[NYAPRS Enews] NYAPRS Leg. Day Agenda: Reinvestment, Rights, Olmstead, Alternatives, Self Direction

[Harvey Rosenthal]

NYAPRS Note: Today, upwards of 800 self and system mental health
advocates are coming to Albany to participate in NYAPRS' 14th Annual
Legislative Day, urging Albany to reinvest in housing, peer support and
employment, protect choice and promote alternatives in the various new
healthcare initiatives, advance policies to serve New Yorkers with
disabilities in the most integrated community setting and in ways that
maximize self direction. 

ee below for excerpts from today's legislative day positions. 

 

 

Reinvest Medicaid Inpatient and ER Savings

to Expand Housing, Peer Support and Employment Services

 

Background: 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 managed care
expansion and to 

*         continue to close and/or consolidate state OMH psychiatric
hospitals and wards.

While NYAPRS members 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 housing and economic
instability and social isolation are needed and 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% 

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."

Recommendations: 

*         Expand the 'Supportive Housing Development Reinvestment
Program' to extend discretionary reinvestment authority to OMH to
include local peer support and employment services. 

*         As New York heads for 2013 implementation of fully capitated
Medicaid managed care systems, all proposals and contracts should
explicitly require reinvestment of state and plan savings into local
housing, peer support and employment services. 



Reinvest Savings from State Hospital Downsizing

Person-Centered State Hospital Discharge Planning

 

Background

Too many hospitals for too much money: New York State currently operates
27 state psychiatric hospitals (almost 7 times the national average),
houses fewer individuals per campus than other similar states (most
states house similar amounts in 5-7 facilities) and topped the nation in
cost (our $1.2 billion comes in at more than the combined total of other
top states Pennsylvania and New Jersey. 

Reinvestment: In 1994, the NYS Legislature passed the Community
Reinvestment Act which authorized the closure of 5 state hospitals and
reinvested a portion of the savings into creating an estimated $200
million of community recovery services. 

In succeeding years, the legislature has suspended the requirement to
reinvest savings from closing additional hospital wards and used those
funds for deficit reduction.

In 2007, the state closed Middletown Psychiatric Center and reinvested
about $7 million into boosting services in the surrounding counties.

In 2011, the state authorized the closure of Hudson River Psychiatric
Center and has committed several million dollars to surrounding county
mental health systems.

In the proposed 2012-3 budget, the state proposes to close Kingsboro PC
and several more wards without a definitive reinvestment formula. 

Recommendations: The NYS Legislature should restore the original
Community Reinvestment Act's formula and requirement to reinvest a
portion of savings from state hospital downsizing/closure to boost local
community recovery services. This requires eliminating the
'notwithstanding' language in the Executive proposal. 

 

Person-Centered State Hospital Discharge Planning

Background: NYAPRS members share strong concerns about the pace and the
quality and continuity of transitional and community care afforded to
residents of closing state hospital facilities and wards. 

Recommendations: NYAPRS members strongly believe recovery in the
community should be expected and offered to all, including those we have
traditionally institutionalized in the largest and costliest state
hospital system in the country. To ensure that proposed closures and
downsizing of that system are done properly, we call for a process that
ensures: 


*         Person-driven community recovery and service plans with
sufficient time to put individualized supports in place prior to
discharge


*         Substantive use of peer supports, including peer bridgers,
warm lines, crisis respite programs


*         A transition team from each community being affected by the
closure will meet to design a strategic plan in preparation for the
closure


*         Behavioral Health Organizations and Health Homes will be
active members in the transition and will prioritize services for
individuals


*         Tracking of post-discharge Medicaid and non-Medicaid
reimbursable services and recovery outcomes as outlined in the discharge
plan


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



Protect Consumer Rights & Choices in New Medicaid Initiatives

Background: This year's budget incorporates an unprecedented number of
groundbreaking changes and reforms to our healthcare and social support
systems, in keeping with recommendations from the Medicaid Redesign Team
(MRT). 

While they may ultimately improve care, these changes will limit choices
by: 

*         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

*         restricting access to Medicaid medications as they have become
included in the Medicaid managed care benefit.

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. 

Recommendations

New York must protect the health and rights of Medicaid beneficiaries
by:

*         Education: Improving and expanding on an 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: Step up DOH oversight over Medicaid managed care
plan administration of new components, e.g. with the pharmacy program to
ensure promised continued access to mental health, anticonvulsant and
other previously 'protected classes' of medications

*         Protections: Reinstating prescriber prevails protections. 

*         Assistance: Making available enrollment brokers ($3 million
allocation in Executive Budget proposal)

*         Appeals: Create and educate enrollees about clear and
accessible grievance and appeals processes

*         Self Direction: Ensuring that advance directives are
prominently displayed in new electronic healthcare record systems

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



Serve New Yorkers with Psychiatric Disabilities

in the Most Integrated Community Setting

 

Background

NYAPRS members are passionately committed to advancing policies that
ensure that people with psychiatric and other disabilities are fully
afforded their rights to live and work in the most integrated community
setting, in keeping with the Americans with Disabilities Act and the
Supreme Court's Olmstead decision. Accordingly, we strongly support the
following: 

 

Housing

NYAPRS members view affordable community based housing as an essential
human need that is strongly tied to good health and reduced
institutional costs. 

Accordingly, NYAPRS members strongly support Executive budget proposals
to:

*         create a Supported Housing Reinvestment fund from Medicaid
savings from hospital and nursing home closures or bed de-certifications
to expand supportive housing and related services, explicitly including
peer support and employment services. 

*         3-year commitments to create 1,000 supported housing units for
residents of nursing homes ($10 million this year) and 3,400 beds for
the NY-NY III program.

*         In addition, NYS should establish a 10% set-aside program for
high-need individuals with disabilities.  

 

Bringing Justice to Adult Home Residents 

A federal court found NYS in violation of Olmstead and the ADA in the
segregation of 4,300 NYC residents with psychiatric disabilities in
adult homes, which it considered "segregated institutional settings that
impede integration in the community and foster learned helplessness."
The state has appealed that ruling. NYAPRS strongly feels that NYS must
no longer delay meeting its responsibility to provide the supports
necessary to help adult home residents with psychiatric disabilities to
move into the community. Accordingly, we strongly support the Executive
budget proposal to fund:

*         5,100 supported housing beds over the next 3 years to deal
with "emerging needs", including $16.8 million for adult home residents
named in the lawsuit. 

 

Expand Employment Options and Services  

NYAPRS members strongly support the Governor's and OMH's proposal to 

*         expand the Ticket to Work program to boost federal employment
funding incentives and reimbursements for services that successfully
help New Yorkers with disabilities to return to the work force. 

*         support individuals to move from segregated outmoded sheltered
workshops to employment focused Personalized Recovery Oriented Services.


 

Develop a NYS Olmstead Plan

NYAPRS members enthusiastically welcome Governor Cuomo's commitment to 

*         "develop an Olmstead Implementation Plan that will guide the
transition of individuals from institutional to community-based care,
provide access to affordable and accessible housing, and promote
employment of persons with disabilities". Such a plan must set
measurable targets and dates by which public dollars and people with
disabilities are supported to move from segregated to identified most
integrated settings. 

*         re-energize and re-focus the state's Most Integrated Setting
Coordinating Council. 



Alternatives to Involuntary Outpatient Commitment

Once again, the NYAPRS community continues to strongly oppose Kendra's
Law's highly controversial involuntary outpatient commitment program
that:

*         relies on coercion whose effectiveness has yet to be
scientifically validated, 

*         is used primarily in New York City and Long Island in contrast
to almost every other county, 

*         continues to be disproportionately (66%) used for communities
of color and that 

*         now involves considerably more effort and costly time by local
and court officials in the wake of last year's NYS Court of Appeals
ruling that sharing medical records of individuals under consideration
for a Kendra's Law order is a violation of their HIPPA privacy rights,
unless their approval or a court order is obtained. 

Instead, NYAPRS points to the state's strong commitment to:

*         favor the expanded use of modern, state of the art voluntary
outreach and engagement approaches,

*         maximize the use of peer run services, and

*         to advance more coordinated and integrated and effective care
approaches that are being promoted by the state's new Behavioral Health
Organization and Health Home initiatives. 

In fact, included in the Medicaid Redesign Team's recommendations to the
Governor is an expectation of decreased use of involuntary court orders
as a measure of these programs' effectiveness. 

Finally, NYAPRS members strongly favor non-medical "alternative
treatments' like acupuncture, reiki, shiatsu, meditation, yoga and
nutritional supplements. We will be strongly advocating for the funding
of these approaches in the more flexible capitated managed care
environment of the future. 

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



Adopt Medicaid Self Directed Services and Community First Choice Options


As New York proposes and adopts new provisions to our Medicaid program,
NYAPRS members strongly support the adoption of new federal regulations
to spend Medicaid dollars more flexibly: 


*        the 1915.i Home and Community Based Services Option that
expands Medicaid's flexibility to fund rehabilitation and recovery
services and permits beneficiaries to self-direct individualized budgets
to meet approved health and community goals


*        the 1915.k Community First Choice Option which provides for
hands on assistance to promote daily living and health related
functions, along with expenditures for costs such as rent and utility
deposits, first month's rent and utilities, bedding, basic kitchen
supplies, and other necessities required for an individual to make the
transition from a nursing, mental health institution, or intermediate
care facility to a community based home setting. 


 

 

 

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