2009-10 Enacted Budget Gap-closing Actions – Mental Hygiene

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Mental Hygiene

The Enacted Budget includes a number of initiatives to target New York’s mental health and addiction resources in the most effective manner possible. These include reducing excess capacity, closing underutilized facilities, aligning level of care with national standards, implementing greater operating efficiencies, and other actions.

The Enacted Budget includes resources for the Office of Mental Retardation and Developmental Disabilities to continue to develop roughly 1,000 state and not-for-profit operated community residential opportunities.  This reflects the state’s efforts to continue to downsize developmental center capacity, develop over 500 NYS-CARES opportunities, and expand capacity for other special populations.

Resources also are provided to move forward with the implementation of a Comprehensive Children’s Plan. Working with eight child-serving state agencies, the plan is designed to improve access to services and support best practices models of successful collaboration and service delivery. The Office of Mental Health component of the plan includes: expanding youth involvement in service delivery; enhancing parent education; improving the identification and treatment of emotional disturbances in children; and increasing the integration of service systems.

In the area of alcoholism and substance abuse services, the Enacted Budget funds the development of 126 new community residential treatment program opportunities in 2009-10 to primarily serve high priority OASAS populations, including adolescents, women with children, and veterans, as well as enhance community-based treatment opportunities on Long Island. The budget also supports alternative to incarceration programs intended to direct criminal offenders into treatment and case management programs, as well as relapse prevention services for parolees. Funding also is provided through the Department of Health to increase fees for medically-supervised detoxification services. To support the reforms to the Rockefeller Drug Laws, resources are also provided to fund additional outpatient and community-based residential treatment capacity for individuals who will be diverted to chemical dependence treatment instead of prison.

Federal stimulus moneys provide roughly $38 million in support for a variety of mental hygiene programs. This included funding to continue a 1 percent COLA that otherwise would have been eliminated, support for expanded substance abuse treatment programs associated with Rockefeller drug law reform, and temporary funding to allow more time to implement long term structural reforms to several local assistance programs.

Gap-closing Actions

• Eliminate Cost-of-Living Adjustments (COLA) for Human Service Providers.  The 2009-10 COLA for human service providers is eliminated.  To reflect a long-term commitment to this program, a COLA is still planned for 2010-11 and 2011- 12, and an extension of the COLA was enacted for an additional year (2012-13) to maintain a three-year commitment.  (2009-10 Savings: $93M; 2010-11 Savings: $93M)
• Maximize Non-State Revenues.  The Office of Mental Retardation and Developmental Disabilities (OMRDD) will achieve recurring savings through recognizing increased Food Stamp benefits, maximizing utilization of Home and Community-Based Services (HCBS) Waiver programs and services, and continuing with the health care reimbursement initiative.  OMRDD and its partnering not-for-profit providers will also continue efforts to require families and individuals with developmental disabilities to apply for all Medicaid and Medicare benefits to which they are entitled.  To assure that these benefits are accessed appropriately, OMRDD will provide education and assistance to families and individuals with developmental disabilities seeking or receiving supports and services that can be funded by Medicaid and/or Medicare.  (2009-10 Savings: $179M; 2010-11 Savings: $189M)
• Reform Forensic Services.  The Office of Mental Health (OMH) will shift treatment for sex offenders from an inpatient psychiatric model to treatment standards comparable to those used in other states which require lower staffing ratios; allow certain respondents to remain in prison or on parole until their civil confinement trials; and reduce planned staff by 217 jobs ($11.7M).  Additionally, the budget reflects delayed spending for statutory investments beyond those mandated by a legal settlement concerning mental health services in prison ($11.4M) which postpones hiring 86 new staff.  (2009-10 Savings: $22M; 2010-11 Savings: $26M)
• Reduce OMH Adult Inpatient Capacity.  Reduces state-operated inpatient capacity by nearly 11 percent (450 beds).  Approximately two-thirds of the 450 bed reduction would result from shifting patients to a less intensive, medically appropriate service delivery model to be provided within OMH facilities, while 150 beds would be closed by shifting patients to more appropriate and less costly outpatient/community services saving $6.1 million in 2009-10.  No patient will lose services.  These actions will lower the state workforce by a net of 153 positions.  Over 75 percent of the gross savings from the restructuring are being reinvested in these other mental health services (approximately $38M of $50M is being reinvested on a full annual basis).  Additionally, aggressive controls on hiring and non-personal service costs will save another $10.1 million.  (2009-10 Savings: $15M; 2010-11 Savings: $22M)
• Continue Restructuring OMH Programs.  Maintain commitment to provide $37 million additional funding for OMH Community Residences/Family Based Treatment programs, but on a longer schedule than originally planned.  The OMH Community Residential Pipeline will be maintained at current year levels, excluding the beds targeted for the NY/NY III agreement which will continue to move forward.  The Ambulatory Care restructuring, started by OMH in 2008-09, will continue to rationalize the reimbursement of providers of mental health clinical services.  Additionally, the continuing day treatment program will be restructured to reform service requirements and focus on best practices modalities, and OMH will establish a peer support center to promote and improve access to peer-run organizations.  Finally, OMH plans to use $6 million of federal grant money to improve employment opportunities for individuals with mental illness.  (2009-10 Savings: $23M; 2010-11 Savings: $12M)
• OMRDD State Operations Efficiencies.  Implement State Operations savings through a workforce reduction of 284 positions at OMRDD.  Key recommendations include:
  • Closing the Howard Park OMRDD satellite residential services unit of the Bernard Fineson Developmental Disabilities Services Office (DDSO) in Queens (-28 FTEs), which is programmatically obsolete.  The 41 consumers residing there will be transferred to the nearby Hillside Campus or other community residences;
  • Streamlining research and administrative operations at OMRDD’s Institute for Basic Research located in Staten Island, which results in the elimination of 11 research-related positions that have not generated comparable levels of outside grant funding, and the consolidation of business and payroll functions with the nearby Staten Island DDSO, which results in a reduction of seven FTEs;
  • Reducing Safety & Security Officer staff (-50 FTEs) who are not involved in securing or protecting facilities or consumers.  Instead, other OMRDD staff will be used to conduct fire alarm testing and other related inspections at community-based programs, which are the functions these individuals previously performed; and
  • Consolidating DDSO administrative functions (-55 FTEs), restructuring central office (-65 FTEs), managing position vacancies (-68 FTEs), and controlling non personal service spending.  (2009-10 Savings: $12M; 2010-11 Savings: $27M)
• Reform/Rationalize OMRDD Local Assistance.  Rationalize, reform, and restructure provider reimbursement rates to eliminate antiquated incentives, base reimbursement on regional costs, and target funding based on the level of service complexity.  Specific actions include: reducing reimbursement for less intensive case management services, and eliminating enhanced funding to certain Article 16 and 28 clinics.  OMRDD also will impose tighter controls on Medicaid and non-Medicaid payments to its non-profit provider network, rationalize reimbursement and achieve efficiencies where appropriate in a myriad of programs, including Sheltered Workshops, Medicaid Service Coordination, Respite, Supported Employment, Prevocational, and Clinical services.  Though fully supported in 2009-10, Unified Services funding and the current Day Habilitation rate methodology will sunset on July 1, 2010 to provide adequate planning/implementation time.  (2009-10 Savings: $21M; 2010-11 Savings: $19M)
• Restructure OMRDD “Out-of-State” Placements.  Provide 88 individuals, who are currently receiving more costly OMRDD services in out-of-state or residential school settings, with the choice to receive either the appropriate level of services at in-state community residences, or remain in more costly venues but receive reimbursement at the rate it would cost the state to provide comparably appropriate services.  (2009-10 Savings: $4M; 2010-11 Savings: $6M)
• Close Manhattan ATC and Other Efficiencies.  Close the 52-bed state-operated Addiction Treatment Center (ATC) in Manhattan, saving $4.6 million and reducing staff by 40 employees.  The state will still operate 12 ATC’s, serving 9,400 individuals annually.  OASAS will place the roughly 800 clients served annually by the Manhattan ATC in the four other ATCs in New York City (NYC) and/or to not-for-profit provider programs.  This closure also avoids $14 million in capital costs.  Additionally, aggressive controls on hiring and non-personal service spending will reduce costs by $2.1 million and 11 staff.  (2009-10 Savings: $7M; 2010-11 Savings: $7M)
• Reduce and Restructure OASAS Local Funding.  The budget will slow the phase-in of certain bed development, delay the implementation of a medical model for residential rehabilitation services for adolescents, and reduce funding for certain prevention services.  Though fully supported in 2009-10, Unified Services funding will sunset on July 1, 2010 to provide adequate planning/implementation time.  (2009-10 Savings: $17M; 2010-11 Savings: $18M)