Health First Aid is an eight hour training dedicated to making
individuals aware of signs and symptoms of mental illness and how to
respond to an immediate crisis. It also has played a major role in
eradicating the stigma of mental illness.

The training is effective for the entire community but it has been
particularly effective in the training of law enforcement personnel,
teachers and others who work in fields that are more likely to come across
individuals with mental health issues.

We thank the New York State Senate and in particularly Senator Ortt for
providing funding to our organization to help spread Mental Health First
Aid trainings within our network. This funding has been invaluable. We also
appreciate the support of New York State Mental Health Commissioner Ann
Sullivan for working with us on this important initiative.

We truly believe the entire community should be educated in Mental Health
First Aid and with your support we hope this will one day become a reality.

Recommendation
Continue funding for Mental Health First Aid to help educate community
stakeholders about how to respond to a mental health crisis.

Crisis Intervention Teams
After lagging behind the rest of the country for many years in CIT
development, New York State has now become a leader in the field. Next
week, I am speaking with the next group of counties that have come forward
to develop these teams. Dozens of counties now have this training model in
place and it is because of the leadership of all of you.

Thank you for supporting this intervention that brings together law
enforcement, families and peers to identify how best to respond to an
individual having a mental health crisis in the community. Countless lives
have been enhanced because of this model.

Recommendation
We continue to support enhanced funding for Crisis Intervention Teams.

Managed Care Readiness
The transition in New York State from a primarily fee for service Medicaid
payment system to managed care presents significant challenges to community
based not for profits. While collectively these providers account for a
substantial portion of the mental health services available at the
community level, many lack experience in Medicaid billing or operating
within a managed care environment.

These providers are an indispensable asset to the mental health system of
care and will need financial assistance with startup costs, technology
assistance and expert consultation.

MHANYS believes it is in New York’s best interest to help these providers
survive and thrive in the transition to Medicaid managed care and urges the
Governor and the Legislature to make funding available for this purpose.

Over the last few years, OMH has made money available to community
providers to insure that there be strategic investments made to help create
a Medicaid structure. Health Information Technology funding is also being
made available. We thank the Office of Mental Health for working with us on
this but we also know that to undertake a retooling of the system of care
takes a great deal of investment.

Recommendation

1) As we continue to make strategic investments in behavioral
health transformation initiative, we must continue to recognize the
importance of the funding for HARP Managed Care Start Up/Technical
Assistance. State dollars are important to help not for profits navigate
this new landscape. This funding must be a priority.

2) We also support additional HARP funding to get not for profits
ready for Value Based Payments by helping to fund regional Independent
Practice Associations (IPA)with the understanding that some of this money
be utilized to incent small not for profits to be part of the IPA network.

Enhanced School Based Mental Health Services
As we referenced earlier, we are very pleased that through your leadership
and that of the education chairs, Senators Marcellino, Assemblymember Nolan
as well as Governor Cuomo, we were able to get the mental health education
bill in statute.

That is a great first step but we need more.

Recommendation
Add funding to schools to support additional social workers, counselors
and therapeutic after care mental health services.

Homeless Housing Initiative

Recommendation
We urge the Governor and Legislature to come together and sign an MOU,
along with reaching a final budget agreement that would allow the $2.5
billion dollars being targeted for 6000 new units of new supportive housing
over the next five years to be released. This would be the first step in
meeting the Governor’s promise made last year to develop a total of 20,000
new units of supportive housing.

Funding for Adverse Childhood Experiences Programming (ACE’s)
The Adverse Childhood Experience study (ACE’s) offers research that links
adverse childhood experiences with the adult onset of chronic mental
health, physical health and social health issues. Other studies have shown
short term consequences in school-aged children. ACEs are the best
predictor for poor health and the second best predictor for academic
failure. Understanding and responding to ACEs builds resilient communities.

Recommendation
Funding of a demonstration program would ensure bringing together leading
experts on infusing the groundbreaking research into practical services
aimed at reducing the social determinants of health and well-being for
families in New York State.

Suicide Prevention Efforts
Last September, the Office of Mental Health introduced the innovative
2016-2017 New York State Suicide Prevention Plan entitled ‘1700 Too Many’.
We are very appreciative of the work of Governor Cuomo, Commissioner
Sullivan and the staff of OMH for their work in this arena. We also thank
the Legislature for your support of suicide prevention programming.

Recommendation
We urge continued funding and support for the implementation of the zero
suicide initiative, enhanced trainings for the community as well as for
schools. We also urge continued support for data informed suicide
prevention efforts.

New York State Justice Center for the Protection of People with Special
Needs
Since implementation of the Justice Center three years ago, the Center has
played a significant role in protecting vulnerable adults and children in
licensed and regulated residential and community programs.

There have been many positive functions that have come out of the Justice
Center including statewide reporting numbers, staff exclusion list,
statewide training, provider awareness and most significantly in recent
times, a movement to working collaboratively with the large majority of the
not for profit workforce who work hard every day to insure that vulnerable
New Yorkers are safe and moving forward in their lives.

These are significant accomplishments around safety and support but like
with any nascent initiative, there are unintended consequences. It has had
an impact on worker retention and practice and delivery of services by both
public and private providers.

Recommendation
Now that there is three years of data in place, it is important to assess
the legislation and identify areas of improvement around worker retention,
client safety, incenting the workforce in a positive way and provider
support. We support our colleagues at Northern Rivers in urging the
Legislature to work with the Executive to review the legislation and seek
modifications on how to best improve public safety and worker retention.

HEALTH DELIVERY

Prescriber Prevails
MHANYS is appreciative of the Executive including prescriber prevails
language for Mental Health Medications in Health Plan formularies for
Medicaid patients. We have fought for this provision for many years and are
very appreciative of the Governors’ support and the consistent support of
the Legislature.

Recommendation
We are very supportive of the Prescriber Prevails language but also
recognize that people with mental health related issues are also much more
likely than the general public to have physical health issues as well
including higher rates of diabetes, heart disease, obesity and other
physical illnesses. To truly provide comprehensive care, there should be
full ‘prescriber prevails’ language for all appropriate drug classes. We
urge your support, as you have done so strongly in the past, to add this
language back into the State budget.

Health Care Facilities Transformation Program
This program provides funding for the support of Capital Projects that
facilitate health care transformation activities including merger,
consolidation, acquisition of outside activities intended to create
financially sustainable system of care or preserve or expand essential
health care services. The funding is not for operations. Listed among the
eligible providers would be licensed mental health clinics. The scope of
the project is $500 million with a thirty million set aside for not for
profits.

Recommendation
We have two strong recommendations in this area.

1) The eligibility criteria would preclude many not for profit
behavioral health providers from participating. We urge support for a
language change that would include ‘agencies that have been designated by
the New York State Office of Mental Health as HCBS eligible for HARP
services’ This designation would make it possible to insure inclusion of
many worthy not for profits in the behavioral health community.

2) Last year, the advocacy of the not profit coalition and your
support helped to add $30 million set aside for not for profits. It
represented one quarter of the funding available at the time.

Since this year budget includes $500 million, we urge support for that same
percentage to be available for not for profits which translates into $125
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 statues, 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 responsibilities of
the team would include certificate of needs streamlining, more flexible
rules on licensing and scope of practice for clinicians and caregivers,
streamlining and simplifying the primary care provisions; mental health and
substance abuse use disorder services in an integrated clinic setting;
align care models around home and community based services consistent with
reports issued by the Olmstead Development and Implementation Cabinet;
authorize the Commissioner of Mental Health and Commissioner of Alcoholism
and Substance Abuse to implement time limited demonstration projects to
test and evaluate new and innovative procedures for organizing and
delivering health care services.

Recommendation
This structure would have a great impact on the mental health system of
care. We urge support for the OMH and OASAS Commissioners to be added to
the leadership of this entity as well as the chairs and representatives
from the Behavioral Health Services Council.

LEGISLATION

Mental Health Teachers Education Bill
Last year, Senator Hamilton and Assemblymember Crespo introduced
legislation that would insure Mental Health First Aid training or trainings
based on these principles to be part of the certification process for all
teachers. This legislation has been introduced again this year
(S.3550/A.4004).

Teachers are on the front line of educating our youth every day but often
lack basic resources or knowledge about the signs, symptoms and available
treatments for mental health disorders, or how to respond to a mental
health crisis. Teachers should be fully equipped to recognize and respond
appropriately to these signs and to have the knowledge necessary to also
teach students about mental health.

Recommendation
We strongly support this legislation. MHANYS believes that educating
teachers in public mental health compliments the new mental health
education in schools legislation that students also need to learn about
mental health. We urge passage of this bill.

Mental Health License Plate Bill
As we mentioned earlier, there has been legislation introduced by Senator
Ortt (S.1210) and in the coming days from Assemblymember Gunther that would
add Mental Illness Awareness to the list of currently available custom
license plates in New York that support various causes such as Cancer
Awareness, Autism Awareness, Organ and Tissue Donations and Diabetes among
others.

There would be an additional $25 fee attached to ordering these specialized
plates that would go directly to the mental illness anti-stigma fund
created as part of the mental health income tax check off.

Through the leadership of our Mental Hygiene Chairs, MHANYS and our
colleagues will continue to raise awareness and fight the stigma of mental
illness. New York has become a leader in the field of public awareness
about mental illness and a licensed plate bill raising visibility will
continue that trend.

Recommendation
We urge your support for S. 1210, the Mental Health Public Awareness
License Plate Bill.

Raise the Age
We join with advocates across New York State in supporting the Raise the
Age initiative and we thank Governor Cuomo for his strong support of this
legislation as well as that of the New York State Assembly.

Recommendation
We urge the Senate to join the Assembly in fully supporting the Raise the
Age legislation. There are many 16 and 17 year olds who are treated as
adults in the corrections systems that have an underlying mental health
and/or substance abuse issue. We need more prevention and early
intervention services to insure they receive services and supports and not
an entrance into the corrections system.

Discrimination Against Parents with Psychiatric Disabilities
We strongly advocate for the elimination of NYS Social Services Law (SSL)
subdivision 4 of Section 384-b which discriminates against parents
diagnosed with a psychiatric or developmental disability and can result in
the termination of parental rights.

Recommendation
We urge legislative support for this important initiative. For the first
time last year, the Senate passed this legislation. We thank Senator Ortt
and his Senate colleagues for their leadership on this issue and urge
support for this legislation in the Assembly.