[NYAPRS Enews] NYAPRS Strongly Backs Proposed MMC MH Clinc Rate Hike; Rejects Adult Home, PDL Proposals

Fri Feb 12 11:11:35 EST 2010

Testimony Before the NYS Legislative Joint Fiscal Committees

Health/Medicaid Budget Hearing    February 9, 2010

Presented by Harvey Rosenthal, Executive Director  New York Association
of Psychiatric Rehabilitation Services

On Behalf of NYAPRS Members and The NYAPRS Public Policy
Committee/Co-Chairs:  Ray Schwartz, Carla Rabinowitz

NYAPRS Board of Directors: Co-Presidents William Sullivan, Robyn Krueger
President-Elect Doug Hovey   

Thank you, Chairman Kruger, Chairman Farrell, Chairman Duane,  Chairman
Gottfried and the other members of the Committees for this opportunity
to present to you the concerns of the thousands of New Yorkers
represented by the New York Association of Psychiatric Rehabilitation
Services. NYAPRS is a unique statewide partnership of New Yorkers with
psychiatric disabilities and the community mental health professionals
who support them in over 120 community-based mental health agencies from
every corner of the state.

I'm Harvey Rosenthal, NYAPRS Executive Director. The following testimony
that I will present incorporates the direct input of many hundreds of
NYAPRS members who gathered at local forums that were conducted this
past fall and winter in localities across the state including
Amityville, Binghamton, Brooklyn, Buffalo, Rochester, Westport, White
Plains and others. 

After decades of being represented by others, New Yorkers with
psychiatric disabilities are at long last speaking for themselves. This
was once again evidenced by January 26th's Legislative Day that NYAPRS
co-organized with our friends at the Association for Community Living
and the Mental Health Association of New York State and backed by all of
the other leading state and regional mental health advocacy groups. 

Throughout that day, the Capitol was filled with 1,500 yellow-hatted New
Yorkers with psychiatric disabilities and the community mental health
staff who support them came to urge their state legislators and
Administration officials to "Protect the Community Mental Health Safety
Net." 

State health policy is a very personal matter for our NYAPRS community.
Many of our members, our board members and our staff all share a common
personal journey of recovery from a psychiatric disability. We believe
this strengthens our ability to speak to you on behalf of the tens of
thousands of New Yorkers with psychiatric disabilities we represent. 

Following are the NYAPRS communities' reactions to this year's
Health/Medicaid budget and legislative proposals. NYAPRS sees this
year's Executive Budget on Health and Medicaid as a mixed bag.  At this
time of unprecedented fiscal crisis, the Governor has maintained his
commitment to community-based, person-centered services in many
important ways.  At the same time, there are several proposals that are
unacceptable and incongruous with the "patient first" agenda.

Budget Agenda

DEPARTMENT OF HEALTH

STRONGLY SUPPORT PROPOSAL TO BOOST MEDICAID MANAGED CARE MENTAL HEALTH
CLINIC RATES

NYAPRS has been a strong supporter of the Office of Mental Health's
Outpatient Clinic Restructuring Initiative and its efforts to advance a
recovery (versus mere symptom management) focus, implement more
ambitious and innovative standards of care, add an indigent care pool to
reimburse providers for serving those who cannot afford to pay and
introduce the use of peers and family members to conduct outreach and
engagement for 'hard to serve' individuals. 

This programmatic reform has been linked with re-financing efforts
necessitated by the phase out of federal supplemental payments (COPS)
that are no longer tenable. However, COPS has often served to compensate
for the woefully inadequate Medicaid Managed Care mental health clinic
rates prompting concerns about community providers ability to continue
to serve those clients. 

The Governor's 21 Day amendments released today contain a crucial remedy
to such concerns: included is a provision for the transfer of funds from
the Office of Mental Health to the Department Health to increase the
mental health clinic rates paid by Medicaid managed care organizations. 

To be specific, the 21 day amendment, "Part P", reads as follows:
"relating to increased Medicaid payments to providers through managed
care organizations is added to: transfer funds from OMH to DOH to
increase Medicaid payments for managed care organizations, to provide
equivalent fees per an ambulatory patient group (APG) methodology. This
language is intended to increase payments to managed care organizations
to ensure the continued availability of clinic mental health services."

Recommendation: NYAPRS strongly supports this measure and urges state
legislators to promptly approve it as part of this year's state budget.

--------------

OPPOSE PROPOSALS TO COLLAPSE ADULT HOME RESIDENT FUNDING STREAMS AND
PROTECTIONS

NYAPRS strongly opposes Administration proposals to collapse into one
funding stream several initiatives that have provided critical aid and
guarantees to adult home residents with psychiatric disabilities. 

Previously, the Executive and the Legislature recognized adult home
deficiencies by collaborating to dedicate specific funds that have
historically: 

1.   advanced recovery initiatives for adult home residents with SSI
level psychiatric disabilities (ENABLE)

2.   ensured that residents taking powerful psychiatric medications that
produce dangerous ill effects during hot summer months get financial
assistance to turn on critically needed air conditioners (the operators
were charging poverty-level residents high monthly rates)

Further, the state proposes to abandon requirements that adult home
operators consult with and get the formal support of resident councils
for their applications to receive state Quality Improvement Program
(QUIP) grants. 

Recommendation: We urge state legislators to reject a further weakening
of dedicated supports and rights protections afforded to adult home
residents with psychiatric disabilities at the exact time New York is
under great public, federal and judicial pressure to provide them with
more not less.                                             

-----------------

PRESERVE OPEN UNRESTRICTED ACCESS TO ANTIDEPRESSANT AND ANTIPSYCHOTIC 

MEDICATIONS IN NEW YORK'S MEDICAID PROGRAM

NYAPRS is greatly troubled about the state's decision to remove the
historic and prudent exemption from the Medicaid Preferred Drug Program
for medications for our most vulnerable groups: people with psychiatric
disabilities, AIDS/HIV and who've received organ transplants. The
Legislature has long rejected Administration attempts to weaken access
to these medications and has maintained a strong wall of protection by
insisting they remain out of the PDL and related Prior Authorization
(PA)-driven access restrictions that could greatly jeopardize the health
and sometimes life of these groups. It often takes years for such
individuals to find the right medication and dosage and PA programs can
serve to deny access patients to those exact medications in an effort to
save the state money. 

As the state currently proposes to bring these drugs into the PDL to
collect more rebate dollars from the manufacturers without currently
subjecting them to Prior Authorization restrictions this year, it takes
down a long respected "wall of protection" that moves them only one step
away from that terrible possibility in the future. 

NYAPRS is hearing growing concerns that the state's Prior Authorization
process is more onerous than previously thought; we greatly fear that
the current proposal moves us down a very slippery slope to subjecting
medications for our most vulnerable groups to such a needlessly risky
process. 

-----------------

OPPOSE ELIMINATING MEDICARE PART D AND EPIC WRAPAROUND

Another pharmacy issue of concern to NYAPRS is presented by the
provisions in the budget that would eliminate the Medicaid and Elderly
Pharmaceutical Insurance Coverage program (EPIC) coverage that wraps
around Medicare Part D.  When Medicare prescription drug benefit took
effect, many people faced barriers when attempting to access
medications.  Medicaid wraparound coverage was initially much more
comprehensive than it is now.  In recognition of the gains we have made
in helping the elderly and disabled negotiate the complex Part D
benefit, New York reduced the Medicaid coverage to the four classes of
drugs discussed earlier:  antipsychotics, antidepressants,
anti-retrovirals (HIV treatment), and antirejection drugs (post-organ
transplant surgery).

Similarly, the EPIC wraparound coverage has been tooled back as Part D
coverage has improved.  EPIC no longer functions as a payer of first
resort on drugs covered by Part D.  Instead, EPIC pays only when a Part
D plan denies coverage, and EPIC staff is authorized to pursue Part D
plans when they deny payment for EPIC members.  EPIC has saved over $7
million for EPIC members and the EPIC program in the last 18 months
through pursuit of Part D plans.  Of appeals initiated by EPIC staff,
approximately 1,900 of the initiated appeals have been won.

            While the Department maintains that eliminating these
already minimal wraparound programs would not affect very many people,
the protections they afford to the few they help are critical.  

NYAPRS is strongly opposed to realizing savings on the backs of elderly
and disabled New Yorkers, and opposes elimination of the Medicaid and
EPIC wraparound protection to Medicare Part D. 

--------------

REJECTING PROPOSAL TO CAP PERSONAL CARE

            The Governor has proposed to cap personal care and
consumer-directed services at 12 hours per day.  Anyone needing more
than 12 hours per day would be required to switch to another option -
the Nursing Home Transition and Diversion Waiver, the Long Term Home
Health Care program, or Managed Long Term Care.  

            Targeting people with the most significant needs who are
already being served in the best, most cost-effective way does not make
sense.  It threatens the ability for people to stay in the community,
rather than turning to nursing facilities because the alternative
programs would inherently be inappropriate or unavailable to the people
with the most need.

            This proposal would be a step backward in achieving the goal
of spending Medicaid dollars in the best possible way for the most
vulnerable people.

Recommendation: NYAPRS joins our friends at the NYS Association on
Independent Living, the broader cross disability community and Medicaid
Matters in strenuously opposing this proposal.

----------------

CRACKING DOWN ON MEDICAID FRAUD WITHOUT UNDOING THE MEDICAID SAFETY NET

            The Governor's budget would increase the Medicaid fraud
target by $300 million.  It is up to the state to investigate potential
fraud in the Medicaid program, and it is prudent for the Office of the
Medicaid Inspector General (OMIG) to have broad authority in how to
reach the targets set by the Governor and Legislature.  However, the
OMIG's unlimited, blanket authority has resulted in particularly
difficult and inappropriate audit practices.

Investigations of individual Medicaid beneficiaries lack transparency
and reliable procedures.  Since they are outside of the fair hearing
process, individuals do not have access to the claims against them and
are often refused documentation supporting the allegations made against
them.  Consumers and their advocates have reported abusive treatment by
investigators.  Language barriers, cultural incompetency and general
misunderstanding have led to myriad problems and enormous discrepancies
in how individuals are treated by local district investigators.  It is
understandable that the state has an obligation to go after fraud in the
Medicaid program, but people should be treated fairly, equitably and
with dignity in investigations.  Although these investigations are
initiated by local districts, the OMIG sets the tone.  Since many
individuals who have been investigated were actually eligible or relied
on bad advice from a local district or enroller, the imposition of civil
penalties should be rejected.

In addition, auditing of providers has become unusually onerous.
Community-based clinics, independent living centers, and other providers
have reported spending tens of thousands of dollars and innumerable
staff hours preparing for and going through OMIG investigations.  In
some cases, the audits have been dropped mid-stream, so the providers
have spent time, money and staff resources for no reason.  

NYAPRS agrees with our friends at Medicaid Matters that "going after
fraud is important, but draining the resources and energy of
community-based, safety-net providers that could be better spent on
providing services is inappropriate.

-----------

Year after year, state Legislators have been tremendous partners in our
joint efforts to advance the recovery, rehabilitation and rights of New
Yorkers with psychiatric disabilities. I'd like to thank you for your
extraordinary record of support and for your help going forward once
again this year. 

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