[NYAPRS Enews] NYAPRS Health/Medicaid Budget Hearing Testimony

[Harvey Rosenthal]

Testimony Before the NYS Legislative 

Joint Fiscal Committees

Health/Medicaid Budget Hearing

February 8, 2012

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   President Douglas Hovey   

 

 

I'd like to thank the chairs and members of the respective 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 100 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 Watertown,
Buffalo, Rochester, Syracuse, Owego, White Plains, Newburgh, Lake
Placid, Amityville and Brooklyn. 

You may have seen our members out in great evidence last Tuesday.
Throughout that day, the Capitol was filled with over 800 spirited
mental health self and system advocates who came to urge their state
legislators and Administration officials to advance policies promoting
their recovery, rehabilitation and rights. I've attached some examples
of media coverage of those efforts below.

State mental health policy is a very personal matter for our NYAPRS
community. Many of our members, our board members, our staff and I 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 thousands of New Yorkers with psychiatric disabilities and
their supporters that we represent. 

 

First off, I'd like to extend our great thanks to the Administration and
the Department of Health for extending to us a number of important
opportunities to be heard on a broad range of issues associated with the
Medicaid Redesign Team's considerations. 

This process gave me the honor to serve as a member of the Medicaid
Redesign Team and on the MRT's Behavioral Health and Affordable Housing
Work Groups, along with sub groups on pharmacy, health homes and peer
run services. 

I also want to extend our community's great thanks to Governor Cuomo,
who in his State of the State message emphasized his commitment to see
that "people with disabilities have (the) right to receive care in the
most integrated setting appropriate to their needs," committing our
state to "provide access to affordable and accessible housing, and
promote employment of persons with disabilities." These principles must
indeed be a key driver of our healthcare reform implementation plans in
the coming years. 

Our community greets this year's Executive budget and MRT proposals with
the following reactions and recommendations. 

 

Reinvest Medicaid Inpatient and ER Savings to Expand Housing, Peer
Support and Employment Services

Governor Cuomo's 2012-3 budget continues to substantively re-shape our
health and mental healthcare systems in ways that are intended to
improve care coordination and integration and maximize alternatives to
Medicaid hospital and emergency room care through the use of Behavioral
Health Organizations, health homes and, starting next year, the
integration of service dollars and services for New Yorkers with serious
mental health and substance use conditions from the current fee for
service carve out into a fully capitated Medicaid managed care program.

While NYAPRS members strongly support these approaches, we believe that
they will succeed only if the state dramatically expands the amount and
array of community wellness, prevention and support systems on which New
Yorkers with serious medical and behavioral health conditions will rely.


Otherwise, we will only be repeating the deinstitutionalization failures
of the past where we closed the door to hospitals and ERs without
placing sufficient services and supports in the community. 

SIMPLY IMPROVING PEOPLES' CONNECTION TO MEDICAL SERVICES AND MEDICATIONS
WILL NOT BE ENOUGH!

There is substantial data showing that addressing the social
determinants of health, most notably housing and economic instability
and social isolation can produce striking results in reducing avoidable
relapse rates and costly ER and hospital visits. 

*	A 2002 University of Pennsylvania study found supported housing
produced an average of $16,282 in savings from reduced use of hospitals,
ERs, shelters et al. 
*	A 2010 study by OptumHealth found that peer bridger
hospital-to-community support services reduced Medicaid hospital days by
73% in Tennessee, 44.1% in Wisconsin
*	A May 2006 Mathematica study found that working Medicaid
beneficiaries dropped their Medicaid dollar utilization by 40% 

Accordingly, NYAPRS members strongly agree with the findings of the
Governor's Medicaid Redesign Team, which concluded that "savings from
better managed behavioral and physical health care should be reinvested
to the extent possible for improved outcomes and reduced health costs.
Reinvestment should prioritize non-clinical support services, such as
housing, peer, employment, and family services." This would build on
successful models that moved public mental health services to managed
care and required plans to reinvest savings into community like
neighboring Pennsylvania, where one plan created $60 million of
supported housing. 

Accordingly, we urge the Legislature to:  

*	Expand the 'Supportive Housing Development Reinvestment Program'
and extend discretionary reinvestment authority to OMH to include local
peer support and employment services. 
*	Ensure that, as New York heads for 2013 implementation of fully
capitated Medicaid managed care systems, all proposals and contracts are
written to explicitly require reinvestment of state and plan savings
into local housing, peer support and employment services. 

We await the reconvening of the MRT's Behavioral Health Work Group to
begin the work of crafting key components of the plan to carve
behavioral health benefits and groups into fully capitated managed care
systems to come. 

 

Protect Consumer Rights & Choices in New Medicaid Initiatives

This year's budget incorporates an unprecedented number of
groundbreaking changes and reforms to our healthcare and social support
systems that, while they may ultimately improve care, can limit
beneficiaries' choices and privacy protections. Examples include: 

*	assigning Medicaid beneficiaries to the new health home networks
of care but giving them the opportunity to "opt out,"
*	requiring individuals to enroll in Medicaid managed plans that
will limit choice of services and providers and
*	sharing patient information broadly through the use of
electronic records. 

At the same time, health homes might give people new opportunities to
review the effectiveness and appeal of their current providers and
treatments and to more actively direct their care....if they get the
information and support they need. 

The NYS Legislature can ensure that New York best protects the health
and rights of Medicaid beneficiaries by engaging in strong monitoring
roles to see that the Department of Health:

*	Education: Adequately provides a widely available array of
culturally and linguistically competent and understandable educational
materials and strategies, in keeping with recommendations by the MRT's
Health Disparities Work Group. 
*	Oversight: Conducts strong oversight over Medicaid managed care
plan administration of new components 
*	Appeals: Sufficiently educates enrollees about plan grievance
and appeals processes
*	Assistance: Boosts the amount and use of enrollment brokers,
hence our strong support for the $3 million allocation in the Executive
Budget proposal
*	Self Direction: Ensures that advance directives are prominently
displayed in new electronic healthcare record systems

 

Ensuring Access to Previously Protected Classes of Medications

Many in our community take years to find our which medication works best
for them, at what dosage and for how long. 

Accordingly, our community has long fought policies that have sought to
deny or limit access to those particular medications and/or forced
people to fail on other ones that have failed us before simply because
they were on the state's or a plan's formulary.

These choices don't belong to budget makers, bureaucrats or plan
officials...they belong as part of the personal relationship between
prescriber and person served. 

That's why we were so worried when the Legislature removed longtime
"prescriber prevails" protections for 'protected classes' of mental
health, AIDS, seizure and organ transplant meds. And that's why we were
initially pleased when the Health Department, in apparent recognition of
our community's concerns, announced that 19 out of 20 plans were going
to allow Medicaid beneficiaries to stay on those drugs...even if they
weren't on their formularies.

Insufficient Beneficiary Education

Our hope turned to worry when the Department of Health's and managed
care plans' letters to Medicaid beneficiaries about the drug carve-in
were hard for many to understand and failed to explicitly mention the
grandfathering of mental health and other drugs.

Beneficiaries Being Denied, Delayed

Throughout our regional forums and highlighted at last week's
Legislative Day, we have regularly heard concerns  about the lack of
adequate consumer education and increased details of delays in getting
approval to stay on 'grandfathered' medications...and now outright
denials. Here are some details: 

*         An Owego nurse practitioner has shared with us documented
evidence of numerous denials of patient efforts to stay on the
anti-depressant Pristiq

*         A Long Island psychiatrist reporting that a local plan would
only approve a 15 day supply at a time of the antipsychotic zyprexa,
which would require him to see her twice a month, a 'waste of resources'
and that other plans were taking too long to respond to a continuation
of clozaril, leaving the beneficiary down to their last 2 pills as the
companies were 'still working on it.'

*         A NYC psychiatrist who has complained of being inundated with
unnecessary and time consuming 'paperwork burdens' just to get his
patient continued on grandfathered medications. 

We urge the State Legislature to actively pursue the following remedies:

*         Restore prescriber prevails protections for Medicaid managed
care medications for vulnerable groups like ours that used to be
guaranteed in fee for service. This will assure that plan promises to
ensure crucial continuity of care for our community is a promise that is
kept 

*         Ensure that the Health Department:

o   step up its oversight over plan performance and assure the promised
automatic grandfathering of these medications, without costly delays
that waste prescriber time and jeopardize beneficiary's health. 

o   redouble its efforts to educate beneficiaries about these patient
protections.

o   publicly publish data demonstrating the numbers of beneficiaries who
experienced uninterrupted, undelayed continuity of care in receiving
their 'grandfathered' medications. 

 

Thank you for this opportunity to share our community's concerns and
recommendations.

 

Saying 'Yes' to a Normal Life

Mental Health Advocates Say Housing, Jobs Needed to Help their Recovery

 

by Andrew Carden  Legislative Gazette February 06, 2012

Hundreds of New Yorkers with psychiatric disabilities rallied in Albany
last week to urge Gov. Andrew Cuomo and state legislators to reinvest
savings from planned psychiatric facility downsizing into housing,
employment and peer support.

The New York Association of Psychiatric Rehabilitation Services, a
statewide partnership of tens of thousands of New Yorkers who use or
provide community mental health services, began its 14th Annual
Legislative Day with a two-hour event in the Kitty Carlisle Hart Theatre
at The Egg.

....Among the major initiatives continued under it are health homes and
managed care expansion, aimed at overhauling health and behavior health
care systems to improve outcomes by decreasing the use of hospitals and
emergency rooms.

"If we're going to lower the money in hospitals, it must be reinvested
in housing, peer support and employment for the residents," said
Rosenthal. "We're on board with the governor's support for health homes,
so long as the residents have more control over their care. These people
need a house and a job."

Rosenthal offered praise to the governor and the New York State
Department of Health, though reiterated there is more work to be done.

"The governor is holding the system to be more accountable, trying to
give people more control over their health care and working to close
institutions," said Rosenthal. "There are a lot of good people in the
Health Department, but they have much more oversight to do."

....There are, Rosenthal said, about 80,000 people in New York state
with psychiatric disabilities. Many suffering from mental illness,
Rosenthal said, are often told by their health providers they will never
work, get married or own a home.

"We're here to say 'yes' to a normal life for the 80,000," said
Rosenthal. "You're here to tell your legislators you want a job, want to
get married, want to own a home and want to have rights."
Rosenthal polled the audience on how many are currently employed. While
a mere handful raised their hands, the vast majority raised their hands
upon asked whether they want to work.
...Issac Brown, CEO of Baltic Street, AEH, Inc., which works to support
recovery efforts among the mentally ill, seconded the need to renovate
empty buildings for individuals transitioning out of institutions.
Brown, who now owns a home in New Jersey, was himself once in support
housing.

"Twenty years ago, I was someone wandering the streets who couldn't put
two and two together," said Brown. "I know how difficult it is to be
homeless and without the necessary medication....
http://www.legislativegazette.com/Articles-c-2012-02-06-81288.113122-Say
ing-yes-to-a-normal-life.html#222
<http://www.legislativegazette.com/Articles-c-2012-02-06-81288.113122-Sa
ying-yes-to-a-normal-life.html#222> 

 

Mental-Health Advocates Want "Reinvestment" In Housing, Supports

By Cara Matthews   Gannett News Service   January 31, 2012

Hundreds of people with mental illness and advocates for the
mental-health system were at the Capitol today to lobby for the state to
invest more money in housing, peer support and employment opportunities.
They participated in the New York Association of Psychiatric
Rehabilitation Services' 14th annual Legislative Day.

According to NYAPRS, Gov. Andrew Cuomo's budget would continue the
state's overhaul of its health and mental-health systems in ways that
are intended to continue consolidating and closing Office of Mental
Health psychiatric hospitals, improve coordination of care and help
avoid Medicaid hospitalizations and emergency-room visits. To achieve
these goals, the state has been expanding managed care, establishing
health homes and using behavioral health organizations. New York has 27
state psychiatric hospitals, about seven times the national average.

The organization said the state needs to do more than improve access to
medical services and medications. It wants the state to "reinvest" the
savings in community wellness, prevention and support systems. Research
has shown that housing and economic stability and a community support
system can reduce relapse rates and costly hospital visits, NYAPRS said
in a statement.

....Josue Hernandez, 32, of the Bronx said people with mental illness
have a lot to offer, but they need more help finding jobs and housing
and getting peer support after they are discharged from hospitals. He
participates in a psychosocial club in the Bronx called the Boulevard
Clubhouse, which provides placement in transitional jobs, advocacy and
referrals and social programs. He finished a transitional-employment
program and is now looking for a permanent position.

"My situation now, I'm dealing with finding a job after finishing my
program. And it's been a little hard," he said.

He and his wife, Margaret, got married last July. They both belong to
the Boulevard Club.

"They think that because I get disability and I work part time, they
think I have enough to support the both of us. So until he gets a job, a
lot of things are a stretch," said Margaret Hernandez, 33.

Taxpayers spend more when someone is in a state psychiatric hospital
than if they live in the community, said Christian Florio, a
generalist/case manager at the Boulevard Clubhouse. "It actually costs
less if you reinvest the money back into the community," he said.

  
http://polhudson.lohudblogs.com/2012/01/31/mental-health-advocates-want-
reinvestment-in-housing-supports/
<http://polhudson.lohudblogs.com/2012/01/31/mental-health-advocates-want
-reinvestment-in-housing-supports/>   

   <http://statepolitics.lohudblogs.com/files/2012/01/IMG_1961.jpg>  
<http://statepolitics.lohudblogs.com/files/2012/01/IMG_1963.jpg>  

 

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