[NYAPRS Enews] MHW: Budget Expands BH Community Recovery Services and Supports

[Briana Gilmore]

NY Proposal Expands Community Recovery Services and Supports
Mental Health Weekly; Volume 24 Number 5, 2/3/2014

Mental  health  providers   and  advocates in New York state say they are pleased  with New York Gov. Andrew Cuomo's   FY  2014-2015  executive budget   proposal,   released   Jan.  23, which  calls for increased  funding  to support   supported housing,  home- and community-based services waiver slots, peer-operated recovery centers and better integration of physical and  behavioral  health  services.  The proposal redirects funds from downsizing  state  psychiatric  facilities  to local    community    mental    health systems.
The  proposed  package   of  investments   includes   $25  million  to expand   community  services  in  anticipation  of a reduction  in upward  of 400 inpatient  beds throughout the state. Last summer, state officials announced  plans   to  create   regional centers   of  excellence   (RCEs).  An RCE model  will be regionally  based networks  of inpatient  and community-based  services,  each  with  a specialized  inpatient   hospital  program located at its center, with geographically dispersed community  services "hubs" overseeing  community-based services (see MHW, July 22, 2013).
Cuomo's  proposal supports  his Medicaid  Redesign  plan  to  redirect $120 million in Medicaid funding  to ramp up the state's local community recovery    services   in   advance    of plans   to   integrate   behavioral   and medical   healthcare   and   to  turn  it over  to coordinating managed  care plans  in  2015,  said  Harvey  Rosenthal,  executive  director  of the  New York  Association  of  Psychiatric  Rehabilitation      Services      (NYAPRS). "We're moving  to  a  managed   care redesign   that  will  integrate  behavioral health  and physical  health," he told MHW.
The budget  proposes $71.5 million  to the  Office of Mental Health (OMH)   for   reinvestment  of   state hospital  resources  into the  community,  downstate  supported  housing rent  increase  and  community  housing supports  for adult, nursing home residents.
The OMH funding  includes  $40 million  in  community  housing  and supports    for   current   residents   of adult homes  ($30 million) and nursing  homes  ($10  million)  with  psychiatric   disabilities.   The   proposal features 200 new supported housing units   for  nursing   home   residents, and  a  total  of  600  by  the  end  of 2015;  500  new  supported  housing units  for adult  home  residents,  and 1,750 by  the  end  of 2015; and  300 new housing  beds for the homeless.
For  Medicaid  redesign  housing investments,  the budget  proposes an $18.4 million increase  in supporting housing.
"The budget  basically  sends  a message    that   people    should  be served ideally in the community  and that  resources   [be  redirected]  from institutions to the community, where people  can best  recover," Rosenthal said.  "We  feel  the  proposal  represents  a  culmination   of  issues  and priorities we've been  working on for decades."
He  noted   that  more  than  600 New   York   consumers,   advocates  and  mental  health  providers  participated  in a rally on Jan. 28 in Albany to urge state policymakers  and legislators  to  support   increases   in  the state's     community-based    mental health  services.
New  York  state  officials intend to use  the  1915i <HCBS> option  in Medicaid to reimburse  states  for  services  and  supports that historically have not been  available for reimbursement, such as employment,  education,  peer   support,     psychosocial     rehabilitation,  transportation and self-directed care, said Rosenthal.
A mental  hygiene  budget  hearing at the end of February will signal the next  part of the budget  process  going  forward,  he  said.  Before  the budget  is approved April 1 there will be a number  of hearings coming up, he  said. "We will continue  advocating  with  the  state  legislature,"  said Rosenthal.
Seeking provider increases
Lauri Cole, executive  director  at the New York State Council for Com- munity  Behavioral   Healthcare,   said that  the  council   is  seeking   an  increase   for  children's  mental   health outpatient clinics. "Many of our members who serve a high percentage of children  are  in  fiscal distress,"  Cole told  MHW. "We have  proposed that the administration  and  the  State Department   of  Health  reset  the  Child Health Plus rate to be on par with the Medicaid fee-for-service  rate."
Several years ago the state reset the  Medicaid Managed  Care (MMC) rate  to  be  on  par  with  the  fee-for- service rate, Cole said. "At that time, our  request  to  reset  the  MMC rate was  after  we  learned  that  many  of our  members  were  dropping  their contracts  with MMC companies due to very low rates," she said.
Cole added,  "We think it is time to rationalize  the  Child Health  Plus rate that is considerably lower  than the   Medicaid   fee-for-service    rate. The precedent is there."
Although  pleased  with the governor's  budget   proposal,   Cole  said she is concerned that a long overdue cost-of-living adjustment  (COLA) for the human  services workforce  is not included. "The COLA adjustment  being delayed  puts a tremendous strain on   our   workforce."   she   said.  "It's very difficult to recruit and retain talented,   dedicated  staff   when   you can't pay them what they are worth." The  COLA was  originally  proposed several  years  ago  but  has  been  delayed a number  of times since then, she said.
"We are also working  to resolve an issue for our OASAS [Office of Alcoholism  and  Substance  Abuse Services] hospital-based members," said Cole. Years ago when  the rest of the system moved to Ambulatory Patient Groupings  and revised  rates, hospital-based  organizations  that provide addiction   treatment   services   were delayed,  she said.
"It's now  been  three  years  and the issue is not resolved," Cole said.
"While we understand NYS and CMS [Centers  for  Medicare  &  Medicaid Services]  are  still  working   on  the State   Plan   Amendment   to  resolve this  matter,  in  the  meantime   these organizations  are still being paid the old  Legacy  rates  and  are  in  some cases owed  millions of dollars."
Cole  added,   "They  made   the changes  and  devoted  the  resources  required  to bill using APGs, but the green  light  has  not  been  switched on. We think it is time to resolve this matter."
The   council   intends   to   work hard  this session  to protect  the provisions   in  the   governor's   budget,  said Cole. "We intend  to see that the implementation  of   the   behavioral  health  managed  care  system  prioritizes access to care and the availability of a  range  of behavioral  health service  options  provided by behavioral health agencies who know best how to meet the needs of these individuals," she said.
"We will fight hard  this session to  ensure   adequate  inpatient   and community  services  are available  in local  communities across  the  state," Cole said. "Our priorities will center on access to care and adequate payment  for  services  provided  as  we move   into   a  managed   behavioral health  environment."
http://www.mentalhealthweeklynews.com/
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