Joint Legislative Public Hearing on 2018-2019 Executive Budget Proposal: Topic Mental Hygiene - Testimonies
February 16, 2018
-
ISSUE:
- Executive Budget
-
COMMITTEE:
- Finance
Hearing event notice and video:
https://www.nysenate.gov/calendar/public-hearings/february-13-2018/joint-legislative-public-hearing-2018-2019-executive
Transcript:
1
1 BEFORE THE NEW YORK STATE SENATE FINANCE
AND WAYS AND MEANS COMMITTEES
2 -----------------------------------------------------
3 JOINT LEGISLATIVE HEARING
4 In the Matter of the
2018-2019 EXECUTIVE BUDGET ON
5 MENTAL HYGIENE
6 -----------------------------------------------------
7
8 Hearing Room B
Legislative Office Building
9 Albany, New York
10 February 13, 2018
9:38 a.m.
11
12 PRESIDING:
13 Senator Catharine M. Young
Chair, Senate Finance Committee
14
Assemblywoman Helene E. Weinstein
15 Chair, Assembly Ways & Means Committee
16 PRESENT:
17 Senator Liz Krueger
Senate Finance Committee (RM)
18
Assemblyman Robert Oaks
19 Assembly Ways & Means Committee (RM)
20 Senator Diane Savino
Vice Chair, Senate Finance Committee
21
Assemblywoman Aileen Gunther
22 Chair, Assembly Committee on Mental Health
23 Senator George A. Amedore, Jr.
Chair, Senate Committee on Alcoholism
24 and Drug Abuse
2
1 2018-2019 Executive Budget
Mental Hygiene
2 2-13-18
3 PRESENT: (Continued)
4 Assemblyman Angelo Santabarbara
5 Senator John E. Brooks
6 Senator Fred Akshar
7 Assemblyman John T. McDonald III
8 Assemblywoman Melissa Miller
9 Assemblywoman Carmen de la Rosa
10 Assemblyman Luis Sepulveda
11 Senator Gustavo Rivera
12 Assemblywoman Crystal D. Peoples-Stokes
13 Assemblywoman Patricia Fahy
14
15
16
17
18
19
20
21
22
23
24
3
1 2018-2019 Executive Budget
Mental Hygiene
2 2-13-18
3 LIST OF SPEAKERS
4 STATEMENT QUESTIONS
5 Ann Marie T. Sullivan, M.D.
Commissioner
6 NYS Office of Mental Health 9 14
7 Kerry A. Delaney
Acting Commissioner
8 NYS Office for People With
Developmental Disabilities 107 112
9
Arlene González-Sánchez
10 Commissioner
NYS Office of Alcoholism
11 and Substance Abuse Services 152 157
12 Denise M. Miranda
Executive Director
13 NYS Justice Center for the
Protection of People with
14 Special Needs 209 215
15 Mark van Voorst
Executive Director
16 The Arc New York 235 239
17 Harvey Rosenthal
Executive Director
18 Elena Kravitz
Director for Policy and
19 Public Engagement
NY Association of Psychiatric
20 Rehabilitation Services
-and-
21 Glenn Liebman
CEO
22 Mental Health Association
in New York State 244 257
23
24
4
1 2018-2019 Executive Budget
Mental Hygiene
2 2-13-18
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Wendy Burch
Executive Director
6 Ariel Kaufman
Board Member
7 National Alliance on Mental
Illness of New York State
8 (NAMI-NYS) 262
9 Kelly A. Hansen
Executive Director
10 NYS Conference of Local
Mental Hygiene Directors 269 276
11
12 Randi DiAntonio
LMSW at OPWDD
13 Darlene Williams
Occupational Therapist at OMH
14 NYS Public Employees Federation
(PEF) 281
15
Samantha Howell
16 Executive Director
National Association of Social
17 Workers, NYS Chapter 292
18 Paige Pierce
CEO
19 Families Together in NYS 298 302
20 Dr. Ellie Carleton
Residential Treatment Team Leader
21 Astor Services for Children
and Families 304 309
22
Christy Parque
23 CEO and President
The Coalition for
24 Behavioral Health 310
5
1 2018-2019 Executive Budget
Mental Hygiene
2 2-13-18
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Ann M. Hardiman
President and CEO
6 Michael Seereiter
Executive Vice President/COO
7 New York Alliance for
Inclusion & Innovation 317
8
Arnold Ackerley
9 Administrative Director
Clint Perrin
10 Director of Policy
Self-Advocacy Association
11 of New York State 322
12 John J. Coppola
Executive Director
13 NY Association of Alcoholism
& Substance Abuse Providers 327 337
14
Stephanie M. Campbell
15 Executive Director
Friends of Recovery New York 340
16
Donna Tilghman
17 SAPIS Chapter Secretary
Kevin Allen
18 SAPIS Chapter Chair
DC 37, New York City Board of
19 Education Employees Local 372,
Substance Abuse Prevention and
20 Intervention Specialists (SAPIS) 347
21
22
23
24
6
1 2018-2019 Executive Budget
Mental Hygiene
2 2-13-18
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Winifred Schiff
Associate Executive Director
6 for Legislative Affairs
InterAgency Council of Developmental
7 Disabilities Agencies
-and-
8 Barbara Crosier
VP, Government Relations
9 Cerebral Palsy Associations
of New York State
10 -for-
Coalition of Provider
11 Associations (COPA) 353
12 Antonia Lasicki
Executive Director
13 Association for Community Living
-for-
14 Bring It Home Coalition 361
15 Maclain Berhaupt
State Advocacy Director
16 Supportive Housing Network
of New York 373
17
18
19
20
21
22
23
24
7
1 CHAIRWOMAN YOUNG: Good morning.
2 We're running late, so I'd like to begin.
3 I'm Senator Catharine Young, and I'm
4 chair of the Senate Standing Committee on
5 Finance. And we are joined today by our vice
6 chair, Senator Diane Savino; our ranking
7 member, Senator Liz Krueger; and Senator John
8 Brooks.
9 CHAIRWOMAN WEINSTEIN: I'm
10 Assemblywoman Helene Weinstein, chair of the
11 Assembly Ways and Means Committee.
12 We are joined by the chair of our
13 Mental Health Committee, Aileen Gunther;
14 Assemblymember John McDonald; and
15 Assemblymember Angelo Santabarbara. I'm
16 sorry, and our ranker, Assemblyman Bob Oaks.
17 ASSEMBLYMAN OAKS: And Assemblywoman
18 Missy Miller.
19 CHAIRWOMAN YOUNG: Thank you.
20 Pursuant to the State Constitution and
21 Legislative Law, the fiscal committees of the
22 State Legislature are authorized to hold
23 hearings on the Executive Budget. Today's
24 hearing will be limited to a discussion of
8
1 the Governor's proposed budget for the Office
2 of Mental Health, the Office for People With
3 Developmental Disabilities, the Office of
4 Alcoholism and Substance Abuse Services, and
5 the Justice Center for the Protection of
6 People with Special Needs.
7 Following each presentation, there
8 will be some time allowed for questions from
9 the chairs of the fiscal committees and other
10 legislators.
11 So we would like to begin. And I
12 would first welcome Dr. Ann Sullivan,
13 commissioner of mental health.
14 Following the presentation by
15 Dr. Sullivan, so you can get in the queue,
16 there will be Kerry Delaney, acting
17 commissioner of the Office for People With
18 Developmental Disabilities; the Honorable
19 Arlene González-Sánchez, commissioner of the
20 Office of Alcoholism and Substance Abuse
21 Services; and Denise Miranda, executive
22 director of the Justice Center for the
23 Protection of People with Special Needs.
24 Good morning, Commissioner. Welcome.
9
1 COMMISSIONER SULLIVAN: Good morning.
2 Senator Young, Assemblywoman Weinstein and
3 members of the Senate and Assembly fiscal and
4 mental health committees, I want to thank you
5 for the invitation to present this year's
6 Office of Mental Health budget.
7 The Office of Mental Health is
8 responsible for ensuring that the citizens of
9 the state receive mental health services.
10 The most effective care and the care that
11 provides our citizens the best opportunity
12 for full and enriching lives, is care that is
13 provided in people's homes, neighborhoods and
14 communities. To that end, OMH has and in
15 this budget continues to expand community
16 services to provide better care to more New
17 Yorkers.
18 However, in recognition that for some
19 individuals a hospital stay remains a
20 necessary part of their care, New York State
21 retains the largest number of psychiatrist
22 inpatient beds available in the nation, and
23 we will continue to preserve access to this
24 vital safety net as we work to transform the
10
1 system.
2 For your continuing support of
3 community mental health investment, our
4 efforts to provide individuals with mental
5 illness the right service at the right time
6 in the right setting have started to bear
7 fruit.
8 Since 2014, with a commitment of more
9 than $90 million thus far, we have been able
10 to provide services to approximately 35,000
11 new individuals through December of 2017,
12 including new supported housing for more than
13 1300 individuals, state-operated community
14 services, including crisis residences and
15 mobile integration teams that have served an
16 additional 10,000 individuals, a wide range
17 of locally operated community-based services,
18 including peer crisis respite, first-episode
19 psychosis programs, community support teams,
20 and home and community-based waiver services
21 for more than 20,000 individuals and
22 families.
23 Because these community services are
24 now in place, we can provide inpatient
11
1 services when needed and ensure the necessary
2 outpatient care and supports are available
3 when an individual is discharged. Our
4 ability to serve more citizens of the state
5 has increased through the combination of
6 these improvements and these new and existing
7 services.
8 For the next fiscal year, OMH will
9 continue the path towards greater access to
10 community-based care, targeted towards an
11 individual's needs. Importantly, the
12 2018-2019 Executive Budget proposes to, one,
13 continue the investment in community
14 services. The budget adds another
15 $11 million annually to expand capacity in
16 the less restrictive and integrated
17 community-based settings. This will increase
18 the amount of annualized investment to $103
19 million since reinvestment began in fiscal
20 year 2015. This also includes 200 additional
21 supported-housing opportunities in the
22 community and other community-based services.
23 The budget supports additional
24 residential capacity, including additional
12
1 homeless housing, which will open in fiscal
2 year 2019 through the long-standing
3 New York/New York program. The budget also
4 authorizes $50 million in new local capital
5 spending, to enable the expansion of crisis
6 respite capacity in the community to avoid
7 unnecessary emergency room visits and
8 inpatient hospitalizations.
9 Twenty new ACT teams, Assertive
10 Community Treatment teams, were recently
11 established and will be fully operationalized
12 in fiscal year 2019 to serve an estimated
13 1280 new clients. Ten teams in New York City
14 will work specifically with homeless
15 individuals, and the remainder throughout the
16 state will work with high-need individuals.
17 The budget provides an additional
18 $10 million for existing supported housing
19 and single-room occupancy programs, helping
20 to preserve access and maintain housing
21 capacity.
22 To address the workforce shortage, OMH
23 has approved a total of 62 providers to use
24 telepsychiatry, with an additional 24
13
1 providers under review. OMH has plans to
2 expand regulations further, allowing licensed
3 psychologists, social workers and licensed
4 mental health counselors, in addition to
5 psychiatrists, to utilize video technology to
6 deliver treatment.
7 To improve access to treatment for
8 maternal depression, OMH will expand its
9 Project TEACH to connect OB-GYN and primary
10 care providers with mental health specialists
11 who treat mothers with maternal depression.
12 Also OMH and DOH will launch a strategic
13 awareness campaign to provide critical
14 information about symptoms and treatment
15 options. OMH will also support advancing
16 cutting-edge specialty programs, including a
17 mother/baby inpatient unit and outpatient
18 programs that focus on maternal depression.
19 Finally, OMH is committed to a
20 significant prevention agenda to promote
21 mental wellness, prevent disorders, and
22 intervene early in the trajectory of mental
23 illness. This includes such initiatives as
24 New York State's Suicide Prevention Plan,
14
1 expansion of school-based mental health
2 clinics, and the OnTrackNY early psychosis
3 intervention program.
4 Again, thank you for this opportunity
5 to address you on the 2018-2019 OMH budget,
6 which supports and continues the work we have
7 begun to transform New York's mental health
8 system.
9 Thank you.
10 CHAIRWOMAN YOUNG: Thank you,
11 Commissioner.
12 (Scattered applause from audience).
13 CHAIRWOMAN YOUNG: I do have some
14 questions based on your testimony, just what
15 we see in the Governor's budget proposal. So
16 the Executive Budget proposes to reduce the
17 number of state-operated residential beds by
18 a hundred and replace them with 200
19 community-based scattered-site supportive
20 housing units that would be operated by
21 not-for-profits.
22 The Executive also proposes a second
23 year of clinic restructuring, reviewing and
24 taking administrative action to reduce the
15
1 overlap of services and ensure that clinics
2 are operating at optimal patient capacity
3 based on community need.
4 So the Governor anticipates
5 $2.1 million in savings from the reduction of
6 state-operated residential beds, with $1.2
7 million invested in not-for-profit supportive
8 housing beds, for a net savings of $1 million
9 in this coming fiscal year. There would be a
10 loss of 55 FTEs associated with this
11 proposal.
12 So one of the questions I had regards
13 whether the actions proposed in the
14 Governor's budget, such as the transfer of
15 residential beds and clinical restructuring,
16 represent the start of a future trend of
17 shifting state-operated services --
18 specifically, residential services -- to
19 not-for-profit providers.
20 COMMISSIONER SULLIVAN: Thank you.
21 The purpose of moving the residential
22 beds is really to fully integrate those
23 clients in the community. When the
24 residential beds which we are closing were
16
1 established -- it was like 30 years ago we
2 began developing these. They're large
3 buildings, large institutions where
4 individuals are really separated from living
5 in the community but would be capable of
6 living in the community.
7 So transitioning individuals from that
8 particular kind of housing to the community I
9 think is really in line with what Olmstead
10 requires, and also what's really best care
11 for the clients.
12 We have additional housing in the
13 system, what we call our transitional-level
14 housing, on our campuses. We are not in any
15 way decreasing that. And we in fact, on some
16 campuses, are further developing that
17 transitional level of housing.
18 But these became housing where
19 individuals stayed way too long, and they
20 would be able to actually be in the
21 community. So we're getting two-for-one
22 here, where basically the cost of keeping
23 those services on the campus enables us to
24 open, for every one we close on the campus,
17
1 two slots in the community. Which is really
2 better for the client.
3 What I think we really need on our
4 campuses are really these transitional-level
5 housing, not what had become kind of almost
6 really long-term, close to permanent housing
7 for individuals on our campuses, which is not
8 what we really wanted.
9 In terms of the clinic restructuring,
10 this is really an attempt to just make our
11 clinics as productive as is required of kind
12 of clinics everywhere. We have been very
13 careful at this. We have looked at six
14 clinics over the course of this year, and
15 those reports have been sent to the
16 Legislature. And basically each one that we
17 have either downsized or closed to merge with
18 another one of our clinics, we have discussed
19 with the local stakeholders, with the county,
20 with the local legislators to make sure that
21 this makes sense.
22 Some of our clinics, for example, had
23 a census of maybe only 60 individuals, which
24 is really too small for a clinic. But they
18
1 were kind of close enough for many of those
2 clients to come to another state hospital
3 clinic or, if they preferred, we made sure if
4 they wanted to go to other services in the
5 community, they could do that.
6 One of the big moves was actually two
7 clinics which we had on the Staten Island
8 campus, and there was really no reason to
9 keep them separate. And one clinic had room,
10 and basically we were able to move those
11 clients, all of them, to the other clinic,
12 not use that other space for clinic space,
13 and consolidate staff.
14 So it's really to make it more
15 efficient. It's not a trend in any way for
16 the state to not be involved with clinic
17 services of the seriously mentally ill. We
18 realize that's our responsibility, especially
19 with those that have utilized our inpatient
20 state hospitals.
21 CHAIRWOMAN YOUNG: Well, I wanted to
22 ask about that. Because I think I've been
23 consistent about saying that I believe that
24 this state should do more to help people with
19
1 serious mental illness, and I don't believe
2 that we do enough.
3 And you see it out in the streets
4 every day with the exploding homeless
5 population that we have, not only in the
6 cities -- and New York City certainly has
7 been grappling with this -- but all across
8 the state. We see it in rural areas, we see
9 it in smaller city areas. And OMH has
10 reduced approximately 650 adult and
11 children's beds in recent years. And this is
12 in line with the negotiated agreement that
13 the Governor had with the Legislature.
14 But in order to close a bed, it must
15 be vacant for a continuous 90-day period
16 before it can be reduced. And all of these
17 reductions must be fully reinvested into
18 community services for the mentally ill,
19 which I think is good, but I will point out
20 that there have been situations where the
21 Governor has reduced beds, and then shortly
22 thereafter these facilities are over census.
23 This highlights issues of supply and
24 demand that are fluid in nature, as you know,
20
1 with this population. And the Governor has
2 stated that beds will be reopened as needed
3 if the funded bed number per facility is
4 pierced.
5 So for example, at Creedmoor
6 Psychiatric Center in Queens, the census has
7 exceeded the number of funded beds for a
8 three-month period, based on OMH reports. So
9 the question is, what processes are in place
10 at OMH to reevaluate the number of funded
11 beds at a facility when the census exceeds
12 capacity?
13 COMMISSIONER SULLIVAN: When the
14 census exceeds capacity, we definitely open
15 up the additional beds. Now, usually -- for
16 example, Creedmoor there is a unit where you
17 can expand the services, so you can admit a
18 certain number of additional clients. We've
19 been able to do that when we've had to.
20 So yes, we monitor it extremely
21 closely. We have not closed any bed in any
22 facility where there hasn't been a 90-day
23 vacancy. And in fact at Creedmoor when that
24 happens we absolutely do not close any of the
21
1 beds.
2 When you look across the system, we
3 have instituted a centralized admission
4 process in the city now so that we can
5 basically know exactly where we need to have
6 beds. And sometimes -- not always, but
7 sometimes it's okay for a client to go to one
8 of our other hospitals that may have a
9 vacancy if the client wants to. But we
10 monitor it extremely closely. And we have
11 gotten the waiting list down to close to two
12 weeks to wait to get into our hospitals. So
13 when that begins to go up, we look very
14 carefully at the beds. And if we need to
15 temporarily expand beds to meet those needs,
16 we do.
17 On the overall issue of lowering
18 beds and providing mental health services,
19 the answer really here is to get truly robust
20 outpatient services. And we're really trying
21 to do this across the state, things that
22 include things like crisis respite, mobile
23 integration teams -- all the things that can
24 keep clients in the community. Eventually
22
1 individuals leave hospitals. And if we don't
2 want them to come back, we have to have that
3 kind of robust transformation into the clinic
4 system, into the outpatient support system
5 for the seriously mentally ill.
6 So we really are working very hard
7 with that. But when the beds are needed, we
8 will expand those beds if they are needed.
9 CHAIRWOMAN YOUNG: Okay. And I'd like
10 to follow up. And I may be on a theme here,
11 but I think it's a cause for concern. Our
12 jails across the state are filled with people
13 with psychiatric issues. They act out, and
14 they end up in jail. Local governments are
15 not equipped, you know, to deal with people
16 with mental illness. And on top of it, we
17 see that people are going to emergency rooms,
18 they're being boarded in hospitals. And so
19 with this reduction of beds, it is a cause
20 for concern.
21 So you're saying that you will commit
22 that OMH will add new beds where there's
23 significant need? Specifically in cases
24 where there is a lack of open beds at
23
1 state-operated facilities and then we are
2 faced with the situation that I just
3 described with people going to emergency
4 rooms, people languishing in hospital beds.
5 COMMISSIONER SULLIVAN: When there's a
6 need to -- so far, truthfully, it has been
7 temporary. When there's a need to
8 temporarily re-expand some beds, we do that.
9 But the problems that exist relative
10 to individuals in emergency rooms and
11 unfortunately jails and prisons are not just
12 the state hospital beds. This involves the
13 work that we are doing with the Article 28
14 facilities, with a lot of the community-based
15 services. And all those services, in
16 addition to having them, have to really work
17 well together.
18 So one of the initiatives which we're
19 working very hard on is a survey of all the
20 crisis services across New York State. If
21 you're going to help individuals not end up
22 in jails and prisons and you're going to help
23 them not to go to emergency rooms when they
24 don't need to, you need a robust mobile
24
1 crisis intervention system.
2 Working with many of the PPSs in the
3 DSRIP program, working with many of the
4 counties who have pieces of this system,
5 we're trying to get a robust system across
6 the state that can interface with police, in
7 response to the CIT programs. That robust
8 mobile crisis service is what will ultimately
9 help us and help those individuals not kind
10 of trail into the criminal justice system.
11 I absolutely agree with you that too
12 many of our clients over the years have gone
13 into the criminal justice system. I think
14 the answer to that, though, is really to have
15 the right kind of intervention at the
16 community level -- and hospital beds when you
17 need them, but the right kind of intervention
18 at the community level is where the real
19 diversion point should come. And that's what
20 we're trying to grow with the $100 million
21 that we've reinvested in community services.
22 CHAIRWOMAN YOUNG: Thank you. Under
23 the Regional Center of Excellence plan which
24 was actually rejected by the legislature in
25
1 2014, approximately 600 adult beds and 100
2 children's beds were estimated to be
3 eliminated from the state-operated inpatient
4 system. And this is an estimate, since we've
5 never been able to get from the Governor's
6 office or from the agency exact details
7 beyond facility and ward closures.
8 With the current system of bed
9 reduction in place, the Governor will
10 approximately reach their previous long-term
11 goal in the next year. And I want to point
12 out there have been no facility closures as a
13 result of the Senate's intervention. But
14 under the Executive Budget this year, the
15 amount of total bed reductions since 2014 are
16 approximate in number to the reductions
17 proposed under the now-abandoned RCE plan.
18 What is the long term plan for
19 inpatient service reductions, such as what
20 number is the end goal? What do you have in
21 mind?
22 COMMISSIONER SULLIVAN: You know,
23 quite honestly, we don't have an end goal
24 number because I think you can't do that.
26
1 You have to only lower -- as we have been
2 doing -- beds that are vacant. And if you
3 kind of come up with an end number, then
4 you're not really following that, you're kind
5 of saying, Well, this is my goal of beds I
6 want to get to.
7 So I'm not sure what the end number
8 is. When we propose 100 beds in this year's
9 budget, we're talking about looking very
10 closely -- and never -- we've been very
11 careful about this, in respect of the
12 Legislature -- never closing a bed that is
13 not 90 days vacant. So we have to see. And
14 it really does depend upon utilization in
15 Article 28 hospitals, community-based
16 services, et cetera. So there are some
17 hospitals where we have closed beds, others
18 where we haven't. And I think it's a much
19 more rational plan than just thinking of,
20 well, we'll close a facility here, close a
21 facility there. We're closing it based on
22 the need for those beds to be utilized.
23 So while we have proposed because we
24 think, perhaps -- we can't do it unless
27
1 there's that 90-day vacancy. So I can't
2 honestly give you a target number. And I
3 think we will have to see as we -- because we
4 have to keep up services if we need them. We
5 just have to.
6 CHAIRWOMAN YOUNG: So you're talking
7 about reinvesting in community services,
8 which I think is a good idea. And we've had
9 those over the past several years. But there
10 continues to be major issues related to
11 individuals discharged from state psychiatric
12 centers, related to emergency room use as
13 well as readmission to inpatient settings.
14 And since the reinvestment funding has
15 not significantly improved these metrics, why
16 does the Governor's budget actually propose
17 additional funding for community services
18 outside reinvestment dollars? Why don't we
19 have additional funding going into community
20 services? All that we really see are these
21 reinvestment dollars that are included in the
22 Governor's proposal.
23 COMMISSIONER SULLIVAN: I think
24 that -- it's a tough -- let me just say it's
28
1 also a very difficult budget. But there are
2 some dollars that have gone into community
3 services. For example, Medicaid savings on
4 the 20 ACT teams -- ACT teams are Assertive
5 Community Treatment teams, which are the most
6 effective way of dealing with some very
7 high-need seriously mentally ill in the
8 community. And we are increasing that by 20
9 across the state, which is significant. That
10 came out of savings that was in the Medicaid
11 premium in terms of mental health. So that
12 was an investment also in community-based
13 services.
14 We have, through a variety of
15 mechanisms, increased what we call
16 first-episode psychosis teams, which are now
17 up to I believe about 18 across the state.
18 These teams work with individuals with an
19 early diagnosis of schizophrenia in their
20 teens and going into the middle twenties,
21 helping them stay in school, helping them get
22 jobs, helping stop this whole cycle of the
23 chronic mentally ill eventually ending up in
24 institutions. And we've been very successful
29
1 with that. We are one of the largest states
2 to have expanded this program across the
3 state. I think if we put up another five
4 teams, which we are continuing to try to
5 figure out kind of how to do, we could
6 probably saturate the state for every new
7 diagnosed schizophrenic.
8 So basically I think the issue here is
9 that we are for many areas improving the
10 mental health service system. For example,
11 intensive outpatient services is something
12 which is -- we have just passed in the
13 regulations which will enable clinics to
14 provide very intensive services and get
15 appropriately reimbursed through Medicaid for
16 those services. That's a new regulation
17 that's just out. We have now established it
18 I believe in 10 clinics and we will be
19 establishing it in more.
20 So there's many ways, in addition to
21 reinvestment, that community services are
22 also expanding.
23 CHAIRWOMAN YOUNG: Thank you for that
24 answer.
30
1 Now, so you know that we have a real
2 lack of psychiatrists, especially across the
3 state. And when you're in a rural area such
4 as the one I represent, it is impossible to
5 find a psychiatrist. So what is the
6 department doing to try to attract more
7 psychiatrists to practice in New York?
8 COMMISSIONER SULLIVAN: This is very,
9 very difficult. I mean, it's a national
10 shortage across the country.
11 In our state system we now have a
12 program to do tuition reimbursement for
13 psychiatrists. Now, that's within the state
14 system. But when people graduate from school
15 we have what we call the DANY program, which
16 will provide stipends of up to $30,000 a year
17 for five years to pay off tuition if you stay
18 in the state system.
19 We piloted that in the state system,
20 and we've been getting good results. It took
21 about a year or two for it to catch on, but
22 now we have I think about 15 psychiatrists
23 that we've been able to find across the
24 system. So that's one way to think about
31
1 having psychiatrists stay in New York State,
2 is something like loan reimbursement. This
3 is only now for the state system.
4 However, there is a program for
5 underserved areas through the Department of
6 Health. And the Department of Health, we're
7 working with them, and they have expanded
8 that to now include our psychiatrists as
9 well. So that is for psychiatrists across
10 the state. And that you have to apply for,
11 but that gives tuition reimbursement of up to
12 $120,000 for a three-year commitment. So
13 that's one area.
14 The other is the use of
15 telepsychiatry. I think that when we've
16 looked at a lot of graduating psychiatrists,
17 a lot of them are actually interested in
18 telepsychiatry, and we have changed the
19 regulations now to be able to really make
20 that easy to do. Initially you had to kind
21 of be a psychiatrist sitting in a clinic
22 somewhere. Now a psychiatrist can do it from
23 their office, their home, and basically can
24 do it through clinic settings or we're
32
1 getting very close to having it totally in
2 home-based settings as well. So I think that
3 that will help with the shortage.
4 The other is I think just working with
5 our --
6 CHAIRWOMAN YOUNG: If I may,
7 Commissioner, actually I'm glad you went
8 there on telepsychiatry, because we've
9 expanded telehealth services in the state. I
10 have a bill on expanding telepsychiatry. So
11 you're saying you think that would be a good
12 idea, then.
13 COMMISSIONER SULLIVAN: Yeah, I
14 think -- well, I think telepsychiatry,
15 telemedicine is really a big part of the
16 future of healthcare. And I think we need to
17 get increasingly creative about how we use
18 it, as long as we keep an eye on what's
19 happening. But I think we can get
20 increasingly creative about how we use it,
21 and it's incredibly helpful for both the
22 client, I think, and for the practitioner.
23 So yes, I think we're in the process
24 of really working on the regulations so that
33
1 telepsychiatry will become increasingly
2 utilized in New York.
3 CHAIRWOMAN YOUNG: Thank you. I'm
4 going to come back, but I just have a couple
5 more questions. Thank you.
6 CHAIRWOMAN WEINSTEIN: So we've been
7 joined by Assemblyman Sepulveda.
8 For questions we go to our Mental
9 Health chair, Aileen Gunther.
10 ASSEMBLYWOMAN GUNTHER: So I have a
11 few questions also. Thank you very much.
12 So the number of people receiving
13 mental health treatment in prisons continues
14 to rise, while the overall prison population
15 is actually decreasing. Do you believe this
16 is a result of any of the bed closures that
17 have happened across New York State?
18 COMMISSIONER SULLIVAN: Truthfully, I
19 don't think it's the result of bed closures.
20 I think it is still the problem of not having
21 adequate community-based services. Beds are
22 only a temporary place for individuals to be.
23 They ultimately need to be well-integrated
24 into the community and get the services they
34
1 need. That's what can prevent prison use.
2 You know, in the individuals who have
3 left prison, there is a cohort that we worked
4 with for the appropriate services for the
5 seriously mentally ill. And this involved
6 connecting them with housing and intensive
7 wraparound services when they left prison.
8 The usual returnee rate is
9 significant, within three years to prison for
10 both individuals with mental illness and
11 individuals without. For those seriously
12 mentally ill individuals that we got the
13 right community-based services, we cut that
14 returnee rate in half. So we're working very
15 hard to continue to have those intensive
16 supported housing systems and the intensive
17 wraparound services. You can decrease
18 individuals going into the prison system with
19 that.
20 We just need to, as we have been
21 doing, continually move dollars in the
22 appropriate way from very costly inpatient
23 care to community-based care and getting the
24 right balance. And I think that -- it's not
35
1 easy to do, but I think it's something that
2 we're working very hard on.
3 ASSEMBLYWOMAN GUNTHER: Well,
4 obviously when you look at the statistics I
5 guess we haven't reached the right balance,
6 because there are more people than ever
7 receiving mental health services who have a
8 diagnosis that are in jail beds today.
9 And the Executive has proposed to
10 establish a jail-based restoration program
11 for people deemed incompetent to stand trial.
12 Do you believe that a jail is the best
13 setting for an individual with mental health
14 issues?
15 COMMISSIONER SULLIVAN: The
16 individuals that we're proposing to have
17 jail-based restoration clinically are
18 individuals who if they weren't in the
19 justice system would basically be outpatient
20 restoration. They wouldn't be going into a
21 hospital.
22 The way the law is written currently,
23 if you are either in a jail or a prison to be
24 restored, you have to go into a hospital from
36
1 a jail, you don't have a choice really of a
2 lesser-restrictive setting.
3 Now, jail-based restoration has been
4 done in 10 states and supported by the
5 Judicial Council. If you do it, you've got
6 to do it right. I think it -- I don't think
7 jails are the best places, but I think you
8 can do a very good job of jail-based
9 restoration if you have the right standards,
10 which we will have. We will make sure that
11 there are appropriate clinical staff,
12 including psychiatric staff, social workers,
13 psychologists. And it has to be done with
14 the standards that other places that have
15 done jail-based restoration have done.
16 To that end, there's $850,000, if a
17 county is interested, to help support really
18 getting that started and to support
19 continuing those excellent services in the
20 jails. So I think if it's done well, I think
21 it can be appropriate for individuals.
22 The good thing about it is that it
23 prevents this kind of movement back and forth
24 from one place to the other for individuals,
37
1 and it has also been shown to decrease their
2 actual time in confinement. So if you have a
3 good jail-based restoration program, you're
4 working with the DAs, you're working with the
5 judicial system, the community-based system
6 to get the clients out quicker. And I think
7 that's a very important thing. We also know
8 that when the mentally ill go into jails and
9 prisons, they spend a longer time there than
10 the general population.
11 So I think if done well and
12 appropriately, it can be very good.
13 ASSEMBLYWOMAN GUNTHER: Well, do you
14 think that -- as far as I'm concerned, you
15 know, you have people that work in the jail
16 system and the education process. Is there
17 an education process to identify people that
18 are coming in that are paranoid, that have
19 been off their meds because maybe they
20 haven't been able to afford them? And so
21 that identification of the person that needs
22 mental health care.
23 COMMISSIONER SULLIVAN: Definitely in
24 the prison system, everyone who comes in is
38
1 screened at the time that they arrive in the
2 prison system. And many jails across the
3 counties and in New York City are doing that
4 as well.
5 ASSEMBLYWOMAN GUNTHER: Well, when we
6 talk about housing, in New York State there's
7 almost 12,000 individuals with mental illness
8 in adult care facilities. So they are in
9 adult care facilities, which I consider not
10 an appropriate placement.
11 Do you believe the personal needs
12 allowance needs to be increased so that
13 people do not have to live in adult care
14 facilities?
15 COMMISSIONER SULLIVAN: I think that
16 it's very important that individuals can move
17 out of those adult care facilities. When
18 they move out of the adult care facilities,
19 there's a change in the way they can then
20 monitor their dollars. And actually for many
21 of them, with appropriate supports and making
22 sure they get all the other benefits they can
23 get, when they move into a community-based
24 setting, they do have more dollars to spend
39
1 on what they want to spend it on.
2 In the adult care facilities, because
3 the institution is providing many of those
4 services, the allowances are smaller.
5 So I think the goal here is to help
6 individuals move into community-based
7 settings but also make sure, if they do, that
8 they get all the supports they would need --
9 things like food stamps, et cetera,
10 everything else that they need to support
11 them so that their allowances in the
12 community-based settings do become larger in
13 terms of the actual dollars they can use for
14 their own self care.
15 ASSEMBLYWOMAN GUNTHER: Part Y of the
16 health and mental hygiene budget defines
17 which duties and tasks can be performed by an
18 individual without a clinical license. There
19 have been concerns that this proposal could
20 have unintended consequences on students
21 pursuing a bachelor's or master's degree in
22 social work. Is it the intent of this
23 proposal to alter current authorized duties
24 for these students? How many of these
40
1 student interns would the behavioral health
2 service provider --
3 COMMISSIONER SULLIVAN: The intent of
4 this is really not to change what is the --
5 it doesn't, it couldn't change what is the
6 scope of practice for individuals who are
7 licensed or unlicensed. It maintains that
8 scope of practice.
9 What it does is tighten up the degree
10 of supervision, which has in many ways been
11 going on all these years, of these
12 individuals within the system. So that we
13 really know, if you're licensed, this is what
14 you can do, and if you're unlicensed, this is
15 what you can do. It's based on the current
16 scope of practice. We're not touching scope
17 of practice.
18 I think that it might affect some
19 clinics in terms of the work flow that they
20 have to do, because they might require in
21 some cases -- not in all -- some increased
22 supervision over individuals. It should not
23 deter students from being -- students have
24 always been supervised in these settings, and
41
1 students have always had clear, outlined
2 responsibilities based upon their schools and
3 what they require.
4 So it shouldn't really change the
5 placement of students at all. I think that
6 the issue here is just to kind of tighten up,
7 make sure that we have a very clear picture
8 going forward.
9 There's also a grandfather clause
10 which gives clinics a good period of time to
11 be able to work on any issues that might be
12 there. And the grandfather clause goes back
13 and will be there until 2020.
14 So I think this bill offers a way out
15 of what has been a many, many year extension
16 and exemption that enables us to make sure
17 that we're doing the right things in the
18 clinic without any significant impact on the
19 workforce. Although there will be some
20 changes in work flow in some clinics.
21 ASSEMBLYWOMAN GUNTHER: Through my
22 office, one of the constant subjects we talk
23 about is the fact that so many people that do
24 have insurance, that the psychiatrist does
42
1 not accept the reimbursement. So therefore
2 they do not have access to a psychiatrist to
3 actually control their medications or put
4 them on the appropriate medications.
5 Is there anything that we can do as
6 the State of New York that we're paying such
7 high premiums to have insurance, yet that
8 insurance doesn't give us access to mental
9 health?
10 COMMISSIONER SULLIVAN: We have been
11 working with the Department of Financial
12 Services to look very carefully at the parity
13 issue, especially for commercial payers.
14 There was a very interesting Milliman
15 study that was done which showed that
16 out-of-network use across the country was
17 much higher for any kind of behavioral health
18 service than for any medical service.
19 So with the Department of Financial
20 Services, with the Milliman report, we are
21 looking at critical parity issues here in
22 terms of access for mental health care. In
23 some ways there is better access -- there's
24 significantly better access through the
43
1 Medicaid system for mental health care than
2 there is for commercial payers. And very
3 often what happens is that there's a
4 difficulty with networks actually being
5 adequate. And sometimes there's difficulties
6 with people knowing how to access in
7 insurance.
8 So we're working within the state to
9 see what we can do. But the biggest issue
10 here is to make sure that parity is being
11 followed to the letter of the law. And the
12 state has been very supportive of working on
13 mental health parity in many instances. So
14 we're continuing to work on that. It's a
15 very serious issue.
16 ASSEMBLYWOMAN GUNTHER: You know,
17 within my district one of the things I do
18 notice is that when we talk about bed
19 closures for like emergent care, like in
20 hospitals, that we are closing the beds. And
21 what you often see is that we are utilizing
22 the emergency room. And sometimes people in
23 crisis stay in the emergency room for two to
24 three days until there's a bed available, and
44
1 especially with children in crisis.
2 There are -- you know, if you go to
3 Four Winds, I mean, their census is always
4 full. And you go across the board, and the
5 census is full. And so we are closing the
6 beds, but how much are we spending on
7 emergent care and having a one-to-one in a
8 hospital emergency room until a bed is
9 available? And you know what, we cannot put
10 children on medications without observing the
11 effect of that.
12 And I personally know that I get calls
13 from parents across New York State, not just
14 in my district, of their kids not being able
15 to access the care that we need. And we know
16 that children are being diagnosed earlier,
17 and their needs are greater. And yet between
18 insurance and not letting -- the
19 psychiatrists don't accept, you know, our
20 private insurance -- that the access to care
21 to me is just very, very difficult.
22 And I think that when children are in
23 crisis, the quicker that we can get them in
24 care -- but it doesn't seem to be working
45
1 that way, even though we pay very high
2 premiums, we supposedly deliver the greatest
3 healthcare, but there's something missing.
4 And then if you look in terms of the
5 jails and the more people that are needing
6 treatment in the jail system, there's a
7 message there. There's an underlying
8 message. And you know what, I do think we
9 have to balance. And I think that revisiting
10 what's going on in real time in communities
11 is very important.
12 COMMISSIONER SULLIVAN: No,
13 absolutely. And we work very closely with
14 the communities and with the local county --
15 local mental hygiene directors.
16 There are two bed systems in New York
17 State; there's the state hospital beds and
18 there's the acute-care hospital beds. And
19 the acute-care hospital beds have anywhere of
20 a length of stay of usually two to four
21 weeks. The acute-care hospital system is
22 something that we have worked very hard also
23 to preserve. And we have worked -- whenever
24 there are threatened bed closures on the
46
1 acute-care side, we have worked very closely
2 with those facilities and with those
3 communities.
4 The acute care is the initial access
5 valve from the emergency rooms, et cetera.
6 And what we've often found as we've worked
7 with the acute-care hospitals and the
8 emergency rooms is setting up, again, this
9 kind of continuum of care, especially with
10 kids. Because many children who come to
11 emergency rooms, if you have a mobile crisis
12 team or a mobile integration team, which we
13 have put in certain communities across the
14 state that work with that ED and with those
15 kids, that you don't need to have them
16 admitted, that partly the admission is a
17 default position because they don't have
18 respite beds for youth, because they don't
19 have mobile crisis intervention for youth.
20 If you do, those can have a significant
21 improvement in what tends to clog up the
22 emergency rooms.
23 Similarly, we've worked with the
24 counties, which are great in working with us
47
1 in this, and with some of them we have put
2 some services in schools. Because a big
3 issue of kids going to emergency rooms is
4 often referrals from schools. And if you put
5 mental health teams or clinics in schools,
6 you decrease that volume that then goes to
7 the emergency room.
8 So when you have an area that's in
9 distress -- and I'm not saying we solve this
10 perfectly all the time -- what you really
11 have to do is look at the multiple factors
12 that are causing that distress. One is
13 making sure you have acute-care beds. You
14 have to also make sure you have state beds.
15 But you also need to look at who's coming
16 into those emergency rooms and making sure
17 that you have the wraparound services.
18 And we've been trying increasingly to
19 do this for kids. Where we have put up
20 crisis respite beds for kids, that has had a
21 significant impact on those kids going to
22 emergency rooms and going to hospitals,
23 because we have another way for individuals
24 to get the help they need.
48
1 So that's what we're going to be
2 expanding, especially with some of the crisis
3 respite capital dollars this year, is to
4 increase that. And we want to increase that
5 significantly for kids.
6 CHAIRWOMAN WEINSTEIN: Thank you.
7 We've been joined by Assemblywoman
8 Crystal Peoples-Stokes.
9 CHAIRWOMAN YOUNG: And we've been
10 joined by Senator George Amedore.
11 And our next speaker is Senator John
12 Brooks. Senator Brooks.
13 SENATOR BROOKS: Good morning.
14 COMMISSIONER SULLIVAN: Good morning.
15 SENATOR BROOKS: A couple of areas I
16 would like to address, first on the homeless
17 situation.
18 You know, we're seeing and I'm getting
19 ongoing complaints in different areas that we
20 have people that are showing up at libraries,
21 people who are showing up at railroad
22 stations and sleeping during the night. How
23 much direct outreach do you have in the
24 various areas of the state to try to identify
49
1 and bring these people in? Or are you
2 relying totally on the local communities, the
3 local counties to address that?
4 COMMISSIONER SULLIVAN: A good portion
5 of the state aid that we give to local
6 counties goes to the outreach teams that
7 work -- to work with the homeless. So while
8 they are -- and I think best served by the
9 local counties providing those kinds of
10 services, a lot of it is supplemented or
11 sometimes largely paid for by the state aid
12 that we give to the counties, and the
13 counties use that state aid to do the
14 outreach.
15 Another piece of the importance is
16 housing, to tell you the truth. And that's
17 why across the state we are increasing, every
18 chance we get, supported housing for
19 individuals with serious mental illness, so
20 that they really have a place to go.
21 And then the third is our expansion of
22 Assertive Community Treatment teams and ACT
23 teams, which we've also increased across the
24 state as well as in New York City. Those
50
1 teams work very well with these clients and
2 can help support them in terms of moving into
3 housing.
4 Often with individuals who have become
5 chronically homeless, on the street, the
6 outreach teams have to do a lot of work to
7 get them to begin to really see their lives
8 differently and see the possibility of
9 housing.
10 But we invest a fair amount -- I don't
11 know the exact number of state aid -- in
12 doing that pretty much across the state. But
13 we need to have the supported housing
14 available. And that's something that we're
15 continuing to grow so that these individuals
16 can be in safe environments.
17 SENATOR BROOKS: In terms of housing,
18 one of the things that we're seeing in many
19 communities is an increasing number of zombie
20 houses where people have left those houses.
21 Are you working in any way to try to recover
22 those houses at a lower cost to expand the
23 housing you can provide?
24 COMMISSIONER SULLIVAN: I'm not -- I'm
51
1 not actually sure. I think that's a
2 suggestion we'll look into. I don't know. I
3 mean, I know our providers are out there
4 looking for sites. A lot of them have been
5 supported apartments. But in terms of using
6 some of that housing, I'm not sure. I know
7 we have converted some, but it's usually
8 fairly large areas. We -- I'd look into
9 that, I'll look into that and let you know.
10 SENATOR BROOKS: Because I know within
11 my district there are some communities with a
12 large number of zombie houses available.
13 COMMISSIONER SULLIVAN: Yeah, mm-hmm.
14 SENATOR BROOKS: In terms of, again,
15 opening up more local community beds, how
16 tightly are you managing that expansion with
17 the demand in those communities? Are you
18 having problems in certain areas of the state
19 where the demand is much higher than your
20 ability to provide the housing?
21 COMMISSIONER SULLIVAN: In terms of
22 local inpatient beds, it can vary. I mean,
23 we have parts of the state where the local
24 inpatient acute-care occupancy is probably
52
1 about 85 percent, 80 percent. We have other
2 areas of the state where that occupancy on
3 the acute-care Article 28 side can be as high
4 as 90 percent, 95 percent.
5 So when we have that high occupancy,
6 we work with the counties to see other
7 options that we can use. And that's why in
8 this budget there's a significant $50 million
9 in capital for what we call respite beds.
10 Respite beds are beds which can both prevent
11 admissions but also help individuals leave
12 inpatient services more rapidly.
13 So we are particularly looking across
14 the state at establishing those respite beds
15 in areas where they are particularly needed
16 because of the high occupancy in inpatient
17 acute-care article 28 hospitals.
18 SENATOR BROOKS: And to just pick up
19 on the comments that have been made by some
20 of my colleagues here today, I think we
21 really, really have to get a handle on what's
22 happening in the prisons in terms of people
23 with mental illness in those facilities.
24 And, you know, I think we're way behind the
53
1 eight ball on this. And the fact that we
2 have a system where these people are being
3 probably picked up off the streets more times
4 than not where we've neglected to identify
5 them there and then put into this process,
6 and they're not really getting the help they
7 need, I just think that's an area we have to
8 put tremendous attention to.
9 COMMISSIONER SULLIVAN: I think you're
10 absolutely right. And I know this -- I'm
11 sure there's no -- you're absolutely right
12 that we need to put the emphasis -- and I
13 think where -- you know, it's interesting, I
14 think in some ways we know how to do this.
15 It's getting all the services arranged so it
16 can happen.
17 We have a few counties where, in
18 combination with the CIT training, which has
19 been great in terms of being paid for by the
20 Senate and Assembly to really provide the CIT
21 training, connected with the mobile crisis
22 centers, connected with stabilization
23 centers, connected with the community -- when
24 you talk to the sheriffs in those areas, they
54
1 are bringing less individuals to the jails
2 and prisons.
3 Now, that hasn't yet gotten to the
4 point of seeing gross numbers going down.
5 But it works. And I think that's something
6 that we are going to continue to look at.
7 That's part of our looking at crisis services
8 across the state, making sure that every
9 county has that experience of planning both
10 between the sheriff's office, between mental
11 health services and between the legal system.
12 And if you can pull all those pieces
13 together, you can see a decrease in the
14 number of individuals who manage to wend
15 their way into the jails and then ultimately
16 into the prison system.
17 So that's really our goal. It is
18 taking much longer than anyone would like.
19 And it really is something that I think we
20 will be -- we are emphasizing and will
21 continue to emphasize over the next few years
22 to really get to see those numbers come down.
23 SENATOR BROOKS: I guess the last
24 comment I would make, in speaking with some
55
1 of the families and the rest, they've got
2 concerns as to where programs are going and
3 heading. And I think we need to do a better
4 job explaining to people our long-range plans
5 as to how we're trying to address situations,
6 and give families more comfort that we
7 understand where we're going, there are
8 programs. You know, we seem to be in a
9 situation where we're playing more catch-up
10 than talking about where we're going to
11 address certain situations.
12 So I think, you know, better public
13 relations in terms of the direction we're
14 going in, what problems we have, and
15 recognizing how we're going to handle those
16 situations I think would be helpful.
17 COMMISSIONER SULLIVAN: Yeah. No,
18 you're absolutely correct. And I think it's
19 our responsibility to increasingly work with
20 families and with clients to understand what
21 we have, what's available, and also where --
22 get their input on where our gaps are and
23 where we are not serving them as well as we
24 need to.
56
1 And I think that dialogue has to be
2 ongoing and robust. And, you know, sometimes
3 we're better at it than others, but we're
4 going to continue to work very hard to make
5 sure that we speak with families and clients
6 to know what their needs are and also so they
7 understand what we have, yes.
8 CHAIRWOMAN YOUNG: Thank you.
9 CHAIRWOMAN WEINSTEIN: Assemblyman
10 Sepulveda.
11 ASSEMBLYMAN SEPULVEDA: Good morning,
12 Commissioner.
13 COMMISSIONER SULLIVAN: Good morning.
14 ASSEMBLYMAN SEPULVEDA: So what's OMH
15 doing to remedy the problem of people with
16 mental illness in solitary confinement? The
17 SHU exclusion law says that people with
18 serious mental illness should not be in
19 solitary confinement. Still, there are about
20 800 people with mental illness in solitary
21 confinement. Is the statute too restrictive?
22 Should we amend it? Because the difference
23 between serious mental illness and mental
24 illness sometimes is not easily defined.
57
1 What is OMH doing to remedy this
2 problem? We have over 800 people still,
3 despite the law -- and then I'll have a
4 follow-up question after you respond.
5 COMMISSIONER SULLIVAN: We follow very
6 closely the SHU law. The law states that
7 individuals with -- the law as it is written
8 states that individuals with serious mental
9 illness can't be in the SHU for more than
10 30 days. During those 30 days, we work very
11 closely with them. And after those 30 days,
12 if unfortunately they would still be in SHU,
13 they move into one of our treatment programs
14 in the prison. So that's the law.
15 But what we are doing now is working
16 very, very closely with DOCCS to divert
17 people from ever getting into SHU, not even
18 getting to that 30-day period. And a lot of
19 it is systems within the prison that would --
20 things that sometimes our mentally ill
21 clients do that could get them to be
22 considered for SHU, and we're trying to
23 circumvent that and cut it off before they
24 ever reach the SHU. We're working very
58
1 closely on that with DOCCS.
2 But we follow the law. And we make
3 sure that if mentally ill individuals are in
4 SHU, that they get the four hours of -- the
5 programming out of SHU that they need. And
6 we work very closely with DOCCS to try to
7 avert any individuals from getting in. And
8 it's getting better. It's not where it needs
9 to be yet, but it's getting better.
10 ASSEMBLYMAN SEPULVEDA: The definition
11 of serious mental illness versus mental
12 illness, is that too restrictive? Do you
13 suggest that we amend the law so we can
14 include more individuals?
15 COMMISSIONER SULLIVAN: I think, you
16 know, it's -- I think absolutely it should
17 stand for serious mental illness. I think
18 that there have to be a lot of discussions
19 about broadening the law. And I think that
20 that's something that needs to be discussed
21 between agencies and with DOCCS. And I don't
22 think that that's solely a decision of
23 Mental Health, so that's something we would
24 need to discuss.
59
1 ASSEMBLYMAN SEPULVEDA: You know,
2 Commissioner, we've spoken about the issue of
3 suicide for some time now. It's a personal
4 issue for me. Can you tell me if you have
5 any data on how many people that are in
6 solitary confinement either have successfully
7 or have attempted suicide while in solitary
8 confinement?
9 COMMISSIONER SULLIVAN: I can't -- I'm
10 sorry, I can't give you the exact number for
11 solitary confinement. Unfortunately, the
12 number of suicides in the prison system over
13 years fluctuates per year, very sadly, from
14 somewhere usually between 12 to 16, 17
15 individuals. I can't tell you exactly how
16 many of those individuals were in solitary
17 confinement.
18 ASSEMBLYMAN SEPULVEDA: So OMH doesn't
19 keep any of this -- that kind of data?
20 COMMISSIONER SULLIVAN: We do, I
21 just can't -- I can get it to you. I can get
22 it to you. I'm sorry, no, I just don't know,
23 but I can get it to you. We do know. We do
24 know.
60
1 ASSEMBLYMAN SEPULVEDA: Okay, I'd
2 appreciate it. Please get that to me.
3 Now, back in 2015, Samuel Harrell and
4 Karl Taylor were both on the OMH caseload and
5 were reportedly beaten to death by
6 Corrections staff in 2015. What steps has
7 OMH taken to ensure that this doesn't occur
8 again and to protect patients that are
9 suffering from mental illness from staff
10 abuse and are responded to in an effective,
11 therapeutic manner?
12 COMMISSIONER SULLIVAN: Well, we work
13 very closely with -- first of all, we have
14 throughout the prison system a series of
15 services that go all the way from crisis beds
16 to residential beds to outpatient clinic
17 services. So it's really almost like a
18 community-based treatment service within the
19 prison system.
20 As part of that, we also work very
21 closely with DOCCS and we work jointly
22 together in assessing -- in training DOCCS in
23 terms of working with individuals who have
24 mental illness, and also in being aware of
61
1 signs and symptoms of individuals who might
2 have mental illness.
3 So we -- it's a combination of our
4 clinical services which we provide and also
5 our relationship with DOCCS in terms of
6 training.
7 We work very closely with the staff
8 throughout the prison system in terms of
9 trying to raise awareness of individuals who
10 have mental health problems, and we then
11 provide the services within the system. We
12 serve about 10,000 inmates with a mental
13 health problem a year, and about 25 percent
14 of those have serious mental illness.
15 So we -- a lot of issues also can
16 revolve around just making sure that the
17 staff have the appropriate training. And we
18 are doing that with some motivational
19 interview training, cognitive behavioral
20 training, and a number of trainings which we
21 have instituted across the prison system to
22 continually upgrade the skill sets of our
23 staff. And some of that training also occurs
24 with DOCCS.
62
1 ASSEMBLYMAN SEPULVEDA: I'll get a
2 second round. I'll come back for additional
3 questions.
4 CHAIRWOMAN YOUNG: Thank you.
5 Our next speaker is Senator Krueger.
6 SENATOR KRUEGER: Good morning,
7 Commissioner.
8 COMMISSIONER SULLIVAN: Good morning.
9 SENATOR KRUEGER: So you went over in
10 your testimony a little bit about expanding
11 housing opportunities within OMH and the fact
12 that there's a $13 million increase in
13 funding of adult home beds. While explaining
14 to me how that money is going to be used, can
15 you also address the fact that many of us are
16 hearing from organizations who already
17 provide OMH beds in supportive housing
18 settings and other community-based settings
19 who point out that they get so much less per
20 year to run their beds compared to new
21 programs being approved by the state within
22 Housing, OPWDD, OASAS, that they actually
23 wonder why would they continue to run program
24 beds under OMH for so much less money than
63
1 they could conceivably get if they dropped
2 you and went and applied to run facilities
3 under other state funding streams?
4 COMMISSIONER SULLIVAN: Yes, thank
5 you. And that's -- it's a very difficult
6 issue. But we have been -- over the past
7 four years we have added a total of
8 $42 million, including the $10 million in
9 this year's budget, to up the rates for
10 supported housing for the older housing.
11 That has brought up the number significantly,
12 so that now in the city, while still not as
13 high as it should be -- I believe it's
14 17,700, something like that, of the stipend
15 that we give, when in the past it was like
16 14,900 four years ago. So it's gone up.
17 It's gone up considerably. It's not as high
18 as some of the other supported housing
19 programs that are coming out, but it is a
20 significant increase.
21 All the new housing that OMH is doing,
22 whether it's out of our reinvestment dollars
23 or out of our two-for-one community-based
24 conversions, are all going to be at the
64
1 higher rates. So the issue still remains
2 with getting some of that older housing rates
3 up to where it needs to be. We're continuing
4 to work on that. But I think we have put in
5 $42 million.
6 Also with the increase in direct
7 service workers dollars, a lot of that for
8 our system lies with direct service workers
9 in housing. So that has given another boost,
10 in a way, to at least the staff who work in
11 our housing services.
12 But we're continuing working to get
13 those numbers where they need to be. And
14 there's another $10 million investment, in a
15 very tight budget year this year, to bring up
16 those rates.
17 SENATOR KRUEGER: And you also talked
18 before about I guess the hypothetical, it
19 seems to me, of when people leave adult homes
20 and go into other community settings. Does
21 that actually happen anywhere? Are there
22 actual places that people can go that they're
23 leaving these disturbing adult homes and
24 going into better-quality programs? Or is
65
1 that a -- I don't know, I feel like that's a
2 fairy tale as opposed to an actual reality
3 for anyone.
4 COMMISSIONER SULLIVAN: No, well,
5 actually -- actually, you know, under -- we
6 have moved, from the adult home system in
7 New York City, 650 individuals into
8 community-based apartments. And those
9 apartments I believe the number that have
10 returned to adult homes or have not been
11 satisfied is extremely low. We're talking
12 maybe five or six individuals.
13 So 650 individuals have moved
14 successfully into community-based
15 apartments -- with a lot of help, with a lot
16 of the wraparound services -- and the stories
17 are really quite remarkable. I mean, they
18 really talk about how they never really
19 thought they could live independently like
20 this, that they could, you know, take care of
21 themselves.
22 We do a lot of work when they move to
23 help them join into the community, because it
24 is a difference from going from a big
66
1 structure where there's lots of people to
2 your own apartment. So we have staff and
3 peers who can kind of work with them and help
4 them understand what are the recreational
5 things in their area, introduce them to them.
6 And their lives have really significantly
7 changed.
8 So 650 people have moved out of the
9 adult home, and we're continuing that
10 movement and will continue to move more and
11 more individuals.
12 SENATOR KRUEGER: And there were
13 already also several questions around what
14 happens with people with mental illness in
15 our prison population. And the Governor has
16 a proposal in his budget which I actually
17 support for geriatric parole, the recognition
18 that people above the age of 55 with other
19 serious illnesses are of no danger to the
20 community and they should be let out of
21 prison.
22 But letting someone out of prison to
23 the streets of New York City, into the
24 shelter system or an ER, is a completely
67
1 unacceptable and inhumane solution.
2 I would project, based on what we know
3 about people with mental illness in our
4 prison system, that a significant percentage
5 of these people will have mental illness.
6 Are you being brought in to discuss a plan
7 for how we're moving people, if we do
8 geriatric parole, into programs and services
9 as opposed to putting them on a bus and
10 waving goodbye?
11 COMMISSIONER SULLIVAN: Absolutely.
12 It's important, it's very important. One of
13 the key first steps is housing. So we're
14 looking at, as this would happen, what kind
15 of housing of our supported housing system we
16 can dedicate to helping those individuals
17 move.
18 And then the other is we have in the
19 prison -- and we will be working with the
20 prison to work especially with this
21 population -- we have what we call reentry
22 programs for individuals who are seriously
23 mentally ill for about 12 to 16 months before
24 they leave prison, to be in a specialized
68
1 program to help them get ready to leave. So
2 those individuals can partake in that.
3 Then when they leave, they will need
4 appropriate housing, so we need to look at
5 our housing resources. And they will also
6 need wraparound services in that housing.
7 And when we have done the housing with the
8 wraparound services, we have great results.
9 Generally, you know, we decrease the
10 returning to prison, decrease
11 hospitalizations, everything.
12 So we are going to be looking at that
13 particularly for that population, so that
14 they can have a real successful reentry into
15 the community.
16 SENATOR KRUEGER: Thank you.
17 CHAIRWOMAN YOUNG: Thank you.
18 CHAIRWOMAN WEINSTEIN: Assemblywoman
19 Melissa Miller.
20 Oh, and before she begins, we've been
21 joined by Assemblywoman Carmen de la Rosa.
22 ASSEMBLYWOMAN MILLER: Hi. How are
23 you? I just have one question.
24 You spoke before about the push to
69
1 create a more robust community crisis
2 intervention and crisis services. Are we not
3 there yet, and yet we're discharging patients
4 fairly quickly from these beds? Could that
5 be one of the reasons that maybe we're seeing
6 the unmet need of patients, that's why
7 they're showing up in jails or back in ERs so
8 quickly, and maybe we're -- that's the hope,
9 where you're hoping to reinvest some of that
10 money back into those services. But is that
11 service not yet fully in place?
12 COMMISSIONER SULLIVAN: It's not fully
13 in place. And I think it depends on -- it's
14 more in place in certain parts of the state
15 than in other parts of the state, but I
16 couldn't honestly say that it's in place
17 everywhere that it needs to be.
18 But when someone -- we're still
19 developing ways to ensure that individuals,
20 when they leave hospitals, especially when
21 they're leaving acute-care hospitals, that
22 they have the kinds of wraparound services
23 that enable them to successfully get into the
24 community. And that includes
70
1 sometimes programs where individuals, whether
2 it's the Health Home coordinator or other
3 individuals, work with those individuals to
4 help them adjust in the community.
5 Now, somewhere along the line mental
6 illness can be a very relapsing illness, so
7 you can have a crisis. You need them when
8 you have that crisis to hopefully be able to
9 stabilize so that you don't have to go to a
10 hospital. There's some wonderful respite
11 programs -- one of them is in New York City,
12 called Parachute -- where individuals who
13 begin to decompensate have the opportunity to
14 go into a respite program with lots of
15 supports so that they don't ever have to hit
16 that emergency room or go to the hospital.
17 And I think as we have more of those
18 services, we will begin to have less
19 individuals going to the hospital.
20 Individuals, once they are better, will leave
21 hospitals. I mean, you can't keep people in
22 hospitals after they are better.
23 ASSEMBLYWOMAN MILLER: But sometimes
24 they're not even getting --
71
1 COMMISSIONER SULLIVAN: The question
2 is what are you sending them to in the
3 community.
4 ASSEMBLYWOMAN MILLER: They're not
5 even getting into the hospital. They'll be
6 held in the ER for three, four, five days,
7 there's not a bed, and then they're being
8 discharged from the ER and back -- you know,
9 got through the short-term crisis, then back
10 right out onto the street or wherever it is
11 they are. Then they're getting into trouble,
12 they're winding up in jail, they're winding
13 up in a different place in crisis. Or worse,
14 hurting somebody or themselves.
15 COMMISSIONER SULLIVAN: One of the
16 major initiatives we're working on with DOH
17 and managed Medicaid -- the majority of --
18 almost all of these individuals are on
19 Medicaid -- is to have incentives within
20 managed care to do really robust discharge
21 planning and connecting to community services
22 when someone leaves the hospital, and
23 building incentives --
24 ASSEMBLYWOMAN MILLER: Or ER.
72
1 COMMISSIONER SULLIVAN: Or ER, I'm
2 sorry, yes, the hospital or ER -- and
3 building those incentives into the payment
4 structures of managed care companies.
5 Now, this is new. This is something
6 which is in the DOH budget. And we really
7 believe that working through managed care,
8 working with them, working with hospitals,
9 working with community-based providers to
10 make sure that we pay for the kinds of
11 services that individuals need when they
12 leave emergency rooms and when they need
13 acute-care inpatient services.
14 We have to get the payment service and
15 the service system aligned so that especially
16 those high-risk individuals get the services
17 they need. And that's something we're going
18 to be working on this year, and it's in the
19 DOH budget.
20 ASSEMBLYWOMAN MILLER: I think --
21 because I applaud, I think it's a wonderful
22 goal. But if it's not fully there, we can't
23 ignore it and just, you know, oh, we're
24 there, and put these people out prematurely
73
1 if the service isn't there yet to meet their
2 needs and give them the supports that they
3 need.
4 COMMISSIONER SULLIVAN: I think the
5 issue is that individuals can only be in
6 mental hospitals against their will if
7 they're acutely dangerous.
8 ASSEMBLYWOMAN MILLER: But what about
9 a transition?
10 COMMISSIONER SULLIVAN: But the
11 transition is what we need to fund, that's
12 the issue. We need to fund those
13 transitions.
14 ASSEMBLYWOMAN MILLER: Or a transition
15 residence.
16 COMMISSIONER SULLIVAN: And we do have
17 some transition residences and respite beds,
18 which we have the $50 million in capital
19 which we're going to be putting up. Those
20 will be transition beds. Which will be very
21 helpful, I think, to the system.
22 Thank you.
23 ASSEMBLYWOMAN MILLER: Thank you.
24 CHAIRWOMAN YOUNG: Thank you.
74
1 Our next speaker is Senator Savino.
2 SENATOR SAVINO: Thank you, Senator
3 Young.
4 Good morning, Commissioner. I want to
5 go back to the discussion about the reduction
6 in beds. I'm curious as to whether or not --
7 I see sitting behind you Commissioner Arlene
8 González-Sánchez of OASAS. And I'm somewhat
9 curious as to whether or not we -- are your
10 agencies coordinating together? You know, we
11 are all struggling with this opioid abuse
12 crisis, but quite honestly it's bigger than
13 just opioids, it's addiction in general.
14 And many of the patients in New York
15 State that are struggling with addiction went
16 down that road starting in their doctor's
17 office, whether it was pain management or
18 psychiatry or a combination of the two. We
19 know that depression and pain intersect. We
20 know that many people who have been in an
21 accident or the victim of an assault, who
22 have chronic pain, also suffer from
23 posttraumatic stress disorder. And we see
24 patients who are being prescribed almost a
75
1 toxic combination of drugs to handle their
2 pain, their depression, their anxiety. Many
3 of them are chronically addicted now under
4 the care of a psychiatrist and a doctor.
5 So when those patients go into crisis
6 because of abusing their medication, which
7 they get legally from their physician, where
8 do they go? Right now they go into the
9 emergency room, they go from the emergency
10 room maybe into a detox bed if you can find a
11 detox bed when they're being released. So
12 what I'm wondering is, is there the kind of
13 proper coordination between OMH and OASAS to
14 really begin to address this new category?
15 We've always had MICA patients -- mentally
16 ill, chemically addicted -- but this is
17 almost of an epic proportion, the number of
18 patients who are cycling in and out and not
19 really getting the services that they need,
20 because it seems to be disjointed.
21 So can you speak to the types of
22 coordination that exist between OMH and
23 OASAS, and do you think we could do better?
24 Are we directing the money properly to help
76
1 really get a handle on this crisis?
2 COMMISSIONER SULLIVAN: I think we
3 work very well with OASAS, and we're
4 really -- the important thing here is for
5 both -- for those who treat mental illness to
6 understand and be able to appropriately use
7 medications for individuals who are addicted
8 to, to understand addiction. And for
9 individuals who are primarily addiction
10 treatment, to understand and work with mental
11 health.
12 And we have done together a lot of
13 training. We also have a dual licensure
14 program now where our clinics can be licensed
15 in both addiction services and mental health
16 services. And when you do that, when you say
17 that you're licensed, then you make sure that
18 everyone is really well-trained and that the
19 services are well-designed to be able to have
20 that kind of single point of entry so when
21 someone comes in, a clinician, skilled, can
22 decide which kinds of services someone needs
23 the most of.
24 I absolutely agree with you that we
77
1 need to be making sure that psychiatrists are
2 well-trained in understanding the risks of
3 using some of these drugs. I think some of
4 them are, and some are not. But we've been
5 doing a lot of training of psychiatrists
6 across the state, we've been doing a lot of
7 training of psychiatrists who are primarily
8 mental health clinicians, in using
9 appropriate medications for addiction
10 services, because some of them were not as
11 up-to-speed. So we've been doing training in
12 that area.
13 So yes, we're working very closely. I
14 think our -- both our goals I think is to
15 have any family member or any individual who
16 comes in for help, that they can get the help
17 they need whichever door they come in,
18 whether they come in something that's a
19 little more mental health than addiction or a
20 little more addiction than mental health.
21 So yes, we're working very closely to
22 try and work together to fight this crisis.
23 SENATOR SAVINO: I'm glad to hear
24 that. I just wonder if perhaps maybe instead
78
1 of reducing the number of beds at OMH,
2 perhaps maybe we should reclassify them for
3 this particular purpose. Just a suggestion.
4 Finally, on the adult home transition
5 I heard you respond, I think it was to
6 Senator Krueger, that since -- was it last
7 year or the year before, we've moved
8 650 people from adult homes to
9 community-based residential settings on their
10 own, which is a great thing, and that only
11 five people have returned to the adult home.
12 But does that mean that 645 are still
13 living on their own independently?
14 COMMISSIONER SULLIVAN: Yeah. Yeah.
15 SENATOR SAVINO: Because what I was
16 concerned about is that maybe some of them
17 are decompensating on their own and moving
18 into nursing homes. Because we've heard from
19 some of our nursing home providers that they
20 are now providing almost residential
21 treatment to people who used to live in an
22 adult home or an adult facility.
23 COMMISSIONER SULLIVAN: I don't think
24 of that cohort. I'm not saying that there
79
1 aren't others that maybe have transitioned to
2 nursing homes or discharged perhaps from
3 acute care and then go to nursing homes. But
4 not that cohort. The vast majority, they
5 have really been successful in the community.
6 SENATOR SAVINO: Okay. Thank you.
7 SENATOR KRUEGER: Thank you.
8 CHAIRWOMAN WEINSTEIN: Assemblyman
9 Santabarbara.
10 ASSEMBLYMAN SANTABARBARA: Thank you.
11 Thank you, Commissioner, for being
12 here. And thank you for your testimony.
13 You talk about supportive housing
14 opportunities and the investments that we
15 have made. And I know in my district there's
16 still a significant shortage of supportive
17 housing, and in the Capital Region. I know
18 at the last round of funding we did see -- we
19 were able to add some additional
20 opportunities. But what I'm hearing from
21 places like Schenectady ARC in Schenectady
22 County and Montgomery ARC in Montgomery
23 County in my district -- which are both here
24 today -- is that the direct care crisis is
80
1 presenting a challenge to support these new
2 opportunities.
3 So the turnover rates continue, the
4 vacancy rates continue. And last year we did
5 include some funding to support direct care,
6 direct care staff. But has any thought been
7 given to the new housing opportunities in
8 relation to the direct care crisis?
9 COMMISSIONER SULLIVAN: For mental
10 health, what we try to do in terms of
11 supportive housing for individuals who are
12 mentally ill when we have either reinvestment
13 dollars or whatever other source, we look at
14 needs in various communities.
15 So I think we try to look at the needs
16 where they're greatest, to try to get
17 providers to put up the beds in those areas.
18 So I think we continue to look and to work on
19 that. I think we're not where we need to be
20 yet in terms of having enough supported
21 housing. But as dollars continue to come
22 into the system for the seriously mentally
23 ill, we continue to look at other places in
24 the state that need those the most.
81
1 And when RFPs come into those, that's
2 part of the judgment as to where housing
3 should go.
4 ASSEMBLYMAN SANTABARBARA: If the
5 shortage continues, is there additional
6 investments that are planned for the future
7 to reduce that shortage?
8 COMMISSIONER SULLIVAN: Yeah, we're
9 trying to reduce the shortage as much as we
10 can.
11 ASSEMBLYMAN SANTABARBARA: Just one
12 more question. You mentioned the $50 million
13 for transition beds earlier. Where are those
14 located?
15 COMMISSIONER SULLIVAN: That RFP will
16 come out, and then we will get responses.
17 And we're hopeful that we get responses from
18 all over the state. And that's $50 million
19 in capital to develop the respite beds. And
20 those could be anywhere in the state. As
21 soon as the budget's over, we'll get the
22 paperwork out and we'll start to get requests
23 for those beds.
24 ASSEMBLYMAN SANTABARBARA: Thank you.
82
1 COMMISSIONER SULLIVAN: Thank you.
2 CHAIRWOMAN WEINSTEIN: Thank you.
3 CHAIRWOMAN YOUNG: Thank you.
4 Commissioner, I do have some follow-up
5 questions. We were talking about children's
6 services, and I believe there are a lack of
7 children's services in the state. What
8 concerns me too is that the Governor's
9 proposed budget has a delay of the
10 implementation of expanded Medicaid mental
11 health services for children. These
12 services, as you know, were originally
13 scheduled to be implemented on July 1st of
14 this year and now will be delayed for two
15 years. The Governor has indicated that this
16 delay is to preserve the financial plan.
17 And some providers -- this is part of
18 the problem -- had already hired staff and
19 made preparations. These providers now face
20 substantial challenges in the face of this
21 delay.
22 So the question is, will the 30-day
23 amendments that are out this Thursday include
24 any assistance to help these providers that
83
1 are impacted by the delay in children's
2 services?
3 COMMISSIONER SULLIVAN: That's being
4 discussed. I can't answer whether or not the
5 30-day amendments at this point will.
6 I do know that we, as the Office of
7 Mental Health, will be working very closely
8 with the impacted child agencies. We have
9 something that we call the technical
10 assistance program, and we'll be working very
11 closely with them to assist them in whatever
12 the delay is, whether it -- hopefully to help
13 them be able to redesign so that they will
14 not be at financial risk.
15 Basically there were some changes that
16 were federal changes to HCBS services, the
17 waiver services for kids, that were
18 independent of this delay. But some -- they
19 happened about the same time, so they
20 unbundled some services, making it more
21 difficult for certain providers to bill,
22 et cetera. We're going to be working with
23 them very closely to be able to do that.
24 So we're going to be doing a lot of
84
1 technical assistance. Some providers are not
2 in difficulty; even though they had changed
3 some things, they've been able to adapt.
4 Others are. So we're going to be working
5 very closely with them from the OMH
6 perspective on a technical assistance side.
7 CHAIRWOMAN YOUNG: So it sounds like,
8 Commissioner, the answer is no, that these
9 will not be in the 30-day amendments.
10 COMMISSIONER SULLIVAN: I don't know,
11 actually, Senator. I can't answer it,
12 Senator.
13 CHAIRWOMAN YOUNG: Well, I would urge
14 you to discuss this with the Division of
15 Budget and the Governor, because obviously
16 there's a critical need out in the
17 communities regarding children's services.
18 And I think that even though there's a
19 financial impact, I think delaying them is
20 the wrong direction to take. So thank you.
21 CHAIRWOMAN WEINSTEIN: Assemblyman
22 Oaks.
23 ASSEMBLYMAN OAKS: Yes, thank you,
24 Commissioner.
85
1 Earlier there was some discussion on
2 the jail-based restoration program. And just
3 checking with you, at this point has there
4 been specific -- I know this is the
5 Governor's proposal. Has there been talks
6 back and forth with the county sheriffs and
7 the local jails, and have counties expressed
8 an interest in this program at this point?
9 Just where are we?
10 COMMISSIONER SULLIVAN: We have had
11 some discussions. We don't have any firm
12 commitments from any counties yet.
13 ASSEMBLYMAN OAKS: Okay. And do we
14 know, is there funding behind it? And, you
15 know, how will counties, should they choose
16 to do it, how much -- do we know how much
17 they would receive back, a portion of what
18 they spend on it or whatever is the actual
19 cost, been discussed?
20 COMMISSIONER SULLIVAN: Yeah, there's
21 $850,000 in the budget to support the
22 establishment of a pilot for this. And also
23 some of those dollars could be ongoing,
24 depending upon the need, after it's
86
1 established.
2 Basically what counties pay now -- the
3 cost for a restoration bed is about $120,000.
4 Counties pay half of that, which is about
5 $60,000. With jail-based restoration,
6 because you don't have the overhead costs of
7 inpatient hospitalization, counties would
8 probably be expected to pay something like
9 $20,000, $25,000. So there's significant
10 savings to the county if they do this. And
11 also there's the $850,000 which is in the
12 budget to support the establishment of
13 jail-based restoration.
14 ASSEMBLYMAN OAKS: Thank you on that.
15 I didn't see funding in the Governor's
16 proposal for the Joseph P. Dwyer program,
17 which serves veterans in 16 counties around
18 the state for things like posttraumatic
19 stress and addiction and employment or even
20 just welcoming veterans as they're returning
21 back home.
22 Hopefully -- I know in last year's
23 budget there was a $3.1 million line for
24 that. Hopefully it will get restored -- and
87
1 we're talking about restorative things --
2 restored through negotiations with the
3 Legislature. Do you see the importance of
4 this program or these types of programs as a
5 part of the important kind of community-based
6 services to supplement other state and local
7 programs that we have?
8 COMMISSIONER SULLIVAN: I think
9 that's -- the Peer-to-Peer program is a very
10 valuable program. I think it's very
11 important for our veterans. It is not in our
12 budget, so I can't speak to the restoration,
13 but it's not in our budget. But those kinds
14 of services for vets are very valuable and
15 have been shown to have a significant impact
16 on the lives of veterans.
17 ASSEMBLYMAN OAKS: Thank you very
18 much.
19 CHAIRWOMAN YOUNG: Thank you.
20 Senator Savino.
21 SENATOR SAVINO: Thank you.
22 One follow-up; I'll probably ask this
23 of the other two commissioners as well. As
24 you know, there has been some concern on the
88
1 part of the service providers over the years
2 about rising costs and their ability to meet
3 the demands of the minimum wage increase. So
4 I was wondering if you could talk about
5 how -- whether or not we're addressing
6 that for the agencies that are going to be
7 providing services to the mentally ill.
8 COMMISSIONER SULLIVAN: Yeah,
9 basically the increase in salaries we have
10 for the agencies providing mentally ill --
11 3.2 -- a 6.5 percent increase for direct
12 service, and for clinicians, a 3.25 percent
13 increase in the direct -- in salaries. And I
14 think that that is very welcome and very
15 important for our staff, and I think it can
16 make a significant difference. So we're very
17 pleased that that's in the budget, and I
18 think it's very supportive of our agencies.
19 SENATOR SAVINO: And finally, in the
20 Governor's budget there's a proposal to
21 clarify -- that's what it says, clarifying
22 which tasks and assignments performed by
23 certain individuals require psychology,
24 social work or mental health practitioner
89
1 licensure. This applies to social and mental
2 hygiene workers employed by programs or
3 service organizations; OMH is one of them.
4 Can you -- the Governor wants to
5 extend the current exemption of licensure
6 through July 1, 2020. Can you give me a
7 sense of the history of this exemption?
8 because as you know, a lot of effort went
9 into developing a license for social workers,
10 so that the degree and the work would allow
11 them to advance.
12 So this continuation of the exemption
13 of licensed professionals in this field is an
14 issue that NASW and others have a concern
15 about. Can you explain the history and why
16 we're continuing this exemption?
17 COMMISSIONER SULLIVAN: Yeah. When
18 the initial legislation was passed, it was
19 largely affecting individuals who are what we
20 say in kind of private practice. In other
21 words, that are licensed. An unlicensed
22 social worker should not be able to provide
23 independent services in a private practice or
24 an unregulated setting.
90
1 We have always had, in our Article 31
2 clinics -- which is where the exemption
3 exists, the only place it exists -- and in
4 the clinics in the state system, we've always
5 had a system of supervision, where treatment
6 plans are signed off on by physicians and
7 supervisors, where there are treatment team
8 meetings, where there's joint treatment
9 planning. It's really quite intense.
10 And that level of supervision over the
11 years has been felt to really be sufficient
12 in terms of protecting the individuals who
13 receive the services and in ensuring that the
14 individuals who provide them are of the
15 caliber that they need to be. But
16 technically, no, they are still unlicensed.
17 Now, within the system as it exists
18 even now, individuals can never do anything
19 beyond their scope of practice. That's
20 determined by their schools and where they
21 come from. So that scope of practice is what
22 is there. What the exemption did was not
23 require some levels of supervision, which are
24 now in the new proposal, that as tightly or
91
1 as -- what am I trying to say here -- as
2 well-documented, because they'd had this
3 other system.
4 So, for example, now we're trying to
5 align the two so that instead of having an
6 exemption out there, we are really providing
7 the appropriate services. However, almost
8 all of the services that unlicensed people
9 provide can still be provided within our
10 system. The one area is the ability to
11 diagnose, and the ability to diagnose should
12 be under supervision by State Ed requirements
13 for certain work that is done.
14 So what it really does is kind of
15 tighten it up. And I think letting the
16 exemption be there for another two years
17 enables the clinics that -- to be ready, and
18 then people coming in in the future.
19 Students who are coming to -- there should be
20 no significant change in there, because they
21 were always supervised.
22 So I think where it came from
23 historically was this concept of unlicensed
24 individuals without a lot of supervision
92
1 being out there maybe doing things. But
2 this -- in our system, we have this whole
3 layer of supervisory structure, which is why
4 the exemption went on so long.
5 SENATOR SAVINO: All right. Thank
6 you.
7 CHAIRWOMAN YOUNG: Thank you.
8 CHAIRWOMAN WEINSTEIN: Thank you.
9 We've been joined by Assemblywoman Pat Fahy.
10 And to Carmen de la Rosa for a
11 question.
12 ASSEMBLYWOMAN DE LA ROSA: Thank you.
13 Thank you, Commissioner, for being
14 here and for providing testimony.
15 You know, last session my colleagues
16 and I made it a priority to talk about
17 suicide prevention in our communities,
18 specifically for the African-American
19 children and the Latino children, because
20 we're seeing trends, upward trends in
21 children, at early ages, attempting suicide.
22 And so the task force as well as the caucus,
23 we got together and we made it a priority to
24 not only push for funding for local providers
93
1 that were working in our communities, but to
2 also push to make sure that the services were
3 culturally fluent in our communities. And we
4 actually passed legislation to do that.
5 And I see that the last point in your
6 testimony talks about, you know, the
7 significant investment and commitment to
8 making sure that these services are provided
9 in our state.
10 So I have two questions. The first
11 one is, what does that look like in your
12 budget? What are the programs that OMH is
13 trying to put together to make sure that
14 these services come down to minority
15 communities? And the second is, how is OMH
16 working with local providers to make sure
17 that each sort of corner of the state is
18 touched?
19 COMMISSIONER SULLIVAN: Thank you.
20 You know, I think that the budget
21 right now for -- is about $3 million for
22 overall suicide prevention. We also have a
23 grant of $3.5 million for suicide prevention.
24 So that makes about $6.5 million directly for
94
1 suicide prevention.
2 I think that -- there's a couple of
3 things that we're doing. One is a very
4 wide-based clinical training for providers,
5 training for communities, training for first
6 responders, training for teachers, community
7 organizations, et cetera, on suicide
8 prevention, safe talk, a whole host of
9 various trainings that we do. And last year
10 we touched about 7,000 individuals in
11 training across the state.
12 Those touch our minority communities,
13 but they -- I can't say that they were
14 specific -- I mean, every place we do it, we
15 do it specific to that cultural area, but I'm
16 not saying that they were specifically geared
17 towards those communities, except where we
18 provided them. So that I can't break out for
19 you exactly -- I could get it to you if you
20 need -- how many of those touched minority
21 communities, et cetera. But depending upon
22 where we do the trainings, we take into
23 account all the cultural issues about the
24 training.
95
1 So that's a training system that we
2 have set up and we have been doing now for
3 over five or six years on an ongoing basis.
4 That touches the communities. The other
5 areas that we have where we've been spending
6 a good amount of dollars, including a grant,
7 is something called working with all the
8 mental health providers. You know, as we
9 know, 20 percent of individuals who
10 unfortunately successfully commit suicide
11 have had contact with a mental health
12 provider a month before. So that's a kind of
13 red flag that maybe our providers aren't
14 being as attuned to what they should be,
15 wherever they are located across the state.
16 So that's called Zero Suicide, and we
17 have invested a lot of training and work on
18 that and had a grant from the federal
19 government, from SAMHSA -- that's the
20 3.5 million -- within health systems to
21 expand and to get the appropriate screening
22 in emergency rooms, the appropriate screening
23 in inpatient units and in clinics, and
24 enabling staff to do really evidence-based
96
1 best practices in suicide.
2 The third arm is a collaborative we've
3 had with 170 clinics across the state in
4 terms of suicide prevention. Some of those
5 are in minority communities, some of those
6 are in other communities. And they are
7 working with us on doing suicide best
8 practices.
9 And then lastly on the introduction
10 into collaborative -- in collaborative
11 care -- and a lot of this has happened
12 through DSRIP, and also through other funding
13 within budgets for collaborative care -- of
14 screening for depression in primary care
15 clinics, both for adults and for adolescents.
16 And this is really probably one of the most
17 important places to be doing this kind of
18 screening. And we have done this, again,
19 across communities across the state,
20 including minority communities.
21 The PHQ-9, which is the screening
22 tool, has been translated into multiple
23 languages and is available across the state.
24 And that kind of screening really identifies
97
1 individuals who otherwise would not be coming
2 forward. And that kind of screening occurs
3 in primary care clinics.
4 Now, in addition to all that, we know
5 that we have targeted populations that have
6 been growing in suicide attempts and risks.
7 One is the Latino community; another is the
8 LGBTQ community. And the Governor has
9 established a task force which is looking at
10 particularly the gaps in what we are doing,
11 that we are not doing as much as we should.
12 And that task force is looking
13 particularly at those populations and will be
14 coming out with recommendations I believe
15 towards the end of this year. And they're
16 doing focus groups, they are doing real
17 connections into the grassroots, into the
18 communities, to say what will work.
19 We are doing all this, and we're
20 hopeful it will have an impact. But
21 nationally, the suicide rate has not gone
22 down despite so many efforts. So one of the
23 things we would like the task force to be
24 doing is getting us some ideas about the
98
1 very, very best practices so that when we do
2 do more, we know that we're doing it with the
3 best possible outcome. So while we're doing
4 a lot, we really need to do more.
5 And it's just unfortunate that -- we
6 know that Zero Suicide, in terms of working
7 with mental health professionals, has an
8 impact. Community interventions do have an
9 impact. But it has not had the kind of
10 impact across the country that we would still
11 like to see in terms of really bringing down
12 the number of individuals who unfortunately
13 die by suicide.
14 ASSEMBLYWOMAN DE LA ROSA: Well, the
15 only thing that I would say is that as far as
16 the task force is concerned, one of the
17 things that's very important to us is that
18 that diversity exists. You know, not only
19 across cultures, across language, but also
20 across genders. Right? We want to make sure
21 that we have women that are represented
22 there, that we have service providers that
23 are actually doing the work in our
24 communities represented there --
99
1 COMMISSIONER SULLIVAN: Yes.
2 ASSEMBLYWOMAN DE LA ROSA: -- and that
3 we have LGBTQ individuals as well. So I
4 would just say that that's really important
5 for us.
6 COMMISSIONER SULLIVAN: Yes. Yes.
7 Thank you.
8 SENATOR SAVINO: Before Senator
9 Amedore asks a question, I would like to note
10 that Senator Gustavo Rivera has joined us.
11 Senator Amedore.
12 SENATOR AMEDORE: Thank you,
13 Commissioner, for being here and for your
14 insight.
15 I've got a quick question, and I'm
16 going to ask the same question to
17 Commissioner Sánchez of OASAS.
18 According to published reports, over
19 half the population in local jails suffer
20 from substance abuse disorder. Over
21 two-thirds of these individuals have been in
22 jail before. This is a huge problem that
23 needs to be addressed.
24 So what consideration has OMH or this
100
1 administration given to reaching out to serve
2 this population?
3 COMMISSIONER SULLIVAN: In terms of --
4 I think really -- in some ways I think that
5 is best answered by Commissioner González.
6 However, obviously those individuals
7 do come for access to care through our
8 clinics, et cetera, and through our -- to
9 psychiatrists and social workers in our
10 system of care. And what we have done is
11 really upped the ante here in terms of
12 getting our people trained to be able to kind
13 of provide the kinds of services that can be
14 provided to individuals to help divert any of
15 the problems that can come down the road.
16 So we're working very closely with
17 training and with having dual licensure,
18 having every door be a door that you can open
19 to come in for service. And that's what
20 ultimately can prevent individuals from
21 winding their ways into jails and prisons.
22 And certainly to the extent that when we
23 screen someone in our prison system for
24 mental health issues, we also note any
101
1 substance use issues and work with DOCCS, who
2 provide those services in the prison system.
3 SENATOR AMEDORE: So is there any
4 available funding to the counties through
5 local mental health agencies or the sheriff
6 to deal with this problem?
7 COMMISSIONER SULLIVAN: Local aid,
8 sometimes state aid has been used for these
9 purposes in the counties. We give state aid
10 to the counties, and the counties then report
11 back to us on how they want to use those
12 dollars. And I know that some of those have
13 been used for jail-based services in the
14 counties.
15 SENATOR AMEDORE: Okay, thank you.
16 CHAIRWOMAN WEINSTEIN: Assemblywoman
17 Gunther.
18 ASSEMBLYWOMAN GUNTHER: It's my last
19 question.
20 And I think there's now a new
21 requirement to teach mental health in the
22 schools, which I think is fabulous, I really
23 do. But is there going to be any funding in
24 the budget, with all the schools having
102
1 mandates, et cetera? They're struggling.
2 And I was wondering if there's any money in
3 the budget to help schools provide this
4 service to our children.
5 COMMISSIONER SULLIVAN: There's no
6 direct dollars in the budget, but we have met
7 with the schools, and we are providing a lot
8 of technical assistance in terms of
9 curriculum, which is what they really need,
10 in some ways, to provide this. So we're
11 working very closely with them.
12 And the school district
13 superintendents are very excited about doing
14 this. I think that they have really shown a
15 great willingness to incorporate this into
16 the curriculum.
17 And I absolutely agree with you, I
18 think in terms of reducing stigma and
19 ultimately being able to have really an
20 impact on future generations, this kind of
21 mental health education in schools is
22 critical. So we're really providing
23 technical assistance in whatever way possible
24 for a standardized curriculum.
103
1 ASSEMBLYWOMAN GUNTHER: I agree with
2 you, and I think it's so important that kids
3 recognize other kids' depression, or
4 perhaps -- and I think this is a great
5 learning tool for all of our children.
6 COMMISSIONER SULLIVAN: Absolutely.
7 ASSEMBLYWOMAN GUNTHER: Thank you.
8 CHAIRWOMAN WEINSTEIN: Assemblyman
9 Sepulveda.
10 ASSEMBLYMAN SEPULVEDA: In that light,
11 was there recently cuts to mental health
12 services at community colleges? I believe
13 there were programs that were set up, but was
14 there a cut recently?
15 COMMISSIONER SULLIVAN: I don't know
16 that. I'm not aware of that. But I can
17 check it for you. I don't know. I'm sorry.
18 ASSEMBLYMAN SEPULVEDA: Now, this is
19 by way of statement and a comment. But we
20 hear about wonderful programs that are trying
21 to be implemented or implemented, but do you
22 have any sort of data to indicate the success
23 of these particular programs? In terms of
24 prisons, I'm sorry.
104
1 COMMISSIONER SULLIVAN: Oh, within the
2 prisons.
3 ASSEMBLYMAN SEPULVEDA: Yes.
4 COMMISSIONER SULLIVAN: We track any
5 of the programs that we put in, and we track
6 it in terms of whether or not assaults go
7 down, whether or not -- individuals'
8 satisfaction with the programs, et cetera.
9 So we do get numbers.
10 And basically they do show
11 improvement. And I think that we're not
12 where we need to be entirely yet. But yes,
13 when we put in the programs into the prisons
14 in terms of training, et cetera, we get
15 positive responses both from the prisoners
16 and from the outcomes in terms of, you know,
17 a decrease in incidents, which we like to
18 see, and also an improvement in outcomes in
19 terms of mental health, ability to go back
20 into the general population, et cetera. So
21 we track that, and we do see improvement.
22 These are evidence-based practices
23 which kind of research-wise have been shown
24 to work. So if you do them right, they
105
1 should improve care.
2 ASSEMBLYMAN SEPULVEDA: And does that
3 include any sort of racial assessment, the
4 decisions by OMH, across the board from
5 diagnosis to treatment?
6 COMMISSIONER SULLIVAN: I'm sorry? I
7 don't --
8 ASSEMBLYMAN SEPULVEDA: As part of
9 this analysis that you -- the data that you
10 collect, do you also collect data on the
11 racial impact, the racial assessment of the
12 treatment from -- from diagnosis to treatment
13 on some of the programs and policies that OMH
14 is pushing?
15 COMMISSIONER SULLIVAN: Yes. Yes.
16 ASSEMBLYMAN SEPULVEDA: Is that
17 readily available?
18 COMMISSIONER SULLIVAN: I can get it
19 to you by -- we can get to you what we have
20 by program. We look at outcome measures, we
21 look at metrics -- for example, like hospital
22 readmissions, we look at metrics -- length of
23 stay, that kind of thing. We can get you
24 impact on the programs, yeah.
106
1 ASSEMBLYMAN SEPULVEDA: And just a
2 general statement.
3 Since I've been here, the Executive
4 Budget has proposed cutting funding of
5 budgets for these types of mental health
6 programs. I think the Mental Health budget
7 should be sacred, certainly on the issue of
8 suicide. I believe that the funding that's
9 available now is woefully inadequate, and any
10 proposal to cut it more -- I know there's a
11 20 percent across the board cut for most of
12 the agencies for the state. But when you
13 consider the potentially major issues we have
14 with suicide, especially amongst the Latino
15 community 11 to 19 -- we've spoken about this
16 before. Any cut to these types of budgets I
17 think would be shameful. And I think that we
18 have to do a much better job, the Executive
19 Budget has to do a much better job, to not
20 just prevent any cuts, but should increase
21 the budget so that we can stop what I believe
22 is potentially an epidemic that's happening
23 now in our communities with Latino suicide
24 and suicide amongst communities of color.
107
1 So hopefully with the little funding
2 that you have, you can do the best you can.
3 But we shouldn't be discussing cutting any
4 budgets on mental health, we shouldn't be
5 discussing cutting budgets for suicide
6 prevention. If anything, we should be
7 discussing how do we increase it so that we
8 can implement some of these that I know have
9 been successful but are woefully, woefully
10 and shamefully inadequately funded.
11 Thank you.
12 CHAIRWOMAN WEINSTEIN: Thank you for
13 being here. I think you've answered many of
14 the -- all of the questions. Thank you so
15 much.
16 COMMISSIONER SULLIVAN: Thank you.
17 SENATOR SAVINO: Thank you,
18 Commissioner.
19 (Discussion off the record.)
20 SENATOR SAVINO: Next we're going to
21 hear from Kerry Delaney, acting commissioner
22 of the New York State Office for People With
23 Developmental Disabilities.
24 ACTING COMMISSIONER DELANEY: Good
108
1 morning, Senator Savino, Assemblymember
2 Weinstein, Assemblymember Gunther, and other
3 members of the Legislature. I'm Kerry
4 Delaney, acting commissioner of the Office
5 for People With Developmental Disabilities.
6 Thank you for the opportunity to provide
7 testimony today about Governor Cuomo's 2019
8 Executive Budget proposal and how it will
9 benefit the nearly 139,000 New Yorkers with
10 intellectual and developmental disabilities
11 who are eligible for OPWDD services.
12 Under the Governor's leadership, OPWDD
13 continues to make significant strides in the
14 transformation to a more integrated,
15 person-centered system of services and
16 supports for the people we serve. The 2019
17 Executive Budget proposal includes more than
18 $7 billion in state and federal funding for
19 OPWDD programs and services.
20 The budget proposal supports the
21 investment of $120 million in annual
22 all-shares funding to provide new and
23 expanded services for new and currently
24 eligible individuals; $15 million in capital
109
1 funding to expand affordable housing
2 opportunities; and over $275 million in
3 all-shares funding to help service providers
4 enhance staff salaries, $85 million of which
5 is provided to fund minimum-wage increases,
6 and over $190 million of which is provided to
7 support a 6.5 percent wage increase for
8 direct support and direct care staff, and a
9 3.25 percent increase for clinical staff.
10 The Executive Budget proposal also
11 supports two new critical initiatives that
12 I'd like to highlight for you this morning.
13 The first initiative is a residential pilot
14 program, to be jointly operated by OPWDD and
15 the Office of Mental Health, to serve
16 individuals with both developmental
17 disabilities and significant mental health
18 challenges. This program will ensure that
19 there are available and appropriate
20 residential opportunities for individuals
21 with significant challenges, to assist them
22 to stabilize and return to the community.
23 The second initiative would be
24 supported with a state investment of
110
1 $39 million to support the transition from
2 OPWDD's Medicaid Service Coordination program
3 to a Comprehensive Care Coordination model.
4 As you may know, we have developed a
5 new model of enhanced, cross-system care
6 coordination to be implemented by current
7 service providers who are forming Care
8 Coordination Organizations authorized under
9 the federal Health Homes program.
10 Implementing enhanced care coordination will
11 be the first step in our system's multiyear
12 move to managed care.
13 I'd like to provide you with an update
14 now on how OPWDD has been investing the
15 resources you have been providing to improve
16 the lives of the people we serve. In 2017,
17 nearly 2,100 people accessed either certified
18 or more-independent, noncertified residential
19 services for the first time. Nearly 1,300
20 people moved to a certified residence,
21 75 percent of whom came from home.
22 To meet future demand, OPWDD recently
23 approved the creation of an additional 459
24 certified opportunities by over 50 service
111
1 providers across New York State. This
2 expands OPWDD's residential footprint, which
3 supports more than 41,000 individuals at a
4 cost exceeding $5.2 billion annually and
5 remains the largest in the nation.
6 OPWDD's more-independent residential
7 assistance opportunities are expanding even
8 faster than certified opportunities. The
9 more than 5,300 rental vouchers issued in
10 2017 were more than double the number issued
11 five years ago. For the third consecutive
12 year, the budget proposes to invest an
13 additional $15 million in capital to expand
14 affordable housing capacity for individuals
15 eligible for OPWDD services. These funds are
16 in addition to the resources available from
17 New York's five-year, $20 billion affordable
18 and supportive housing plan, which also helps
19 support the development of residential
20 opportunities.
21 Unwavering support from the Governor
22 and the Legislature in recent years has
23 enabled OPWDD and our service providers to
24 provide an array of services and supports
112
1 that are among the richest and most
2 integrated in the nation. Together we have
3 built a system that now supports 78,000
4 people in day habilitation or employment
5 services; 43,000 people in respite services;
6 and 16,800 people are now participating in
7 self-direction after an increase of nearly
8 40 percent in 2017.
9 Thank you for your continued support
10 and advocacy. We look forward to working
11 with you and all of our stakeholders to
12 achieve real and lasting system-wide
13 transformation on behalf of our friends,
14 neighbors and loved ones with intellectual
15 and developmental disabilities.
16 Thank you.
17 SENATOR SAVINO: Thank you,
18 Commissioner.
19 Starting with questions is Senator
20 Krueger.
21 SENATOR KRUEGER: Hi, Commissioner.
22 So partly you -- I think you partly
23 answered when you described the joint beds
24 with OMH, because of the concern, again, in
113
1 the community -- I don't know if you heard me
2 when I asked the commissioner of OMH about
3 what seemed to be inequity in the payment
4 structure for whether you're running a
5 program serving someone with mental illness
6 as opposed to the other O contracts for
7 supportive housing.
8 So when you are doing joint projects,
9 are these then buildings with units that are
10 defined as an OMH unit versus an OPWDD unit?
11 And is it the same payment structure for both
12 sets of units?
13 ACTING COMMISSIONER DELANEY: We
14 actually are working jointly with OMH to
15 develop those units, and we are now working
16 on how they will be certified and operated.
17 But we will ensure that there is sufficient
18 funding for those units to operate.
19 SENATOR KRUEGER: But would you agree
20 that it would not be right to have two
21 different formulas of payments?
22 ACTING COMMISSIONER DELANEY: I think
23 equity is very important. I think we need to
24 have adequate payments to make sure that
114
1 people can get the services that they need,
2 so that they can receive those
3 community-based supports.
4 SENATOR KRUEGER: And then in your
5 testimony you talk about 16,800 people now
6 participating in self-directed services,
7 which is an increase of nearly 40 percent in
8 2017. Can you explain a little bit to me
9 what we mean by self-directed services?
10 ACTING COMMISSIONER DELANEY: Sure.
11 Self-directed services are an option that we
12 have available for individuals who want to
13 have more control over arranging and the
14 delivery of their services.
15 So in more traditional service models,
16 an individual works with an agency; that
17 agency will arrange staffing, will arrange
18 the programs the individual needs. In
19 self-direction, individuals will work
20 directly to hire their own staff, to arrange,
21 for example, classes they're interested in
22 attending. So it gives people a lot more
23 control over the services that they're
24 receiving and their staffing.
115
1 SENATOR KRUEGER: And how do you
2 evaluate that model compared to models that
3 are actual programs that you contract with?
4 ACTING COMMISSIONER DELANEY: Well,
5 these are programs that individuals with
6 self-direction participate in. So for
7 example community habilitation, where an
8 individual hires a community habilitation
9 worker to go with them in the community and
10 help them learn skills. So oftentimes
11 they're the same types of work that's
12 happening in traditional provider settings,
13 but the individual is just arranging for
14 their own services.
15 We look at things like individual
16 satisfaction. We have a number of groups
17 around the state that we are meeting with
18 that contain our stakeholders who are talking
19 with us about either their concerns about
20 self-direction or areas where they feel
21 self-direction is really assisting them to
22 get the services that they need. And
23 overall, it does have very high satisfaction
24 reported from participants.
116
1 SENATOR KRUEGER: So your population
2 at OPWDD is sort of one of the later ones to
3 explore moving into Medicaid managed care
4 through Health Homes. And I guess the public
5 comment period just closed a month ago. So
6 yesterday many of us sat through an entire
7 day of hearings on health and Medicaid where
8 there were endless people who testified,
9 Here's what's not working with Health Homes,
10 here we've done Health Homes, or here it's
11 time to stop Health Homes.
12 So you're late into the entire story
13 line. You still believe that this is a model
14 that makes sense for the population you're
15 serving, even though there's a lot of lessons
16 to be learned about what the state rolled out
17 with different populations.
18 ACTING COMMISSIONER DELANEY: I do. I
19 do.
20 SENATOR KRUEGER: And how are you
21 going to be different and not make the
22 mistakes?
23 ACTING COMMISSIONER DELANEY: I do
24 think it's still a model that needs to be
117
1 pursued. We have looked at and spoken with
2 our sister state agencies about challenges
3 that they've had, about things that are
4 working, and we really believe that this is
5 the right model because of the cross-system
6 care coordination.
7 Oftentimes people with developmental
8 disabilities have needs that cross the mental
9 health system, they have physical health
10 needs, and bringing those services all
11 together behind one care manager we think
12 really will be helpful. But many of the
13 challenges that have been experienced we are
14 working on ways to ensure our system has
15 resolved before we roll out Health Homes
16 later this year.
17 SENATOR KRUEGER: And how many Health
18 Home providers do you estimate working with?
19 ACTING COMMISSIONER DELANEY: We have
20 not finalized the review process yet. We had
21 10 applicants to become CCO Health Homes.
22 We've now approved six. We have four more
23 that are still under review.
24 SENATOR KRUEGER: And the six that
118
1 you've approved are already working with
2 other populations so they have a track
3 record, or they're new entities?
4 ACTING COMMISSIONER DELANEY: No, we
5 felt that it was very important, after
6 listening to our stakeholders, that OPWDD's
7 Health Homes be comprised of OPWDD providers,
8 who really understand the unique and
9 habilitative nature of our services. So our
10 providers are actually starting OPWDD
11 eligible-individual-specific Health Homes.
12 SENATOR KRUEGER: My time's up. Thank
13 you.
14 ACTING COMMISSIONER DELANEY: Thank
15 you.
16 CHAIRWOMAN WEINSTEIN: Thank you.
17 Assemblywoman Gunther.
18 ASSEMBLYWOMAN GUNTHER: Thank you for
19 coming today.
20 As you know, last year's budget
21 included funding to increase salaries for
22 direct care workers. The first phase, a
23 3.25 percent increase, was due to take effect
24 January 1st of this year. Have DSPs been
119
1 receiving those increases?
2 ACTING COMMISSIONER DELANEY: We have
3 been working with the Department of Health on
4 incorporating the funding for that first
5 3.25 percent increase. That increase in
6 rates will be posted by the end of this week.
7 It will be retroactive to January 1st. So
8 DSPs should start seeing those increases very
9 soon.
10 ASSEMBLYWOMAN GUNTHER: Since 2010, we
11 have had two COLAs for our DSPs, one being
12 just .2 percent. Do you believe this has had
13 an effect on the ability to recruit and
14 retain DSPs? DSPs is direct support
15 professionals, by the way.
16 ACTING COMMISSIONER DELANEY: I think
17 there are a number of factors that impact our
18 ability to recruit and retain DSPs as a
19 system, salary obviously being one of the
20 most significant. That is why the Governor
21 and the Legislature last year worked together
22 to provide about $191 million in funding to
23 support what will amount to a 6.5 percent
24 increase over the course of this year, so the
120
1 January and April amounts.
2 So we are going to be monitoring the
3 impact of that increase. There are also a
4 number of other actions that we're taking to
5 try to help develop and continue to
6 professionalize our direct support workforce,
7 including working with community colleges and
8 other entities to try to develop a workforce
9 for our DSPs.
10 ASSEMBLYWOMAN GUNTHER: Do you believe
11 that it would be beneficial to create a
12 career ladder and credentialing? You know,
13 the care that direct support professionals
14 give on a daily basis to a lot of times our
15 most vulnerable folks, and it's not
16 considered a career. And it's been -- you
17 know, having just opened a casino, which
18 we're grateful for, but the -- as far as the
19 reimbursement.
20 The other issue I think is important
21 to talk about is most of the people that work
22 in DSPs across New York State are women, many
23 of them women with children.
24 So I think that, you know, in order to
121
1 provide this care, we have to look at the
2 whole picture. And I think a career ladder
3 is important, and I also think that there are
4 women -- and these are low wages. You know,
5 now that we increased minimum wage, look at
6 the care they're giving to this vulnerable
7 population.
8 ACTING COMMISSIONER DELANEY: Yes. I
9 think the two issues you raised are
10 incredibly important in how we can recruit
11 and retain additional DSPs.
12 First, with respect to the credential,
13 as you know, several years ago we did a
14 comprehensive study designed to look at how a
15 credential would operate in our system. We
16 have now been working over the last several
17 years to develop a pilot program for a
18 credential, which we anticipate to be
19 operational within the next year or so.
20 And you're absolutely right, about
21 75 percent of the direct support workforce
22 are women. And one of the things we've been
23 looking at -- and in addition to the work of
24 the Governor's Task Force on Women and Girls,
122
1 we're looking at issues related to improving
2 the economic standing of women -- is we've
3 been looking at how we can make our
4 workplaces more flexible, more
5 individual-friendly, looking at flexible
6 scheduling, working with our providers, on
7 how we can really take the workforce that we
8 have, which is predominantly women, and adapt
9 in some ways to the needs that women have.
10 ASSEMBLYWOMAN GUNTHER: I've heard
11 complaints from providers that they don't
12 even receive their rates, you know, their
13 rates for the next year in order to make an
14 appropriate budget, until six months after
15 the beginning of the fiscal year.
16 Is OPWDD doing anything about that?
17 And I hear this from many of the providers:
18 How can you have a budget for a year when you
19 don't know what your rates are going to be?
20 And I just think that they're living on the
21 edge at this moment. You know that salaries
22 are difficult to go up. And basically I feel
23 that the least we can do is give them their
24 rates so they can make an appropriate budget.
123
1 And I hear this from all the agencies across
2 New York State.
3 ACTING COMMISSIONER DELANEY: It is
4 accurate that rates that were effective
5 July 1st of 2017 were only published months
6 later. That is not a situation that we
7 wanted to be in or that the Department of
8 Health wanted to be in. They are the lead
9 rate-setting entity for Medicaid, as you
10 know.
11 However, we and the Department of
12 Health began hearing a number of concerns
13 from providers about the expected impact of
14 those rates. And we really felt that it was
15 important to take the time, before we just
16 went out with the rates, to understand what
17 those concerns were. And we actually made a
18 number of changes to the methodology based on
19 what we heard from providers during that time
20 period. So we really did take that time to
21 try to improve the rate methodology so that
22 the end product was better and was something
23 that many of our provider associations who
24 helped us in this process could support.
124
1 ASSEMBLYWOMAN GUNTHER: Well, they
2 live very close to the edge. And when you
3 get a letter a year later that you owe
4 New York State a million dollars and you have
5 to come up with the money, it makes it very,
6 very difficult to budget at all. And I mean,
7 these are large agencies that are really
8 providing such vital services.
9 The Executive Budget also provided
10 $30 million for OPWDD service expansion. Do
11 you feel there's a sufficient amount of
12 resources to meet housing and other
13 community-based needs?
14 ACTING COMMISSIONER DELANEY: So the
15 $30 million becomes $60 million when you add
16 in the federal share. And when you look at
17 the commitments for last year that are
18 annualizing and what we expect to bring
19 online this year, it's really the value of
20 $120 million that we receive for services
21 this year.
22 We do believe that that commitment
23 will meet individuals' needs. In fact we
24 were able to, as you know, put out a request
125
1 for services for 459 new housing
2 opportunities. So we believe that that
3 funding will really help us this year to grow
4 our service system.
5 ASSEMBLYWOMAN GUNTHER: Do we have an
6 accurate number -- I know that I have a lot
7 of parents that come and meet with our
8 office, and I just think this is an important
9 point. What they feel is like they have
10 young people that have been together since
11 early childhood, and a lot of the housing, it
12 seems that goes to emergent situations. That
13 there's 459 spots, and there's a waiting
14 list, but what happens is when there's an
15 aging parent, that person goes to the top of
16 the list.
17 So movement in that 459 doesn't seem
18 to be -- there doesn't seem to be much
19 movement. And I think that having talked to
20 parents, that the trepidation, the anxiety --
21 and also, when we talk about self-directed
22 care, there are young people that I've met,
23 they've been in the same school, they're in
24 the DD community for seven, 10 years. And
126
1 the parents are friendly. So their wish in
2 life is that they stay together. And because
3 of the housing situation, that might never
4 happen.
5 And, you know, in the past like
6 parents have, you know, offered to pay for
7 the house itself, to put their finances
8 together and buy the house. But we need the
9 service. And, you know, I think in the
10 future that what I'm hearing is there are not
11 enough available spots, even though we made
12 some investment, that we don't even have any
13 realization of how many people are waiting in
14 line.
15 ACTING COMMISSIONER DELANEY: One of
16 the things that we've done over the course of
17 the last several years is to really try to
18 take a proactive look at who will need
19 housing in our system in the coming years.
20 We looked at what the natural turnover is,
21 and with 41,000 opportunities, you can
22 imagine we have significant turnover each
23 year. And then we looked at what we think
24 will be needed investments, so that we can
127
1 make sure that parents and loved ones
2 understand that we are developing new
3 opportunities as we need them.
4 We've actually worked with a number of
5 families who have come to us with those kind
6 of creative options and said they wanted to
7 work towards buying a residence, could a
8 provider provide staffing for that, and we've
9 successfully done that on a number of
10 occasions. And flexibility and creativity --
11 ASSEMBLYWOMAN GUNTHER: I had one in
12 my community that I know of that worked with
13 an ARC.
14 ACTING COMMISSIONER DELANEY: Yes.
15 ASSEMBLYWOMAN GUNTHER: But only one.
16 ACTING COMMISSIONER DELANEY: Yes.
17 They can sometimes be difficult within our
18 current structure of the Home and
19 Community-Based Services Waiver, but we've
20 done it successfully. We want to do more of
21 that. And in the 1115 waiver that we're
22 moving to, that's the place where we want to
23 try to provide a lot more of that flexibility
24 and ability to more creatively meet people's
128
1 needs.
2 ASSEMBLYWOMAN GUNTHER: The next thing
3 I wanted to talk about is telemedicine, which
4 I'm very fond of.
5 Do you believe that the use of
6 telemedicine can be an effective way to
7 improve health outcomes and improve
8 efficiencies in the OPWDD system?
9 ACTING COMMISSIONER DELANEY: I
10 absolutely do. I think, as Commissioner
11 Sullivan indicated, telemedicine is certainly
12 something we'll be talking about a lot in the
13 future of healthcare in the coming years.
14 But for many of our individuals, the
15 individuals we serve, particularly those who
16 have concerns, difficulty leaving their
17 homes, what we want to do is enable them to
18 receive access to specialty services that
19 they need right from their homes. Certainly
20 it has to be carefully done. We have to make
21 sure that where someone needs emergency
22 response, they can have that.
23 But we think telemedicine will overall
24 improve the quality of care and individual
129
1 outcomes for the people we serve, and also
2 help us provide services in areas where we
3 don't have enough providers and people would
4 have to travel very long distances to see a
5 specialist that they might need.
6 ASSEMBLYWOMAN GUNTHER: The Executive
7 Budget also includes $38.9 million to support
8 the establishment of Care Coordination
9 Organizations, or CCOs. Can you provide more
10 detail about what this funding will be used
11 for and how it will be distributed in
12 New York?
13 ACTING COMMISSIONER DELANEY: Sure.
14 We are, as I noted, establishing Care
15 Coordination Organizations under the federal
16 Health Home program. Those entities will
17 have a number of startup costs, including IT,
18 which is a very significant cost --
19 ASSEMBLYWOMAN GUNTHER: And difficult
20 in places in upstate New York.
21 ACTING COMMISSIONER DELANEY: And
22 difficult, absolutely.
23 -- and a number of other costs as they
24 start up these new organizations, which will
130
1 be made up of OPWDD providers. So that
2 funding is really going to support these
3 startup costs in IT and in other things.
4 CHAIRWOMAN WEINSTEIN: Thank you.
5 Senate?
6 SENATOR SAVINO: Senator Brooks.
7 SENATOR BROOKS: Thank you.
8 And good morning. Or good afternoon,
9 whatever it is. Just a couple of points.
10 First I think on the caregivers. I
11 think it is absolutely critical that we work
12 on a career-path-type program for them. I
13 think these folks are doing an outstanding
14 job, and we really haven't given them the
15 recognition and the compensation that they
16 deserve.
17 On your transition plan to the managed
18 care program, we're hearing a lot of concern
19 from the parents, as they're not really sure
20 what's totally happened. Can you talk about
21 how you're providing them the information on
22 what's going on, what benefits they're going
23 to see from these programs, and what input
24 they'll have in the care given to these
131
1 individuals going forward?
2 ACTING COMMISSIONER DELANEY: Sure.
3 We have been talking about the move to
4 managed care in our system for a number of
5 years, and we've held a number of public
6 forums. We have released a number of
7 stakeholder messages, webinars, we have
8 videos on our website. We are really trying
9 to work with the individuals we serve and
10 their parents, to understand what the next
11 several years in our system will bring. We
12 are always looking for how we can improve
13 communication to the people we serve and
14 their families.
15 But we have been talking about these
16 changes for a number of years. We've been
17 meeting with parent groups, with advocacy
18 groups, and trying to get the understanding
19 out there of the changes coming to our
20 system, and we'll continue to do so.
21 SENATOR BROOKS: From a housing
22 standpoint, as has been pointed out, there
23 are a number of parents rightly concerned
24 with what the future is going to hold.
132
1 Can you address or put together a
2 situation where you're providing some of
3 these parents with an indication of your
4 longer-range planning so they can see that
5 these facilities are going to be available
6 for their children when that time comes? It
7 is a major concern. As has been mentioned,
8 many of the parents are looking to put funds
9 together or use their own home for that
10 purpose. So it's a major concern.
11 And I think there's that uncertainty
12 for the parents on what the long-range
13 planning is in terms of facilities going
14 forward. I think it's important that we
15 communicate it to the people.
16 ACTING COMMISSIONER DELANEY: Yes,
17 absolutely. And our hope is that parents and
18 people in our system will see that for the
19 first time in several years, our proactive
20 development of residential supports that we
21 began this year with the 459 opportunities,
22 is exactly OPWDD doing that -- looking at
23 what our needs will be and projecting that
24 into the future, and beginning development so
133
1 that we have opportunities available when
2 people need them.
3 SENATOR BROOKS: Are you comfortable
4 with where you are in terms of facility and
5 what we have in terms of short-term needs
6 right now?
7 ACTING COMMISSIONER DELANEY: Yes. I
8 believe that with the plans that we have for
9 new development, I believe we'll be able to
10 meet the needs of those who will need housing
11 in our system in the coming years.
12 SENATOR BROOKS: Okay, thank you.
13 CHAIRWOMAN WEINSTEIN: Assemblywoman
14 Melissa Miller.
15 ASSEMBLYWOMAN MILLER: Hi. Good
16 morning.
17 ACTING COMMISSIONER DELANEY: Hi.
18 good morning.
19 ASSEMBLYWOMAN MILLER: I know that
20 we've spoken about this, and I want to thank
21 you for your commitment to working with me on
22 making some of these changes. But for the
23 sake of everybody else, I just want to
24 reiterate a little bit of what we spoke about
134
1 and what my concerns are.
2 As far as self-direction and the
3 self-direction budget that I had some
4 concerns over, my first question was
5 basically about transparency and who decides
6 what funds can and can't be used for. Is
7 there a panel that is put together, and by
8 whom? Because it doesn't seem to me that the
9 family has much input as to what the
10 individuals who are receiving the budget
11 funds -- you know, we should have some input
12 over what those funds are used for.
13 So I was just curious who decides.
14 ACTING COMMISSIONER DELANEY: You
15 absolutely should have input into how those
16 funds are used. Every person who comes into
17 the OPWDD system receives an assessment as
18 far as what their needs are, what their
19 strengths are, where they need support. At
20 that point people should be presented with a
21 range of options that will be available to
22 meet their needs. So at that point in our
23 process, families and individuals should have
24 significant input into what services their
135
1 loved one will be receiving.
2 ASSEMBLYWOMAN MILLER: But that isn't
3 what -- at what point are the decisions made?
4 What items or what services are approved in a
5 self-direction budget, and what are not?
6 For instance -- and this was the next
7 point -- it seems that skilled care services
8 or, in our case, an enhancement of a skilled
9 care service seems to be a nonapproved
10 service. So we were looking to -- since my
11 son has skilled care needs, we were looking
12 to enhance a private-duty-nursing hourly
13 rate. And that was a firm no, as something
14 you cannot do with a self-direction budget.
15 However, he is excluded from most of
16 the approved items that you can use a
17 self-direction budget for, because of his
18 skilled care needs. So it seems somewhat
19 discriminatory.
20 So I was just curious, who does decide
21 what is approved and what is not approved?
22 ACTING COMMISSIONER DELANEY: And I
23 will tell you that self-direction for people
24 that have medical challenges or significant
136
1 mental health challenges has been one of the
2 most difficult issues that we have confronted
3 as we've been trying to grow self-direction,
4 because there are some very strict Medicaid
5 rules about how funding can be used in
6 various settings, and the federal government
7 is very concerned that funding streams are
8 separated.
9 That's one of the very reasons why
10 we're moving into Health Homes and managed
11 care, because we do believe that when you
12 bring these sources of funding together and
13 you look together at all of the different
14 funds that are available to help meet
15 someone's needs, we can do a much better job
16 actually of analyzing and saying are there
17 additional nursing hours needed, how do we
18 make that happen, versus looking at it purely
19 from the, well, in self-direction, we can't
20 pay for this.
21 We change from looking at what the
22 funding stream can pay for and what the
23 requirements are to what are the individual's
24 needs and how do we bring those resources to
137
1 bear to meet those needs.
2 ASSEMBLYWOMAN MILLER: But it's -- a
3 large part of the population have these
4 medical needs, so it's --
5 ACTING COMMISSIONER DELANEY: It is.
6 It is. And again, it's been one of our --
7 one of the greatest challenges that we have
8 had with self-direction, and I know something
9 that has been very frustrating to many
10 parents and loved ones in our system who feel
11 that self-direction really is not something
12 that can meet their needs. And it's
13 something we're really looking to fix.
14 ASSEMBLYWOMAN MILLER: Especially
15 because the push is so towards
16 self-direction.
17 ACTING COMMISSIONER DELANEY: Right.
18 Well, we do want to get to a place where
19 everyone who's interested in self-directing
20 can do so. But that should not come at the
21 expense of people who want or need a
22 different type of service model or option.
23 And that should be available to those
24 individuals.
138
1 ASSEMBLYWOMAN MILLER: Okay. My next
2 question is about residential facility. And
3 there is a need, obviously, across the state,
4 but I have been contacted by numerous
5 families, and there seems to be a need for
6 one upstate, specifically in the Capital
7 District.
8 And it seems to be -- the families
9 have been asking for more of a campus-style.
10 I was happy that you were acknowledging that
11 there is a need and that you are in agreement
12 that a campus-style might be an approach that
13 would work to meet the needs for individuals
14 that have both behavioral challenges as well
15 as complex medical needs or skilled care
16 needs. It would provide, you know, similar
17 to like a college-style campus where you
18 could meet all of the needs without having to
19 really leave a facility.
20 Is there a way that maybe OPWDD could
21 work collaboratively with the Department of
22 Health, similar to how you work with OMH, for
23 funding for setting rates in order to provide
24 the necessary level of skilled care to meet
139
1 those needs?
2 ACTING COMMISSIONER DELANEY: Yes. So
3 first I would say we have looked very closely
4 and worked very hard with our stakeholders to
5 make sure that everyone lives in the most
6 community-integrated setting possible. As
7 you and I have talked about, there are some
8 individuals who because of their medical
9 needs might benefit from living with other
10 individuals. And maybe for them an
11 apartment-style setting is not the right
12 opportunity.
13 We're certainly willing to talk with
14 you, with our families, with our advocates
15 about how we can design and make sure that we
16 have the right opportunities for individuals
17 who may have skilled nursing needs or other
18 types of needs that sometimes can be
19 difficult in the community.
20 CHAIRWOMAN WEINSTEIN: Thank you.
21 Senate?
22 CHAIRWOMAN YOUNG: Senator Savino.
23 SENATOR SAVINO: Thank you, Senator
24 Young.
140
1 Thank you, Commissioner. Good to see
2 you.
3 I want to talk about an issue -- as
4 you know, you'll be coming to Staten Island
5 and to Brooklyn soon for the annual
6 breakfast, and one of the issues that always
7 comes up is the length of time it takes for
8 housing opportunities for families. As you
9 know, there's several families who have been
10 waiting a very long time.
11 And so I know -- I've read your
12 testimony and, you know, the numbers of units
13 that you think will be available soon. But
14 of the ones that are already existing -- and
15 this is an increasing concern. I had the
16 opportunity to visit a home in Staten Island
17 that's run by AHRC. It's a beautiful home,
18 you could see that the people who -- the
19 consumers that live there are very happy
20 there. But as we're seeing, many people are
21 aging in place.
22 Well, we would like them to age in
23 place in a home that they may have lived in
24 for several years now. And some of these
141
1 homes, unfortunately, were not designed to
2 help people who are developing complex
3 physical problems as they age. So they're
4 oftentimes waiting a very long time to get
5 approval for changes to the home that will
6 accommodate people who are aging in place.
7 Is there anything you can do to
8 expedite that process?
9 ACTING COMMISSIONER DELANEY: You
10 know, the issue of how people with
11 developmental disabilities age in the
12 community is very similar to that that's
13 confronted by everyone else, which is how do
14 we make sure that we have the right supports
15 in place as someone ages and as their needs
16 change.
17 Our service system probably has not
18 been as easy to navigate in those situations.
19 We are looking at how we can speed up and how
20 we can make better the process by which
21 providers come to us and say that they need
22 some funding to help make modifications to
23 allow individuals to stay in their homes.
24 SENATOR SAVINO: Well, I would
142
1 encourage you guys to develop that expedited
2 process, because it would be disruptive.
3 Now, it would not be a budget hearing
4 if I didn't turn to one of my favorite issues
5 that I think every commissioner has to
6 address because it's -- when I embarked on
7 this journey to bring medical marijuana to
8 New York State, I never thought I would be
9 like peeling back the layers of an onion.
10 And so now what we're seeing is patients or
11 consumers who are residing in homes that are
12 licensed and operated by your partner
13 agencies. They are suffering from the same
14 physical ailments and the same chronic
15 conditions that the general public does, and
16 many of them are eligible to become medical
17 marijuana patients in New York State.
18 But there seems to be some
19 concern about the delivery or the dispensing
20 of medication in these residential
21 facilities. We addressed this with school
22 nurses, who in State Ed issued an advisory to
23 school districts about nurses being able to
24 dispense medical marijuana without it being
143
1 in violation of their license, which says
2 that they can't handle Schedule 1 substances.
3 But in this instance they can, because we've
4 made that Schedule 1 substance legal in
5 New York State.
6 I have heard from some parents of some
7 of the consumers who are residing in homes
8 that they're encountering the same thing,
9 because there seems to be some concern on the
10 part of the partner agencies about whether
11 their staff can administer the medication to
12 people who are entitled to it.
13 So have you addressed that with the
14 agencies? Or are you able to do that, or do
15 you need some direction on how to make that
16 happen?
17 ACTING COMMISSIONER DELANEY: Yes, we
18 are working with the Department of Health,
19 which as you know is the lead state agency
20 tasked with implementing medical marijuana in
21 New York State.
22 There have been a number of
23 complexities that have given us some pause as
24 far as being able to implement as
144
1 expeditiously as we would like to. First we
2 had issues with the State Board of Nursing,
3 as you referenced. We're also somewhat
4 concerned about recent federal guidance in
5 this area and the impact of that on direct
6 support professionals. So we are working
7 with the Department of Health on what our
8 next best step should be in light of those
9 complexities.
10 SENATOR SAVINO: I'm glad to hear that
11 you guys are working on it. I would probably
12 like to speak offline with you about that if
13 there's a legislative issue that needs to
14 address the problem or if it's purely
15 regulatory. But I do think that we need to
16 find a solution.
17 I wrote to both the president -- as
18 you can imagine, he didn't reply -- but I
19 have also written to the four U.S. Attorneys
20 in New York State to ask them to respect not
21 only the Legislature and the Governor, who
22 have created this program, but the rights of
23 the patients in New York State who have
24 registered for it. Hopefully one of them
145
1 will respond to me.
2 But in the meantime I look forward to
3 working with you on this because it doesn't
4 help us to have patients who become certified
5 and then are incapable of having access to
6 the medication that they -- that we've
7 determined is best for them. Thank you.
8 ACTING COMMISSIONER DELANEY: Thank
9 you.
10 CHAIRWOMAN YOUNG: Thank you.
11 I'd like to announce that we've been
12 joined by Senator Fred Akshar.
13 CHAIRWOMAN WEINSTEIN: Thank you.
14 Assemblyman Angelo Santabarbara.
15 ASSEMBLYMAN SANTABARBARA: Thank you,
16 Commissioner. Thank you for being here
17 today. Thank you for your testimony.
18 I just wanted to get an update on the
19 development of certified and noncertified
20 housing opportunities that you talked about.
21 What I hear in my district, and a lot of
22 people hear the same issue, parents talk
23 about their child not being able to get a
24 placement unless they're in an emergency
146
1 situation. So with the new priority system,
2 how is it working for deciding who's eligible
3 for these opportunities? And does it offer
4 more opportunities to those that are still on
5 the waiting list -- that is still very
6 long -- and that are not necessarily in those
7 emergency situations, but still in need of
8 residential housing?
9 ACTING COMMISSIONER DELANEY: Sure.
10 So we have heard concern from families, from
11 parents of the individuals we serve, about
12 access to a housing opportunity in our
13 system.
14 It is accurate that we always
15 prioritize those who have an emergency need
16 first, because they truly have an emergency
17 need, as you can imagine. However, each year
18 we help many other people access residential
19 placements in our system who are not of that
20 emergency need category.
21 The 459 opportunities that we're now
22 working with providers to develop are not for
23 people that are in that highest category of
24 need, it's for people who are living at home
147
1 with their caregivers. In some cases we are
2 seeing some new development for people with
3 mental health needs.
4 But parents absolutely should
5 understand that we are working and doing all
6 we can to ensure sufficient opportunities for
7 residential placements in our system for
8 those who will need them.
9 ASSEMBLYMAN SANTABARBARA: And I
10 talked about this earlier, there's still, you
11 know, a significant shortage of DSPs, direct
12 care staff, and the turnover rates are still
13 there, the vacancy rates. And, you know, we
14 talked about the funding in the budget last
15 year, but without continued investment in our
16 direct care staff, the new opportunities that
17 we've seen still, it still presents a
18 challenge, you know, to staff those
19 opportunities.
20 So what more can be done to support
21 the direct care workers and recruit and
22 retain this critical piece of the puzzle?
23 ACTING COMMISSIONER DELANEY: I think
24 there are a number of things. Obviously the
148
1 $191 million that's going into our system
2 from the increases for the #bFair2DirectCare
3 campaign is one. The career ladders that we
4 are looking at is another. Looking at how we
5 develop and professionalize and continue to
6 professionalize the direct support workforce
7 is another.
8 So there are a number of things that
9 we need to do to ensure that we have an
10 adequate direct support workforce, from
11 compensation to specific targeted
12 recruitment.
13 ASSEMBLYMAN SANTABARBARA: And my last
14 question is about children who are remaining
15 in hospitals for too long because they don't
16 have adequate access to services. Is there
17 something being done in the budget to address
18 this issue? It's a very significant issue.
19 ACTING COMMISSIONER DELANEY: Yes, we
20 are aware of circumstances where children end
21 up in the hospital, end up in situations
22 where we don't want them to have to be.
23 One of the key things that we look at
24 is how can we prevent this from happening, as
149
1 much as how can we help people leave those
2 settings. That's why we and the Office of
3 Mental Health, because it's very often kids
4 that have significant psychiatric issues, are
5 working on a program -- there's actually two
6 programs. There's one for adults, which will
7 be downstate, and one for children that will
8 be in the western part of the state, that
9 will help us to better address the
10 cross-system needs of those children.
11 Because oftentimes the problem comes
12 in when you have two different government
13 systems trying to work together to meet those
14 needs, developing a cross-system coordinated
15 program we think will really help and assist
16 in this issue.
17 ASSEMBLYMAN SANTABARBARA: Thank you.
18 ACTING COMMISSIONER DELANEY: Thank
19 you.
20 CHAIRWOMAN WEINSTEIN: Thank you.
21 Assemblywoman Miller.
22 ASSEMBLYWOMAN MILLER: Thank you.
23 I just wanted to finish up what I was
24 asking before and then just make one comment.
150
1 When I met with your team last week, I
2 did ask for an actual number -- I haven't
3 received it yet -- of the actual number of
4 patients or individuals that are over 21 that
5 are living in residential facilities that are
6 children's facilities, up to age 21, and have
7 been for some time.
8 ACTING COMMISSIONER DELANEY: Sure.
9 ASSEMBLYWOMAN MILLER: Just curious
10 what that actual number is. But what that
11 does -- because I know of a few families who
12 have children who are over 21 who have been
13 living in those residential facilities for
14 several years and feel that not enough has
15 been done or that there really just is no
16 appropriate placement. They feel somewhat
17 forced into choosing a less than appropriate
18 placement, and rather than choose that,
19 they're just staying where they are.
20 But that is what's creating this
21 waiting list and these backlogs for everybody
22 else, and it puts everybody in a very unsafe
23 situation -- the children who are in the home
24 with 22-, 23-, 24-, 25-year-olds when they
151
1 shouldn't be there, the staff -- it's a
2 strain on everybody. So it's just not a
3 healthy situation for anybody involved.
4 So if you could just get me that
5 number at some point, I would appreciate it.
6 ACTING COMMISSIONER DELANEY: Sure, I
7 will do so.
8 ASSEMBLYWOMAN MILLER: Thank you.
9 And I just wanted to make a comment.
10 Like Senator Brooks, I too was getting a lot
11 of feedback and comments to my office when
12 there was the open comment period about the
13 conversion process, the transition process,
14 to the care coordination, the 1115. But I
15 have to applaud you for the efforts you've
16 been making because as a parent myself with a
17 child in the process, the webinars, the
18 workshops, the outreach has been
19 extraordinary and very, very helpful, and I'm
20 hearing that as well.
21 So I am hearing very positive feedback
22 on the families are responding to that, and
23 that is helping them. So that response to
24 parents asking for help is very -- you know,
152
1 something to applaud you for. So thank you.
2 ACTING COMMISSIONER DELANEY: I'm glad
3 to hear that. Thank you.
4 CHAIRWOMAN WEINSTEIN: Thank you.
5 CHAIRWOMAN YOUNG: Thank you.
6 Everybody set? Okay. So that
7 concludes your appearance today. We truly
8 appreciate it, Commissioner, and look forward
9 to having more positive dialogue.
10 Our next speaker is Commissioner
11 Arlene González-Sánchez, New York State
12 Office of Alcoholism and Substance Abuse
13 Services.
14 So we welcome the commissioner. Thank
15 you for being here.
16 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
17 you.
18 CHAIRWOMAN YOUNG: Anytime you want to
19 go ahead.
20 If we could have some order in the
21 house, please. Go ahead, Commissioner.
22 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
23 you. Good afternoon, Senator Young,
24 Assemblymember Weinstein, Senator Amedore,
153
1 and distinguished members of the Senate and
2 Assembly. My name is Arlene
3 González-Sánchez. I am the commissioner of
4 the New York State Office of Alcoholism and
5 Substance Abuse Services.
6 First, thank you all for supporting
7 our mission and providing me the opportunity
8 to present Governor Cuomo's 2018-2019
9 Executive Budget as it pertains to OASAS.
10 Before I discuss the specific details
11 of the upcoming Executive Budget, I want to
12 take a moment to share with you our
13 accomplishments to date. We have opened new
14 programs and expanded existing services to
15 respond to the needs created by the opioid
16 epidemic. We have added treatment capacity
17 and have launched Peer Engagement and Family
18 Support Navigator Programs, and opened Youth
19 Clubhouses, Recovery Centers and Addiction
20 Resource Centers in every region of the
21 state.
22 We have more than 160 prevention
23 agencies, at least one in every county,
24 providing education-based programming, public
154
1 awareness activities, positive alternatives
2 and counseling services. Overall, more than
3 60 percent of our prevention programs target
4 elementary school children. And we recently
5 launched a $2.5 million prevention initiative
6 at 20 SUNY and CUNY colleges designed to help
7 prevent and reduce underage drinking and drug
8 use on college campuses.
9 To ensure the availability of
10 treatment services throughout the state, we
11 have implemented telepractice and now have
12 more than 20 mobile treatment vehicles,
13 providing services and transporting people to
14 treatment programs. More are expected to
15 come online this year. Additionally, we have
16 expanded our educational campaigns and
17 created a Youth and Young Adult Statewide
18 Recovery Network.
19 We've opened our first 24/7 Open
20 Access Center, to help people access
21 treatment on demand by providing assessments
22 and referrals to the appropriate level of
23 care 24 hours a day, seven days a week.
24 It gives me great pleasure to inform
155
1 you that today we will be announcing the
2 award of more than $4 million to open l0 more
3 Open Access Centers, resulting in there being
4 at least one in every region of the state.
5 So as you can see, we have been implementing
6 the Governor's strategies for combating the
7 opioid epidemic and developing new programs
8 for New Yorkers in need of our services. But
9 we realize that much more work still needs to
10 be done.
11 The Governor's Executive Budget
12 proposes nearly $787 million that supports
13 OASAS's ability to respond to needs
14 identified by our constituents throughout the
15 state, and allows us to move forward on our
16 key priorities, including the full annual
17 salary increases of 6.5 percent for direct
18 care and support positions and 3.25 percent
19 for clinical titles, as well as the increase
20 in the minimum wage for funded OASAS
21 providers.
22 We will open 203 new residential
23 treatment beds and 350 Opioid Treatment
24 Program slots. In addition, we are
156
1 continuing a scholarship program to support
2 250 new candidates to become Certified
3 Recovery Peer Advocates. And in the coming
4 weeks, we will announce the award of
5 $10 million in capital funding to develop new
6 detox beds throughout the state.
7 The Executive Budget allows us to
8 develop seven regional Problem Gambling
9 Resource Centers and gives us the flexibility
10 to expand evidence-based prevention models in
11 schools that teach children self-regulation
12 and positive decision-making, focusing on
13 school engagement and achievement as
14 protective factors.
15 The budget also includes funding to
16 support on-site, peer-delivered substance use
17 disorder treatment services in eight homeless
18 shelters in New York City and 14 shelters in
19 the rest of the state, reaching a total of
20 22 shelters statewide.
21 There is a proposed surcharge on
22 opioid prescriptions, to be assessed at
23 2 cents per morphine milligram equivalent.
24 These funds will be used to support opioid
157
1 prevention, treatment and recovery efforts.
2 Opioids purchased by OASAS programs to treat
3 addiction, like methadone and buprenorphine,
4 will be exempt from the surcharge.
5 So to conclude, the 2018-2019
6 Executive Budget proposal includes funding to
7 support OASAS's continued work to develop
8 innovative new services and advance key
9 initiatives, to confront the opioid epidemic.
10 We look forward to your continued partnership
11 and support as we advance these priorities.
12 Thank you for your time today.
13 CHAIRWOMAN YOUNG: Thank you.
14 Our first speaker will be Senator
15 George Amedore, who is the chair of our
16 Committee on Alcoholism and Drug Abuse.
17 Senator Amedore.
18 SENATOR AMEDORE: Thank you,
19 Senator Young.
20 And thank you, Commissioner, for being
21 here today. It's always a pleasure to work
22 with you, and there's no question this
23 substance abuse disorder is wreaking havoc in
24 every part of the State of New York in every
158
1 which way, whether it's gambling, alcohol,
2 whether it's tobacco, whether it is now the
3 scourge of heroin and the increase of opiate
4 deaths, we're trying to tackle this in a
5 multipronged approach. And I know that
6 you've given us testimony that you've
7 increased prevention and educational
8 opportunities, so thank you for that.
9 The 24-hour Open Access Centers have
10 been -- are new, and they have been helpful.
11 The clubhouses have been helpful,
12 particularly with our young adolescents and
13 after-school programs. And the need for more
14 recovery peer advocates and the investment in
15 such plays a big part of how we're going to
16 eradicate this epidemic that we see.
17 As you mentioned, the Governor has
18 proposed a surcharge on the first sale of
19 opiates. And, you know, I want to discuss
20 that a little bit with you, because according
21 to Commissioner Zucker, the surcharge is
22 meant to be paid for by the pharmaceutical
23 companies. However, under the language of
24 the bill, the surcharge is levied at the
159
1 first sale in the state.
2 So my question is, what is the first
3 sale? And when in the supply chain is it
4 going to occur?
5 COMMISSIONER GONZÁLEZ-SÁNCHEZ: The
6 last part of your question, when --
7 SENATOR AMEDORE: When in the supply
8 chain is it going to occur, that first sale?
9 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay,
10 so the way it was written was so that the
11 surcharge would be, of course as you
12 indicated, at the first point of sale to the
13 state, essentially targeting the
14 manufacturers and the distributors who I
15 don't think I have to beleaguer the issue
16 that they have really financially gotten a
17 lot of monies out of the sale of these
18 opioids, and I think that maybe they need to
19 take a little responsibility for the increase
20 in the sale of these opioids.
21 In terms of --
22 SENATOR AMEDORE: But -- excuse me,
23 Commissioner, I'm not -- I'm not actually
24 asking who's meant to pay for the surcharge,
160
1 I'm asking who actually will pay for the
2 surcharge.
3 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Those
4 specifics, I think it's better to ask the Tax
5 Department, who will be actually implementing
6 that. That is out of my jurisdiction, so I
7 really don't want to say something that's
8 incorrect. So I'm not in a position to
9 answer that.
10 SENATOR AMEDORE: Okay. So can the
11 first sale be a consumer?
12 COMMISSIONER GONZÁLEZ-SÁNCHEZ: This
13 first sale is not the consumer. The first
14 sale is who sells the actual product to the
15 state, in which case it would be the
16 manufacturer and the distributors.
17 SENATOR AMEDORE: Okay, but I'm
18 thinking of those who get their prescription
19 drugs on mail order. Is there any language
20 regarding a mail order pharmaceutical -- or
21 pharmacies?
22 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I am
23 not familiar to that extent on the language
24 of the bill. Again, I think that that's a
161
1 better question to the Tax Department, who
2 will be monitoring how this surcharge will be
3 delivered.
4 SENATOR AMEDORE: Okay. You also
5 mention in your testimony that the exclusions
6 of Suboxone and buprenorphine, which are --
7 OASAS providers are excluded from this. But
8 what about those who are not and those
9 medically assisted treatment centers?
10 COMMISSIONER GONZÁLEZ-SÁNCHEZ: We've
11 heard similar concerns. And what I say is
12 that I think that there's still room for some
13 discussions around those items.
14 SENATOR AMEDORE: Has there been any
15 discussion regarding exclusion of hospice or
16 palliative care or cancer patients that -- be
17 considered on --
18 COMMISSIONER GONZÁLEZ-SÁNCHEZ: It's
19 the same -- my same answer. We heard of
20 concerns that have been raised, and I believe
21 that there's still room for discussion.
22 SENATOR AMEDORE: Well, I would hope
23 that there would be discussion and exclusions
24 for this, particularly at the end of life and
162
1 at hospice, when there's a large amount of
2 morphine or other opiate type of medication,
3 you know, that it would really put a huge
4 financial burden on those services.
5 You know, what are -- are there any
6 new opiate prevention, treatment, education
7 initiatives that will be brought online with
8 the funding received from the surcharge?
9 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Well,
10 it's -- the language says that the money
11 could only be used to develop, you know,
12 opioid prevention, treatment and recovery
13 services. Based on that, my assumption is
14 that monies will be -- we will be allowed to
15 use some of those monies to be able to,
16 moving forward, deliver some of the services
17 that we have planned.
18 SENATOR AMEDORE: Would that be
19 medically assisted treatment centers?
20 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I'm
21 sorry?
22 SENATOR AMEDORE: Would that include
23 medically assisted treatment centers?
24 COMMISSIONER GONZÁLEZ-SÁNCHEZ: It
163
1 would include all of our services within our
2 budget.
3 SENATOR AMEDORE: Okay. How does the
4 department intend to monitor or establish
5 enforcement that requires this legislation to
6 ensure that the surcharge is not going to be
7 passed on to the consumer?
8 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Again,
9 that's something that, you know, I would say
10 that we need to work on and discuss further.
11 SENATOR AMEDORE: Let's move to
12 for-profit providers. As you know, I have
13 carried a bill for several years, sponsored a
14 bill for several years which would allow
15 providers, all providers in the state, not
16 just not-for-profits, to participate in
17 OASAS's RFP process, the request for
18 proposal. This legislation has passed the
19 Senate several times. What can we do to make
20 progress in this area?
21 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Well,
22 you know, we welcome for-profit providers to
23 be part of our delivery of care, we just
24 can't fund for-profits. In fact, we do have
164
1 several for-profits that we do license. So
2 there's no intention to not continue that
3 practice. If there are for-profit providers
4 that want to be licensed by us and are
5 willing to, you know, give the care that's
6 needed, we will entertain doing so.
7 SENATOR AMEDORE: Well, I hear from a
8 lot of for-profit providers that a lot of
9 times the RFP process is closed to them and
10 they're not able to apply. And that, you
11 know, when we have such high demand for the
12 services, the capacity that we're trying to
13 build in the State of New York to service
14 this problem that we have in society, I would
15 just think that we would need all hands on
16 deck, everyone who's involved in this to have
17 the opportunity.
18 So I would look forward to some
19 assistance and your help on this.
20 COMMISSIONER GONZÁLEZ-SÁNCHEZ:
21 Absolutely. I agree. And if there's
22 anything, just -- you know where to find me,
23 we can talk.
24 SENATOR AMEDORE: As I asked the
165
1 commissioner of OMH, I will ask you the same
2 question. According to the published
3 reports, over half of the population in local
4 jails suffer from substance abuse disorder.
5 Over two-thirds of these individuals have
6 been in jail before. This is a huge problem
7 that needs to be addressed.
8 So what consideration has OASAS or
9 this administration given to reach out to
10 serve this population?
11 COMMISSIONER GONZÁLEZ-SÁNCHEZ: So
12 thank you for that question because, you
13 know, we've been working really very closely
14 with the commissioner of Corrections.
15 Currently we have -- out of the
16 54 state correctional facilities, 52 of them
17 provide SUD services behind the wall. And
18 what we do is we have developed guidelines
19 that they are to use performing the
20 counseling that they do behind the wall. We
21 monitor those guidelines, we monitor them,
22 we go, we visit, we do site visits to ensure
23 that they are doing what the guidelines are
24 requiring.
166
1 We also meet with some of the inmates
2 that are receiving the services to get their
3 input as to how it's going, and so on and so
4 forth.
5 Separate and aside from that, there's
6 like five programs that are specifically for
7 parole violators that are under the umbrella
8 of DOCCS. Edgecombe is the one in New York
9 City that a lot of people are very familiar
10 with. And there will be three more opening
11 throughout the state, I believe in Orleans,
12 Hale Creek, and Willard. And these programs
13 will be running a Vivitrol program with these
14 inmates -- or not really inmates but parole
15 violators. And I'm sure you know that
16 Bedford Hills does have a medication assisted
17 treatment program for women who are pregnant
18 who are incarcerated.
19 Aside from that, you know, there are
20 like 58 county jails throughout the state --
21 I believe 58, if my brain is working. We
22 have already established 35 Vivitrol programs
23 in those county jails, and this coming year
24 12 more will come on board. So that means we
167
1 have -- 35, 12 -- 47. We will be in 47 out
2 of the 58 county facilities. They will be
3 offering Vivitrol assistance to individuals
4 that come in front of them.
5 Also let me just remind you that DOCCS
6 also provides a -- you know, Narcan for
7 inmates that are being released back into the
8 community.
9 So you know, we're very aggressively
10 working with DOCCS to see how we could
11 continue to improve on services and how can
12 we work better with them behind the wall.
13 SENATOR KRUEGER: Thank you.
14 SENATOR AMEDORE: Thank you. I'm out
15 of time.
16 SENATOR KRUEGER: We'll come back for
17 a second round, I'm sorry.
18 Assembly?
19 CHAIRWOMAN WEINSTEIN: Assemblywoman
20 Gunther.
21 ASSEMBLYWOMAN GUNTHER: On behalf of
22 my good friend Linda Rosenthal, who couldn't
23 be here today -- but she's probably
24 watching -- can you explain why the increases
168
1 in the Executive Budget are primarily for
2 continued funding of existing programs and
3 wage support and not new or expanded
4 programming? And why are we not increasing
5 funding to match the scope of the ongoing
6 opioid crisis?
7 COMMISSIONER GONZÁLEZ-SÁNCHEZ: So in
8 general this budget really accommodates over
9 $200,000 -- over $200,000 for programming
10 directed at the opioid treatment, prevention
11 and recovery. It allows us to move forward
12 with programs that will be opening, like I
13 just indicated.
14 ASSEMBLYWOMAN GUNTHER: Two hundred
15 million, right?
16 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Two
17 hundred, yes. Which I just finished saying,
18 we will be opening more clubhouses, a couple
19 more recovery centers, the 24/7 Open Access
20 Centers. There will be additional
21 residential treatment beds that will be
22 opening up. This is all in this budget. So
23 these are all new services. These are not
24 services that have been implemented. They
169
1 will be implemented in this coming year.
2 ASSEMBLYWOMAN GUNTHER: Thank you.
3 Is OASAS working with community-based
4 providers and DOH to increase harm-reduction
5 initiatives? Have safe consumption or safe
6 injection sites been part of that discussion?
7 COMMISSIONER GONZÁLEZ-SÁNCHEZ: We
8 always work with our community-based
9 providers to get input on whatever we do.
10 With respect to safe injection
11 facilities, what I can assure you is that
12 given the epidemic that we have, we are
13 looking at everything very seriously. I'm
14 working with the Department of Health, and
15 everything's on the table. We're giving
16 everything serious consideration.
17 ASSEMBLYWOMAN GUNTHER: We hear from
18 your presentation each year that there are
19 enough beds for persons in need of care.
20 However, we still hear about people traveling
21 great distances to access appropriate
22 treatment. Are there currently an adequate
23 number of beds with sufficient geographic
24 representation to ensure those who need
170
1 treatment are able to receive it?
2 COMMISSIONER GONZÁLEZ-SÁNCHEZ: So
3 you're absolutely right, and thank you for
4 that question. I hear that everywhere I go.
5 Just yesterday I went online myself,
6 and there were over a thousand beds available
7 throughout the state.
8 I continuously say, can I promise you
9 that there will be a bed, you know, down the
10 block from where people live and they need?
11 I can't promise that. But is there a bed in
12 this state that will serve the purpose? Yes.
13 I mean, just yesterday I actually looked. So
14 there is quite a bit of beds.
15 I think that there are other issues
16 that are in play here that get murky into the
17 fact that there are no beds. There are beds.
18 There are beds available at any one time.
19 ASSEMBLYWOMAN GUNTHER: The last one
20 is -- you know what, I was going to -- I'll
21 ask you something that Linda didn't ask you.
22 What about there are beds available, but
23 insurance-wise and accepting insurances -- I
24 mean, if you're not on Medicaid -- but a lot
171
1 of insurances won't pay unless you fail like
2 three or four times, and they will not pay.
3 COMMISSIONER GONZÁLEZ-SÁNCHEZ: If
4 that happens, it shouldn't be happening
5 because we passed, you know, regulations last
6 year that indicated that that could not
7 happen. And there's no fail-first.
8 And every time I hear that, I get a
9 little annoyed because that should not be
10 happening. I always tell people, if you know
11 that that is happening, you need to reach out
12 to us. There is no fail-first. You are to
13 get the service that you need, as long as
14 it's deemed necessary by a physician. If a
15 physician says this is the level of care you
16 need, that's where you need to go. Insurance
17 companies cannot deny that access.
18 If it does happen, please, reach out
19 to us. That's the only way we're going to be
20 able to ensure that this doesn't continue.
21 ASSEMBLYWOMAN GUNTHER: What progress
22 has the state made in implementing CARA? Has
23 there been an increase in providers in
24 underserved areas as a result of this act?
172
1 What is the state doing or can the state do
2 to encourage more providers to prescribe
3 buprenorphine?
4 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay,
5 there's a couple of questions there.
6 With the CARA, we're hopefully going
7 into the second year. With the first year,
8 we identified 16 regions, underserved regions
9 throughout the state. And we have been able
10 to develop the mobile vans that I've been
11 talking about. We're developing Centers of
12 Treatment Innovations throughout the state in
13 these 16 regions. We've expanded capacity in
14 terms of treatment beds. So we've done a lot
15 with the monies that we got through the STR
16 grant last year.
17 And moving forward, we're planning now
18 on maybe adding another 16 or 17 more regions
19 to have now a total of over 30-something
20 regions that we will be addressing with the
21 same similar programming. So we've been
22 really hard at work making sure that we, you
23 know, get the money out in the street and do
24 the things that we need to do.
173
1 I need to remind you, the first phase
2 we really targeted in the very, you know,
3 rural areas where people -- I've not only
4 heard but I've experienced, as I've traveled
5 the state, where people would have to travel
6 two and three hours to just get medication.
7 I mean, the chances that people would do that
8 will be slim.
9 So that's where we're focusing on
10 doing the mobile treatment. But we're also
11 focusing on bringing telehealth. You know,
12 until we're able to maybe develop more stable
13 clinics in those areas. But we've been
14 really, really implementing a lot of very
15 innovative work and programming to address
16 this.
17 ASSEMBLYWOMAN GUNTHER: Through my own
18 office -- we're somewhat in the middle of an
19 area where there is a lot of addiction and
20 treatment, and one of the things that I have
21 spent hours and hours on the phone is -- are
22 people that do have private insurance,
23 et cetera, but a lot of these addiction
24 centers are asking for cash up-front.
174
1 Namely, I've had as far as $45,000 to
2 $60,000.
3 And, you know, I work very closely
4 with Catholic Charities and, you know, we
5 spent an afternoon looking. And it's very,
6 very difficult sometimes when someone is in
7 that moment of readiness and you can't get
8 the bed.
9 Secondly, I do -- my other thought is,
10 you know, as a nurse, I remember a long time
11 ago when the joint commission said that no
12 one should be free of pain {sic}. And it
13 seems to me at that point in history was when
14 the use of Demerol, morphine and all those
15 wonderful drugs and sending people home, you
16 know, with a prescription not with two pills
17 but 40 pills, happened.
18 And what are we doing to control these
19 drug manufacturers about, number one,
20 advertising on our television and kind of
21 encouraging everybody to be pain-free, that
22 that's what life is all about. And, you
23 know, doing something to correct, I think,
24 something that went very, very wrong.
175
1 COMMISSIONER GONZÁLEZ-SÁNCHEZ: So a
2 couple of things. You know, we've been very
3 proactively out there with our own campaign,
4 really reaching out to as many people as we
5 can, trying to educate folks around what
6 their rights are and, you know, what to do in
7 certain situations.
8 It's very complicated. I don't know
9 that, you know, we could address all of
10 those. But what we are doing is very
11 aggressively out there with campaigns,
12 talking to as many people as we can,
13 informing them of their rights. And when we
14 are told that things are not going the way
15 they should be going based on revised
16 regulations, we will enforce them.
17 ASSEMBLYWOMAN GUNTHER: But again, I
18 know right now we're going to charge them a
19 surtax because I guess somebody must think
20 there's some responsibility there. But I
21 also think that at this point in time using
22 the television to like pound it in people's
23 heads, you know, I think that's important to
24 address. And also prescribing habits.
176
1 And I think that with prescribing and
2 also addressing some of those issues, we
3 educate the public with an advertisement.
4 So --
5 COMMISSIONER GONZÁLEZ-SÁNCHEZ: And we
6 are doing advertisement -- TV advertisement
7 is a little over the top, but we are doing
8 advertisement --
9 ASSEMBLYWOMAN GUNTHER: Not you, I
10 meant the drug manufacturers.
11 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
12 ASSEMBLYWOMAN GUNTHER: Not you at
13 all. You're good.
14 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
15 you.
16 CHAIRWOMAN WEINSTEIN: Thank you.
17 CHAIRWOMAN YOUNG: Thank you.
18 Our next speaker is Senator Akshar.
19 SENATOR AKSHAR: Thank you very much,
20 Madam Chairwoman.
21 Commissioner, always good to be in
22 your company. Allow me to begin, of course,
23 by thanking you for being a good partner to
24 me and the people that I represent in the
177
1 Southern Tier, you and your team.
2 I want to publicly thank you and the
3 Governor for all of your hard work on the
4 work we did at the former Broome
5 Developmental Center to bring additional
6 treatment services online there. It was a
7 very heavy lift, of course, in our community.
8 However, it's done and I applaud you and your
9 staff for that.
10 I just want to hit a couple of things
11 if I can. I want to go back to the
12 surcharge, as Senator Amedore spoke about. I
13 just want to be clear about something, that
14 this surcharge could in fact, as the Governor
15 has proposed, generate something like
16 $127 million in revenues. Is that your
17 understanding?
18 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes.
19 If it passes, if it starts July 1st, yes,
20 that's what's anticipated.
21 SENATOR AKSHAR: Okay, you know that
22 there is probably no bigger fan of OASAS than
23 I, so I have concerns about this surcharge,
24 of course, because my understanding is that
178
1 that $127 million is simply going to supplant
2 current funding, and it's not for new
3 services. Is that your understanding as
4 well?
5 COMMISSIONER GONZÁLEZ-SÁNCHEZ: That
6 is not my understanding, being that the way
7 it is written, it says it goes into a fund
8 and it's to be used only for treatment,
9 prevention and recovery services to deal with
10 the opioid epidemic.
11 And as I indicated, moving forward,
12 you know, I would expect that some of that
13 funding we would be able to tap into for
14 future programming.
15 SENATOR AKSHAR: So with all due
16 respect, Commissioner, am I to believe
17 sitting here that we will have access -- I
18 say "we," you and your agency will have
19 access to an additional $127 million if
20 passed as proposed by the Governor to deal
21 with this particular issue?
22 COMMISSIONER GONZÁLEZ-SÁNCHEZ: What
23 it says is that the monies could only be used
24 to provide prevention, treatment and recovery
179
1 services to deal with the epidemic.
2 Having said that, there may be other
3 departments like the Department of Health
4 that may provide and do provide very critical
5 services around addiction that they may be
6 able to access dollars. That's the way it's
7 written.
8 But it's our anticipation that we will
9 be able to access some of those dollars as
10 well.
11 SENATOR AKSHAR: One would always feel
12 so much more comfortable if we could put that
13 $127 million in the proverbial lockbox and
14 make sure that nobody else took that money
15 from you, of course.
16 Let me change topics, if I may, and go
17 back to substance use disorder within the
18 confines of correctional facilities. Are you
19 familiar with the recent report published by
20 the Conference of Local Mental Hygiene
21 Directors in which they're asking for
22 $12.8 million to address SUD in the 57 county
23 correctional facilities throughout the state?
24 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes, I
180
1 am familiar.
2 SENATOR AKSHAR: So is that something
3 that you would support?
4 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I
5 think we need to talk about it and look at
6 it. It's something that has been presented
7 to me. It's something, as I indicated, we
8 ourselves have been talking with the
9 commissioner of DOCCS to see how we could
10 better implement services and complement
11 services that exist there.
12 So it's under review, and that's all I
13 can really say at this point.
14 SENATOR AKSHAR: Sure, I appreciate
15 that.
16 With that said on that particular
17 issue, giving local control to the local
18 mental health providers and so on and so
19 forth, with oversight from OASAS -- of course
20 it's under review, as you just said -- is
21 that something that you're comfortable with,
22 or that too needs additional discussion?
23 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I
24 think that needs additional discussion.
181
1 SENATOR AKSHAR: Okay, let me move to
2 the topic of fentanyl and -- I'm running out
3 of time. Is OASAS seeing an influx of
4 overdoses related to increased use of
5 fentanyl?
6 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes.
7 SENATOR AKSHAR: Okay. Is the agency
8 taking any particular steps to deal with this
9 particular issue?
10 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Well
11 like I said, we are very aggressively out
12 there, campaigns -- we have a lot of
13 campaigns to inform people of fentanyl,
14 because a lot of the overdoses that we are
15 seeing is really the fentanyl that is lysed
16 in the chemical.
17 So it's really important that we get
18 the word out there, that we educate people as
19 much as we can about the dangers of fentanyl,
20 and the fact that people think they know what
21 they're buying but they really don't. Never
22 before have we heard of people OD'g on
23 cocaine. Well, it's not the cocaine, it's
24 the fentanyl that's in there.
182
1 So we are aggressively doing whatever
2 we can to inform the public about the
3 fentanyl piece and to access, you know,
4 treatment. We're out there also aggressively
5 trying to get people to seek treatment.
6 SENATOR AKSHAR: As you well know, my
7 background's in law enforcement. And one
8 thing that I have been consistent about since
9 the day I was elected in dealing with this
10 particular issue is that we should focus less
11 attention on enforcement and more on
12 prevention and treatment, recovery and so on
13 and so forth.
14 However, this is one particular area
15 in which I think we need to make
16 improvements. Clearly the federal government
17 has moved fentanyl, its derivatives, so on
18 and so forth, into a schedule. We are
19 lagging behind in that particular area, and
20 I'm wondering if you have a position on
21 whether or not it's time for the State of
22 New York to make some changes as -- where
23 fentanyl is concerned.
24 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I
183
1 believe just recently there was a press
2 release that there is consideration to have
3 fentanyl and fentanyl analogs as well as
4 synthetic marijuana to be part of this
5 scheduling.
6 SENATOR AKSHAR: I would hope that
7 regardless of our politics or regardless of
8 what side of the aisle we sit on, that this
9 is an area where we could come together and
10 find some common ground. Because clearly
11 this influx of fentanyl is killing people by
12 the masses, and we have to address it.
13 I'll end on this, by simply saying
14 thank you once again for your commitment to
15 the people of this great state. And you have
16 a difficult job, and I want to personally
17 thank you again for the friendship that we've
18 developed. Thank you.
19 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
20 you, Senator.
21 SENATOR AKSHAR: Thank you, Madam
22 Chairwoman.
23 CHAIRWOMAN WEINSTEIN: Assemblyman
24 Oaks.
184
1 ASSEMBLYMAN OAKS: Yes, thank you.
2 One of the Governor's proposals in the
3 budget is allowing BOCES to enter into an MOU
4 with non-component school districts to
5 develop what have been called Recovery High
6 School programs. So I was just checking --
7 at this point, have any BOCES expressed an
8 interest in operating one of these types of
9 schools?
10 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes.
11 Actually, we did an RFI, we got 11 responses
12 from throughout the state, so there are 11
13 areas that have expressed interest. And in
14 the coming weeks, we will be meeting with all
15 11 to discuss next steps.
16 ASSEMBLYMAN OAKS: And that would
17 include, obviously -- so is the proposal just
18 to do a single one, model one, or is it --
19 COMMISSIONER GONZÁLEZ-SÁNCHEZ:
20 Originally we had anticipated three, but
21 we're going to meet with the schools and see
22 how far they are. Every one will be
23 different, and we will be able to implement
24 as many as we can throughout the state.
185
1 This has been something that has been
2 very well received, and not only well
3 received but very much needed, especially
4 with a lot of our young people who are
5 addicted and are in the high-school age and
6 really should be able to finish their
7 education in a setting where they get the
8 support that they need.
9 ASSEMBLYMAN OAKS: And do we have a
10 sense of how the funding would work for those
11 recovery schools?
12 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yeah,
13 I don't have that. I could try to get
14 something to you, but I don't have it off the
15 top of my head.
16 ASSEMBLYMAN OAKS: I'd appreciate it.
17 Thank you.
18 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
19 CHAIRWOMAN YOUNG: Thank you.
20 Actually, I have a couple of
21 questions, Commissioner. And again, we
22 appreciate you being here today.
23 But I know that this is an issue of
24 importance that we would like to have
186
1 answered, and I know that Senators Amedore
2 and Akshar both asked about it. We want to
3 have the specifics of the opioid surcharge
4 proposal that the Governor has put forward,
5 the $127 million. And you've been asked
6 twice about it, and you haven't given any
7 specifics. So we're hoping that you can
8 provide those to us.
9 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
10 I will try. I mean, I've been as specific as
11 I can.
12 CHAIRWOMAN YOUNG: So how would the
13 $127 million actually be spent?
14 COMMISSIONER GONZÁLEZ-SÁNCHEZ: The
15 way it indicates in the bill is that it could
16 only be used for the prevention, treatment,
17 and recovery of opioids.
18 CHAIRWOMAN YOUNG: But -- so that's
19 kind of a broad, broad, broad, broad
20 overview. But what exactly would the money
21 be spent on to meet those ends?
22 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Well,
23 from a department perspective, it would be to
24 develop more clubhouses, recovery supports,
187
1 if we need to expand residential treatment
2 programs, if we need to continue to expand
3 mobile capacity. It would mean all of that
4 if that was to go forward.
5 I mean, all of that is what we have in
6 our current budget system moving forward to
7 address the opioid epidemic. I can't tell
8 you I'm going to open six clubhouses,
9 seven -- because the details have yet to be
10 determined. And I need to also make some
11 analysis as to where there's still some
12 needs, you know, in terms of areas that there
13 are gaps that we don't have certain basic
14 things that we would maybe need to look at.
15 So I'm not being evasive purposely,
16 I'm just trying to be honest and up-front.
17 CHAIRWOMAN YOUNG: So you don't have
18 that analysis already as to where there are
19 gaps in the system?
20 COMMISSIONER GONZÁLEZ-SÁNCHEZ: We do
21 have -- I do have -- I have -- I know where
22 the gaps are, and we know what we would need
23 to do if we needed to move forward, and we
24 have the money to address those gaps, yes.
188
1 CHAIRWOMAN YOUNG: Okay. So you just
2 said you need to do the analysis, but now you
3 say that you haven't. So what I would say to
4 you is if you have a specific plan, I would
5 recommend that you get that to the
6 Legislature as soon as possible.
7 This is a serious issue, to raise
8 these taxes. And without any kind of
9 specifics, it's hard for us to make any kind
10 of informed decision on whether or not we
11 would go ahead with this. As you know, we
12 have a concern about the tax burden already
13 in New York State, and to have kind of this
14 open-ended -- not even plan that you've
15 talked about, really doesn't do much to
16 advance the issues that you're talking about.
17 So we would like to see if you could
18 get it to our offices, a detailed explanation
19 of the plan, how the money would be used,
20 where it would be used, when it would be
21 used. That would be very, very helpful to
22 us.
23 And just following up on that, you had
24 said that you're trying to fund new services
189
1 and those are coming online. The question
2 that I have, are these actual services that
3 were supposed to be put forward this year,
4 and they're not new services but they're
5 services that were already funded in this
6 year's budget and they just haven't come
7 online yet?
8 COMMISSIONER GONZÁLEZ-SÁNCHEZ: No,
9 these are -- the new services that I spoke
10 about are services that are coming online
11 this fiscal year.
12 CHAIRWOMAN YOUNG: So they are not --
13 COMMISSIONER GONZÁLEZ-SÁNCHEZ: They
14 are new services.
15 CHAIRWOMAN YOUNG: But are they new,
16 or should they have already been services
17 that were already established?
18 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Some
19 of them may have been procured last year but
20 weren't operational. They will become
21 operational this year, and the funding is in
22 this year's budget.
23 CHAIRWOMAN YOUNG: And what are those
24 new services again?
190
1 COMMISSIONER GONZÁLEZ-SÁNCHEZ: The
2 203 treatment beds, the 75 -- up to maybe
3 75 detox beds throughout the state, the
4 $10 million. I believe we have a couple of
5 clubhouses that we will be bringing online.
6 The 24/7 access centers that we're
7 announcing, that we just announced, these are
8 all new services, and all the dollars are in
9 this current budget.
10 CHAIRWOMAN YOUNG: Okay, thank you.
11 (Discussion off the record.)
12 CHAIRWOMAN WEINSTEIN: Thank you --
13 CHAIRWOMAN YOUNG: No, we have other
14 speakers.
15 So on the list we have Senator Savino,
16 then Senator Rivera, Senator Krueger, and
17 finally Senator Brooks. We have a lot.
18 SENATOR SAVINO: Thank you. Thank
19 you, Senator Young.
20 Good afternoon, Commissioner.
21 So I'm going to ask you the same
22 question that I asked Commissioner Sullivan
23 from OMH. Knowing that there are so many
24 patients suffering with addiction treatment
191
1 disorder that also have mental health issues,
2 do you believe there's sufficient
3 coordination between your agencies to help
4 address that, whether it's through detox
5 beds, into inpatient settings, or a
6 coordination of programs?
7 And is there -- what more can we do to
8 bring in, I think, the medical providers,
9 particularly psychiatrists who are treating
10 these patients, many of whom are taking
11 psychotropic drugs, they're also taking
12 Ativan or Xanax or Valium for their anxiety
13 disorder or posttraumatic stress, as well as
14 pain medication?
15 COMMISSIONER GONZÁLEZ-SÁNCHEZ: So as
16 Dr. Sullivan indicated, you know, we've been
17 very proactively working among ourselves,
18 including with the Department of Health, to
19 better get a better integration of care, not
20 only between mental health and addiction but
21 also primary health.
22 There's language actually in the
23 budget now that allows for one single
24 licensure, which I think is going to really
192
1 help and move this integration process
2 further.
3 And, you know, we continue the best
4 that we can to work together to ensure --
5 because I believe that that's the key. You
6 can't treat people for different parts. You
7 know, you have to treat them altogether,
8 everything in the same. So we continue to
9 work towards, you know, a better integrated
10 plan, and I think we're getting there.
11 Now, with the single licensure, I
12 think you're going to see that that may open
13 other opportunities.
14 SENATOR SAVINO: I certainly hope so.
15 Assemblywoman Gunther asked about the
16 denial of coverage by some insurance
17 carriers. And while there may not be as many
18 instances of the fail-first requirement --
19 because as you pointed out, we outlawed
20 that -- I do think the bigger problem is a
21 lot of insurance carriers don't provide the
22 right type of coverage.
23 So if you're on Medicaid, you're fine,
24 because there's no restrictions. If you are
193
1 a 55-year-old woman who's disabled and is on
2 Medicare, you're pretty much on your own.
3 There's no programs that accept Medicare, and
4 that is I think the bigger problem that we're
5 seeing, is an inconsistency in insurance
6 coverage for addiction treatment.
7 And so that leaves a lot of people
8 out. So if they get out -- if they go to
9 detox and they get out, they have to go to
10 outpatient, and many of them are not able to
11 go to -- I mean, this is, as you know, this
12 is a new kind of addiction problem we're
13 seeing where, you know, people are saying
14 that they can't get off of these drugs
15 because they're that much more potent and
16 that much more dangerous.
17 So I think -- I really think that's
18 the challenge for us, is how do we get
19 consistency across all insurance carriers so
20 that everyone, when they finally realize that
21 they need help, are able to access the help
22 best suited for them.
23 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yeah.
24 And we have been working with DFS along those
194
1 lines to see how we could maybe implement
2 some changes along those policies.
3 But it is difficult. I mean, it's
4 something that -- you know, it's outside of
5 my realm. But, you know, DFS has been very
6 helpful in terms of listening to us and
7 working with us to see what we can do to
8 resolve that issue.
9 SENATOR SAVINO: And I think someone
10 asked you about the issue of locations where
11 people could -- what is the term that's used?
12 Where they can come in and be -- supervised
13 injection sites? I have my own concerns
14 about that because of what they're injecting.
15 But I have a piece of legislation that
16 I've introduced, along with
17 Assemblyman O'Donnell, to add addiction
18 treatment disorder as a qualifying condition
19 under the medical marijuana program.
20 As you know, the majority of opioid
21 abusers who are in treatment are under
22 medical therapy as well. So they're either
23 replacing their opioids with Suboxone or
24 methadone or Vivitrol or whatever the other
195
1 medications are.
2 And so there's sufficient evidence in
3 other states that have medical marijuana
4 programs that placing your opioids with
5 medical marijuana, instead of one of the
6 other medical treatments, has been
7 successful.
8 I don't know if you have an opinion on
9 that. If you don't, that's fine. What I
10 would appreciate is, though, if you could
11 look into it and see if you think that would
12 be something that would work here in
13 New York.
14 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yeah.
15 I don't have an opinion right now, but what I
16 can tell you is that we are looking at
17 everything, together with DOH.
18 SENATOR SAVINO: Okay. Thank you.
19 CHAIRWOMAN YOUNG: Thank you.
20 Our next speaker is Senator Rivera.
21 SENATOR RIVERA: Hello, Commissioner.
22 How are you? Just -- I just -- just a couple
23 of quick questions.
24 A few of my colleagues already asked
196
1 about this, and I just want to reiterate
2 that -- so that it's clear on both sides of
3 the aisle, whether it's Senator Young,
4 Senator Akshar, or Senator Amedore and
5 myself, who is obviously in quite a different
6 wing of the thing, we both are concerned
7 about the details of this surcharge, the
8 opioid surcharge.
9 I want to reiterate, like Senator
10 Akshar said, that language should be added --
11 and I did not see it -- that is -- that -- so
12 it's a lockbox. And I know this is not you,
13 but I just want it for the record, there
14 needs to be a lockbox on it. We know too
15 much about dedicated taxes that don't
16 actually go to the things that they're
17 dedicated to. Ask MTA about that.
18 So there's that. The fact that having
19 a more detailed plan about $127 million --
20 which is a good chunk of change, certainly
21 necessary for the crisis that we're dealing
22 with -- having a more detailed plan would be
23 a welcome -- would be something very welcome
24 to us.
197
1 And also clarification on the issue of
2 first points of sale. We had -- just
3 yesterday we had pharmacists come in and tell
4 us that they were extremely concerned.
5 Because even though they were, like the rest
6 of us, concerned about the crisis, they --
7 because of the way that many pharmacies do
8 their purchasing, they would be the first
9 point of sale. So it would not get the
10 manufacturers or the distributors. It would
11 get the pharmacists.
12 And if you have local pharmacies,
13 that's going to be a problem. They would
14 have to restructure the whole way that they
15 do their business, and they might not stock
16 some things that are necessary in some
17 medical cases.
18 And so on that first point of sale, do
19 you have any further clarification on that
20 issue?
21 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I
22 don't. I don't.
23 SENATOR RIVERA: Okay. So that is
24 something -- again, and I know it is not you,
198
1 Commissioner, but it is obviously -- it is
2 going to potentially, hopefully accrue to the
3 agency that you run so that you have more
4 resources to do the good work that you do, so
5 that would be important.
6 And lastly, I just want to -- just
7 like Assemblymember Gunther asked earlier
8 about supervised injection facilities, I'm
9 glad that the state is looking into them. We
10 had a brief discussion about it yesterday
11 with the commissioner of Health, and he said
12 basically the same thing, that the state is
13 looking at it. I would certainly suggest
14 that we need to seriously look at it, as it
15 is a policy area that is -- it is an area
16 that we need to go into if we're really going
17 to deal with this crisis.
18 So I just wanted to put those things
19 out there. Sorry that you do not have
20 further clarification, but I am hoping that
21 we can get you more resources to do the work
22 that you do.
23 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
24 SENATOR RIVERA: Thank you.
199
1 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
2 you.
3 CHAIRWOMAN YOUNG: Thank you.
4 Our next speaker is Senator Krueger.
5 SENATOR KRUEGER: Hi, Commissioner.
6 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Hi.
7 SENATOR KRUEGER: Okay. So Senator
8 Rivera just started off where I was going to,
9 which is it's critical we understand what's
10 new money for new things versus just
11 replacement. Because your budget shows an
12 $80 million increase, and yet you're
13 expecting $127 million from this tax. So
14 that's why there are red flags being raised.
15 Okay?
16 Second, even though it was also asked,
17 but I was not satisfied with the answer --
18 and you said ask Tax and Finance, but I think
19 it's very important for you to go back and
20 help us get the answer. So the Governor has
21 proposed this opioid manufacturer surcharge.
22 If you sat through yesterday's hearing, you
23 heard from the pharmacies, panicked that they
24 would be the ones expected to collect the
200
1 money, which would be a charge to the
2 consumer which they wouldn't be able to bill
3 the opioid manufacturers for or the
4 wholesalers for, because they have no
5 negotiating room with the wholesalers or
6 manufacturers, many of which are out of
7 state.
8 What I think we need to know, is the
9 Governor proposing this as a kind of excise
10 tax, the way we do excise taxes on alcohol or
11 tobacco? Where, even if you're a
12 manufacturer out-of-state, we make you pay
13 it? Or are we talking about a situation
14 where this would land on pharmacies and
15 consumers to deal with? Which I think most
16 of us here think that's the wrong punch line.
17 Okay? So yes, maybe it's someone
18 else's division, but as the commissioner who
19 sits here for OASAS, we need to get that
20 information back from you --
21 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
22 SENATOR KRUEGER: -- about who
23 actually would pay it and how it would be
24 collected. Okay.
201
1 So I want to go on to ask you about
2 something that people didn't ask about yet.
3 In your testimony you talked about having
4 funds to open up up to seven gambling
5 addiction sites. So are we going to open up
6 seven gambling addiction sites? And tell me
7 what the basis for that is.
8 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes,
9 actually we should be making the announcement
10 shortly.
11 The monies come from -- remember, last
12 year we said that there would be some fees on
13 table games and so on and so forth. That's
14 what's funding this initiative.
15 And there are seven centers that have
16 been identified throughout this state, and
17 currently I believe the RFP is being reviewed
18 by OSC, so it should be out shortly and we
19 should be able to identify these seven
20 centers in the very near future.
21 SENATOR KRUEGER: And so you're going
22 to put out an RFP to providers to run these?
23 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes.
24 Yes.
202
1 SENATOR KRUEGER: So --
2 COMMISSIONER GONZÁLEZ-SÁNCHEZ: We
3 have to bid it out, yes.
4 SENATOR KRUEGER: Right.
5 Is there going to be any coordination
6 between the gambling addiction sites and
7 other substance abuse providers for alcohol
8 or drugs?
9 Because I've been doing quite a bit of
10 reading of the scientific research, and
11 basically the researchers have concluded that
12 it's a comorbidity of being someone who could
13 be trapped in gambling addiction and also
14 addiction to other items such as alcohol
15 and/or drugs, because it has the same
16 triggers in the brain. And that we have more
17 and more models that trigger addiction in our
18 brains on a daily basis.
19 So we've been expanding gambling --
20 and as I told you, I was concerned about the
21 fact that there's more and more research
22 showing that smartphones and computers and
23 games are also being programmed to train us
24 for an addiction. I actually think Cathy
203
1 Young and I need a 12-step program for our
2 phones.
3 (Laughter.)
4 SENATOR KRUEGER: I'm naming myself
5 first. But --
6 CHAIRWOMAN YOUNG: I'm not giving up
7 my phone.
8 (Laughter.)
9 SENATOR KRUEGER: I'm not either. But
10 I'm just highlighting the addiction issue.
11 So is there going to be co-programming
12 between other addiction issues and gambling
13 at these centers?
14 COMMISSIONER GONZÁLEZ-SÁNCHEZ:
15 Absolutely. There has to be, yes,
16 coordination of care.
17 SENATOR KRUEGER: And so the money for
18 gambling addiction treatment is a formula off
19 of the casinos?
20 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Yes.
21 The funding came -- remember, there was a
22 $500 charge for each table game. And the
23 results thus far has been the $3.5 million.
24 SENATOR KRUEGER: So $3.5 million for
204
1 this coming year with -- as there's a growth
2 in the table games. But not the slot
3 machines, just the table games?
4 COMMISSIONER GONZÁLEZ-SÁNCHEZ: I
5 think it's table games and it could be slot
6 machines too. I can't remember right now,
7 but -- yeah, I think so. Yes. Yes.
8 SENATOR KRUEGER: Yes, okay.
9 So as these sites come online and
10 get -- the assumption is they'll get bigger,
11 although maybe not -- that we will have an
12 increased, ongoing funding stream that can't
13 be used for anything else?
14 COMMISSIONER GONZÁLEZ-SÁNCHEZ: That's
15 the way I understand it, yes.
16 SENATOR KRUEGER: Thank you.
17 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Okay.
18 CHAIRWOMAN YOUNG: Senator Brooks.
19 SENATOR BROOKS: Thank you,
20 Madam Chair.
21 Commissioner, it's good to see you.
22 Obviously we're in a situation with
23 the opioid addiction that's an epidemic
24 throughout the country, and one that we're
205
1 not doing so well with. Back at home, I'm a
2 first responder, and I see many of these
3 cases firsthand.
4 One of the things we did in our
5 offices, we established workgroups in all of
6 the communities that we're trying to address
7 and put programs forward, including drug
8 take-back programs and educational programs
9 for the community.
10 But the reports show last year, on
11 Long Island alone, more than 600 lives were
12 lost from addiction. Do you have any
13 specific programs targeted for Long Island
14 that you're working on?
15 COMMISSIONER GONZÁLEZ-SÁNCHEZ:
16 Actually, yes. We actually opened the first
17 recovery center, THRIVE, in Long Island.
18 SENATOR BROOKS: Right. I was there.
19 COMMISSIONER GONZÁLEZ-SÁNCHEZ: We've
20 also opened family support programs there.
21 We've also expanded young adult beds in
22 Long Island. And as we move forward, we're
23 going to continue to see -- my understanding
24 is that, you know, there's a request for
206
1 additional recovery centers in Long Island.
2 And so as we move forward, these are some of
3 the things that we're going to continue to
4 address and look at.
5 Having been in Long Island for a
6 while, I understand the complexities of the
7 travels and so on and so forth.
8 So yes, we are looking at Long Island
9 the same way we're looking at other parts of
10 the state that need, you know, specific
11 attention.
12 SENATOR BROOKS: Okay. I think --
13 I've been at THRIVE, I think it's a great
14 program. Obviously, I think we should be
15 expanding that.
16 The fentanyl is an absolute problem
17 we've got to be addressing.
18 I think one of the driving points
19 that's being made here by everyone, you know,
20 we're putting in place a fee to raise an
21 additional $127 million to go into this
22 effort. Everybody, I think, in the
23 Legislature, regardless of party, is
24 absolutely committed to addressing this
207
1 epidemic. But I think we are asking, and we
2 have a right to know, exactly how those funds
3 are going to be used specifically, enhancing
4 programs that you know are working or changes
5 in new programs.
6 But, you know, there was a commercial
7 years back: Where's the beef? I think
8 that's what we're saying, because this
9 problem isn't going away. We're making
10 limited progress. We're asking people in a
11 state right now that pay some of the highest
12 taxes going, we're going to put in a new
13 program, a new tax that hopefully is not
14 going to be passed on to the residents, but
15 funded by the manufacturers of these drugs.
16 But I think it's critical that we know
17 exactly how these funds are being used, and I
18 think it's critical that we start measuring
19 the various programs that we have in terms of
20 what is successful and not. And certainly
21 the programs that you have that are
22 successful can be passed down to workgroups
23 like we have, or we can work with you to
24 enhance and utilize those programs.
208
1 So I think this whole problem has been
2 a cooperative effort. But I think the
3 Legislature is saying we're going to put
4 forward a significant money source, but we
5 want to see exactly how that's going to be
6 used. This problem is an everyday problem in
7 every single community, in almost every
8 family. And we've got to get it resolved.
9 So I thank you for everything that
10 you're doing. I think it's clear both sides
11 have the same request: What are we doing
12 with the money, number one? And perhaps most
13 importantly, how is that being charged, how
14 is that being collected?
15 And I apologize, that was -- Madam
16 Chairman -- Chairwoman, excuse me, I
17 apologize. Thank you.
18 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
19 you.
20 CHAIRWOMAN YOUNG: Thank you,
21 Senator.
22 I think we're done? Okay. Well,
23 thank you, Commissioner, for being here
24 today. We really appreciate your testimony.
209
1 COMMISSIONER GONZÁLEZ-SÁNCHEZ: Thank
2 you.
3 CHAIRWOMAN YOUNG: Our next speaker is
4 Executive Director Denise Miranda, New York
5 State Justice Center for the Protection of
6 People with Special Needs.
7 Thank you for appearing today. We
8 appreciate it. Anytime you're ready.
9 EXECUTIVE DIRECTOR MIRANDA: Good
10 afternoon, Senator Young, Assemblywoman
11 Weinstein, Assemblywoman Gunther, and other
12 distinguished members of the Senate and
13 Assembly.
14 CHAIRWOMAN YOUNG: Could you get
15 closer to your mic?
16 EXECUTIVE DIRECTOR MIRANDA: Sure. Is
17 this better?
18 CHAIRWOMAN YOUNG: A little bit, yeah.
19 EXECUTIVE DIRECTOR MIRANDA: My name
20 is Denise Miranda, and I am the executive
21 director of the New York State Justice Center
22 for the Protection of People with Special
23 Needs. I would like to thank you for the
24 opportunity to testify today regarding
210
1 Governor Cuomo's 2018-2019 Executive Budget
2 proposal for the Justice Center.
3 New York has a history of implementing
4 changes that shape the course of the nation,
5 and the Justice Center is no exception. I
6 can unequivocally say those receiving
7 services in the State of New York are safer
8 today than they were five years ago. Our
9 agency's Staff Exclusion List has prevented
10 400 people who committed heinous acts against
11 individuals with special needs from working
12 in direct care positions. The Justice
13 Center's Criminal Background Check Unit
14 prevents several hundreds of applicants with
15 convictions including assault, rape, and
16 murder from working with vulnerable
17 populations.
18 But we believe our mission consists of
19 more than investigating after an incident has
20 happened. It also centers on preventing it
21 in the first place. To do that, the
22 Justice Center works extensively with
23 providers, advocacy organizations, and other
24 relevant stakeholders. In 2017, more than
211
1 125 external on-site training and outreach
2 seminars involving various stakeholders were
3 conducted across the state.
4 Another key agency effort focuses on
5 reviewing cases and identifying abuse and
6 neglect-related trends. The agency produces
7 the Spotlight on Prevention, a tool developed
8 for providers, individuals and family
9 members. The Spotlight includes educational
10 materials on the dangers of being left
11 unattended in vehicles, of recognizing
12 caregiver fatigue, and on the danger of the
13 inappropriate use of restraints. These
14 efforts will continue in 2018.
15 While we are very proud of the work
16 that has been accomplished, the
17 Justice Center is no stranger to criticism,
18 and l want you to know that we have heard
19 you. I recognize there needs to be a balance
20 between our oversight responsibilities and
21 the anxiety and fears of the dedicated
22 workforce. I have spent the past year
23 meeting with service recipients, caregivers,
24 direct care workers, and providers to hear
212
1 their feedback.
2 I have also spent considerable time
3 reviewing the operations, policies, and
4 procedures of the Justice Center. To support
5 quality and efficient investigations, we
6 continue to regionalize our staff to high
7 volume areas. This move, combined with
8 technology improvements and training for
9 staff, has cut case cycle time by 40 percent.
10 Another key initiative was the
11 creation of the 72-hour case assessment
12 model. This process holds initial
13 classification of an incident while
14 additional information is gathered from the
15 provider, to ensure appropriate
16 classification. This allows investigators to
17 process serious cases of abuse and neglect
18 more efficiently.
19 In our continued effort to expedite
20 cases, we have secured a memorandum of
21 understanding with the Department of Health,
22 giving our investigators immediate access to
23 death certificates.
24 Additionally, in response to concerns,
213
1 we've eased the burden on mandated reporters.
2 In cases where there are multiples witnesses,
3 only one is now required to report. This
4 model allows workers to focus on providing
5 care while still giving the Justice Center
6 critical information about an incident.
7 In the interest of transparency, we
8 post monthly aggregate data reports
9 summarizing the Justice Center’s abuse and
10 neglect work. Additionally, we are now
11 publicly posting our findings regarding
12 visits to New York State correctional
13 facilities to monitor their compliance with
14 the Special Housing Unit Exclusion Law.
15 While our goal is to maintain an
16 environment free from abuse and neglect,
17 unfortunately incidents do happen. It is our
18 duty to hold workers involved in abuse and
19 neglect responsible for their conduct. We
20 believe the work of the Justice Center is
21 crucial to the health, safety, and support of
22 our most vulnerable populations.
23 The Governor's Executive Budget
24 supports the Justice Center in a number of
214
1 ways, by operating 16 regional offices and a
2 24/7 hotline to receive reports of abuse and
3 neglect; expanding our Individual and Family
4 Support Unit to help family members and
5 individuals throughout the investigative
6 process; offering extensive training for both
7 internal and external investigators;
8 supporting training for all staff on the
9 various ways diversity fosters professional
10 and culturally appropriate interactions with
11 our varied stakeholders; and collaborating
12 with provider agencies and our Advisory
13 Council on the best ways to educate the
14 workforce about their responsibilities.
15 This year will mark the five-year
16 anniversary of the Justice Center. It will
17 be a year of continued improvement. We will
18 be evaluating the processes by which the
19 agency operates and examining areas for
20 efficiency improvements. This includes an
21 audit of all investigatory training, a
22 thorough examination of our intake model,
23 exploring an expedited track for cases with
24 certain fact patterns, and a shortened time
215
1 frame for appeals. We will also be enhancing
2 our collaborative efforts with stakeholders
3 at all levels.
4 The Justice Center looks forward to
5 working with our partners in the Legislature,
6 state oversight agencies, and our other
7 stakeholders to enhance the protections for
8 some of New York’s most vulnerable people.
9 I now welcome your questions.
10 CHAIRWOMAN YOUNG: Thank you very
11 much. And I appreciate your testimony. I'm
12 glad to hear of some of the advances, because
13 the Legislature has brought those to the
14 agency's attention in the past.
15 So for example, on the mandated
16 reporters, if, you know, 10 people are
17 witnessing an incident, only one has to
18 report now. That's what you're saying?
19 EXECUTIVE DIRECTOR MIRANDA: The
20 requirements for mandated reporting have been
21 relaxed. So if a person is a mandated
22 reporter and they're aware that a report has
23 already been made and that they were named in
24 that report as a witness, they no longer have
216
1 the obligation to make that report.
2 We're hoping that that will ease the
3 burden for providers in ensuring the safety
4 and quality of the people that they're caring
5 for.
6 CHAIRWOMAN YOUNG: That seems like a
7 great change, because it was very duplicative
8 before. So it sounds like progress.
9 But one of the issues that we still
10 see is that staff who are being investigated
11 as a result of a complaint may either be
12 placed on administrative leave or terminated.
13 The length of time for investigation forces
14 providers to hire new staff, and employees
15 then can be left in employment without pay
16 until the situation is resolved. So
17 obviously those situations create a lot of
18 issues. And this -- these situations may
19 last a significant amount of time.
20 So you talk a little bit about some
21 upcoming reforms. What specific actions has
22 the center taken in response to the numerous
23 complaints regarding the length of time for
24 investigations? Because from what we're
217
1 hearing, it continues to be an issue.
2 EXECUTIVE DIRECTOR MIRANDA: So I've
3 traveled the state, and I heard that concern
4 throughout the various meetings that we've
5 had.
6 We recognize the burden that's placed
7 on providers, and so in an effort to be
8 responsive, we're constantly trying to
9 improve our cycle times. But we have to be
10 mindful that we do have to balance the need
11 for a thorough investigation with
12 efficiencies.
13 I'm very happy to report that case
14 cycle time is down by 40 percent. In 2016,
15 the average was 117 days. In 2017, we're
16 down to 71 days. Cycle time is still a
17 priority for us, and we'll continue to
18 improve those numbers.
19 We also have a 72-hour protocol that
20 was introduced this year, and the 72-hour
21 protocol seeks to pull certain cases of abuse
22 and neglect so that they can be assessed for
23 the accuracy of the classification.
24 And so what happens in that process is
218
1 that we're able to communicate directly with
2 a provider and get information that will help
3 us make a more informed decision regarding
4 the category. These are desk-review sort of
5 audits.
6 And so what we found in looking at
7 2500 cases is that we were able to reclassify
8 approximately 47 percent of those cases. So
9 looking at that model and seeing what we've
10 learned, we hope to implement that overall at
11 the Justice Center to make sure that we can
12 be responsive.
13 CHAIRWOMAN YOUNG: Anytime you can get
14 the time period -- any time period to be
15 shorter -- even over two months still -- I
16 don't know, it still seems like a long time
17 for some of these investigations to hang out
18 there.
19 But we really want to make sure that
20 people are protected. And -- however, there
21 continues to be complaints that the Justice
22 Center has a law enforcement approach for
23 every investigation, regardless of the nature
24 of the complaint. And this has led to fear
219
1 and anger among provider staff.
2 I know that I've personally spoken to
3 people in my district office who have come to
4 me, and they're very concerned about the very
5 heavy-handed way things sometimes are handled
6 by the Justice Center.
7 So how do you respond to these
8 allegations, and what actions have been taken
9 to make it more a helpful approach and less
10 of a coming-down-on-your-head approach?
11 Because not everything that you investigate
12 has the same level of seriousness.
13 EXECUTIVE DIRECTOR MIRANDA:
14 Absolutely. And so we recognize that that is
15 an important concern that is articulated by
16 many of the providers, and so we've engaged
17 extensively in outreach. We've conducted
18 over 48 workshops for DSPs, to make sure that
19 we're able to answer questions and correct
20 misconceptions that exist regarding the
21 Justice Center.
22 We employ 175 investigators. I think
23 it's noteworthy that only 15 percent, a
24 little less than 15 percent of these
220
1 investigators are sworn police officers. We
2 recognize that very few cases are criminal in
3 nature, which is a good thing. And so we
4 recognize that we need to certainly make
5 adjustments in our tone.
6 And so to that end, we're very proud
7 to share with you that our investigative
8 workforce comes from a background of
9 employment within the settings that we have
10 jurisdiction. So over 50 percent of the
11 investigators have actually worked in these
12 service settings. Additionally, many of our
13 investigators also have family members who
14 are in these service settings.
15 So with respect to the approach, there
16 have also been some policy changes. We
17 eliminated the use of the word "suspect" this
18 year, which I think was very important. I
19 think the word "suspect" should only be used
20 in a criminal context. I think language
21 matters, and I think that reflects a shift in
22 how we're approaching business at the
23 Justice Center.
24 CHAIRWOMAN YOUNG: I think language
221
1 matters too, and I -- I mean, that's a great
2 example to point out the power that you have.
3 And by calling somebody a suspect, obviously
4 that has very negative connotations. And
5 oftentimes I talk to people who are being
6 investigated by the Justice Center, and they
7 just feel like their lives and their careers
8 are over.
9 So if it's not a serious complaint,
10 you still have to follow up on it, we
11 understand that. But at the same time,
12 anything that you can do to kind of parse out
13 the levels of seriousness, I think it would
14 be helpful.
15 Now, the most recent information from
16 the Justice Center indicates approximately
17 11,254 closed cases. Does that sound correct
18 to you?
19 EXECUTIVE DIRECTOR MIRANDA: That
20 sounds correct.
21 CHAIRWOMAN YOUNG: Okay. So of this
22 amount, only 4,169 -- or 35 percent -- were
23 found to be substantiated. So that's quite a
24 difference. And I was wondering -- I wanted
222
1 to get your thoughts about it, because of the
2 Justice Center's closed cases, with
3 approximately 35 percent found to be
4 substantiated, there is a discrepancy there.
5 So why is there such a discrepancy
6 between the reports of abuse and neglect that
7 are investigated and the actual number of
8 cases that are substantiated? Is this a
9 staff training problem? What is it?
10 EXECUTIVE DIRECTOR MIRANDA: No, I
11 would maintain that the staff is extremely
12 well trained at the Justice Center. But the
13 reality --
14 CHAIRWOMAN YOUNG: No, but I mean also
15 out in the field.
16 So say, for example, you're at an
17 OPWDD facility. I had one person come to me
18 and say they were put on report because there
19 was a participant in the house, a program
20 participant who had a nickname that he
21 preferred to go by. And apparently the
22 supervisors wanted him to be called by his
23 full name, his real name, whether it's
24 William or Robert or whatever. And they were
223
1 reported because they continued to call him
2 by his nickname.
3 So like -- if there are complaints
4 like that, isn't that a staff training issue
5 more than anything else? So -- that's a
6 two-part question.
7 EXECUTIVE DIRECTOR MIRANDA: So with
8 respect to the example you gave, I'm not
9 familiar with the specifics. But I can
10 certainly assure you that in 2018 the
11 Justice Center would not find that, as you
12 described it, to be an incident of abuse and
13 neglect.
14 We do realize that these cases are
15 substantiated approximately one-third, as you
16 mentioned. And I think it's important to
17 remember that these are extremely complicated
18 cases. We're dealing with sometimes multiple
19 victims with very different capacities.
20 We're dealing with trauma. We're also
21 dealing with circumstances that are difficult
22 with respect to the care that these people
23 are receiving.
24 So I think that the substantiation
224
1 rate is consistent with the Child Abuse
2 Hotline, which is the 33 percent number. And
3 so we're confident that we'll continue to
4 assess cases in a reasonable way to make sure
5 the cases like you're mentioning, Senator,
6 are not part of that pool of cases that are
7 classified as abuse and neglect.
8 CHAIRWOMAN YOUNG: Okay, thank you.
9 And you just brought up trauma, which
10 is great, because that's where I wanted to go
11 to next.
12 And the Justice Center provides
13 background information and contact to assist
14 providers, and also they give it to family
15 members for individuals who have been
16 suffering from some sort of trauma. Can you
17 share more details of your efforts in that
18 direction? Because I think that's a great
19 idea.
20 EXECUTIVE DIRECTOR MIRANDA: So we've
21 trained all of our investigators to make sure
22 that they are using an appropriate approach
23 when investigating these cases. And this is
24 a trauma-informed, evidence-based,
225
1 victim-centered approach that we are using.
2 We've also been doing a lot of
3 education with our investigators to help them
4 understand that when we're talking about
5 trauma, we're talking about trauma across the
6 field. Right? So if you're a witness, or
7 perhaps you are a subject in an
8 investigation, inherently this is a traumatic
9 experience. And so we want to make sure that
10 our investigators are leading with that in
11 mind, and using that approach, whether you're
12 a witness, whether you're a subject, or
13 whether you're a victim of abuse and neglect.
14 So we've done extensive training and
15 invested a significant amount of resources in
16 that effort.
17 CHAIRWOMAN YOUNG: Okay, thank you.
18 Assembly?
19 CHAIRWOMAN WEINSTEIN: Assemblywoman
20 Gunther.
21 ASSEMBLYMAN GUNTHER: Well, we just
22 met the other day, and I was certainly
23 impressed by the changes that you've
24 initiated in the Justice Center -- not making
226
1 it punitive, but more educational. And we do
2 appreciate that.
3 Do you think that the definition of
4 abuse and neglect should be changed, like
5 statutorily?
6 EXECUTIVE DIRECTOR MIRANDA: I believe
7 the statute as it exists is fine. I believe
8 that we are able, as an agency, to make sure
9 that we're using a reasonable standard when
10 we're making these assessments.
11 There's been a lot of discussion about
12 the use of "neglect" and making sure that the
13 appropriate cases are being classified.
14 That's not a function of changing the
15 statute. That's a matter of making sure that
16 the lens with which we're looking at these
17 cases is appropriate given the circumstances
18 that people are working in every single day.
19 ASSEMBLYMAN GUNTHER: Thank you.
20 CHAIRWOMAN YOUNG: Thank you.
21 Senator Krueger.
22 SENATOR KRUEGER: Hi. Thank you for
23 your testimony today.
24 So I think I want to just do a little
227
1 bit of follow-up on the questions. So if --
2 I just want to double-check on the record
3 you're right, that if a third of your cases
4 are being concluded as something needed to be
5 done, there was in fact abuse or neglect,
6 that is a standard that is not uncommon in
7 other kinds of mandatory reporting hotline
8 type of situations?
9 EXECUTIVE DIRECTOR MIRANDA: So every
10 case that comes into the Justice Center
11 that's classified as abuse and neglect will
12 conclude with either a substantiation or an
13 unsubstantiation.
14 Cases are unsubstantiated perhaps
15 because we're unable to meet our burden, our
16 standard of proof, which is preponderance of
17 the evidence. Sometimes they are
18 unsubstantiated because there may be false
19 allegations, we see that as well. So there
20 are a host of different reasons why a case is
21 unsubstantiated.
22 But I think, you know, the
23 Justice Center is here to ensure that that
24 one-third of the people where cases are
228
1 substantiated, that those individuals are
2 held accountable. Right? And that we're
3 able to issue corrective action plans. And
4 whether that's retraining, changing policies
5 or looking at supervision levels, that abuse
6 and neglect is being accounted for but also
7 being prevented.
8 SENATOR KRUEGER: And just to remind
9 us all, the reason that we created the
10 Justice Center was because there were so many
11 complaints being brought to the state, to
12 individual legislators, to police and DAs of
13 problems happening, so to speak, on the
14 state's watch for the most vulnerable people.
15 I mean, all the agencies that you oversee
16 serve people who are in institutional-type
17 settings and are quasi -- the responsibility
18 of the State of New York. That's correct,
19 right?
20 EXECUTIVE DIRECTOR MIRANDA: Correct.
21 SENATOR KRUEGER: So while there is
22 going to be a stress between those who think
23 you're pushing too hard and those who may
24 think you're not pushing hard enough, again,
229
1 I think I wanted to remind myself that there
2 was a very specific reason we created the
3 Justice Center.
4 My understanding is that there was a
5 decision concerning whether the Justice
6 Center had prosecutorial authority and
7 whether you needed DAs to be the leads in
8 court. And I'm curious whether, based on
9 that decision, you're finding that you need
10 to change your protocols or that you need the
11 Legislature to change the statute.
12 EXECUTIVE DIRECTOR MIRANDA: So the
13 constitutional issue is an important
14 question. Thank you for asking it.
15 There's nothing in the State
16 Constitution that prohibits the Legislature
17 from appointing a special prosecutor. We
18 receive our authority in the same fashion as
19 county DAs, through the Legislature. We have
20 concurrent authority with county DAs, and we
21 enjoy a very collaborative and supportive
22 relationship with them.
23 There are, as you mentioned, a small
24 handful of cases in Albany County, but there
230
1 are also cases downstate in the Bronx as well
2 as in Kings County where motions to dismiss
3 based on the constitutional challenge of
4 prosecutorial authority have been denied.
5 We're very confident that upon appeal,
6 the cases here in Albany -- that we will be
7 successful and the Justice Center will remain
8 in good stead.
9 SENATOR KRUEGER: Thank you. Thank
10 you for your work.
11 CHAIRWOMAN YOUNG: Thank you.
12 Assembly?
13 CHAIRWOMAN WEINSTEIN: Assemblyman
14 Santangelo -- I'm sorry, Santabarbara.
15 Angelo Santabarbara.
16 ASSEMBLYMAN SANTABARBARA: That's
17 okay. It's sort of a combination of names.
18 CHAIRWOMAN WEINSTEIN: It's been a
19 long couple of weeks.
20 ASSEMBLYMAN SANTABARBARA: That's
21 okay.
22 Thanks for being here today, and
23 thanks for your testimony. Just a few
24 questions.
231
1 In the testimony you talk about you've
2 eased the burden for mandated reporters, and
3 you list a couple of changes. How are these
4 changes going to help compared to what was in
5 place before that?
6 EXECUTIVE DIRECTOR MIRANDA: Sure. So
7 previously -- and under the Justice Center,
8 there's an obligation, mandated reporting of
9 any abuse and neglect. That's any person who
10 witnesses or has knowledge of an event.
11 So we take for an example an incident,
12 perhaps, of abuse or neglect that may occur
13 in a dining room where there are four or five
14 DSP workers. Under our previous guidance,
15 all four or five would have to make their own
16 individual report to the Justice Center.
17 Now, with the relaxed requirements, we only
18 require for one person to make that report.
19 And I think it's important to realize
20 that that one person who makes the report
21 doesn't necessarily have to be a DSP who's
22 providing care, it can be a supervisor. So
23 our hope is that we are leaving workers where
24 they need to be, right -- working, taking
232
1 care of individuals with special needs, and
2 not creating situations where we're pulling
3 staff away to make phone calls that are
4 duplicative.
5 ASSEMBLYMAN SANTABARBARA: And my next
6 question is around the -- sort of the
7 auditing process. You're talking about
8 looking for improvements on operations and
9 efficiency. How often does that happen? Is
10 it every time an incident is reported, or is
11 it periodic?
12 EXECUTIVE DIRECTOR MIRANDA: I'm
13 sorry, can you repeat the question? The
14 beginning again?
15 ASSEMBLYMAN SANTABARBARA: You talk
16 about evaluating the process and the
17 efficiencies of your operations, and you talk
18 about an audit of investigatory training
19 that's going to happen. Does that happen
20 every time, or is it just a periodic --
21 EXECUTIVE DIRECTOR MIRANDA: So audits
22 are built into the agency. I will say,
23 though, upon arriving here a year ago, we've
24 done a deep dive as to our various processes
233
1 to see where we can make improvements.
2 You know, the Justice Center is also a
3 new agency, we'll be turning five years old
4 this year. I think it's important for us to
5 use this opportunity to assess what has
6 worked and what hasn't worked so well, and to
7 make those changes.
8 So while some of the audits that I
9 mentioned are operationalized and occur on a
10 regular basis, we're taking a more holistic
11 look and view of the entire agency to see
12 where we can improve efficiencies, whether
13 it's investigative cycle times or the appeal
14 process. All of these areas are areas that
15 are points of focus for 2018.
16 ASSEMBLYMAN SANTABARBARA: And my last
17 question is on the training for internal and
18 external investigators. What does that
19 training consist of?
20 EXECUTIVE DIRECTOR MIRANDA: Sure. So
21 our internal investigators receive an
22 extensive training process when they come
23 on board. As I mentioned, about 50 percent
24 of them actually have experience working in
234
1 the service settings, so we find that to be,
2 I think, of great value to the agency. They
3 will receive training on forensic
4 interviewing, evidence collection, working
5 with people with special needs, as well as,
6 as I mentioned before, the victim-centered,
7 evidence-based, trauma-informed approach of
8 investigating these cases.
9 Additionally, every year we convene an
10 in-service, and all 157 of our
11 investigators are brought up to Albany and we
12 have a three-day training program where we
13 will discuss new trends, perhaps there will
14 be some training on legal issues that have
15 presented within the past year. We'll
16 discuss different approaches, and there will
17 be guest speakers. And so we'll offer a more
18 robust training. But we ensure that that
19 occurs every single year and that every
20 investigator participates.
21 With respect to external
22 investigators, our law enforcement academy
23 conducts trainings, and they trained over
24 500 individuals outside of the agency. And
235
1 the goal there is to make sure that we're
2 able to educate people as to working with
3 this population that has very distinct and
4 special needs.
5 ASSEMBLYMAN SANTABARBARA: Thank you.
6 CHAIRWOMAN YOUNG: Are you all set?
7 CHAIRWOMAN WEINSTEIN: Yeah. We're
8 done.
9 CHAIRWOMAN YOUNG: Okay. So I want to
10 thank you for your testimony today. And we
11 need to protect our most vulnerable
12 New Yorkers, and I know that you're working
13 hard at it, and I know that you've made
14 several changes at the center which sound
15 like they're very positive, and I would just
16 say to you, keep going.
17 EXECUTIVE DIRECTOR MIRANDA: Thank
18 you.
19 CHAIRWOMAN YOUNG: Thank you.
20 CHAIRWOMAN WEINSTEIN: Thank you.
21 CHAIRWOMAN YOUNG: Our next speaker is
22 the Arc New York and its executive director,
23 Mark van Voorst. The Arc.
24 Welcome.
236
1 MR. VAN VOORST: Excuse me?
2 CHAIRWOMAN YOUNG: Welcome.
3 MR. VAN VOORST: Thank you.
4 CHAIRWOMAN YOUNG: Good to see you.
5 Look forward to your testimony.
6 MR. VAN VOORST: Thank you.
7 Senator Young, Assemblywoman
8 Weinstein, Senators and Assemblypeople, thank
9 you for giving me the opportunity to speak to
10 you today.
11 I come to you today with two and a
12 half months of experience as the executive
13 director of the Arc New York, but 40 years of
14 experience in the field. I started off as a
15 direct support worker, and before coming to
16 the Arc New York I had completed a 16-year
17 stint in the city, so I'm familiar with the
18 upstate/downstate issues.
19 One of the things that I wanted to
20 point out before we get into some of the more
21 specific requests that we have is that a lot
22 of our requests probably wouldn't be even
23 relevant had the Legislature, OMRDD -- or
24 OPWDD, as it's now called in the voluntary
237
1 sector -- not actually established what is
2 truly the gold standard of service provision
3 in the entire country.
4 We have historically done a tremendous
5 job. The Arc of New York itself serves
6 roughly 60,000 individuals. It employs
7 30,000 staff and it operates in 52 counties.
8 With that as a backdrop, though, there
9 are serious issues that we are currently
10 facing. I'm not going to go through the
11 testimony which I have provided to you in
12 writing, but there are a couple of things
13 that I do want to highlight.
14 The most significant problem we are
15 facing is our ability to hire and retain
16 competent staff. We are extremely grateful
17 for the money that has been given to us, the
18 3.25 -- 3.25 for direct support and then
19 3.25 for clinical staff -- is obviously a
20 tremendous help to our burden. However,
21 having said that, we also want to highlight
22 that it is only the beginning of a process
23 that we hope continues. And we actually need
24 it to occur at a faster pace than it was
238
1 originally planned, because the statistics
2 seem to suggest that not only are our vacancy
3 rates increasing, but our turnover rates are
4 increasing.
5 Now, ironically, this should not have
6 come as a surprise to anyone. In 2006, HHH
7 provided a report to the United States
8 Congress on direct support professionals.
9 And at that time, so 12 years ago, the
10 vacancy rate was already noted to be roughly
11 37 percent and was estimated to hit
12 50 percent by 2020. We are well on our way
13 to hitting 50 percent.
14 The voluntary sector has prided itself
15 on providing the best quality of care for
16 individuals with developmental disabilities.
17 Our ability to continue to do that is being
18 weakened at this point because we cannot find
19 and retain sufficient staff. The numbers
20 suggest at this point that our vacancy rate
21 is somewhere around 24 percent. Our turnover
22 rate within the first six months is somewhere
23 around 30 percent. And the way you have to
24 understand this, I think, is to put it in the
239
1 context -- if you had a family who was in a
2 nursing home or receiving medical care and
3 you had that kind of turnover rate, what
4 would your level of comfort be?
5 We can hardly get staff trained before
6 they're leaving. It's costing us a fortune
7 to hire new people. And so accelerating the
8 dollar amount that we can pay staff and doing
9 a couple of other things that I've outlined,
10 I think, in my testimony would be extremely
11 helpful to trying to stabilize the field.
12 But this is a long-term problem, and we need
13 to begin to work on it extremely quickly if
14 we hope to maintain the gold standard.
15 Thank you.
16 CHAIRWOMAN YOUNG: Thank you.
17 Where are staff leaving to? Where are
18 they going for jobs?
19 MR. VAN VOORST: Probably any job
20 that's somewhat easier. It's an extremely
21 difficult position. This is not a specialty
22 where you can say, okay, this person does one
23 thing. Direct support professionals do just
24 about everything that you can imagine with a
240
1 person of need. But they're leaving for jobs
2 that pay more. They're leaving for jobs with
3 less responsibility. We're competing with
4 the Burger Kings, with the Walmarts. There
5 are tremendous stresses that are placed on
6 the staff that work for us.
7 I know that, you know, the executive
8 director of the Justice Center has made
9 tremendous strides in trying to improve the
10 relationship between the Justice Center and
11 the field, and I give her tremendous credit
12 for that because the past year has seen many
13 changes. However, direct support staff still
14 are extremely fearful of the Justice Center,
15 because once your name is on that list as
16 a -- she doesn't call them suspects anymore,
17 but they themselves would call themselves
18 suspects -- they're sitting out there for
19 weeks, if not months at a time, not knowing
20 what their future is -- and for things that,
21 you know, probably in the criminal world
22 would not be regarded as criminal, but in our
23 world can come very close to having sort of
24 criminal consequences. Peoples' lives are
241
1 getting ruined.
2 The other thing I just wanted to
3 quickly highlight, though -- and again, this
4 is not to take away anything from the
5 #bFair2DirectCare campaign, because it has
6 been a tremendous success -- is that's what
7 we actually looked at, one level of staff
8 that we're hurting for. We actually have a
9 huge need for mid-line supervisory staff, who
10 are leaving in droves and we cannot seem to
11 find clinical staff who want to work in this
12 field at the salaries that we can pay as
13 well.
14 So you have actually three types of
15 employees who are critical to our ability to
16 perform top-quality care who we actually are
17 now having a difficult time attracting.
18 CHAIRWOMAN YOUNG: Thank you for that
19 answer.
20 And just to switch gears for a second,
21 I've had several agencies that serve people
22 with disabilities, and they've come to me and
23 said that they have a very substantial case
24 for a rate appeal, and rate appeals are
242
1 almost impossible to get through right now.
2 MR. VAN VOORST: Correct.
3 CHAIRWOMAN YOUNG: Could you address
4 that problem?
5 MR. VAN VOORST: The only thing I can
6 tell you, Senator, is rate appeals don't
7 exist anymore. They stopped several years
8 ago, and that's a huge problem.
9 In fact, one of the chapters of the
10 Arc of New York went out of business --
11 actually merged with another county --
12 because it was costing them so much to
13 operate one four-person facility that they
14 financially couldn't sustain themselves, and
15 they collapsed. So there are no more rate
16 appeals.
17 CHAIRWOMAN YOUNG: And what happened
18 to the people served by that agency?
19 MR. VAN VOORST: Well, fortunately the
20 Arc of New York is comprised of 52 chapters,
21 and we had a chapter that was adjacent --
22 actually, it wasn't adjacent, it was somewhat
23 south of where this chapter was -- where they
24 were able to take over the operations and
243
1 continue to supply the services to the
2 individuals.
3 CHAIRWOMAN YOUNG: So this would be
4 Niagara County and Cattaraugus County.
5 MR. VAN VOORST: Correct.
6 CHAIRWOMAN YOUNG: Okay. All right.
7 Thank you for that answer.
8 I think we're all set, but we
9 appreciate you taking the time today.
10 MR. VAN VOORST: If I'm not going to
11 be asked -- I would like to put one thing on
12 the table, and I spoke to Assemblymember
13 Gunther about this.
14 Telemedicine has been mentioned a
15 couple of times today. It is absolutely
16 essential that OPWDD begin to move this
17 forward. You know, for years and years our
18 industry has been criticized for overusing
19 emergency rooms and hospitals. Well, there's
20 a reason for that. There's a reason when
21 state survey teams -- or prior to Denise
22 taking over the Justice Center, there was
23 this constant questioning of nursing
24 decisions. To protect themselves, nurses
244
1 would say: Well, I'm not going to make that
2 call, I'm going to send somebody to the ER.
3 There are organizations out there now
4 where you can use telemedicine where you're
5 actually -- the person picking up the phone
6 is an ER physician. There's tremendous costs
7 savings associated with it. And at this
8 stage I can't conceive of a reason why we
9 wouldn't want to push telemedicine as quickly
10 as we possibly can.
11 CHAIRWOMAN YOUNG: I totally agree on
12 telemedicine, telehealth.
13 Thank you so much.
14 MR. VAN VOORST: Thank you.
15 ASSEMBLYWOMAN GUNTHER: Thank you.
16 CHAIRWOMAN YOUNG: Our next speakers
17 are Executive Director Harvey Rosenthal and
18 Director for Policy and Public Engagement
19 Elena Kravitz, from the New York State
20 Association of Psychiatric Rehabilitation
21 Services, Incorporated, and also Glenn
22 Liebman, CEO of Mental Health Association of
23 New York State. I think. Is that correct?
24 MR. LIEBMAN: Yes, it is.
245
1 CHAIRWOMAN YOUNG: Okay. Very good.
2 MR. ROSENTHAL: Good afternoon.
3 CHAIRWOMAN YOUNG: Good afternoon.
4 MR. ROSENTHAL: Thank you, Senator
5 Young, Assemblywoman Weinstein, and members
6 of the committee, Ms. Gunther --
7 CHAIRWOMAN YOUNG: As you know, we're
8 asking the speakers to summarize their
9 testimony, so --
10 MR. ROSENTHAL: What's that?
11 CHAIRWOMAN YOUNG: We're asking the
12 speakers to summarize their testimony instead
13 of reading it word for word. So if you could
14 do that, that would be great.
15 MS. KRAVITZ: A summary. Summarize.
16 MR. ROSENTHAL: Summary? Oh, a
17 summary. I'm sorry. I didn't bring my
18 hearing aids.
19 (Laughter.)
20 MR. ROSENTHAL: So speaking of my
21 hearing aids, this is my 25th year of
22 providing testimony, and I hope that 25 is
23 the charm.
24 So I want to first introduce Elena
246
1 Kravitz to you. She is our new policy
2 director. I'm particularly proud to have
3 stolen her back from New Jersey. She was a
4 Brooklyn native, but -- she has a great
5 story, we won't have time for you to hear it
6 today. And she'll be doing some incredible
7 work. But we're also proud that she sits on
8 the highest body in the nation, which is the
9 Interdepartmental Serious Mental Illness
10 Coordinating Council.
11 So Elena -- and welcoming Glenn, of
12 course. You'll be hearing from him. He's my
13 partner and colleague, and we'll be going
14 over a number of issues. So I'm going to go
15 fast.
16 NYAPRS is a statewide -- a unique
17 statewide coalition of people with mental
18 illnesses, like Elena and me, and community
19 providers who have been working for 37 years
20 to try to transform the system, to move one
21 from illness to wellness and from
22 institutions to the community and from
23 coercion to rights and things like that.
24 Over the years we've worked on a
247
1 number of issues together with the
2 Legislature, and last year we were very
3 grateful that you funded the $1.9 billion for
4 supportive housing over 35 years, crisis
5 intervention teams, raised the age of
6 criminal liability, and the increase in the
7 workforce that you just heard about.
8 We're very grateful for that, and
9 we're also grateful to the Governor for some
10 of the things he put in his budget -- the ACT
11 teams reinvestment, the crisis in community
12 beds.
13 I'm not going to talk about -- I am
14 going to talk about the housing issue.
15 Housing, stable housing, is essential to hope
16 and health and recovery. We work on the
17 streets of New York City with people that are
18 frequently readmitted in emergency rooms or
19 hospitals, jails and prisons, and the one
20 thing they share, so many of them in common,
21 is they didn't have stable housing.
22 So it's really important not only to
23 build new housing, but to keep and maintain
24 the housing we have now. And even though the
248
1 Governor -- he puts up $10 million, it's not
2 enough by any means. And so we're a member
3 of the Bring It Home, Better Funding for
4 Better Care Campaign, and we urge the
5 Legislature and the Governor to make a
6 commitment to put in $120 million to
7 stabilize 40,000 units of mental health and
8 permanent housing in five program types over
9 the coming years.
10 I'm going to focus a little bit on
11 criminal justice. I was so glad to hear the
12 questions earlier. This is a top priority
13 for us. We have way too many people in jails
14 and prisons. Right now we have people
15 suffering in the box who are 23 hours a day
16 in the dark -- and you heard earlier today
17 that's 850, I think. And even though we have
18 that law we all worked on to pass, there
19 still are these procedures where people can
20 be put in the box.
21 Actually, I'm out of order here, but
22 the way to really prevent folks even getting
23 into prison is at the arrest level. And so
24 the training of police to be more responsive,
249
1 and to not escalate but to be able to handle
2 a situation and avoid a tragedy or an arrest,
3 is critical. The Legislature has been great
4 on that, the Senate in particular has
5 funneled money -- if you look at my
6 testimony, you'll see a broad number of
7 communities that have received that funding.
8 And Mrs. Gunther, last year you funded for
9 half a million dollars an alternative to
10 outpatient commitment that's very -- it goes
11 to people before tragedy and before crisis
12 whenever possible. We're looking forward to
13 seeing how that goes.
14 I mentioned earlier about solitary
15 confinement. There are 844 people in the OMH
16 caseload in the SHU. Thirty percent of the
17 suicides in 2014 to 2016 happened in the SHU.
18 Rates of suicide attempts and self-harm,
19 11 times higher in solitary confinement.
20 Even though Colorado has implemented a
21 program to cut solitary confinement from
22 1,500 to 18, for our population, New York is
23 still -- is lagging behind.
24 As part of the Mental Health
250
1 Alternatives to Solitary Confinement
2 Coalition, we urge the Legislature to pass
3 the HALT legislation. We want to
4 particularly appeal to the Senate because our
5 understanding is last night Speaker Heastie,
6 he made a commitment to pass this bill, which
7 would not only get into this issue about
8 serious mental illness, or mental illness, it
9 would ban solitary confinement with
10 vulnerable groups -- the young and elderly,
11 people with physical or mental disabilities,
12 pregnant women and new mothers, and LGBTQI
13 individuals. Long overdue.
14 If you're not mentally ill before you
15 get in the SHU, you will be afterwards. We
16 really have to stop this practice. So we
17 urge you, we urge you for help in this area.
18 I won't talk about the living wage,
19 because Glenn will. You heard earlier about
20 adult homes. I think it is tragic that only
21 14 percent of the 4500 that were supposed to,
22 by a court settlement, be able to move into
23 supportive housing have moved. I know
24 there's been some progress, but it's
251
1 miniature.
2 And I'm glad that the Governor's
3 budget is funding $5 million for specialized
4 peer supporters to go to the adult homes and
5 instill hope and trust and help the people
6 move all the way through the very complex
7 process into the community. I think you
8 heard earlier, too, that -- I know last year,
9 at the end of last year, the operators, adult
10 home operators, were able to get a bill
11 passed through both houses that would
12 increase their rates. The Governor, he
13 vetoed it, partly because he didn't want to
14 do budget outside of budget.
15 But we really urge and insist that if
16 there's a hike to the operators, there needs
17 to be an equal hike to the personal needs
18 allowance of the residents. They live on so
19 little money.
20 We are very -- again, one more year,
21 really happy to see the funds from the
22 downsizing of facilities into the community.
23 This reinvestment money, $11 million this
24 year, goes to mobile intensive outreach
252
1 teams, peer bridger and respite programs,
2 crisis intervention, warm line and housing
3 services, family empowerment services,
4 managed care transitional supports, forensic
5 ACT team and social club services. It's
6 critical, and we're grateful to the Governor
7 and the Legislature for supporting this year
8 after year.
9 Are you doing prescriber prevails?
10 MR. LIEBMAN: No --
11 CHAIRWOMAN YOUNG: Yeah, Harvey, I was
12 wondering if you could kind of summarize --
13 MR. ROSENTHAL: Actually, you know
14 what --
15 CHAIRWOMAN YOUNG: And then we'll let
16 Glenn go.
17 MR. ROSENTHAL: -- the rest of my
18 issues he's going to take.
19 CHAIRWOMAN YOUNG: Perfect.
20 MR. ROSENTHAL: So I'll yield to my
21 partner.
22 CHAIRWOMAN YOUNG: Thank you.
23 MR. LIEBMAN: Thank you very much.
24 And I appreciate you squeezing me in here at
253
1 the last minute. I thank Harvey as well for
2 working with me on this.
3 So my name is Glenn Liebman. I'm the
4 director of the Mental Health Association of
5 New York State, and this is my 16th year of
6 testifying. I really appreciate it very
7 much.
8 Our organization is comprised of
9 26 affiliates in 52 counties throughout
10 New York State. Largely we provide
11 community-based mental health services; we're
12 also involved in a lot of education and
13 advocacy as well. And we want to thank
14 Assemblymember Gunther for being part of our
15 press conference yesterday when we introduced
16 a new mental health license plate -- as well
17 as Senator Ortt, who I know is not here
18 today. But we thank them for all their
19 support, not just for that.
20 But there has been a major sort of
21 change, and New York is leading the way on a
22 lot of anti-stigma efforts. The license
23 plate, we have a mental health tax check-off.
24 And more significantly, we even have a mental
254
1 health education bill in New York State now,
2 which is great. And I appreciate questions
3 being asked about that, because it's going to
4 be operationalized on July 1st of this year.
5 And we're very excited to make sure
6 that all schools across New York State and
7 all students across New York State now have a
8 greater knowledge about mental health in
9 schools, and I'll get into just that briefly.
10 And I'll be very brief, because frankly there
11 are 13 issues we're covering, and I obviously
12 won't cover -- carry -- Harvey did carry most
13 of them.
14 But I did want to talk about workforce
15 specifically. I think workforce -- you've
16 heard it from everybody, it's a continuing
17 theme. What you all did last year was
18 phenomenal. The #bFair2DirectCare campaign
19 and everybody who was involved -- and this
20 was the greatest change in over a decade for
21 living wage, for the direct care workforce.
22 It was a great victory, and we as the mental
23 health organizations and behavioral health
24 organizations also were able to receive
255
1 funding for that. And again, that was
2 terrific.
3 But it's a step. It's a step in a
4 staircase of need, frankly. We have a lot of
5 issues that are going on. This is a great
6 add to the workforce, but we need so much
7 more. We need continuous support. We're
8 looking for -- and it's in our budget
9 proposal -- we're looking for a 3.25 percent
10 increase, much like you had last year, to be
11 implemented January 1st of this year for the
12 so-called 100, 200, 300 series in the direct
13 care workforce, which also includes clinical
14 staff as well, which we think is essential to
15 support because many of us in the mental
16 health system recognize that our clinical
17 folks are really in many ways our direct care
18 folks. So we're really appreciative of
19 hopefully your support in this.
20 And the other thing I'll just touch on
21 is the mental health education bill. Again,
22 we look at this as a groundswell of support.
23 We look at this as a major transformation of
24 the system of care, but there is absolutely
256
1 no money behind it. And this is -- we don't
2 want this to go down as an unfunded mandate.
3 We don't want to look at this as the great
4 experiment -- we finally broke through the
5 schools and all that, and yet there's no
6 money behind that.
7 So we have a proposal that we put out
8 that's in your testimony as well in creating
9 a mental health education resource center,
10 which we think is very important.
11 And again, I keep -- so many of these
12 issues are so important, and Harvey did a
13 great job in covering them, but I just want
14 to also thank Senator Krueger.
15 Senator Krueger, thank you for
16 bringing up gambling prevention. And really,
17 nobody talks about it, and it's so important.
18 We have a $4 billion gaming industry in
19 New York State, and we work very closely with
20 the gambling prevention folks -- they get
21 $1 million. A $4 billion industry,
22 $1 million in prevention. So there's got to
23 be a complete sea change in that area.
24 And again, I can go on and on, but you
257
1 have my testimony. And we're very strongly
2 supportive of NYAPRS and many of our other
3 colleagues who you will hear from.
4 CHAIRWOMAN YOUNG: Thank you.
5 I do have a couple of questions.
6 So -- and I appreciate everything that you
7 said. I had a conversation with Commissioner
8 Sullivan regarding the Governor's plans to
9 actually close more inpatient beds, which I'm
10 very concerned about because, as you know,
11 we're over census in several of the
12 facilities, so beds stay closed and there are
13 too many people that need to be served.
14 Could you give your perspective on
15 that?
16 MR. ROSENTHAL: Well, we have been a
17 supporter of the downsizing of the state
18 hospital system. I started when there were
19 5,000 beds, and at one point there was
20 92,000 -- 90,000 to 100,000 -- 92,000.
21 But I think the OMH has taken the
22 right direction with preinvesting the
23 services before the closures and putting in
24 play the kinds of services and the continuum
258
1 that should really support people and prevent
2 readmissions.
3 I will say, too, that the Governor's
4 managed-care redesign is very street-based
5 and very outreach, engagement, and diversion.
6 So I think there's a number of instances
7 where the right resources are on the street
8 and that in -- we don't want to keep
9 expensive hospital beds open. We have I
10 don't know how many campuses all over the
11 state, and we really -- the focus ought to be
12 on the community.
13 And when people do need inpatient
14 services, they are available, including the
15 Article 28s.
16 CHAIRWOMAN YOUNG: But we do have
17 people that go to the hospital and just -- or
18 the emergency room, and they're languishing
19 there in some cases. So I think there's a
20 balance.
21 And I agree with you that the pendulum
22 has swung, I think. So back in the day, we
23 used to have all kinds of developmental
24 centers and psychiatric centers that were
259
1 just warehousing people inappropriately, I
2 fully agree with that. And then the pendulum
3 swung in the other direction.
4 And I guess what we have to find is
5 the balance. Because people with mental
6 illness, let's face it, are still severely
7 underserved in this state in so many ways,
8 whether it's been urban areas -- and we see
9 the exploding homelessness that we discussed
10 earlier. But that's all over the state where
11 we see homelessness on the rise. We see
12 people in jail cells, as you pointed out,
13 local jails. The sheriff's departments
14 aren't equipped to deal with people with
15 mental illness. And so we see a lot of the
16 problems that are out there.
17 And one of the questions I have,
18 though, has to do with whether or not -- so
19 let me preface it by saying this. I'm
20 excited about the transitional housing and
21 supportive housing that's included in the
22 budget, because I think that's sorely needed.
23 But is that sometimes quite a step down, to
24 go from inpatient to transitional housing?
260
1 And you talked about the managed care, but
2 could we just talk about that for a second?
3 Because I'm concerned that maybe there's too
4 much of a step down. Is there something that
5 should be in the middle?
6 MR. ROSENTHAL: Well, you mean -- for
7 example, the crisis respite beds to some
8 degree are --
9 CHAIRWOMAN YOUNG: Right.
10 MR. ROSENTHAL: -- a diversion.
11 CHAIRWOMAN YOUNG: Yeah. Right. So
12 things like that.
13 MR. ROSENTHAL: And maybe will
14 function if people do relapse sort of
15 quickly, they'll be able to go there?
16 CHAIRWOMAN YOUNG: Right. Could you
17 address that? Because it's -- I think that
18 there may be a gap --
19 MR. ROSENTHAL: I understand your
20 point. I have seen people backed up in the
21 Capital District Psychiatric Center waiting
22 for a bed.
23 I'm not saying this is black and white
24 either, Senator. I just -- I don't know the
261
1 answer is to keep the state hospital beds
2 open, though.
3 CHAIRWOMAN YOUNG: But again, we have
4 a census that is going over in some cases.
5 Glenn, did you want to say something?
6 MR. LIEBMAN: Just from my
7 perspective -- and I agree with Harvey that
8 we have been long, strong advocates of
9 reinvestment for many years. And we're glad
10 to see that there's over $100 million now
11 annualized for reinvestment.
12 There -- you know, as a family member,
13 and many of us are, you know, I've seen
14 firsthand some of the issues around housing
15 and bed use and inpatient facilities. But I
16 really, you know, agree and the Mental Health
17 Association agrees that, you know, we are
18 very supportive of, you know, that money
19 going to the community.
20 And I think that the failure of the
21 system -- and the closures of the beds aside,
22 the failure of the system is we've been so
23 underfunded for so long -- you know, the
24 outcomes in terms of community-based services
262
1 are so much stronger than what you're seeing
2 in outcomes from other arenas. And yet we
3 have been severely underfunded for as long as
4 we've been doing this.
5 So had we been properly funded from
6 the get-go, I think a lot of the issues that
7 we see right now would not be appearing to as
8 us, unfortunately, as they are.
9 CHAIRWOMAN YOUNG: Thank you, Glenn.
10 Assembly?
11 CHAIRWOMAN WEINSTEIN: No. We're
12 done.
13 CHAIRWOMAN YOUNG: I think we're done.
14 Thank you. Thanks for testifying
15 today.
16 MR. ROSENTHAL: Thank you.
17 SENATOR KRUEGER: Thank you very much.
18 MR. LIEBMAN: Thank you.
19 CHAIRWOMAN YOUNG: Our next speaker is
20 Executive Director Wendy Burch, from the
21 National Alliance on Mental Illness of
22 New York State.
23 Welcome.
24 MS. BURCH: Thank you. Good
263
1 afternoon. Can you hear me okay?
2 My name is Wendy Burch, and I am the
3 executive director of the National Alliance
4 on Mental Illness of New York State. With
5 me today is Ariel Kaufman, a NAMI-NYS board
6 member and a family member of someone with a
7 serious mental illness. We represent
8 thousands of New Yorkers living with a mental
9 illness as well as the family members who
10 love and support them. We appreciate the
11 opportunity to testify today.
12 You have our written testimony, so
13 briefly, our focus is to ensure that those
14 living with a mental health condition have
15 the tools necessary to pursue their recovery.
16 One of the most important is access to safe
17 and affordable housing, which is why NAMI-NYS
18 is an active participant in the Bring It Home
19 campaign.
20 When providers don't have the adequate
21 funding to retain qualified staff, our loved
22 ones suffer. Instead of focusing on
23 improving their health, they find themselves
24 hospitalized, incarcerated, or living on the
264
1 streets. They must have a home before they
2 can begin to think about the things that many
3 of us take for granted, like having a job and
4 being an active part of the community.
5 NAMI-NYS also wants to ensure that the
6 budget addresses community reinvestment. For
7 someone living in recovery, access to
8 services is vital to sustained progress. For
9 every hospital that closed, we've been
10 assured that $110,000 will be invested in
11 community resources. These community
12 investments are not only essential for those
13 living with mental illness to have meaningful
14 lives, they also save the state the
15 astronomical costs associated with
16 hospitalization and incarceration.
17 MS. KAUFMAN: I'm proud to be here
18 today representing NAMI-NYS and the tens of
19 thousands of New York State families and
20 individuals who live daily with the
21 devastating effects of serious and persistent
22 mental illness. Not only have I worked in
23 the behavioral health system for nearly
24 20 years, I am also the caregiver and
265
1 daughter of a father who lives with a serious
2 mental illness. So these issues mean more to
3 me than just data, statistics, and politics.
4 I ask all of you to envision a family
5 member that you care deeply about struggling
6 to recover from a life-changing illness that
7 affects their ability to reason, their
8 physical health, and their ability to
9 maintain the social ties that mean so much to
10 them. This is what families and caregivers
11 of people with serious mental illness face
12 every day.
13 We work tirelessly to troubleshoot a
14 fragmented health system that lacks
15 appropriate resources just to ensure that our
16 loved ones get the medication, healthcare,
17 and housing that they so desperately need in
18 order to remain stable and connected to daily
19 activities that many of us just take for
20 granted -- like planning a meal, calling a
21 friend, or following up on our physical
22 health needs.
23 As deinstitutionalization has
24 progressed, families have been faced with the
266
1 troubling reality of whether or not their
2 loved one will be able to integrate into a
3 community that they have limited ties to in a
4 world that frequently stigmatizes their
5 battle to recover from mental illnesses that
6 they did nothing to cause.
7 My father lives in mental health
8 housing and receives treatment at a certified
9 community behavioral health center on
10 Long Island. Most recently, he experienced a
11 life-changing event. In his mid-60s, he
12 began to experience tremendous pain in his
13 back to the point where his 6-foot-5 frame
14 was literally bent over a walker for months.
15 He couldn't get out of the house to shop, and
16 we needed an aide to come to his house just
17 to complete simple daily tasks. During this
18 time his psychiatric symptoms began to spiral
19 due to his fears about surgery and his
20 inability to fulfill his daily routine.
21 Fortunately, this story does not end
22 in sadness like so many others, because my
23 dad lived in a permanent subsidized apartment
24 in Long Island. He was able to have surgery,
267
1 go to rehab, get consistent psychiatric
2 treatment, and return home to an apartment
3 that was safe and supportive. Without the
4 mental health housing system, these triumphs
5 would not have been possible.
6 That is why funding existing mental
7 health housing at sustainable rates is
8 imperative. When properly funded and
9 staffed, this type of housing allows people
10 to focus on recovery in a supportive and safe
11 environment. I believe that it is the duty
12 of our Legislature to set aside political
13 discourse and achieve a moral imperative by
14 ensuring people like my father do not lose
15 their housing or face limitations on their
16 opportunities to leave institutional settings
17 because there are no appropriately funded
18 community housing options with wraparound
19 services that fulfill the obligation that the
20 state has to ensuring that disabled citizens
21 receive the best quality care and treatment
22 possible.
23 NAMI-NYS calls upon the Legislature to
24 make our families a priority by funding
268
1 mental health housing and services in the
2 community at sustainable rates, to ensure
3 access to mental health services, properly
4 prescribed medication, and adequate resources
5 such as psychiatrists, psychologists, and
6 mental health professionals.
7 Adequately funded mental health
8 housing and services keep people from falling
9 through the cracks, help avoid unnecessary
10 incarcerations, hospitalizations, and
11 repeated trips through the homeless system.
12 I do thank you for your motivation and
13 desire to fix these long-standing issues, and
14 thank you for allowing me to talk to you
15 today.
16 CHAIRWOMAN YOUNG: Thank you.
17 MS. KAUFMAN: I've taken a lot out of
18 this hearing today, and I do believe that all
19 of you are on the same page as me, so I
20 know --
21 CHAIRWOMAN YOUNG: Good. Thank you.
22 MS. BURCH: And I had a couple more
23 points to make, which I won't, because -- in
24 the interests of time. But I just wanted to
269
1 mention that as you'll see in our testimony,
2 we do address enforcing insurance parity,
3 funding for CIT, and also reinstituting
4 prescriber prevails.
5 CHAIRWOMAN YOUNG: Thank you very
6 much. We really appreciate it.
7 MS. KAUFMAN: Thank you.
8 MS. BURCH: Thank you very much.
9 CHAIRWOMAN YOUNG: Next we have
10 Executive Director Kelly Hansen, New York
11 State Conference of Local Mental Hygiene
12 Directors.
13 (Discussion off the record.)
14 MS. HANSEN: Good afternoon, ladies
15 and gentlemen.
16 CHAIRWOMAN YOUNG: Good afternoon.
17 MS. HANSEN: My name is Kelly Hansen,
18 and I am executive director of the Conference
19 of Local Mental Hygiene Directors. We
20 represent the county mental health
21 commissioners in each of the counties and the
22 Department of Mental Health in the City of
23 New York.
24 We have several topics on the budget
270
1 to talk about, but I'm going to limit my
2 testimony to one specific issue, and it has
3 to do with the opioid and heroin epidemic.
4 Attached to my testimony is a copy of
5 a report that was conducted by the Conference
6 of Local Mental Hygiene Directors, our
7 organization, in collaboration with the
8 New York State Sheriffs' Association and the
9 New York State Association of Counties. And
10 what it does is it provides the evidence base
11 and the research that shows that providing
12 substance abuse disorder treatment and
13 transition services to individuals in jails
14 will increase public safety, save costs, and
15 most importantly, save lives.
16 In listening to all of this testimony,
17 I think almost everyone has raised an issue
18 about the opioid and heroin crisis. So the
19 reason we did this study is that our
20 directors of community services and the
21 sheriffs have continually been seeing an
22 increase in the number of individuals coming
23 into the jails with a substance use disorder.
24 And because we have kind of this drone view,
271
1 the DCSs see all of the system together,
2 they're able to see the linkages between
3 criminal justice, foster care, all of this
4 other extra-collateral damage that's
5 happening because of the opioid epidemic.
6 And what they were finding is that
7 there is no funding to offer services inside
8 the jail. And that while there's been a lot
9 of support, with the Legislature and the
10 Governor providing funding to provide
11 services in the community, there's no money
12 going into the jail.
13 And while they're putting together
14 these new services -- on-call peer programs
15 that can meet people in the emergency room, a
16 24/7 crisis center, recovery centers, family
17 support navigators -- there's all of these
18 community services being put together, but
19 there's a donut hole right in the middle, and
20 that's the jail.
21 Because we know that addiction is
22 directly linked with criminal justice
23 activity. National data will tell you that
24 drugs and alcohol are implicated in
272
1 80 percent of the crimes related to DWI, drug
2 abuse, domestic violence, property damage,
3 and personal injury.
4 And we also know -- when we surveyed
5 our jails, we asked the sheriffs on this
6 particular day how many individuals -- what
7 was the percentage of individuals who have
8 come in on substance-use-related crime who
9 have been in the jail already. And that
10 number was 68 percent.
11 So people are coming in and out of the
12 jail, and we know that that's an area where
13 we're missing an opportunity. So what the
14 conference, the Sheriffs' Association, and
15 NYSAC are doing is we're coming to you to ask
16 for funding to be able to provide these
17 services. Because like it or not, the jail
18 is part of the continuum of care. We know
19 that the jails are housing thousands of
20 individuals with substance use disorder, and
21 they have no money to provide any treatment.
22 We also know from the clinical
23 standpoint, even more importantly, is that we
24 are missing a huge opportunity to be able to
273
1 offer treatment when an individual is clean
2 and sober and may have some insight into
3 their addiction, insight as to why they're
4 using, and be able to put in place, you know,
5 treatment services so that they know when
6 they leave there is another option other than
7 just going out and starting to use again, and
8 being able to transition.
9 In New York State there's several
10 counties who have put together model
11 programs, so I'll just talk briefly about the
12 Albany County SHARP program. This is Sheriff
13 Apple's program, the Sheriff's Heroin
14 Addiction Recovery Program. I actually had
15 the opportunity to visit the program a couple
16 weeks ago in preparation for our advocacy
17 here, and it's a separate unit of the jail.
18 It's outside of the general population. They
19 have a CASAC, who everyone loves, they have
20 peer programs, they do groups, they do
21 individual counseling. And in talking with
22 the women and the gentlemen who are in that
23 program, they were grateful that they had
24 this opportunity, they appreciated the
274
1 support and the safety they had with other
2 folks in the unit as well.
3 But I want to just give you this
4 number, because the reduction in recidivism
5 is astounding. So Sheriff Apple's county
6 numbers are generally, out of everyone who is
7 coming into jail with a substance use
8 disorder -- they're screened for suicide and
9 substance use at booking -- 40 percent of
10 those individuals are going to recidivate.
11 That's what their number is.
12 For individuals who have been in the
13 SHARP program, that number drops to
14 12 percent. That's a 28 percent reduction in
15 recidivism. And think of what that means for
16 public safety for the community. It means
17 less crime, less court costs, less
18 prosecution costs. And it's a diversion
19 program, because those folks will not be
20 coming back into the jail after.
21 And in fact, a DCJS study that looked
22 at over 1,000 New York State specific data
23 elements, looking at the cost benefit of
24 specific criminal justice interventions --
275
1 and by the state's own data, they indicated
2 that if you provided substance use disorder
3 services during incarceration, it would save
4 the system $2,100 per person in cost
5 avoidance. Again, court, prosecution, law
6 enforcement, incarceration costs.
7 And they also went a step further and
8 said it would save victims $670 per person
9 served in the program. And those costs are
10 tangible costs -- medical costs, mental
11 health costs, property damage, and loss of
12 earnings due to loss of wages due to injury.
13 So we have evidence that shows that
14 this works in county programs in New York
15 State. We have New York State data that
16 indicates that there's a savings to the
17 system. And we haven't -- these are just the
18 numbers. We haven't even talked about the
19 human component as well, which I know you all
20 hear about repeatedly from the constituents
21 in your county.
22 CHAIRWOMAN YOUNG: Could you summarize
23 the rest, please?
24 MS. HANSEN: Yup, absolutely.
276
1 So what we are asking for is an annual
2 appropriation to the counties of
3 $12.8 million, which we find and think is a
4 very reasonable amount, and --
5 (Interruption.)
6 CHAIRWOMAN YOUNG: Okay.
7 MS. HANSEN: So that is what we're
8 looking for in terms of some funding to go to
9 the counties to be able to provide substance
10 use disorder treatment and transition
11 services for people to be able to re-enter
12 into the community with housing, hopefully,
13 and treatment, and we would hope that we
14 would have your support.
15 Those are my formal comments. I don't
16 know if you're interested, Senator; I could
17 catch you at another time in terms of what
18 the county directors are experiencing in
19 terms of bed closures.
20 CHAIRWOMAN YOUNG: Okay. Thank you.
21 CHAIRWOMAN WEINSTEIN: Assemblyman
22 Oaks has a question.
23 ASSEMBLYMAN OAKS: Just -- I know one
24 of the questions that came up before was on
277
1 the jail-based restoration. And I know in
2 speaking -- I know in this instance you're
3 talking about sheriffs and county mental
4 health kind of working together to say we can
5 do this within our setting.
6 When I asked the question have any
7 counties come forward to do the restoration
8 one --
9 MS. HANSEN: Competency restoration.
10 ASSEMBLYMAN OAKS: The sheriffs have
11 not been as supportive on that end, I don't
12 think, because of some of the challenges, or
13 maybe feeling not capable of actually having
14 success. Are there any comments --
15 MS. HANSEN: Yes, absolutely. And a
16 very good question.
17 So what we're asking for for the
18 substance use disorder treatment -- and these
19 are individuals who we know have a substance
20 use disorder. They're competent, they've
21 been charged with a crime, and that we can --
22 the counties can bring in services from the
23 community to be able to provide treatment in
24 the jail, and hopefully they will not come
278
1 back again.
2 On the jail-based restoration, which
3 the conference does not support -- it relates
4 to individuals who've been charged with a
5 crime and have been deemed incompetent to
6 stand trial and understand the charges
7 against them. Those individuals will go from
8 the arrest and the county jail, they have a
9 psych eval, a determination of competency is
10 made, and then they are sent to a state
11 psychiatric center to be restored to
12 competency, for which the county pays
13 50 percent.
14 The state is saying that this jail --
15 that restoration could be done in the jails.
16 As you said, the sheriffs are not supportive.
17 We are not supportive because it is not the
18 right therapeutic place, for someone who has
19 been deemed incompetent, to be restored to
20 competency in a jail. They don't have the
21 resources, they don't want to build these
22 programs, and they're just not appropriate.
23 So in fact last year, when you guys
24 were nice to take that provision out of the
279
1 budget, at Commissioner Sullivan's direction,
2 OMH staff had been meeting all over the
3 summer with our attorneys, mental hygiene
4 legal services, the DAs association -- they
5 put together the workgroup that we wanted
6 them to and started working on what can we do
7 to help move the process, what can we do to
8 share information, what can we do -- because
9 what my members would tell you, what the
10 county directors would say is it's extremely
11 difficult to get a 730 bed -- which is what
12 we refer, 730 of the Criminal Procedure Law.
13 And if you have an inmate who has a
14 serious mental -- has a mental illness,
15 serious mental illness in the jail and just
16 needs that level of care -- 508 is what they
17 refer to it as -- they don't even ask
18 anymore, because there's no bed. They can't
19 get a bed.
20 So we're not a fan of the jail-based
21 restoration. I was disappointed to see that
22 the state booked savings again with this,
23 after we had thought we had made some pretty
24 significant progress. And I'm sure we'll
280
1 continue that workgroup.
2 But yes, you're correct, Assemblyman,
3 there is no real appetite out there.
4 ASSEMBLYMAN OAKS: Thank you.
5 CHAIRWOMAN YOUNG: Thank you.
6 ASSEMBLYWOMAN GUNTHER: Just before
7 you go --
8 MS. HANSEN: Yes.
9 ASSEMBLYWOMAN GUNTHER: You know what?
10 I do believe that there should be some sort
11 of education, because you know, we just --
12 sometimes if -- the way that we approach a
13 person, that some other approach would be
14 different, but that if you do it calmly --
15 and a lot of times -- you know, we just saw
16 something, and it's your approach. And, you
17 know, somebody else -- if you approach
18 certain people quickly or fast or without any
19 knowledge of what's going on, the reaction
20 and the outcome is so much different.
21 So that's why these kinds of programs
22 in jail situations, incarceration situations,
23 that you have to have that education to be
24 able to approach and get better outcomes.
281
1 MS. HANSEN: Absolutely. Absolutely.
2 Thank you for your time.
3 CHAIRWOMAN YOUNG: Thank you.
4 CHAIRWOMAN WEINSTEIN: Thank you.
5 CHAIRWOMAN YOUNG: Our next speakers
6 are -- actually, a very good crew. We have
7 the New York State Public Employees
8 Federation. We have Darlene Williams,
9 occupational therapist at OMH; Greg Amorosi,
10 legislative director; Randi DiAntonio,
11 licensed master social worker.
12 So welcome. Thank you for being here
13 today.
14 MR. AMOROSI: Thank you for having us.
15 MS. DiANTONIO: Good afternoon. I
16 want to start by thanking Senator Young,
17 Assemblywoman Weinstein, and Chairwoman
18 Gunther and members of the Senate and
19 Assembly for the opportunity to speak to you
20 today about the 2018-2019 Executive Budget
21 proposal as it relates to OPWDD.
22 My name is Randi DiAntonio. I'm a
23 licensed social worker, and I've been
24 employed by OPWDD since 1999. I'm here today
282
1 representing the New York State Public
2 Employees Federation and the more than 3,000
3 members who provide services across New York
4 State to the developmentally disabled.
5 Our members take very great pride in
6 the work that they do. They care deeply
7 about the individuals that we serve. And as
8 we've heard today, for the past several years
9 OPWDD has undergone a massive system
10 transformation. Some of these initiatives
11 have resulted in positive impacts, while
12 others have sounded really good on paper but
13 unfortunately resulted in closures as well as
14 services and choices being diminished, mostly
15 due to lack of staffing and resources being
16 provided.
17 You have our written testimony, so I
18 am going to touch on a few things briefly.
19 This year's Executive Budget has some
20 positives and some negatives. We were very
21 pleased that there were no additional
22 closures in this budget.
23 We were also very pleased to see the
24 continuation of the blue ribbon panels for
283
1 the IVR facility in Staten Island, so that
2 there are ongoing discussions as to whether
3 it is logical or reasonable to move that
4 facility under the auspices of CUNY. We are
5 supportive of it remaining under OPWDD, and
6 we believe the 100 or so PEF members there
7 have a lot to contribute.
8 We're also very positive about the
9 salary increases for the direct support
10 professionals, even though they're not in our
11 sector. We believe that this really improves
12 the likelihood of our system continuing to do
13 the great work that it does.
14 We are also supportive of the plan to
15 convert the Bernard Fineson program into a
16 transitional program for individuals who are
17 being discharged from the OMH system into the
18 OPWDD system. We believe this model gives us
19 a chance to evaluate and assess before
20 plunking somebody into a setting that might
21 not be in their best interest or anybody
22 else's best interest.
23 We actually believe this model should
24 be evaluated and potentially expanded across
284
1 the state. We've had several situations
2 where placements have occurred because of
3 emergencies, and they've been very unsafe for
4 both the consumer and the other individuals
5 in the home, as well as the staff.
6 Now on to the things we're not so
7 pleased about. When it comes to residential
8 opportunities, we do see that there's
9 $120 million in the Executive Budget, but not
10 one single dime of it is going towards the
11 state-operated end. It's our position that
12 this is really short-changing the needs of
13 consumers with very highly specialized needs.
14 We have undergone closures throughout
15 the state for the last several years,
16 reducing the number of specialized inpatient
17 and intensive treatment beds by 1300, give or
18 take. We have realized down to about
19 150 beds, but that is not sufficient to take
20 care of the needs of those who have
21 behavioral, medical, or severely challenging
22 psychiatric issues and are dually diagnosed.
23 We believe that some of this money
24 should be given towards the state-operated
285
1 end to develop specialized services so that
2 people with these needs can be served in the
3 community-based settings and can be treated
4 in ways that will allow them to be
5 successful.
6 Additionally, we are pleased to hear
7 from the Justice Center that things are
8 changing. However, I'm not sure that this is
9 rippling out into the field. PEF continues
10 to be concerned about the Justice Center and
11 some of their practices. We certainly
12 understand and support the importance of
13 thorough investigations, but in many cases
14 their frivolous accusations end up putting
15 people out of work and scaring people from
16 coming to work with us, and for us, that are
17 really skilled in their field.
18 I can tell you in my own district we
19 have over 50 employees, primarily direct
20 care, that are placed on administrative
21 leave. That ripples into how our members do
22 their work, because if we don't have people
23 in the homes that are familiar with our
24 individuals that are supplying staff from one
286
1 place to another, the quality of care and
2 ability to provide clinical services is
3 diminished.
4 The last thing I'd like to touch on,
5 just for the sake of time, is the money being
6 put in towards the move to managed care and
7 CCOs. While conceptually PEF supports the
8 idea of care coordination -- we ourselves
9 provided Medicaid service coordination from
10 the state side for many, many years -- we are
11 very skeptical that this is again another
12 initiative that is not well resourced, not
13 well thought out, and that there's almost
14 unlimited numbers of details in how it's
15 actually going to be implemented and what the
16 impact will be on those living in
17 state-operated homes.
18 What we have found is that the further
19 disconnected the care coordinator or Medicaid
20 coordinator is from the person and the
21 treatment team, the less accountability and
22 communication there is. And we would like
23 this to be slowed down, possibly done as a
24 pilot, or to have more dialog about the
287
1 direct impact this would have on the
2 consumers in the state system.
3 I thank you for your time. I will
4 give the rest of my time to my colleague.
5 And I appreciate being here with you today.
6 CHAIRWOMAN YOUNG: If you could
7 summarize, because you've gone over a lot of
8 time. But that's fine. If you could please
9 summarize, though, that would be good.
10 MS. WILLIAMS: Yes, I will. I will
11 not read the testimony, and I'll try my best
12 to speak more from the heart than reading off
13 information.
14 CHAIRWOMAN YOUNG: That's always the
15 most effective.
16 MS. WILLIAMS: Every Tuesday afternoon
17 before I start my 4 p.m. patient rights
18 group, I tell our clients: Your illness
19 doesn't define you. For the past 37 years, I
20 have entered an OMH facility. And my name is
21 Darlene Williams, and I work as a certified
22 occupational therapist. And I'm a PEF
23 member. So I know the good, the bad, and the
24 ugly.
288
1 For 2018-2019, OMH has proudly
2 emphasized their downsizing plans of
3 inpatient beds in order to reinvest more
4 resources into outpatient. A 150-bed
5 reduction -- I think we heard someone else
6 talk about this earlier.
7 With money being allocated into
8 outpatient, it hasn't done anything for our
9 outpatient staff members. PEF members are
10 still overburdened with excessive caseloads.
11 I was just talking to a social worker
12 during a health and safety conference where
13 she explained to me that she had a list of
14 20 patients she was going to see for the day.
15 She was starting her day at 9:00, and she was
16 going to leave at 6:00, but her day actually
17 was supposed to end at 5:00. Well, her day
18 didn't end -- she didn't go home until
19 9 o'clock because she had to see -- three
20 additional patients came in, with the 20
21 patients that she was already scheduled to
22 see. Those three patients were released from
23 their treatment facility. Those three
24 patients had no food to eat. And she had to
289
1 make sure that they had a place to live and
2 food to eat.
3 But our problems are not just limited
4 to outpatients, they also extend to
5 recruitment and retention. I was just
6 watching television this morning, I heard
7 that President Trump has a problem also with
8 recruitment and retention.
9 (Laughter.)
10 MS. WILLIAMS: PEF continues to be
11 concerned about recruitment and retention of
12 professionals in OMH. Recruitment and
13 retention is still ongoing with our nursing
14 professionals as well as psychiatrists. But
15 OMH has challenges recruiting other titles.
16 I was just looking online for our civil
17 service, and I think there are only maybe
18 five occupational therapists within the State
19 of New York.
20 Occupational therapists as well as
21 other titles go to the private sector, where
22 the pay scale is more. But these challenges
23 are -- just don't boil down just to money.
24 It's also the Justice Center, nurses working
290
1 multiple voluntary or involuntary overtime,
2 not getting time off, and dealing with health
3 and safety issues of violent attacks. Those
4 issues have not decreased.
5 One of the things that I have a guilty
6 pleasure of is that I look at Facebook, and I
7 saw that a nurse sent a meme with a skeleton
8 looking out of the window. The skeleton
9 represented a nurse, she was waiting for her
10 break to come. I know nurses who keep food
11 in their pockets so that they can treat
12 patients and eat at the same time.
13 First I would like to thank you for
14 passing the bill last year to stop the
15 closing and consolidation of the Western
16 New York Psychiatric Center. Unfortunately,
17 the Governor vetoed the legislation. But
18 moving forward, we hope that you will
19 continue to work with us to keep this
20 children's facility open at its current
21 location. That just as well as there are
22 plans for Hutchings Children Psychiatric
23 Center, that all stakeholders be provided
24 with the opportunity to weigh in on potential
291
1 changes and deliver mental health services.
2 Lastly, the previous speaker spoke
3 about the jail-based restoration to
4 competency. As an OMH employee, I know
5 firsthand that most of our patients would
6 want to receive treatment in a hospital
7 facility and not in a jail. I have a son
8 who's a New York City detective, and each day
9 he's out there on those streets looking and
10 taking care of the citizens of New York City.
11 And he sees full well that we have people
12 with mental illness who he has to arrest and
13 place them in jail. And he always says,
14 "Mom, I think the best thing would be is to
15 make sure that those individuals got help
16 within a treatment-like setting instead of in
17 a prison or in a jail."
18 So I'm going to end by saying that at
19 the end of the day we have limited resources,
20 but like I said, our limited resources -- the
21 mental illness doesn't define our patients,
22 and our limited resources don't define us as
23 mental health professionals. We will
24 continue to do our best with what we have.
292
1 And thank you for this opportunity.
2 CHAIRWOMAN YOUNG: Thank you for being
3 here today.
4 Any questions?
5 SENATOR KRUEGER: We appreciate your
6 testimony.
7 MS. WILLIAMS: Thank you.
8 MS. DiANTONIO: Thank you.
9 CHAIRWOMAN WEINSTEIN: Thank you for
10 your work in the community.
11 CHAIRWOMAN YOUNG: Out next speaker is
12 Executive Director Samantha Howell, National
13 Association of Social Workers, New York State
14 Chapter.
15 Welcome.
16 MS. HOWELL: Thank you. Good
17 afternoon.
18 CHAIRWOMAN YOUNG: Go ahead. If you
19 could summarize your testimony, please.
20 MS. HOWELL: Of course.
21 CHAIRWOMAN YOUNG: Within five
22 minutes.
23 MS. HOWELL: Thank you very much for
24 allowing me to testify today and to be here
293
1 with you. My name is Samantha Howell, and
2 I'm the executive director for the National
3 Association of Social Workers. I'm here
4 today also on behalf of our partners, the
5 National Association of Social Workers for
6 New York City, the New York State Society for
7 Clinical Social Workers, and the New York
8 State Association of Deans for the Schools of
9 Social Work.
10 NASW is the largest social work
11 membership association in the world, and the
12 primary mission of social work is to enhance
13 human well-being and help meet the basic
14 human needs of all, with particular attention
15 to vulnerable communities.
16 Social workers possess a varied and
17 broad set of skills necessary to practice
18 appropriately and, therefore, the current
19 licensure law that guides and directs social
20 work in this state reflects the importance of
21 education and experience that we think is
22 necessary to engage in this profession.
23 The current licensure law was passed
24 as a consumer protection measure to ensure
294
1 that licensed clinical social workers were
2 providing care to those in need. But at the
3 time that the law was passed, there also was
4 included an exemption. That exemption allows
5 seven state agencies, and the programs that
6 are funded and directed by them, to not hire
7 licensed social workers to provide the skills
8 that have been expressly reserved for social
9 workers.
10 New York State, despite being the
11 49th state to pass a licensure law for social
12 workers, has some of the most stringent
13 requirements including an MSW with over
14 900 hours of curriculum-based content
15 involving social work, at least 12 semester
16 hours of clinical social work with a focus on
17 skill development and diagnosis and
18 assessment, and clinical social work
19 practice, clinical social work treatment, and
20 clinical social work practice with general
21 and specific groups, as well as at least
22 2,000 client contact hours under appropriate
23 supervision.
24 This ensured that the people who were
295
1 providing mental health treatment and
2 diagnosis have been properly trained and
3 supervised in those very skills. But with
4 the exemption, these seven state agencies --
5 OMH, OPWDD, OASAS, OCFS, OTDA, the Department
6 of Corrections and Community Supervision, as
7 well as the Office for Aging, and any local
8 mental hygiene or social services
9 department -- are exempt from hiring social
10 workers for those very responsibilities.
11 This is an unfathomable exemption for
12 us to have in New York State. One of the
13 criticisms that has come up over the request
14 to end the exemption this year is that it
15 would be costly to hire licensed clinical
16 social workers to provide diagnoses and
17 treatment in these facilities. But I ask
18 you, where else would this happen within a
19 profession?
20 Imagine going into an emergency room
21 with a broken leg, and rather than seeing a
22 surgeon to fix it, you're told: Well there's
23 somebody here who passed biology and they've
24 been working on the job for a couple years,
296
1 so we're going to let them patch you up.
2 That wouldn't happen.
3 Nor would it happen in the legal
4 profession. You couldn't go into a courtroom
5 and say, You know what, I passed civics, I
6 failed the bar a couple of times, but I think
7 I can handle this capital murder case. That
8 doesn't happen.
9 And yet we are allowing individuals
10 who don't have those 2,000-plus hours of
11 supervised training to provide mental health
12 diagnosis and treatment for people in need.
13 As a result, we are calling on the
14 Legislature to finally end this exemption.
15 There's a couple of steps to this,
16 because we are cognizant of the concerns that
17 have been raised by other organizations. We
18 don't want people to lose their jobs
19 unnecessarily, so we have requested a
20 financial contribution in investing in the
21 profession of just over $22 million total,
22 which would include an $18 million incentive
23 program for currently exempt agencies to
24 increase the number of licensed social
297
1 workers available; $4 million for a loan
2 forgiveness program, to encourage people to
3 enter the profession; and then an additional
4 financial contribution to help develop
5 appropriate test materials and do data
6 analysis.
7 We also have included several
8 recommendations we went over in testimony
9 today that I think will also go to help the
10 profession, including a grandparenting window
11 for people who have MSWs with at least two
12 years of documented supervised experience to
13 become licensed at the LMSW level, so that we
14 can help move people who are currently
15 unlicensed into licensed positions within
16 these seven agencies.
17 Appropriately licensed clinical
18 supervisors being directly involved -- there
19 was testimony earlier today that while
20 unlicensed individuals might be the first
21 person of contact, that there's an
22 institutional hierarchy of supervision. We
23 contend that is not enough. We want direct
24 supervision to be part of these provision of
298
1 services, and we think that the state can do
2 this.
3 And so, in conclusion -- I see I'm out
4 of time -- I want to just thank you so much
5 for your work. Thank you for allowing me to
6 be here today. And I urge you to let this
7 exemption end and implement a financial
8 investment in the social work profession.
9 Thank you.
10 CHAIRWOMAN YOUNG: Thank you for being
11 here today. We appreciate it.
12 Our next speaker is CEO Paige Pierce,
13 Families Together in New York State.
14 MS. PIERCE: Good afternoon. How are
15 you?
16 CHAIRWOMAN YOUNG: Good afternoon.
17 Well.
18 MS. PIERCE: I'm Paige Pierce. I'm
19 the CEO of Families Together in New York
20 State. We're a family-run, family-governed
21 organization that represents families of kids
22 with social, emotional, and behavioral needs.
23 We represent thousands of families across the
24 state who have had children in multiple
299
1 systems including mental health, substance
2 use, special education, juvenile justice, and
3 foster care.
4 I'm here today just to talk about the
5 mental hygiene budget. You know, you guys
6 have seen me here before for Raise the Age,
7 you've seen me here for the child welfare
8 funding, but this is the year -- this should
9 have been the year that the state budget put
10 children first. It should have been the year
11 that children were up at the top of the list.
12 And unfortunately, we weren't.
13 Children and families really got a raw deal
14 as it relates specifically to this budget.
15 The Office of Mental Health's budget should
16 have included $15 million for -- it wouldn't
17 have been in Office of Mental Health budget,
18 but it was for children and families with
19 behavioral health needs, $15 million that was
20 to shore up the -- to match the federal match
21 for Medicaid managed care for children's
22 behavioral health. And they decided to kick
23 the can down the road for two years.
24 And what they did by doing that was
300
1 not only put providers in a difficult
2 position -- because they spent the last
3 several years gearing up for this, and have
4 reduced the services that did exist -- but
5 more importantly, it affects families and
6 children. The children that would have
7 gotten those services are not going to
8 anymore.
9 We spent six years, as part of the
10 Medicaid Redesign Team for Children's
11 Behavioral Health, designing a system that
12 would be comprehensive and wrap around the
13 child and family. We used a lot of research,
14 we knew -- we had experts on the team who
15 knew what would work and what wouldn't, and
16 we all agreed. And we applied to CMS to get
17 it approved, and it was approved.
18 And now, at the 11th hour, when it's
19 time to flip the switch in July, they kicked
20 it down the road for two more years. The
21 kids who are currently needing those services
22 can't wait two years. There's no reason for
23 them to be at the bottom of the list, except
24 that we hadn't already been -- because of
301
1 other delays, we hadn't already implemented
2 the Medicaid managed care in our system. But
3 that made us low-hanging fruit. And just
4 because our kids weren't getting the services
5 they needed now, doesn't mean we can continue
6 for two more years.
7 So we're asking that $15 million that
8 was supposed to be earmarked for the state
9 match for the children's behavioral health
10 Medicaid managed care be allocated for
11 children's behavioral health services --
12 specifically, SPA services, which are what we
13 call -- the State Plan Amendment, we call
14 them SPA services. It's SPA services like
15 family care support, youth peer support,
16 respite. We know that those are the kinds of
17 services that are inexpensive and will save
18 millions of dollars down the road, millions.
19 Because the average childhood
20 experiences that happened that are going to
21 cause health problems later and all kinds of
22 other problems later can be avoided if we can
23 get children and families served first.
24 Any questions?
302
1 CHAIRWOMAN YOUNG: Are you done?
2 MS. PIERCE: I'm done.
3 CHAIRWOMAN YOUNG: Well, I do want to
4 make a comment, I guess.
5 And so what you're talking about was
6 actually brought up in the questioning of the
7 commissioner of OMH.
8 MS. PIERCE: Right.
9 CHAIRWOMAN YOUNG: And could you give
10 a little bit more of a sense -- and I think
11 you've done a great job covering it, because
12 now everyone's geared up to provide these
13 services. The families and the children are
14 expecting these services, the providers are
15 ready, and the plug is being pulled for two
16 years.
17 So could you give us a better sense of
18 the impact on the providers and where they're
19 at in the process?
20 MS. PIERCE: Yes. So they spent a lot
21 of money, a lot of money getting technical
22 assistance so that they could make sure that
23 they had like electronic health records and
24 value-based payment structures. Because
303
1 that's all part of the scheme, right? It's
2 all part of what they needed to have come
3 July 1. None of that is going to be
4 necessary for the next two years, so they've
5 spent that money when they didn't have it.
6 And worse is that the kids that would
7 have been being served under our Home and
8 Community-Based Waiver, which is a waiver
9 that we've had for, you know, 20 years that
10 provides those kinds of soft services, they
11 were -- people weren't being -- families
12 weren't being referred to the Home and
13 Community-Based Waiver. We have 1800 slots
14 statewide, 500 vacant waiver slots, 500 slots
15 for kids who would have -- should be getting
16 those services and they're not because they
17 thought waiver was going away in July. They
18 thought that they were going to have the SPA
19 services, and it was going to be available to
20 so many more thousands, literally thousands
21 more children.
22 And now not only are the kids that
23 need the waiver not getting the slots filled,
24 but the other kids who would have gotten the
304
1 SPA services aren't going to get them.
2 CHAIRWOMAN YOUNG: So it's really
3 created a crisis, right?
4 MS. PIERCE: It really has, for both
5 the providers and for the children and
6 families.
7 CHAIRWOMAN YOUNG: Okay. Thank you
8 for that. That's very valuable testimony.
9 Any questions?
10 SENATOR KRUEGER: Thank you again for
11 coming back.
12 CHAIRWOMAN YOUNG: Thank you.
13 MS. PIERCE: Thank you.
14 CHAIRWOMAN YOUNG: Our next speaker is
15 Dr. Ellie Carleton, residential treatment
16 team leader, from Astor Services for Children
17 and Families.
18 DR. CARLETON: Good afternoon. My
19 name is Ellie Carleton. I'm a residential
20 treatment team leader for the RTF, the
21 Residential Treatment Facility, at Astor
22 Services for Children and Families. I am a
23 licensed psychologist, and I have been
24 working at Astor in the RTF for 20 years.
305
1 And I appreciate the opportunity to be here
2 today.
3 Astor is a large provider of
4 children's early childhood and behavioral
5 health services in both the Hudson Valley and
6 the Bronx. Last year, we served 10,000
7 children throughout our various programs.
8 Our RTF serves 20 children between the ages
9 of five and l4.
10 RTFs were created as a subclass of
11 hospitals and were able to have -- the
12 program has been funded 100 percent by
13 Medicaid, as children were deemed a family of
14 one for Medicaid purposes by virtue of their
15 mental health disability. RTFs have been
16 viewed as a less restrictive, community-based
17 alternative to state psychiatric inpatient
18 treatment.
19 There are currently 18 RTFs in the
20 state that serve nearly 500 children. For
21 many children and families, the RTF is their
22 last hope. The children that we serve in
23 these programs have very serious emotional
24 and behavioral disorders. They are
306
1 physically aggressive, lack social skills,
2 and demonstrate problems with impulse
3 control. Many have psychotic disorders,
4 learning problems, and are prone to
5 self-injury. Many have a history of
6 tremendous trauma.
7 The children's mental health community
8 has been participating and planning for the
9 transformation of the healthcare system;
10 however, we've only been able to access a
11 relatively small amount of money. We have
12 not been able to access capital dollars to
13 any significant degree.
14 Older RTFs do not have the physical
15 facilities to provide the kinds of services
16 that children need and deserve. Our programs
17 are committed to reducing restraints,
18 shortening lengths of stay, and the
19 facilities that we have are not adequate to
20 do so. Programs that want to redesign their
21 units to meet the needs of the children do
22 not have a access to capital dollars.
23 RTFs are a critical safety net and
24 need to be able to have the environments
307
1 necessary to provide the highest quality of
2 care.
3 Astor is one of the few programs
4 that's been able to construct a brand-new
5 facility. Our space is state-of-the-art and
6 allows for single bedrooms for each child.
7 The space was designed and constructed in
8 accordance to all OMH standards, and it's a
9 safe space, physically and emotionally, that
10 helps meet the children's needs.
11 We obtained a mortgage for
12 construction, and those costs are being paid
13 down due to an add-on on our Medicaid rate.
14 If the RTF is to continue to operate as it
15 has been since opening, there would be no
16 concerns with this debt. However, given all
17 the work that is going on to transform the
18 systems, we believe the future of our agency
19 could be in jeopardy. It is not a given that
20 managed-care companies would include the rate
21 in any payments that would occur when the
22 program transfers to managed care.
23 We're budgeted at 98 percent
24 occupancy, something we have achieved without
308
1 difficulty. However, we expect that
2 commercial payers will want to significantly
3 reduce length of stay, and this will result
4 in reduced occupancy as a percentage of care
5 days, which would put our ability to pay the
6 debt in jeopardy.
7 We believe debt relief would provide
8 us with long-term security as well as the
9 flexibility needed to adjust in an
10 environment that demands that we are very
11 nimble to respond to the needs.
12 In summary, RTFs are a vital provider
13 in the continuum of care for the most needy
14 and the most high-risk children. We need
15 capital to be able to provide the therapeutic
16 facilities for this population that we are
17 being asked to serve. Hospital systems have
18 been able to access hundreds of millions of
19 dollars. We ask that in the name of mental
20 health parity, RTFs have the same
21 opportunity.
22 Thank you.
23 CHAIRWOMAN YOUNG: Thank you for your
24 testimony.
309
1 Any questions?
2 ASSEMBLYWOMAN GUNTHER: Yeah. I
3 actually visited the one in Rhinebeck.
4 So your length of stay in your
5 facility, average length of stay? And just
6 because I visited there -- these children
7 really had very few options as far as where
8 to go, and I just think that it would be
9 important for people to know your success
10 rate.
11 DR. CARLETON: Mm-hmm. Our length of
12 stays are over a year, the average length of
13 stay.
14 And in terms of about 30 to 40 percent
15 of our population is able to go to a lower
16 level of care, typically back to their home.
17 About another 40 percent move on, either to
18 an adolescent facility or a slightly lower
19 level of care, such as a community residence.
20 And a small percentage go on to a long-term
21 hospitalization before they can be stabilized
22 and returned to a lower level of care.
23 ASSEMBLYMAN GUNTHER: Thank you.
24 Thank you.
310
1 CHAIRWOMAN YOUNG: Thank you.
2 Appreciate it.
3 Our next speaker is CEO and President
4 Christy Parque, Coalition for Behavioral
5 Health.
6 MS. PARQUE: Hi. Good afternoon.
7 CHAIRWOMAN YOUNG: Good afternoon.
8 Thank you for being here.
9 MS. PARQUE: Thank you for this
10 opportunity. My name is Christy Parque. I
11 am the president and CEO of The Coalition for
12 Behavioral Health.
13 And The Coalition is the umbrella
14 advocacy and training organization of
15 New York's behavioral health community,
16 largely New York City and the outer counties
17 surrounding New York City. We represent
18 about 140 community-based providers of
19 substance use and mental health services. We
20 serve about 500,000 New Yorkers with these
21 services. And proudly, I represent about
22 35,000 workers, and that's a lot of what I'm
23 going to talk about today.
24 You have my testimony, but I just want
311
1 to give you some context. I know that you've
2 had a lot of hearings and testimony in the
3 last two days, but as you know, the
4 behavioral health field in New York is in the
5 midst of transformation. There's greater
6 emphasis on meeting the needs of people in
7 their communities, and that's rightly so,
8 while at the same time we seek to improve
9 efficiencies and outcomes in the delivery of
10 Medicaid services. The Coalition thoroughly
11 embraces these goals and is trying to be an
12 active partner in these areas.
13 Our members comprise an intricate
14 network of safety-net providers throughout
15 all the neighborhoods they serve. They care
16 for our most vulnerable among us. They
17 provide all kinds of services -- PROS, day
18 treatment, clinic programs. They provide it
19 in every language, they provide it in sign
20 language. It is a comprehensive network of
21 services that they provide.
22 The Coalition's budget priorities
23 reflect this comprehensive approach that we
24 provide to our communities. We strongly
312
1 support measures that preserve and strengthen
2 community-based mental health and substance
3 use programs through reinvestment of
4 resources in community-based programs.
5 I will be focusing my testimony, and
6 you have it there, in three areas, which is
7 workforce, infrastructure, and access. And
8 what I ask for you to do is as we move
9 forward through this transformation, invest
10 in our success.
11 So you've heard the discussion of the
12 3.25 percent. Hooray, we really appreciated
13 that last year. We really are having a
14 workforce crisis currently. Our retention
15 rates are challenging because people are
16 leaving to go into other sectors like
17 hospitals or government or managed-care
18 organizations.
19 There is truly a workforce crisis
20 trying to find culturally competent and
21 language-proficient folks to run our
22 programs. And we are moving forward towards
23 a sector where people can come in any
24 right -- there's no wrong door -- any right
313
1 door, any time, to get the services, and we
2 need the staff to do that.
3 And things like regular COLAs, which
4 we've not had, and things like the
5 3.25 percent, go a long way to helping us to
6 retain our staff. And there are some other
7 great ideas about helping to retain our
8 workforce.
9 I also want to talk about the clinical
10 practice exemption. We are absolutely a
11 partner in trying to resolve this
12 long-standing issue. However, we cannot have
13 a solution that exacerbates our workforce
14 crisis. Again, the biggest place where we
15 would be impacted is around culturally
16 competent and language-proficient folks.
17 I have one provider I was meeting with
18 today, they have 35 LMHs, and they're all
19 bilingual in Spanish or Haitian or French.
20 None of their LCSWs are. They receive
21 supervision. We have a highly qualified
22 workforce, it's been highly qualified. We
23 have intense supervision, we have oversight
24 by multiple agencies. We're very confident
314
1 in the high quality of the services we
2 provide.
3 We of course want to be at the table
4 when we look at opportunities to deal with
5 this issue that I know that you're as tired
6 of as we are. However, I have grave concern
7 for not just my workforce, but the bigger
8 piece of access. If that one provider has to
9 let 35 staff go, who will serve those people
10 in the languages that they need to be served
11 in?
12 Related to enforcement of supporting
13 our sector, we have a request related to the
14 Statewide Health Care Facilities
15 Transformation. You were tremendous last
16 year -- last year's budget put in
17 $30 million, the Legislature came in at
18 $75 million. That was heroic. We are so
19 grateful. That's going to get us to where we
20 need to go.
21 This year, however, have a
22 $425 million budget for that pot. Last year,
23 the percentage we got was 15 percent. This
24 year we're at about 9 percent. What we're
315
1 requesting is that we get proportionally a
2 larger share of that. We support that
3 assisted living, they should get what they
4 need. However, we need to pull them out of
5 our pot and strengthen the community health
6 centers and the behavioral health clinics in
7 the districts.
8 So we look for your support to try and
9 bring that parity up. It's not a dollar ask,
10 it's just rejiggering what that bucket looks
11 like.
12 The other piece related to
13 strengthening our sector is the Nonprofit
14 Infrastructure Capital Program, which affects
15 folks that are not in healthcare
16 transformation, but it could be a senior
17 center that needs a new boiler or a shelter
18 that needs a program or a new heating system.
19 This is available to all the nonprofits in
20 the state.
21 Two-thirds of the folks that
22 applied -- over 634 organizations applied --
23 two-thirds were denied. So clearly there's a
24 need for that. There's no money in this
316
1 year's budget. We'd love to get some money
2 back in the budget.
3 And the final piece, as we address our
4 services related to access, we must keep in
5 mind that whatever actions the agencies take,
6 whatever actions the state takes, that we
7 have to preserve access because we are in a
8 crisis. We're facing an opioid crisis. We
9 have to ensure, as you heard around kids,
10 that kids have the access to services. We
11 support the request that Paige mentioned.
12 We also support the Bring It Home
13 campaign, because housing is healthcare, and
14 the best way for recovery is in a safe,
15 stable place.
16 And you have the rest of my
17 recommendations. I'm happy to take any
18 questions.
19 CHAIRWOMAN YOUNG: I don't think we
20 have any questions, but we appreciate your
21 testimony. Thanks for being here.
22 MS. PARQUE: Thank you.
23 CHAIRWOMAN YOUNG: Our next speaker is
24 President and CEO Ann Hardiman, New York
317
1 Alliance for Inclusion and Innovation.
2 MR. SEEREITER: Good afternoon. I'm
3 Michael Seereiter, the executive vice
4 president and COO of the New York Alliance
5 for Inclusion and Innovation.
6 Since the last time we presented
7 before you all, this is a new organization,
8 resulting from the merger of the New York
9 State Rehabilitation Association and the
10 New York Association of Community and
11 Residential Agencies. My colleague and I,
12 Ann Hardiman, are the two respective
13 organization heads of those, and we're coming
14 together as a new organization.
15 Our number-one priority is the
16 workforce issue, which Ann is going to speak
17 about right now.
18 MS. HARDIMAN: Yes, I wanted to take
19 the opportunity to thank you all, on behalf
20 of the Be Fair coalition. You were awesome
21 last year in supporting our move toward a
22 living wage for DSPs. The Executive Budget
23 includes full funding to support 6.5 percent
24 salary increases, and we thank you for that
318
1 important increase.
2 Since then, we've done another
3 snapshot survey, and our data is worsening.
4 Providers in 2017 have vacancy rates of one
5 in seven, 14.4 percent. They have a turnover
6 rate of 26.7 percent, up 8 percent from 2016
7 and up 42 percent from 2014. One in three
8 DSPs leave in less than six months. If you
9 calculate using $4,000 as their on-board
10 training and recruitment cost, that's just a
11 waste of money when people leave in under
12 six months.
13 Our overtime is 10 million overtime
14 hours in 2017. Due to this worsening crisis,
15 we respectfully request a third installment
16 of direct support for direct support
17 professionals in the Be Fair campaign, with
18 an investment of an additional $18.25 million
19 in the budget this year.
20 I also want to briefly mention around
21 housing. We all know how important housing
22 is for people with developmental disabilities
23 and with psychiatric disabilities. They're
24 foundational to health and well-being. And
319
1 the New York Alliance has created a housing
2 navigator training initiative that includes
3 some innovations in using assistive
4 technology to live more independently, and
5 also around other innovations like shared
6 living.
7 We know those are important. We
8 respectfully ask, in light of the success of
9 this housing navigator program, where we've
10 trained 150 housing navigators, that there be
11 an additional add of $500,000 to expand that
12 program.
13 We appreciate all your work and thank
14 you for the Be Fair dollars. And over to
15 Michael for comments on managed care.
16 MR. SEEREITER: Our last component
17 that we wanted to bring to your attention
18 revolves around that systemic transformation
19 for the OPWDD systems -- specifically, the
20 Care Coordination Organizations and the shift
21 towards managed care.
22 We submitted comments to OPWDD in
23 three areas -- the Health Home application,
24 the 1115 waiver, and the care coordination
320
1 transition plan -- that were all made
2 available for public comment. The common
3 theme, I think, from our comments in those
4 comments was our concern about the
5 unrealistic time frames, or what we think are
6 unrealistic time frames, and the insufficient
7 resources made available thus far to really,
8 I think, get those transitions right.
9 The Care Coordination Organizations
10 are proposed for essentially creating the
11 Health Home model for the I/DD population.
12 There are many unclear aspects of the
13 transition that's scheduled to take place on
14 7/1. Technology is going to need to
15 immediately replace the communication that
16 has taken place between the care manager and
17 now -- or, excuse me, the MSC and now the
18 care manager and the provider of the services
19 themselves.
20 What is the preparedness, what are the
21 preparedness activities that organizations
22 that are providing those services need to be
23 undertaking now to be prepared for that 7/1
24 implementation?
321
1 Likewise, on the managed-care
2 transition, the larger managed-care
3 transition that's scheduled for a few years
4 out, we believe that there are major
5 investments that are necessary in terms of
6 readiness, the tools and the capacity that
7 providers need to be ready to participate in
8 that new structure.
9 I think IT is a wonderful example of
10 that. You were talking about EHR,
11 participation with the Statewide Health
12 Information System, and the ability to
13 collect and analyze data in a way that really
14 prepares organizations to participate in that
15 new structure. The ability to answer a
16 question about whether the funding that is
17 proposed to support one individual is
18 actually sufficient, based on previous
19 experience of the overall supports that are
20 necessary for an individual.
21 That transition, I think, actually has
22 been exacerbated or will be exacerbated by
23 the experience that we've been through with
24 the rate rationalization exercises over the
322
1 past four years, where we've moved actually
2 further away from some of the goals of moving
3 toward managed care and value-based payments.
4 I think that this really speaks to the
5 need for larger investments in the system,
6 particularly in provider readiness activities
7 and investments in the technology and
8 capacities of providers to participate in the
9 new environment of managed care that's coming
10 very, very quickly.
11 Thank you.
12 SENATOR KRUEGER: Thank you.
13 CHAIRWOMAN YOUNG: Thank you very
14 much.
15 MS. HARDIMAN: Thanks so much.
16 CHAIRWOMAN YOUNG: Our next speaker --
17 actually, we have two. We have
18 Administrative Director Arnold Ackerley and
19 director of Policy Clint Perrin, from the
20 Self-Advocacy Association of New York State.
21 If people want to get closer, too.
22 After them, we have the Association of
23 Substance Abuse Providers, and after that,
24 Friends of Recovery. If you could get closer
323
1 to the front, that would be helpful.
2 Thanks for being here. Please
3 summarize your testimony.
4 MR. PERRIN: Hello.
5 MR. ACKERLEY: So first we just want
6 to thank you for allowing us to be here and
7 give testimony today.
8 MR. PERRIN: New York State's system
9 of services for people with disabilities is
10 undergoing a big change. Part of this intent
11 is to change -- to create more community
12 integration and choice for people with
13 disabilities.
14 Funding is needed so that this change
15 meets the goals in a real way of our lives.
16 For people with disabilities, solutions need
17 to consider a full range of supports and
18 services to ensure that the person has
19 meaningful choices and sustainable
20 opportunities for independence and inclusion.
21 It is important to consider housing,
22 staffing, transportation and employment
23 opportunities together when planning
24 development for people with developmental
324
1 disabilities.
2 In addition to people with DD, there
3 are many people in need of housing and better
4 services -- veterans, the elderly, people
5 with mental health concerns. We urge you, we
6 urge the Legislature to think of how to
7 mobilize communities to think of all its
8 members together to offer solutions and
9 create real communities.
10 MR. ACKERLEY: Okay. So there's just
11 a few points that we want to make. Of course
12 you have our testimony, so I won't read the
13 whole thing. But one area of concern that's
14 come up is housing and the investment in
15 housing opportunities.
16 The state -- which we're very grateful
17 for that investment, and we're very grateful
18 that OPWDD's budget was able to be increased
19 again by 4 percent. However, there's a
20 preponderance of investment in legacy
21 services still to this day -- traditional
22 group homes, traditional day programs. When
23 you contrast that, there's about $120 million
24 proposed, $15 million into independent
325
1 settings.
2 There's many people with developmental
3 disabilities that are currently living and
4 residing and receiving legacy services that
5 really could be in more independent settings.
6 There could be significant cost savings if we
7 were to invest more into getting people into
8 places they need to be, in more independent
9 settings. And for those that really require
10 these legacy services, moving them into them
11 rather than continuing to invest in new
12 development, which we know is still ongoing.
13 In terms of #bFair2DirectCare, you
14 know, workforce and the DSP turnovers, I
15 think that you really understand that, and
16 I'm sure you've heard a lot about that over
17 time today. I think the most important thing
18 we would ask to you remember is that you've
19 heard a lot of numbers, but I think it's
20 important to remember there's lives behind
21 those numbers. For the DSPs, of course. But
22 for people with developmental disabilities in
23 many cases, when they don't have that person
24 available to them or they have high turnover
326
1 rates, really their lives are being put on
2 hold. They're really not able to participate
3 in their communities as they would like to.
4 They're not really able to hold down jobs
5 that they would like. They're simply not as
6 successful as they would like to be.
7 So we just stand with Be Fair, and we
8 really ask for that to be expedited to solve
9 that issue. There's also real risk to
10 safety, dignity and well-being, you know,
11 with these current numbers.
12 Transportation I know is a difficult
13 issue, and we certainly don't have some sort
14 of a magic spell, but I do think it's
15 important for people to understand that
16 throughout the state, for people with
17 developmental disabilities, their options for
18 transportation are vastly limited.
19 Even in our case, our office -- we
20 share an office with OPWDD, that has been
21 very generous in giving us office space. A
22 couple of years ago in Buffalo, our Buffalo
23 office, the paratransit line was cut. So
24 even for us, the Self-Advocacy Association,
327
1 we no longer have an accessible office
2 through paratransit. So we are using remote
3 sites and exploring other alternatives. But
4 I think that's a good example of how bad it
5 can get.
6 Another thing is for people in rural
7 areas, they really don't have any options.
8 So when you combine these staffing
9 shortages -- who may be their only line to
10 sort of transportation community
11 integration -- with the fact that there's no
12 public transit for them, it can lead to
13 tremendous isolation.
14 CHAIRWOMAN YOUNG: Thank you.
15 MR. ACKERLEY: Thank you very much.
16 CHAIRWOMAN YOUNG: Thank you. I think
17 self-advocacy is extraordinarily important,
18 and we appreciate you being here today.
19 MR. ACKERLEY: Thank you very much.
20 MR. PERRIN: Thank you.
21 CHAIRWOMAN YOUNG: Next we have
22 Executive Director John Coppola, Association
23 of Substance Abuse Providers.
24 Thank you for being here.
328
1 SENATOR KRUEGER: Hi, John. When
2 you're ready.
3 MR. COPPOLA: Good afternoon. I want
4 to just start out where I left off last year.
5 When we came here last year, we asked for a
6 significant increase in commitment to
7 prevention treatment and recovery. And we
8 predicted that if we didn't do that, there
9 would be a continued upward trajectory of
10 record deaths and overdoses, et cetera.
11 Well, that's exactly what happened, at
12 least the latter part of that. We had a
13 record number of overdose deaths in 2017.
14 And I know that each one of you has a
15 personal awareness of one of your
16 constituents who lost somebody to an
17 overdose. There will be a record number of
18 overdoses in 2018, and there will be a record
19 number of overdoses in 2019. People who know
20 about health trends are saying this. And
21 what hasn't happened is a massive infusion of
22 resources.
23 I want to correct the record. Last
24 year I believe the Governor at some point was
329
1 talking about the commitment that was being
2 made to the opioid crisis, and I believe he
3 used the number $213 million, a substantial
4 number. If you look at the chart in my
5 testimony that lays out local assistance --
6 and I would strongly encourage the Finance
7 and Ways and Means folks to take a look at
8 the local assistance budgets over the course
9 of the last five years and ask a very simple
10 question: How much money did we commit to
11 OASAS for prevention, treatment, and recovery
12 services in the communities across New York
13 State? You will not see anything remotely
14 resembling the number $213 million.
15 And I don't know that the Governor
16 frankly was representing that that was the
17 case. I think the Governor was simply
18 describing that based on the influx of people
19 into our system, that is essentially how much
20 resources were being consumed by the system.
21 Okay?
22 So if you look at the local assistance
23 dollars over the course of the last five
24 years, we have barely kept pace with
330
1 inflation --
2 ASSEMBLYMAN GUNTHER: Are you on
3 page 2?
4 MR. COPPOLA: Yes.
5 ASSEMBLYWOMAN GUNTHER: Okay.
6 MR. COPPOLA: Yup. So we've barely
7 kept place with inflation. It's less than
8 3 percent from year to year to year, okay?
9 So again, I do think it's not a
10 misrepresentation to say that $213 million is
11 being used to fight the opioid crisis; that's
12 simply because of the demand of the people
13 coming into the existing system.
14 And the thing that you have to ask
15 yourselves and think a little bit about is
16 you are acutely aware of all of the changes
17 that were necessary when we moved from
18 fee-for-service to managed care. People were
19 buying electronic health records, people were
20 hiring billing clerks.
21 You have to ask yourself the following
22 question. If we weren't keeping pace with
23 inflation, which is for your utilities and
24 your healthcare costs and everything else --
331
1 so if we weren't keeping pace with inflation,
2 and if these programs had to buy electronic
3 health records and if they had to hire
4 billing clerks, how did they possibly do it?
5 Well, it cannibalized existing open
6 positions. So you're going to hear in a
7 little bit from our prevention friends in
8 New York City, and I was shocked when I heard
9 this. Fifteen years ago, there were about
10 500 prevention specialists in New York City
11 schools -- and we did a survey statewide,
12 similar numbers for upstate -- 500 prevention
13 professionals in the New York City schools.
14 Today, there's 280. Well, 220, or 40 percent
15 of the workforce, went poof.
16 Now, that's in part because the
17 federal government walked away from
18 prevention. But I just want to reiterate the
19 point very simply, that there has been barely
20 enough money to keep pace with inflation,
21 much less giving the commissioner of OASAS
22 the resources that she needs to deal with the
23 pandemic.
24 Quickly on the Governor's
332
1 recommendation of a surcharge, $127 million.
2 And I believe a number of you asked questions
3 of the commissioner and others, you know:
4 Well, where's the $127 million? Well, the
5 reason why you are asking that question is
6 because you don't see it in the OASAS budget.
7 It's not clearly articulated, right? And
8 what we don't want to do is take $127 million
9 from the surcharge, put it in the OASAS
10 budget, and then shuffle $101 million out the
11 door to go pay for something else -- and then
12 say we just took $127 million as if it's new
13 dollars. Okay?
14 So again, I'm just asking you to
15 please keep an eye on the real numbers. And
16 the Ways and Means and Finance staff can kind
17 of look at these numbers and let you know
18 that they're very real.
19 I just have a couple of additional
20 points I'd like to make. The executive
21 director of NASW was here a little while ago
22 to talk about licensing issues. The Governor
23 put something in his budget that would
24 continue to address a very significant flaw
333
1 in the social work licensing bill.
2 There's a reason why it's been 14
3 years that it hasn't been enacted, and the
4 reason for that is that it was way beyond
5 what was initially conceived, and there was
6 very little awareness about how significantly
7 implementing that licensing statute would
8 impact the workforce in addiction programs
9 and mental health programs, et cetera,
10 extraordinarily highly regulated environments
11 where people in recovery and people with
12 lived experience can work and practice as
13 part of larger teams.
14 And what we don't need is to have the
15 State Education Department implementing a
16 statute that is seriously flawed and
17 significantly -- and we will be displacing
18 thousands of people working in addiction
19 programs if we just let those exemptions
20 sunset, right?
21 So we're not talking about putting
22 people -- making them do diagnoses. That
23 scope is a serious problem. OASAS, OMH, and
24 others have documented it, and it's really
334
1 not fair to sort of suggest that the
2 workforce which has been doing addiction
3 treatment for years under a highly regulated
4 environment is somehow incompetent and
5 somehow OASAS and the other state agencies
6 are abdicating their responsibilities by not
7 hiring nonexistent licensed professionals,
8 okay?
9 So I just strongly suggest that you
10 don't just dismiss this because it's been on
11 the table for 15 years. There's a reason why
12 it's been an issue for 15 years. It's
13 extraordinarily difficult to fix, but I think
14 we can come up with a solution better than
15 displacing people from the addiction
16 workforce at a time when we can least afford
17 to do so.
18 Just one final point, and that is that
19 as you contemplate -- and again, we need you
20 to make a serious commitment of resources to
21 address this pandemic, and I ask that you
22 seriously think about the existing
23 programs -- it's not just about putting up a
24 new clinic here and a new clinic there.
335
1 And Christy talked about the workforce
2 crisis that we're having, right? We have to
3 make an investment, and most of my written
4 testimony speaks about strengthening the
5 prevention workforce, strengthening the
6 treatment workforce, and strengthening the
7 recovery workforce. We've got to take care
8 of the existing infrastructure. It's not
9 okay that for years we have failed to keep
10 pace with inflation with our allocation, in
11 the midst of the death and addiction
12 associated with the opioid crisis and the
13 ongoing addiction to alcohol and other drugs.
14 SENATOR KRUEGER: I'm going to ask you
15 to sum up.
16 MR. COPPOLA: Yeah. So one final
17 point is we did commission a workforce survey
18 with the Center for Human Services Research,
19 and there's a number of the findings in my
20 written testimony. And they really just
21 demonstrate that there is a decreased ability
22 to deal with the existing demand for services
23 that is being caused by turnover and by the
24 inability to fill positions.
336
1 And frankly, I think I mentioned it a
2 little bit earlier, that some of those
3 positions have been cannibalized and we'll
4 never see them again unless, you know, you
5 come in and really -- but, you know, I would
6 end with the following question. What is it
7 going to take?
8 What is it going to take for you all,
9 for the Senate and the Assembly, what's it
10 going to take for you to just do something
11 dramatic to deal with an issue that's quite
12 dramatic in and of itself? Like, what's it
13 going to take, you know? It's going to be a
14 record number of deaths again. What's it
15 going to take?
16 We'll work with you in whatever way
17 that we can to address this. It's tragic,
18 it's horrible, but we have to do more. We're
19 not doing enough.
20 And on the very last page is a graphic
21 illustration of the juxtaposition of flat
22 funding and elevated level of overdose
23 deaths, and I think the red line for the flat
24 funding is a little bit on the generous side.
337
1 It probably should be a little flatter than
2 it actually is.
3 SENATOR KRUEGER: Thank you.
4 Question?
5 ASSEMBLYMAN GUNTHER: I just want to
6 say that I agree with you 100 percent, and I
7 think that we're not addressing this crisis
8 the way that we should. And I think that in
9 my opinion, we need everybody on board that
10 is on board today, and a lot less people I
11 think are going into social work and becoming
12 CASACs.
13 It's a very difficult program, and we
14 need more beds, we need to do more long-term
15 care for this issue, and hopefully we'll be
16 able to do something about it.
17 MR. COPPOLA: Well, just thank you for
18 all that you guys do, and I really appreciate
19 your service to the community and for, you
20 know, the questions you've asked and the
21 consideration you give this.
22 I think the Legislature is more
23 knowledgeable about addiction today by far,
24 unfortunately, for reasons that are really
338
1 tragic. But I really appreciate your
2 engaging with us on this.
3 ASSEMBLYWOMAN GUNTHER: There are so
4 many people that get to the point where they
5 do want recovery and they've been long-term
6 addicts and they've been through it once,
7 twice -- but sometimes, as you know, it takes
8 three times.
9 And at this moment in time the
10 difficult of getting inpatient stays is
11 unbelievable. And I said before, I called
12 for hours and hours and hours. And, you
13 know, and I knew because of being a nurse --
14 and I worked at a detox unit when I was
15 younger -- and being a nurse and working with
16 Catholic Charities a lot that, you know, at
17 least I knew what to do.
18 But for people that it's a new thing,
19 and it's becoming new to so many families
20 across New York State -- we have never seen
21 young people involved, robo-tripping, all
22 these kinds of things. It's just different
23 than it was before, or maybe because of
24 social media we're just more aware of it.
339
1 MR. COPPOLA: And Assemblywoman, if a
2 secret handshake is necessary, I know it in
3 every single region of the state. And I have
4 the exactly same experience that you do.
5 I was trying to get a 23-year-old
6 woman who had an alcoholism problem into a
7 treatment program on several occasions. Time
8 number one, waiting lists every place that I
9 knew. Time number two, waiting lists
10 everywhere. Time number three, her father,
11 who lives in Albany, put her in the car, took
12 her to Buffalo, and she found a bed in
13 Buffalo. Right?
14 So this is really -- you don't forget
15 that experience.
16 ASSEMBLYMAN GUNTHER: No, I don't.
17 And also I know that -- I mean, there
18 are some bizarre things going on in the world
19 that I think we should be aware of, like if
20 somebody is stoned or high. But some people
21 actually, I have heard now through the
22 grapevine -- they actually shoot up to get an
23 admission into a hospital. And I'm sure
24 you've heard that.
340
1 MR. COPPOLA: Mm-hmm.
2 ASSEMBLYWOMAN GUNTHER: You know,
3 because they'll take you when you're stoned,
4 I guess, and not when you're not. So people
5 actually do it one more time. And it is
6 absolutely true, because I work with a lot of
7 people in that community.
8 MR. COPPOLA: Yeah.
9 SENATOR KRUEGER: Thank you very much,
10 John.
11 MR. COPPOLA: Thank you.
12 SENATOR KRUEGER: Stephanie Campbell,
13 Friends of Recovery New York.
14 And then for people watching the
15 lineup, to move down closer. After that,
16 DC37. After that, Coalition of Provider
17 Associations.
18 Good afternoon.
19 MS. CAMPBELL: Good afternoon.
20 SENATOR KRUEGER: Thanks for being
21 with us.
22 MS. CAMPBELL: Thank you so much.
23 ASSEMBLYWOMAN GUNTHER: You're so
24 happy after waiting so long.
341
1 MS. CAMPBELL: I know. It's so true.
2 My name is Stephanie Campbell --
3 ASSEMBLYWOMAN GUNTHER: This is a
4 half-day.
5 SENATOR KRUEGER: Don't listen to her.
6 We're very early today. We're fine.
7 MS. CAMPBELL: Oh, good.
8 (Discussion off the record.)
9 MS. CAMPBELL: -- and as the executive
10 director of Friends of Recovery New York, I'm
11 honored to be here at today's hearing to
12 discuss how we can address the public health
13 crisis of addiction here in New York State.
14 As you may know, Friends of Recovery
15 New York represents the voice of individuals
16 and families living in recovery from
17 addiction, people who have lost a family
18 member and folks that have otherwise been
19 impacted by this scourge.
20 The stigma and shame that surrounds
21 addiction has prevented millions of
22 individuals from seeking help, and
23 FOR New York is dedicated to breaking down
24 some of those barriers to access to addiction
342
1 treatment, healthcare, housing, education,
2 and employment.
3 But more importantly, my name is
4 Stephanie Campbell, and I'm a person in
5 sustained recovery. And what that means for
6 me is I haven't used alcohol or drugs in over
7 17 years. And that's allowed me to be the
8 mother of two beautiful girls, one who
9 recently graduated from Sarah Lawrence
10 College, and one a teenager in her senior
11 year of high school.
12 It's allowed me to be a partner, an
13 employee, a taxpayer instead of a tax drain.
14 It's allowed me to save the state of New York
15 millions of tax dollars because someone made
16 an investment in my recovery. And as a
17 result, I went from being a homeless street
18 kid in New York City to having a master's
19 degree from Columbia University and New York
20 University.
21 So instead of bouncing in and out of
22 jails and institutions, I advocate for folks
23 that have been impacted by this illness. And
24 I know that you folks know that heroin use
343
1 and prescription opioid use are having
2 devastating effects on the public health and
3 safety of New Yorkers. According to the CDC,
4 drug overdoses, as you know, now surpass
5 automobile accidents as the leading cause of
6 accidental death for Americans between the
7 ages of 25 and 64.
8 And since I've begun this work -- the
9 first year I was here in 2015, we were losing
10 about 129 people a day. That number jumped
11 the following year to 144, and this year it's
12 174. So as John Coppola just said, and other
13 folks have said, this is not going away.
14 It's going to continue to increase if we
15 don't address it the way that it needs to be
16 addressed.
17 And so the surge of people dying from
18 this crisis continues to rise. And given
19 right now the $4.4 billion shortfall that the
20 New York State budget is facing, we must have
21 a steady revenue stream of critically needed
22 funding for prevention, for treatment and
23 recovery services that are desperately needed
24 to address the greatest public health crisis
344
1 this nation has seen in generations.
2 New Yorkers have been fearless in
3 taking on previous epidemics, like HIV and
4 AIDS. And I worked -- I sank my teeth into
5 advocacy early on in ACT UP and, you know, we
6 saw a real change that happened not only here
7 in New York State, not only here in the
8 United States, but globally when we took that
9 epidemic seriously.
10 So we wholeheartedly see that it is
11 time for the drug manufacturers who
12 contributed to this public health emergency
13 to cover state expenses that are associated
14 with the epidemic here in New York State.
15 And we see that proposed surcharge, which --
16 language is everything, right? So we really
17 see this as an opioid stewardship fee, is
18 what we're calling it, to expand support
19 services to address the pandemic through new
20 prevention, treatment, and recovery programs
21 that will effectively address this public
22 health emergency.
23 And I just want to say that, you know,
24 part of my recovery process was from
345
1 prescription drugs. You know, and there's
2 many of us, there's thousands of us across
3 the state who I've talked -- you know, some
4 of them I've talked to in recovery talks that
5 we've had who have said, you know, "I
6 relapsed, you know, on prescription drugs.
7 My doctor didn't know." Right? And it's not
8 that they don't care, but the overuse of
9 these prescription drugs has really created,
10 you know, part of this pandemic.
11 So, you know, I just want to reiterate
12 that we see this surcharge as a clear message
13 not only to manufacturers that they too have
14 a responsibility to pay their fair share, and
15 for its recognition that additional funds are
16 needed to stem the tide of this devastating
17 epidemic. But we feel strongly that the
18 state's first priority for these funds must
19 be the needs of OASAS prevention, treatment,
20 and recovery.
21 And I also want to say that we want to
22 see that this not -- we don't want to see
23 this passed on to the consumer. And there's
24 a way to do that. There's a way to have
346
1 conversations in which, you know, the right
2 appropriations are made to the right people.
3 And so we certainly support that.
4 So as a person in recovery who
5 continues to hold her illness in remission, I
6 see this proposed opioid stewardship fee as
7 the way to holding those who contributed to
8 this crisis accountable, while reducing that
9 demand.
10 As individuals continue to struggle
11 with addiction with no end in sight for
12 grieving families who continue to lose loved
13 ones to overdose deaths -- and I can't tell
14 you folks how many people I've buried in the
15 past two years alone. You know, how many
16 funerals -- and I know you guys have gone to
17 funerals as well.
18 It's -- it's -- it's time. It's
19 really time. You know, addiction --
20 SENATOR KRUEGER: Could I ask you to
21 summarize, to wrap up? Sorry.
22 MS. CAMPBELL: Oh, no. Thank you.
23 It doesn't discriminate. You know, I
24 know that we have Senator Brooks here from
347
1 Long Island. You know, we've got a wonderful
2 THRIVE Recovery Center that's doing
3 extraordinary work, they're facilitating
4 referrals, mobilizing resources, and linking
5 individuals to community supports.
6 We must continue this work. We need
7 more recovery community outreach centers, we
8 need more recovery community organizations,
9 more peers that are engaging with folks,
10 family support navigators, and youth
11 clubhouses. It's really time to stop
12 investing in the problem and start investing
13 in the solution, which is recovery.
14 Any questions?
15 SENATOR KRUEGER: Any questions?
16 ASSEMBLYWOMAN GUNTHER: Thank you very
17 much.
18 SENATOR KRUEGER: Thank you very much
19 for being here today and for all your work.
20 DC 37 Local 372, Kevin Allen and Donna
21 Tilghman. Did I get that right?
22 MS. TILGHMAN: Yes.
23 SENATOR KRUEGER: Welcome.
24 MS. TILGHMAN: Thank you.
348
1 SENATOR KRUEGER: Whenever you'd like
2 to start.
3 MR. ALLEN: Good afternoon, everyone.
4 Good afternoon, Chairwoman Weinstein. Thank
5 you for inviting us. On behalf of DC 37 and
6 President Francois, we thank you so much for
7 listening to what we have to say.
8 We're representing a group of
9 1.2 million school students. SAPIS provides
10 work in the following areas: School
11 programming, clubs, leadership, mental health
12 awareness, peer mediation, classroom
13 presentations, counseling services -- which
14 is at-risk counseling, group, and individual
15 sessions -- drug and gang prevention, and a
16 host of additional mental health services for
17 a variety of conditions.
18 These counselors help children keep
19 their focus on remaining learning-ready
20 through the use of coordinated and
21 collaborative proven methodologies to cope
22 with the myriad of societal pressures that
23 detract them from their daily work in life.
24 We're excited that we seem to be a
349
1 unique group that counsels groups from the
2 letter A to the letter Z. We counsel
3 children from the letter K to the number 12.
4 We're excited about that. In a community of
5 over 1800 schools, which incorporates
6 1.2 million students -- if you do the
7 numbers, that breaks down to 6,000 students
8 per SAPIS. In reality, each SAPIS provides
9 direct classroom lessons and counseling
10 services to an average of 500 students each,
11 with services available to only 325 out of
12 over 1,800 schools.
13 We're passionate about that because
14 just look at what we see on TV, just look at
15 the daily grind, look at what the influx of
16 social media has done with the students that
17 we work with. That's why we provide that
18 means on an ongoing basis, and Local 372
19 SAPIS are employed to bring that research.
20 SAPIS have consistently implemented
21 evidence-based programs with fidelity.
22 In addition, SAPIS are used to support
23 schools during crisis -- unfortunately, one
24 of the recent crises that we talk about is in
350
1 the Bronx, in the Urban Assembly School for
2 Wildlife Conservation, when that student
3 unfortunately died due to an incident. SAPIS
4 counselors was one of the groups that came
5 and that was called less than one half hour
6 after getting the information that that
7 happened. The reason why I can speak so
8 passionately about that, I was one of the
9 staffers that was there, that were on the
10 scene.
11 The result of that is priceless. The
12 result of that is catastrophic to a
13 neighborhood, to a school, and to a
14 community.
15 For the past three years, the Assembly
16 has allocated an additional $2 million, and
17 that has provided the funding for
18 approximately 25 additional SAPIS positions.
19 Together, these 25 SAPIS are able to provide
20 prevention, education in the classroom, and
21 direct counseling for approximately
22 12,500 at-risk students and their families
23 who would otherwise not have the support that
24 they needed.
351
1 For us to be able to maintain the
2 current number of employees, we are asking
3 the Assembly to maintain this $2 million
4 allocation in the 2019 budget, and for the
5 Senate to contribute an additional million
6 dollars to support the hire of an additional
7 12 counselors.
8 We thank both the Senate and Assembly
9 for their expressed support and recognition
10 of the 1.2 million students taught in more
11 than 1800 schools. The resources and the
12 services that SAPIS offer to help keep pace
13 with adverse societal pressures -- suffice it
14 to say that New York City schools need to be
15 safeguarded for that funding.
16 While there are limited state
17 resources, which we all understand, New York
18 State has always been a leader in
19 prioritizing opportunities for the children.
20 Local 372's goal is to partner with the state
21 in making a smart investment in the qualities
22 of life for both New York students, their
23 families, and communities at large. Of
24 course we look forward to working with you to
352
1 make this possible.
2 Again, we thank you for the
3 opportunity to come before you on behalf of
4 DC 37, Local 372 of the New York City Board
5 of Education employees and the 280 Substance
6 Abuse Prevention and Intervention Specialists
7 that are on the ground each day looking and
8 working for that change, all about children.
9 We will answer any questions that you
10 have.
11 SENATOR KRUEGER: Thank you.
12 So any questions? Any questions,
13 Assembly?
14 MR. ALLEN: Thank you very much.
15 SENATOR KRUEGER: You did explain it
16 beautifully.
17 MS. TILGHMAN: Thank you.
18 MR. ALLEN: Thank you.
19 ASSEMBLYMAN OAKS: Thank you.
20 SENATOR KRUEGER: Thank you. Thank
21 you both for being here today with us.
22 And our next testifiers -- don't lose
23 your list -- excuse me -- Coalition of
24 Provider Associations, Winifred Schiff and
353
1 Barbara Crosier. And then getting ready to
2 line up next, Association for Community
3 Living and then Supportive Housing Network of
4 New York.
5 Good afternoon, ladies.
6 MS. CROSIER: Good afternoon.
7 MS. SCHIFF: Good afternoon. Thank
8 you to Chair Gunther and to all our friends
9 in the Senate and the Assembly for your
10 ongoing support of all of our issues and for
11 hearing our comments today.
12 ASSEMBLYWOMAN GUNTHER: Thank you for
13 being so patient, all of you.
14 MS. SCHIFF: No problem.
15 MS. CROSIER: Thank you for sticking
16 around.
17 MS. SCHIFF: I'm Wini Schiff, of the
18 InterAgency Council of DD Agencies, and this
19 is Barb Crosier from CP Associations of
20 New York State, and we're today on behalf of
21 COPA, which is the Coalition of Provider
22 Associations.
23 COPA consists of five associations,
24 which are the Alliance of Long Island
354
1 Agencies; CP Associations; DDAWNY, in Western
2 New York; IAC; and the New York Association
3 of Emerging and Multicultural Providers.
4 And before we get into our comments, I
5 want to just say how grateful we are to your
6 support of our #bFair2DirectCare living wage
7 initiative. Thank you so much.
8 To give you just a small context for
9 the reason -– you know, for our asks, in each
10 of the past five years the adopted budget
11 contained increases to Aid to Localities
12 spending. But because of midyear reductions,
13 each year it was less than that, the spending
14 was actually less. For example, last year
15 there were $88 million less spent than the
16 year prior. And even though this year the
17 proposed spending is $151 million higher, the
18 cumulative spending over the past seven years
19 has been $53 million less.
20 In addition to that, we have not
21 received a Medicaid trend -- except for a
22 1.2 percent increase two years ago -- since
23 2010.
24 And we did get two increases that
355
1 we're grateful for. In 2015, there were two
2 2 percent increases just for staff. And then
3 again this past year, the two increases for
4 our direct support professionals, which are
5 absolutely necessary and, you know, still is
6 our biggest priority.
7 But at the same time, all of our costs
8 are rising, and so providers are in more and
9 more of a precarious situation financially.
10 From about 1993 till 2010, we got
11 Medicaid trends every single year. Now it's
12 been eight years that we have not received
13 any kind of an overall trend.
14 In addition to that, rate
15 irrationalization, is what we call it --
16 because it's based more on an idea than on
17 actual costs of providing services -- have
18 created a situation where there are no
19 surpluses for any of our programs. And so
20 programs that lose money, like clinics,
21 Early Intervention, and other services for
22 people with the most significant needs, are
23 actually closing because they're money losers
24 and we can't afford to support them because
356
1 there are no more surpluses to do that.
2 Getting right into something that
3 you've heard before, which is our request to
4 actually give us the payments toward the
5 living wage more quickly. So in the
6 beginning, we had asked for $45 million every
7 year for six years, to bring us to the living
8 wage, which is $17.72 downstate and $15.54
9 upstate. But based on new data that we have
10 collected, our vacancy rates have gone up to
11 14.4 percent, our turnover rate is up to
12 26.7 percent, and programs are really
13 suffering. So we are asking for the original
14 plan to be sped up and for $18.25 million to
15 be added to this year's budget for the next
16 installment.
17 So just the other day -- on Liz
18 Benjamin, actually -- I know you had heard
19 that SWAN, which is a statewide parent
20 advocacy network, joined the
21 #bFair2DirectCare coalition, and Barb DeLong
22 and Pat Curran were on there talking about
23 our worsening crisis for staff. And Barb
24 said that she's been given 45 staff hours for
357
1 support in their home per week, and she's
2 only able to staff 10 of those hours. So
3 that's pretty telling.
4 I'll turn it over to Barbara for
5 development.
6 MS. CROSIER: And I'll just quickly
7 summarize.
8 As development and particularly
9 residential development for people living at
10 home with aging caregivers is continuing to
11 be a severe problem, we recognize that there
12 is additional funding in the Governor's
13 budget, but most of that is spent before it's
14 even allocated. And then we also have
15 concerns about actually seeing some of the
16 additional what would be $120 million
17 all-shares actually go out the door and be
18 spent.
19 There's concerns about families are
20 unfamiliar with the new residential request
21 wait list and the certified residential
22 opportunity list; concerns about how
23 backfills are maybe being inappropriate, that
24 people who really -- because there's an
358
1 opening, that's the only place they can go.
2 Or that's what they're offered, even though
3 it's not necessarily an appropriate placement
4 for the individual, and that they're no
5 longer being supported in places that are
6 person-centered and really most appropriate.
7 So we would ask that.
8 Mark mentioned telemedicine. And
9 Assemblywoman, you also asked about it. We
10 think that telemedicine is critically
11 important, particularly for individuals with
12 developmental disabilities. We think it can
13 provide much better quality of care and
14 significant Medicaid savings, particularly on
15 the healthcare side.
16 There have actually been several
17 pilots that have been funded through PPSs and
18 BIP grants that showed that 86 percent of
19 emergency room visits could be avoided with
20 telemedicine. So that's far better care for
21 an individual with a developmental disability
22 not having to be transported to the emergency
23 room. When we are in the emergency room,
24 emergency room physicians tend to admit
359
1 individuals with developmental disabilities.
2 So it's a huge cost savings to the
3 healthcare side, and we think it is much
4 better quality of care for individuals with
5 developmental disabilities.
6 What we're asking for is that there's
7 language in the budget for the Office for
8 People With Developmental Disabilities to
9 promulgate regulations. We're asking that
10 that be emphasized and that the office does
11 promulgate the regulations allowing
12 telemedicine, particularly in our residences,
13 but also that there be some funding for
14 agencies that don't have either Article 16
15 clinics or Article 28 clinics that can access
16 funding through the healthcare facility
17 transformation fund in the health department.
18 The other thing that we're asking for
19 is that for telemedicine -- in our clinics,
20 we get an add-on, because it's recognized
21 that it takes longer and more staffing to
22 treat an individual with developmental
23 disabilities than it does a typical
24 individual in our like Article 28 clinics.
360
1 And so we're asking that a similar add-on be
2 included in the telemedicine rate to be able
3 to bill through Medicaid.
4 SENATOR KRUEGER: Thank you. I'm just
5 cutting you off because you're at zero.
6 Does anyone have any questions?
7 ASSEMBLYMAN GUNTHER: No.
8 And I think you make a great point
9 about the telemedicine, because diagnosis of
10 a child with a disability or an adult with a
11 disability is so much different. They
12 exhibit pain differently.
13 And also the transportation itself
14 sometimes -- as you said, it's not just one
15 person, it's two to three people doing the
16 transfer, so it's very, very costly. And
17 really you need someone with a specialty in
18 DD folks.
19 MS. CROSIER: Right.
20 ASSEMBLYWOMAN GUNTHER: I think it's a
21 great idea.
22 SENATOR KRUEGER: Right. Thank you.
23 Thank you both for testifying.
24 MS. SCHIFF: Thank you.
361
1 MS. CROSIER: Thank you very much.
2 SENATOR KRUEGER: Our next testifier
3 is Antonia Lasicki, Association for Community
4 Living.
5 MS. LASICKI: Thank you.
6 Good afternoon. Almost done. How are
7 you?
8 SENATOR KRUEGER: All right.
9 MS. LASICKI: So thank you very much
10 for the opportunity to testify today. My
11 name is Toni Lasicki, and I'm the executive
12 director of the Association for Community
13 Living.
14 ACL is a statewide membership
15 organization of not-for-profit providers of
16 community-based housing and rehabilitation
17 services for more than 35,000 New Yorkers who
18 have been diagnosed with serious, persistent
19 psychiatric disabilities and who have been
20 functionally impaired by those disabilities.
21 I am going to read parts of my
22 testimony, but I've crossed out an awful lot
23 of it, so it's like a summary.
24 Today I will be speaking on behalf of
362
1 my organization, ACL, as well as the Bring It
2 Home campaign, a statewide coalition of more
3 than 200 community-based mental health
4 housing providers and advocates, faith
5 leaders, residents, and their families.
6 You've heard from Harvey and from NAMI and
7 from others about the Bring It Home campaign
8 today -- Christy Parque as well. We're
9 working to bring better funding for better
10 care to New York, and we strongly urge you to
11 include adequate funding for our critical
12 mental health community-based housing in the
13 final New York State Budget.
14 New York has historically been a
15 national leader in mental health healthcare.
16 Under the leadership of both Governor Andrew
17 Cuomo and his father Mario -- and with the
18 support of the New York State Legislature,
19 including many of you listening today --
20 New York set new national standards to care
21 for and protect people with psychiatric
22 disabilities. However, despite building a
23 breadth and depth of mental health housing
24 opportunities that is unparalleled in the
363
1 nation, the state has not kept its promise to
2 adequately fund these housing programs that
3 care for the New Yorkers who most need our
4 help.
5 For more than 25 years, mental health
6 housing providers have received few increases
7 in their funding, and most of those increases
8 that were provided went to New York City,
9 Long Island, and the Lower Hudson Valley,
10 because the state just wouldn't make enough
11 money available. So it focused on the units
12 that would literally imminently fail without
13 immediate help.
14 In bad years we've been told that
15 there isn't any money, and in good years
16 we've been told there wasn't any for us
17 either. Within the five models of housing
18 programs, only three have received increased
19 funding since 2009. So out of five models,
20 only three have received anything, and only
21 in restricted geographic areas.
22 All of the programs throughout the
23 state are stretched untenably thin. For
24 example, the Supported Housing program in
364
1 New York City spends nearly all of its
2 funding on rent, which leaves little for
3 mandatory staffing, lease management, and
4 other obligations.
5 With unreliable funding across the
6 state, our mental health housing system has
7 reached a financial breaking point. And the
8 people who feel it are some of New York's
9 most vulnerable residents, who suffer from
10 the disruption that staff vacancies and staff
11 turnover create, not to mention to overworked
12 supervisors.
13 And I just want to respond to the
14 commissioner for a minute. She spoke about
15 the $42 million that have been added to the
16 state budget over the last few years for
17 housing. That sounds like a lot of money,
18 but it really has to be put into context.
19 There's a certain model of housing,
20 8200 units, that had gotten so little
21 increases for 25 years that they had lost
22 80 percent of their funding due to inflation.
23 They literally got 10 percent in increases
24 over 25 years. So a chunk of that
365
1 $42 million went to them. They are now at
2 the point where they have lost 70 percent of
3 their funding due to inflation, even with the
4 investment that the Office of Mental Health
5 made.
6 The Supported Housing program in
7 New York City, Long Island, Westchester,
8 Rockland, and Putnam, also received a large
9 part of that $42 million. That brought their
10 rates up to, as the Commissioner said, around
11 $17,000 in New York City. Just to put that
12 into context, OASAS pays $25,000 per year per
13 unit. New York City pays HIV-supported
14 housing -- it's the same exact model --
15 $30,000 per unit.
16 The new units that the Governor is
17 putting online, the services will be $25,000
18 a year because they knew these providers --
19 and it's these providers that will do those
20 new beds -- these providers would not develop
21 those at $17,000 per year for services. It
22 doesn't work. It just doesn't work.
23 I have a provider on Long Island who
24 has two large facilities, 65 units in each,
366
1 and he's losing $250,000 per year on each
2 building, and he has one staff person for
3 65 clients. And to respond to Senator Young,
4 in terms of what's -- how steep is the step
5 down from a state hospital to the community,
6 those people who are staffed at one staff
7 person for 65 clients, that facility emptied
8 an entire ward of Kingsboro State Psychiatric
9 Hospital.
10 So an entire ward went into one of
11 those facilities. And they went from a state
12 hospital to one staff for 65 people. It is
13 not reasonable any longer, and providers --
14 their boards of directors are now telling
15 them, We cannot allow you to continue to do
16 this.
17 We have providers in New York City,
18 they are losing massive amounts of money at
19 $17,000 a year per bed in supported housing.
20 It just doesn't work.
21 So I do want to be clear. Mental
22 health housing providers cannot survive under
23 these circumstances. They have reached the
24 point where they'll be forced to reconsider
367
1 renewing state contracts -- and some have
2 said that to the Governor's office -- and
3 without adequate funding they are going to
4 shut down. Maybe not tomorrow, but it will
5 eventually happen.
6 Beyond the moral imperative, taxpayers
7 end up footing a larger bill when our clients
8 fall through the cracks. Without mental
9 health housing options, those with major
10 psychiatric disabilities end up hospitalized,
11 homeless, in nursing homes, or become
12 incarcerated, often due to minor infractions.
13 And I know I'm repeating what Wendy Burch
14 said, but it's true.
15 Governor Cuomo made a commitment to
16 combat homelessness, and he is funding all
17 those new housing opportunities at an
18 adequate and much higher services rate. So
19 my providers are saying to themselves, Well,
20 why wouldn't I just turn back the ones I've
21 got that I'm losing a ton of money on and
22 develop the new ones which will be fine? So
23 that's the dilemma that they're all in.
24 They're having board conversations all the
368
1 time about this.
2 So as we face the dilemma, we can
3 either become a national model for how states
4 can successfully protect a population that so
5 desperately needs support, or watch the
6 system collapse and become an example of what
7 can go wrong. So it's time to make the right
8 choice. And on behalf of all New Yorkers
9 impacted by mental illness, their families,
10 friends, colleagues, and neighbors, we urge
11 you to increase funding for community-based
12 supportive mental health housing in this
13 budget.
14 So we're mindful of the state budget
15 environment that we have right now,
16 obviously. On the last page there's a -- the
17 last page of my testimony shows what the
18 financial need is by program type, and it's
19 about $117 million that they need to
20 stabilize approximately 40,000 units of
21 housing across the State of New York. It
22 sounds like a lot of money, but it is 40,000
23 units of housing that have been really
24 neglected for a very, very long time.
369
1 But given the state budget environment
2 right now, what we're suggesting is that the
3 Governor's $10 million which he added to the
4 budget this year for these housing models --
5 and how it's allocated hasn't been decided
6 yet, so our suggestion is that the Senate and
7 the Assembly support moving that $10 million
8 to the fourth quarter of the state's budget.
9 Then that $10 million would annualize to
10 $40 million.
11 That would go a long way to helping
12 us, and we think that the Governor might be
13 more willing to make that move if the Senate
14 and the Assembly put something in as well.
15 If the Senate and the Assembly put in
16 $20 million, the $30 million combined would
17 equal $120 million for the next year, which
18 is exactly what we need. We understand even
19 that might not be possible, but if you match
20 the Governor's $10 million and there are
21 $10 million from the Legislature and
22 $10 million from the Governor in the fourth
23 quarter, that would equal $80 million
24 annualized, and that would go a long way to
370
1 helping us in the short term.
2 We realize we'd have to come back
3 again and continue to try to get more,
4 especially now that I think we're moving into
5 a time of increased inflation. We've been
6 relatively lucky because the last four years
7 have been low inflation, but we're probably
8 moving into a time when we're going to have
9 much higher inflation. And so all of my
10 program types, they're either at about --
11 they've lost either 43 percent to inflation
12 to 70 percent to inflation. So it's
13 desperate.
14 And the workforce issue. We are
15 running 50, 60 percent staff vacancy rates,
16 and Assemblywoman Gunther heard just
17 yesterday from a provider who has six staff
18 people per week for a program, and they only
19 have two hired. So four are vacant out of
20 six. So that means the program managers and
21 the supervisors, they're swooping in to cover
22 shifts.
23 They usually have a group of respite
24 workers they can call in. Respite workers
371
1 are going away because, you know, we're at
2 full employment. So it's very difficult to
3 find anybody to do respite work. So we're
4 wearing our staff out. I even have a CEO who
5 does midnight shifts in one of her programs
6 in Ulster County.
7 SENATOR KRUEGER: I do have to cut you
8 off, but I also want to thank you so much.
9 And I asked -- I tried to ask these
10 questions of the commissioner earlier today,
11 but you were so much more articulate at
12 laying out how desperate the situation is.
13 And I'll probably get in trouble for
14 this, but you know what, I think your
15 providers should say "We're not taking the
16 $17,000-a-year contracts," and shift gears.
17 Because it's crazy that we're paying $25,000
18 under the new contracts for exactly what we
19 need, we say we need -- the next testifier's
20 going to tell me that too -- and that we need
21 to be speeding along our increase in
22 supportive housing. And then you find
23 yourselves being penalized so extremely for
24 having been in the business of doing this
372
1 important work for so long.
2 MS. LASICKI: Yeah. You know, our
3 providers are mission-driven, and they are
4 loath to give back beds. They are loath to
5 do any of this. They really want to
6 continue -- they have wait lists a mile long.
7 SENATOR KRUEGER: Yeah. Right.
8 MS. LASICKI: They recognize that
9 reducing the number of beds in the system is
10 a terrible outcome.
11 SENATOR KRUEGER: Right.
12 MS. LASICKI: So they do their best to
13 not do that.
14 SENATOR KRUEGER: Are there questions?
15 ASSEMBLYWOMAN GUNTHER: We talked
16 yesterday.
17 MS. LASICKI: Yes, we did. Thank you.
18 SENATOR KRUEGER: Thank you very much
19 for being here.
20 And our last testifier today --
21 (Laughter.)
22 ASSEMBLYWOMAN GUNTHER: You get the
23 Patience Award.
24 (Laughter.)
373
1 SENATOR KRUEGER: -- from the
2 Supportive Housing Network of New York, is
3 Maclain Berhaupt.
4 Hi, Maclain. How are you?
5 MS. BERHAUPT: Hi, very well. Thank
6 you so much for the opportunity to testify
7 today.
8 My name is Maclain Berhaupt, and I am
9 the State Advocacy Director of the Supportive
10 Housing Network of New York. We represent
11 just over 200 nonprofits who build and
12 operate supportive housing throughout the
13 state.
14 I mean, I really could just sit here
15 and echo exactly what Toni just so eloquently
16 laid out for everyone. Just a couple of
17 additional points I wanted to make that I
18 think are important to the conversation.
19 You know, in New York City, where Toni
20 mentioned the increases have occurred --
21 which were extremely modest, $500 per
22 person -- HUD puts the fair market rent for
23 an efficiency apartment in New York at just
24 over $18,000 annually. The current rate
374
1 there is just over $16,000. So while this
2 program 20 years ago was intended -- roughly
3 50 percent of the funding would go for
4 services and 50 percent for rent, it's not
5 even covering rent anymore. So that's the
6 issue.
7 You know, a few years ago we were here
8 saying, Oh, there's a couple of hundred
9 dollars for rent, and we're barely making
10 it -- but now it's not even covering the cost
11 of rent. So something is going to give
12 eventually.
13 The other thing I just wanted to
14 mention is, you know, the way providers are
15 dealing with this right now is they're
16 doubling up tenants. And that's not ideal
17 for any situation, particularly for this
18 population. And you know, again, the
19 chronically low rates, you know, in addition
20 to the doubling up -- we're watching
21 landlords just refusing to renew leases now.
22 So we're really in a dire situation.
23 And we're urging the Legislature -- through
24 the campaign, as Toni mentioned -- to work
375
1 with the Governor, you know, to look at the
2 funding requests of the $10 million that was
3 put in this budget, put it in the fourth
4 quarter and then annualize it into next year
5 so we can really get the relief that we need.
6 And then the last point I'd like to
7 make, as Senator Krueger had mentioned
8 earlier, is that we advocated heavily for the
9 last three years to see these new supportive
10 housing units come online. There are 6,000
11 over the next five years. If we watch the
12 existing units just evaporate -- because
13 that's exactly what's going to happen --
14 we're not addressing the homelessness crisis
15 as the Governor and the Legislature really
16 intended last year by doing the five years of
17 funding for these new units.
18 So we would just urge you to work with
19 the Governor to support the $10 million, to
20 try to do some additional funding and
21 annualize it going into next year.
22 So thank you.
23 ASSEMBLYWOMAN GUNTHER: Thank you.
24 SENATOR KRUEGER: Thank you.
376
1 Any questions? No?
2 Well, then, thank you for being our
3 last testifier.
4 And this officially closes the
5 Senate-Assembly budget hearing on Mental
6 Health. For those of you who are used to
7 coming here every day of your lives, don't
8 come back until the 27th for the next budget
9 hearing.
10 Thank you, everyone.
11 (Whereupon, the budget hearing
12 concluded at 3:49 p.m.)
13
14
15
16
17
18
19
20
21
22
23
24