2010-2011 Executive Budget – Briefing Book
Mental Hygiene
- Commission on Quality of Care and Advocacy for Persons with Disabilities (CQCAPD)
- Department of Mental Hygiene (DMH)
- Developmental Disabilities Planning Council (DDPC)
- Office of Alcoholism and Substance Abuse Services (OASAS)
- Office of Mental Health (OMH)
- Office of Mental Retardation and Developmental Disabilities (OMRDD)
I. Overview
The mental hygiene agencies provide services to individuals with mental illnesses,
developmental disabilities, chemical dependencies, and problem gambling. These agencies —
OMH, OMRDD, OASAS, DDPC, and one oversight agency, CQCAPD — are expected to serve
nearly one million individuals in 2010-11, including more than 600,000 persons with mental
illness, 260,000 persons with chemical dependencies or gambling problems, and 125,000
persons with developmental disabilities.
II. History/Context
The mental hygiene system currently operates 47 institutional facilities serving a State-operated
inpatient residential capacity of 7,200 individuals. The State also provides funding to support
approximately 86,000 community residential housing options. Additionally, the State supports
numerous outpatient, employment, clinic, habilitative, and treatment programs in partnership
with 4,300 not-for-profit provider agencies. There are three facilities dedicated to conducting
state-of-the-art research into the causes of and appropriate treatments for serving adults and
children with psychiatric and developmental disabilities.
The proposed Executive Budget for the mental hygiene system would total approximately $8.5
billion in 2010-11.
III. Proposed 2010-11 Budget Actions
The 2010-11 Executive Budget recommends $134 million in net savings actions for the mental
hygiene agencies in addition to those ongoing actions reflected in the 2009-10 Deficit Reduction
Plan and proposed via collective bargaining. Savings would be achieved by placing aggressive
cost controls on agency operations; maximizing payments from third-party payers; reforming
and restructuring State and local programs and administrative practices; reducing adult
inpatient psychiatric center capacity; and delaying community bed development. In addition
to these savings actions, the budget does not include any funding for a previously planned
human services cost-of-living increase, but does propose legislation to forestall a 2.1 percent
reduction that would otherwise occur, driven by the Consumer Price Index-based methodology
in current law.
The Executive Budget recommendations support the development of approximately 2,600 new
residential beds in 2010-11, including:
- 1,111 OMH beds, already in the pipeline, that provide both supported housing and
congregate housing options;
- 256 OMH beds for New York/New York III;
- 992 OMRDD beds, including 510 associated with OMRDD’s NYS-CARES initiative; and
- 272 chemical dependence treatment beds, including 183 associated with drug law reform.
The budget includes funding to divert individuals from prison to treatment programs, consistent
with recent reforms to the State’s drug laws, increases support for mental health services to
adult home residents, and provides a Medicaid trend increase for OMRDD in 2009 and 2010.
IV. Summary of Spending (All Funds)
| Category |
2009-10
($ in millions) |
2010-11
($ in millions) |
Change |
Dollar
(in millions) |
Percent |
| Total Mental Hygiene Spending |
8,070 |
8,499 |
429 |
5.3 |
| OMH |
3,212 |
3,414 |
202 |
6.3 |
| OMRDD |
4,270 |
4,465 |
195 |
4.6 |
| OASAS |
565 |
597 |
32 |
5.7 |
| CQCAPD |
17 |
17 |
0 |
0.0 |
| DDPC |
4 |
4 |
0 |
0.0 |
| DMH |
2 |
2 |
0 |
0.0 |
The majority of the spending increase is attributable to increased Federal support of $223
million for a variety of ongoing State and local operated programs. General State Charges
costs are projected to increase by $129 million.
V. Major Initiatives
Gap Closing Actions
| Proposal |
2010-11
($ in millions) |
2011-12
($ in millions) |
| OMRDD State Operations Efficiencies |
25 |
28 |
| OMRDD Local Restructuring |
24 |
43 |
| OMH State Operations Efficiencies |
44 |
38 |
| OMH Inpatient Restructuring |
9 |
18 |
| OMH Forensic/SOMTA Reforms |
10 |
11 |
| OMH Local Restructuring |
18 |
13 |
| OASAS Restructuring |
3 |
3 |
| CQCAPD Restructuring |
1 |
1 |
| Total |
134 |
155 |
- OMRDD Local Restructuring. The major savings actions include:
- Achieving an overall 18 percent reduction in targeted case management services through
reform of Medicaid Service Coordination. Reforms include increasing staff caseloads,
reassessing the number of individuals requiring service, and developing different levels
of service that are more closely tailored to individual needs;
- Implementing a three percent overall rate reduction in the financing of residential
habilitation services delivered in supervised Individualized Residential Alternative
programs effective October 1, 2010. This reduction would be partially offset by trend
increases provided in 2009 and 2010;
- Delaying the development of certain residential opportunities for individuals aging-out
of the school system and children’s residential placements; and
- Reforming the administration and oversight of the Family Care program over a multiyear
period beginning in 2010-11.
(2009-10 Savings: $24 million; 2010-11 Savings: $43 million)
- OMH State Operations Efficiencies. Key actions include reducing non-critical staff via
attrition; converting certain information technology consultant staff to less costly State
employees; reducing overtime and the use of stand-by/on-call shifts; increasing the use
of alternative work schedules; eliminating redundant reports; and eliminating all nonessential
non-personal service spending. (2010-11 Savings: $44 million; 2011-12
Savings: $38 million)
- OMH Inpatient Reforms. Eight psychiatric center wards would be closed at various
facilities, reducing State-operated inpatient capacity by approximately five percent. The
resources associated with closing six wards would be used to support less costly and
more appropriate community programs, and two wards would be replaced with
Transitional Placement Program beds, a less staff-intensive outpatient model designed to
support the transition of patients to community care. (2010-11 Savings: $9 million;
2011-12 Savings: $18 million)
- OMH Forensic/SOMTA Reforms. The census for civilly confined sexual offenders is
projected to increase, but not to exceed 230 individuals in SFY 2010-11. Additional
inpatient capacity is scheduled to open at St. Lawrence Psychiatric Center; therefore,
inpatient capacity for sexual offenders at Manhattan Psychiatric Center would no longer
be required. The budget also reflects efforts to encourage courts to use videoconferencing
to reduce costly transportation and security services. (2010-11 Savings: $10
million; 2011-12 Savings: $11 million)
- OMH Local Restructuring. OMH would continue to restructure a variety of programs
to focus resources on emerging priorities. OMH would maximize payments from
recoveries through enhanced audit efforts, including recovery of payments from third
party payers and exempt income revenue in excess of operating costs. Savings would
also result from a change in billing practices by carving out Medicaid prescription drug
costs from the operating costs of residential treatment facilities. A portion of the
savings would be reinvested in a proposed multi-year remedial plan for adult home
residents with mental illness, described in further detail below. (2010-11 Net Savings:
$18 million; 2011-12 Net Savings: $13 million)
- OASAS Restructuring. This proposed restructuring reflects approximately $1 million in
operational savings by using e-technology for communications, training and
procurement; controlling travel, food and pharmaceutical costs; streamlining
administrative functions while limiting the use of cell phones and other electronic
devices; and by deferring the development of new gambling prevention programs.
(2010-11 Savings: $3 million; 2011-12 Savings: $3 million)
- CQCAPD Efficiencies. CQCAPD would achieve savings through elimination of all non-critical,
non-personal service costs; increased use of alternative work schedules;
elimination of two staff positions associated with the Interagency Coordinating Council
for Services to Persons who are Deaf, Deaf-Blind, or Hard of Hearing and oversight of
Special Housing Units; and increased use of Federal funding for certain local aid
payments. (2010-11 Savings: $1 million; 2011-12 Savings: $1 million)
Other Budget Actions
- Adult Homes Reinvestment. A portion of savings from delays in bed development begun
in 2009-10, as well as proposed actions in this year’s budget, are being reinvested
pursuant to a proposed multi-year remedial plan in response to a Federal district court
decision. This remedial plan would provide additional OMH supported housing for
individuals leaving adult homes. The remedial plan would provide additional funding
of $1 million in 2010-11 to begin assessments of current residents, with funding of $20
million annually in five years to be used for 1,000 additional supported housing units,
education, skills development, and ongoing reviews of remaining adult home residents.
(2010-11 Investment: $1 million; 2011-12 Investment: $4 million)
- Paterson Drug Law Reform. The Executive Budget reflects funding to support the
operating costs for new residential treatment beds and outpatient treatment slots for
addiction treatment services associated with drug law reform enacted in 2009-10. The
OASAS budget includes $13 million of funding for this effort.
- OMRDD Residential Opportunities. While the Executive Budget reflects a slowdown in
funding for new bed development, funding for nearly 1,000 new residential opportunities
in 2010-11 is still recommended. This includes support for over 500 NYS-CARES
opportunities, as well as for individuals leaving institutional settings (including nursing
homes) and aging-out of educational environments, representing an investment of $46
million in 2010-11 and $53 million in 2011-12.
