Joint Legislative Public Hearing on 2017-2018 Executive Budget Proposal: Topic "Mental Hygiene" - Testimonies
February 7, 2017
-
ISSUE:
- Mental Hygiene
-
COMMITTEE:
- Finance
Hearing Event Notice
https://www.nysenate.gov/calendar/public-hearings/february-06-2017/joint-legislative-public-hearing-2017-2018-executive
Archived Video:
https://www.youtube.com/watch?v=oBYK4js4mh0
___________________________
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
2017-2018 EXECUTIVE BUDGET ON
5 MENTAL HYGIENE
6 -----------------------------------------------------
7
8 Hearing Room B
Legislative Office Building
9 Albany, New York
10 February 6, 2017
1:08 p.m.
11
12 PRESIDING:
13 Senator Catharine M. Young
Chair, Senate Finance Committee
14
Assemblyman Herman D. Farrell, Jr.
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
Senator Robert G. Ortt
22 Chair, Senate Committee on Mental Health
and Developmental Disabilities
23
Assemblywoman Aileen Gunther
24 Chair, Assembly Committee on Mental Health
2
1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17
3 PRESENT: (Continued)
4 Assemblywoman Linda B. Rosenthal
Chair, Assembly Committee on Alcoholism
5 and Drug Abuse
6 Senator George A. Amedore, Jr.
Chair, Senate Committee on Alcoholism
7 and Drug Abuse
8 Assemblywoman Ellen C. Jaffee
9 Senator James Tedisco
10 Assemblyman Angelo Santabarbara
11 Assemblyman Michael Cusick
12 Senator John E. Brooks
13 Assemblyman Clifford Crouch
14 Senator Todd Kaminsky
15 Assemblywoman Didi Barrett
16 Assemblyman Michael P. Kearns
17 Senator Fred Akshar
18 Assemblyman John T. McDonald III
19 Senator David Carlucci
20 Senator Patrick Gallivan
21 Assemblywoman Melissa Miller
22
23
24
3
1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17
3 LIST OF SPEAKERS
4 STATEMENT QUESTIONS
5 Ann Marie T. Sullivan, M.D.
Commissioner
6 NYS Office of Mental Health 9 15
7 Helene DeSanto
Acting Exec. Deputy Commissioner
8 NYS Office for People With
Developmental Disabilities 91 97
9
Arlene Gonz·lez-S·nchez
10 Commissioner
NYS Office of Alcoholism
11 and Substance Abuse Services 169 175
12 Jay Kiyonaga
Executive Deputy Director
13 NYS Justice Center for the
Protection of People with
14 Special Needs 241 249
15 Michael Seereiter
President and CEO
16 New York State Rehabilitation
Association
17 -and-
Ann M. Hardiman
18 Executive Director
NYS Association of Community
19 & Residential Agencies 289
20 Steven Kroll
Executive Director
21 NYSARC 296
22 Glenn Liebman
CEO
23 Mental Health Association
in New York State 303 314
24
4
1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Harvey Rosenthal
Executive Director
6 NY Association of Psychiatric
Rehabilitation Services 318
7
Wendy Burch
8 Executive Director
Irene Turski
9 Government Affairs Chair
National Alliance on Mental
10 Illness of New York State 331
11 Kelly A. Hansen
Executive Director
12 NYS Conference of Local
Mental Hygiene Directors 339 350
13
John J. Coppola
14 Executive Director
NY Association of Alcoholism
15 & Substance Abuse Providers 352 364
16 Ed Snow
Statewide PEF/OPWDD Labor
17 Mgt. Committee Labor Chair
-and-
18 Virginia Davey
Statewide PEF/OMH Labor
19 Mgt. Committee Cochair
Public Employees Federation 367
20
Paige Pierce
21 CEO
Families Together in NYS 379
22
23
24
5
1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Barbara Crosier
VP, Government Relations
6 Cerebral Palsy Associations
of New York State
7 -and-
JR Drexelius
8 Government Affairs Counsel
Developmental Disabilities
9 Alliance of Western NY
-for-
10 Coalition of Provider
Associations (COPA)
11 -and-
#bFair2DirectCare 384
12
Christy Parque
13 CEO and President
The Coalition for
14 Behavioral Health 391
15 Lisa Wickens-Alteri
President, Capital Health
16 Consulting, LLC
-on behalf of-
17 Save Our Western New York
Children's Psychiatric Center 404
18
Arnold Ackerley
19 Administrative Director
Clint Perrin
20 Director of Policy
Self-Advocacy Association
21 of New York State 410
22
23
24
6
1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Stephanie M. Campbell
Policy Director
6 Friends of Recovery New York
-and-
7 Pete Volkmann
Police Chief
8 Chatham, NY
-and-
9 Kristin Hoin
Mother of Summer Smith 414
10
Patrick Curran
11 Member, Steering Committees
Eastern NY Developmental
12 Disability Advocates
(ENYDDA)
13 -and-
StateWide Advocacy Network
14 (SWAN) 427
15
16
17
18
19
20
21
22
23
24
7
1 CHAIRWOMAN YOUNG: Good afternoon.
2 CHAIRMAN FARRELL: Good afternoon.
3 CHAIRWOMAN YOUNG: I'm Senator
4 Catharine Young, and I'm chair of the Senate
5 Standing Committee on Finance.
6 I'm joined by my colleague Assemblyman
7 Denny Farrell, chair of the Ways and Means
8 Committee.
9 And we also have several colleagues on
10 the Senate side. I would like to introduce
11 Senator Rob Ortt, who is chair of the Mental
12 Hygiene and Developmental Disabilities
13 Committee in the Senate. We have Senator
14 Fred Akshar, Senator Jim Tedisco, Senator
15 John Brooks, and last but not least, my
16 colleague who is ranking member on the
17 Finance Committee, and that's Senator Liz
18 Krueger.
19 CHAIRMAN FARRELL: And we have been
20 joined by Assemblywoman Aileen Gunther,
21 Assemblyman Michael Cusick, Assemblyman
22 Angelo Santabarbara, Assemblywoman Ellen
23 Jaffee, Assemblyman Michael Kearns, and
24 Mr. Oaks.
8
1 Good morning -- good afternoon.
2 CHAIRWOMAN YOUNG: Thank you,
3 Mr. Chairman. We're a little bit maybe
4 off-sync today because we normally start
5 early in the morning. But it's great to be
6 here this afternoon after the Super Bowl.
7 Pursuant to the State Constitution and
8 Legislative Law, the fiscal committees of the
9 State Legislature are authorized to hold
10 hearings on the Executive Budget. Today's
11 hearing will be limited to a discussion of
12 the Governor's proposed budget for the Office
13 of Mental Health, the Office of Alcoholism
14 and Substance Abuse Services, the Office for
15 People With Developmental Disabilities, and
16 the Justice Center for the Protection of
17 People with Special Needs.
18 Following each presentation there will
19 be some time allowed for questions from the
20 chairs of the fiscal committees and other
21 legislators.
22 First of all, I'd like to welcome
23 Dr. Ann Sullivan, who is commissioner of
24 Mental Health. And following the
9
1 presentation by Dr. Sullivan will be Helene
2 DeSanto, executive deputy commissioner of the
3 Office for People With Developmental
4 Disabilities; the Honorable Arlene
5 Gonz·lez-S·nchez, commissioner of Alcoholism
6 and Substance Abuse Services; and Jay
7 Kiyonaga, executive deputy director of the
8 Justice Center for the Protection of People
9 with Special Needs.
10 So good afternoon, Commissioner.
11 Welcome. We look forward to your testimony.
12 COMMISSIONER SULLIVAN: Good
13 afternoon, Senator Young, Assemblyman
14 Farrell, and members of the Senate and
15 Assembly fiscal and Mental Health committees.
16 I want to thank you for the invitation to
17 explain this year's Office of Mental Health
18 budget.
19 First allow me to provide a little
20 background. As we've discussed before, the
21 Office of Mental Health seeks to expand
22 community services to provide better care to
23 more New Yorkers. The goal is based upon the
24 framework developed by the Institute of
10
1 Healthcare Improvement, which aims to
2 optimize health system performance.
3 ASSEMBLYWOMAN GUNTHER: Excuse me.
4 Can you pull that a little closer to your
5 face?
6 COMMISSIONER SULLIVAN: Sure. I'm
7 sorry. Is this better? It still echoes?
8 CHAIRWOMAN YOUNG: Yes.
9 COMMISSIONER SULLIVAN: The "Triple
10 Aim" framework seeks to accomplish three
11 things: Improve patient care for
12 individuals, including quality and
13 satisfaction; improve the health of
14 populations; and, through these two
15 improvements, reduce the per-capita cost of
16 healthcare.
17 For decades there were few options for
18 individuals with mental illness in the
19 community. Inpatient care was the only
20 readily available and standard option.
21 Unfortunately, it was not the best option for
22 many people. In the years since
23 institutionalization was the norm, mental
24 health care has evolved so that individuals
11
1 need not spend their entire lives as an
2 inpatient, but can successfully live and work
3 in their communities.
4 Through your continuing support of
5 reinvestment, our efforts to provide
6 individuals with mental illness the right
7 service at the right time in the right
8 setting have started to bear fruit. With a
9 commitment of more than $81 million thus far,
10 we have been able to provide services to more
11 than 20,000 new individuals through December
12 2016. This includes new supported housing
13 for more than 900 individuals; state-operated
14 community services, including crisis
15 residences and mobile integration teams that
16 have served an additional 6,900 individuals;
17 and a wide range of locally operated
18 community-based programs, including peer
19 crisis respite, first-episode psychosis,
20 community support teams, and Home and
21 Community-Based Waiver services for more than
22 13,000 individuals.
23 Because these community services are
24 now in place, we are able to provide
12
1 inpatient services when needed, and also
2 assure the necessary outpatient care and
3 supports are available when an individual is
4 discharged. Our ability to serve more
5 citizens of the state has increased through
6 the combination of these improvements to new
7 and existing services.
8 The fiscal year 2017 Executive Budget
9 priorities. Next I will move to what we plan
10 on doing this coming year. For the next
11 fiscal year, OMH will continue on this path
12 towards greater access to community-based
13 services, targeted at each individual's
14 particular needs. Importantly, the 2017-2018
15 Executive Budget proposes to:
16 (1) Continue the investment in
17 community services. The budget adds another
18 $11 million, annually, to expand capacity in
19 less-restrictive, more-integrated
20 community-based settings. This amounts to an
21 annual investment of $92 million since fiscal
22 year 2015 to expand community mental health
23 services based on OMH inpatient savings.
24 (2) Fund 280 additional supported
13
1 housing community beds. OMH will reconfigure
2 140 state-operated residential beds, which
3 are less integrated and more costly to
4 operate, and replace them with funds to
5 develop 280 community-based, scattered-site
6 supported housing units in the same
7 geographic area. These new units, when
8 provided in tandem with access to other
9 existing community services, will ensure the
10 continued support and care of all individuals
11 transitioning into less-restrictive settings,
12 while keeping them close to their families.
13 (3) Provide $10 million to enhance
14 support for existing residential programs.
15 The budget increases funds for supported
16 housing and single-resident-occupancy
17 programs. This investment will help preserve
18 access and maintain existing housing capacity
19 as the state brings new housing units online
20 through the Empire State Supported Housing
21 Initiative.
22 In this year's budget we continue
23 investing in the implementation of Medicaid
24 managed-care initiatives for adults and
14
1 children. Key accomplishments and
2 initiatives include:
3 Increased HARP enrollment. Almost
4 80,000 people are currently enrolled in
5 Health and Recovery Plans (HARPs), the
6 state's behavioral health specialty
7 managed-care product, approximately 45,000 in
8 NYC and 34,000 in the rest of the state;
9 New ACT Teams. Funding for 20 new
10 Assertive Community Treatment teams offering
11 targeted help for homeless and high-need
12 individuals in need of intensive behavioral
13 health services;
14 Managed care for youth. A commitment
15 to integrate children's behavioral health
16 services into managed care, including the
17 expansion of six new state plan services for
18 children and continued support for the
19 operation of a comprehensive Home and
20 Community-Based Services network.
21 Lastly, as I noted earlier in my
22 testimony, improving patient care and the
23 health of our population will save the state
24 money. OMH's strategy to achieve this goal
15
1 is through the development of targeted
2 community services to assist individuals in
3 their communities and hopefully intervene
4 with these services in order to avoid the
5 need for inpatient hospitalization.
6 For those individuals who continue to
7 occasionally need inpatient hospitalization,
8 New York State has the largest number of
9 psychiatric inpatient beds available in the
10 nation, and we will continue to preserve
11 access to inpatient care as we work to
12 transform the system.
13 Again, thank you for this opportunity
14 to address you on the 2017-2018 OMH budget,
15 which supports and continues the work we have
16 begun to transform New York's mental health
17 system. Thank you.
18 CHAIRWOMAN YOUNG: Thank you.
19 We've been joined by Senator Diane
20 Savino.
21 ASSEMBLYMAN OAKS: We've been also
22 joined by Assemblywoman Miller.
23 CHAIRWOMAN YOUNG: Thank you.
24 Our first speaker will be Senator Rob
16
1 Ortt, chair of the committee.
2 SENATOR ORTT: Good morning,
3 Commissioner. How are you?
4 COMMISSIONER SULLIVAN: Good
5 morning -- afternoon.
6 SENATOR ORTT: I want to thank you for
7 joining us. I certainly appreciate your
8 testimony this morning and your presumed
9 forthright answers to all the questions that
10 will be coming your way.
11 You and I have spoken significantly
12 over the past two years about the Western
13 New York Children's Psychiatric Center, and I
14 guess I wanted to start off by asking, so
15 where is that today? Where are we in the
16 process of the planned merger -- the closure
17 of Western New York Children's and the merger
18 with Buffalo Psychiatric Center?
19 COMMISSIONER SULLIVAN: At this point
20 in time, we are still continuing to work on
21 and review the plan to move Western
22 Children's to relocate to Buffalo. I think
23 you're probably aware that a bid did go out
24 for the construction for Buffalo. And those
17
1 bids will be received in February and
2 reviewed. So at this point in time we are
3 still in the process of continuing moving
4 towards that goal.
5 SENATOR ORTT: And you and I have had
6 back and forth discussions on this. But, you
7 know, one of the main arguments that I've
8 heard from families and from advocates in
9 both my district and across Western New York
10 is that several years ago, Western New York
11 Children's in West Seneca was created because
12 there was evidence, clinical evidence to
13 suggest that separating children from adults,
14 having them on a separate campus, having them
15 I think specifically on that campus, was much
16 more conducive to their rehabilitation and to
17 providing them the treatment and services
18 that we know we need in children's mental
19 health.
20 So I guess has something changed
21 clinically or has something shifted that
22 makes merging it with the Buffalo Psychiatric
23 Center a -- the right move from a clinical or
24 service standpoint?
18
1 COMMISSIONER SULLIVAN: There are many
2 models, actually, of children's psychiatric
3 services. Sometimes children's inpatient
4 services are collocated within the same
5 building as adult services, sometimes they
6 are in separate facilities, sometimes they
7 are within facilities but right next door to
8 adult services.
9 So the model has taken various forms
10 over the years. In 1968, when West Seneca
11 was established, I'm assuming a decision was
12 made that it made sense at that point in
13 time. The length of stay in those days was
14 much, much longer in children's facilities.
15 The average length of stay today is about two
16 months, which is probably just a little bit
17 longer than some of the acute-care services,
18 which is sometimes like a month's stay. And
19 they are right next to, sometimes in the very
20 same building as adult care services.
21 So the models differ. But the
22 literature today is really showing very
23 strongly that if you have the right
24 community-based services, that that's the
19
1 key. Because really we should only be having
2 youth in hospitals when it's absolutely
3 necessary.
4 So the plan for West Seneca in terms
5 of moving it was to enable us to put those
6 community services in place for like a
7 thousand youth.
8 I do not believe there will be any
9 diminishing of the quality of care. The same
10 clinical team will move. We will have the
11 same number of beds. The new facility is
12 designed to be separate, both separate
13 entrances, a separate recreational area for
14 youth. And I have seen facilities located
15 like that that provide excellent care. So I
16 don't think there will be any diminution in
17 care, and it enables us to invest in
18 community services.
19 SENATOR ORTT: Would you agree that
20 the data shows that the outcomes currently at
21 Western New York Children's are the best of
22 any state children's psychiatric center?
23 COMMISSIONER SULLIVAN: They have
24 great outcomes, yes, they do. We're very
20
1 proud of them for that.
2 SENATOR ORTT: Right. So the model --
3 it would be wrong to argue that the model in
4 West Seneca is not producing the desired
5 outcomes.
6 COMMISSIONER SULLIVAN: I think those
7 outcomes are more to do with the clinical
8 programming and the clinicians who are at
9 the -- not to say that my clinicians at other
10 sites aren't also excellent. But the
11 clinical program which has been developed
12 along -- for quite a while and has very
13 innovative approaches, I don't believe that
14 that quality will diminish in the new
15 setting.
16 SENATOR ORTT: What is the estimated
17 savings?
18 COMMISSIONER SULLIVAN: The estimated
19 savings is about $3.5 million annualized, of
20 which we've already invested about a
21 million and a half in the community services.
22 SENATOR ORTT: And what's the total
23 cost of the build-out?
24 COMMISSIONER SULLIVAN: There are
21
1 actually two numbers. The cost to do the
2 build-out in Buffalo will be about
3 $12.5 million.
4 SENATOR ORTT: It's never good to have
5 two numbers, just as an accounting rule.
6 COMMISSIONER SULLIVAN: No, no, I
7 meant to say there were two numbers on the --
8 for West Seneca. One is short term at
9 West Seneca, which would be probably somewhat
10 comparable, in the range of $12 million to
11 $14 million.
12 But West Seneca is a building that is
13 also -- hasn't really been refurbished in
14 basic infrastructure since -- for many, many
15 years. So there's another price tag on
16 capital, which would increase another
17 $40 million to bring it up to what it would
18 need to be if you were to stay at West Seneca
19 indefinitely. That was the one I was talking
20 about. The numbers are the -- only one
21 number for Buffalo.
22 SENATOR ORTT: Are there registered
23 sex offenders currently in BPC?
24 COMMISSIONER SULLIVAN: Yes. At the
22
1 time that we -- there would be no, and this
2 is an absolute commitment, there would be no
3 registered sex offenders at BPC at the time
4 we would move children. And it's about a
5 two-year -- if this goes forward, about two
6 years. So we have time to move all -- any
7 individuals who are from Buffalo. And we
8 would not ever have them again.
9 SENATOR ORTT: So it's your commitment
10 to the parents and everyone here in this room
11 that you would move those individuals --
12 COMMISSIONER SULLIVAN: Yeah,
13 absolutely. Absolutely.
14 SENATOR ORTT: Moving to, I guess,
15 broader children's health, children's mental
16 health, it's my understanding the proposed
17 savings on the children's side in the current
18 budget is because of delayed implementation
19 of Medicaid redesign proposals, is that
20 accurate?
21 COMMISSIONER SULLIVAN: Yes. Yes.
22 SENATOR ORTT: If the focus is on
23 redesign to expand capacity and access to
24 services, it's been under design, I believe,
23
1 for four years?
2 COMMISSIONER SULLIVAN: Yes -- I'm
3 sorry, I didn't understand --
4 SENATOR ORTT: It's been under design
5 for approximately four years, right?
6 COMMISSIONER SULLIVAN: Yes. Yes.
7 SENATOR ORTT: Now we're saying we're
8 going to have to wait another year for
9 services. Don't you think there's a need to
10 invest in some of these crisis services today
11 while we wait for the federal side to get
12 their act together?
13 COMMISSIONER SULLIVAN: Well, just to
14 explain a little bit, the commitment on the
15 part of the Department of Health and the
16 Governor to expand children's services is
17 considerable. So when the expansion happens,
18 which means when we begin the services for
19 the six new SPA amendments and other waiver
20 services, it's estimated that it will be up
21 to $30 million additional investment for SPA
22 and $30 million additional investment for
23 children's services for waiver services.
24 So that's $60 million. That's not
24
1 predicated on any savings, that's pure
2 expansion. So that money is still there, and
3 that money will happen.
4 However, it is also true that because
5 of a delay, largely because of some of the
6 uncertainty at the federal level, children's
7 managed care will not happen until October of
8 this year, and the SPA services until July.
9 So there is a period of time to save dollars
10 from those projected expansions.
11 And yes, those dollars have been used
12 to assist DOH in dealing with some of the
13 global cap issues.
14 SENATOR ORTT: Has OMH developed a
15 plan for how to spend the $10 million in
16 subsidies for housing?
17 COMMISSIONER SULLIVAN: Yes. Yes.
18 And that will enable us to try to bring
19 closer to the need the already existing
20 supported housing. We'll probably be adding
21 about $500 to the subsidies in downstate.
22 And for SROs, which is single-room
23 occupancies, a little over 600 upstate and a
24 little over 700 downstate.
25
1 This is important because to find
2 apartments now, especially in certain parts
3 of the state, is extremely difficult. Our
4 distribution of the dollars is based on HUD
5 market rate and the difference between the
6 cost of an apartment and the difference
7 between the subsidy and HUD market rate. So
8 that's how we decide where to put the money.
9 SENATOR ORTT: Commissioner, under the
10 current budget, how many state-operated
11 outpatient clinics would be closed?
12 COMMISSIONER SULLIVAN: Truthfully, I
13 don't know.
14 What we're going to be doing is
15 looking at, across the board, all the state
16 clinics. We're doing what I think every
17 other healthcare system is doing, looking at
18 our efficiency, looking at our productivity,
19 looking at if there's anywhere where there's
20 duplication of services or services could be
21 better designed.
22 So we will start that process, after
23 the budget, to look at those clinics. We
24 will decide which ones may be appropriate for
26
1 closing. Some may be consolidated, some may
2 be enhanced. I mean, we need to look at the
3 needs in the community. It will be a process
4 that will involve community as well as us --
5 we're not doing this without input from the
6 communities where our clinics are.
7 And even if a clinic were not all that
8 productive, if it is the only clinic there --
9 which we have in some in parts of the
10 state -- that clinic will remain. Our major
11 focus is to make sure access is preserved,
12 and we will not in any way close any clinics
13 where we have any question that access would
14 be impaired.
15 SENATOR ORTT: Thank you,
16 Commissioner.
17 CHAIRWOMAN YOUNG: Thank you.
18 Chairman Farrell.
19 CHAIRMAN FARRELL: Aileen Gunther,
20 chair.
21 ASSEMBLYWOMAN GUNTHER: The first year
22 I was chair of this committee, the Executive
23 Budget included Regional Centers of
24 Excellence, a plan to close and consolidate
27
1 state-operated mental health facilities. We
2 held hearings across the state and were
3 successful in negotiating compromises that
4 held for a number of years. OMH can close a
5 bed only after it has been vacant for
6 90 consecutive days. And when a bed is
7 closed, OMH will invest $110,000 per closed
8 bed into community-based services.
9 Yet now I see in the Executive
10 Briefing Book -- and this has to do with
11 Hutchings -- a proposal to transfer operation
12 of the children and youth beds from Hutchings
13 to a yet-to-be-named hospital, though we do
14 hear some rumors. To the best of my
15 knowledge, there is no information in the
16 Article VII bills and no information anywhere
17 else on the motive and the means for
18 transition, with the exception of an
19 anticipated savings of $900,000.
20 What is the impetus for this? Why is
21 this happening?
22 COMMISSIONER SULLIVAN: First of all,
23 these are very -- I have to say these are
24 still very preliminary discussions with SUNY
28
1 Upstate.
2 The impetus for it is that basically
3 at this point in time we have a census of
4 about 23 children that we can accommodate at
5 Syracuse. In that area of Syracuse, with the
6 work -- talking with Syracuse, Upstate
7 University, it looks like we could -- they
8 would be committed to possibly enhancing that
9 to a count of about 30 beds that would be
10 available.
11 One of the issues in that area is
12 commercial insurance, commercial insurance
13 for youth. There are no other child beds in
14 this area, and the commercial insurance has
15 always, traditionally, been very reluctant to
16 enable individuals under commercial insurance
17 to be hospitalized at state hospitals. So
18 part of the impetus for this is to expand the
19 availability of children's beds to the wider
20 community. That will not only include
21 Medicaid, but will include commercial payers.
22 Also, Upstate has a wonderful
23 reputation with children's services and I
24 think, as an academic institution, could help
29
1 us recruit. Recruitment is always an issue,
2 both for psychiatrists and nurses anywhere.
3 I think it will help with that as well.
4 Also, they have some very innovative
5 ideas about programming, et cetera.
6 So I think this is a move that could
7 really benefit the community and the
8 children. And it's very preliminary, and
9 that's why we're putting it out there now, so
10 people know that these are under discussion.
11 There will be no decrease in services; in
12 fact, there's a possibility of an expansion
13 of the beds.
14 ASSEMBLYWOMAN GUNTHER: So one of the
15 issues is the recruitment of registered
16 nurses because of the level of pay right now
17 and --
18 COMMISSIONER SULLIVAN: Yes.
19 ASSEMBLYWOMAN GUNTHER: And so if it's
20 SUNY or -- so that there would be an
21 increased level of pay to registered nurses,
22 and that would be more of an encouragement to
23 come and work?
24 COMMISSIONER SULLIVAN: Yes.
30
1 ASSEMBLYWOMAN GUNTHER: So you
2 reenvision the location of all these
3 services. Let's imagine, for the sake of
4 argument, that on Monday the operation of
5 these 30 beds is transferred to SUNY Upstate.
6 We're just using that, we're not sure yet.
7 On Tuesday, SUNY Upstate decides to close
8 these beds. It seems to me that this could
9 be the scenario. OMH has just saved itself
10 $3.3 million in community reinvestment, and
11 the community has lost access to critical
12 beds.
13 What are you doing to prevent this
14 scenario?
15 COMMISSIONER SULLIVAN: Throughout the
16 state, whenever there is an attempt or an
17 interest in closing beds, that has to come
18 before the Behavioral Health Services Council
19 and then ultimately before the Health
20 Planning Council, and there has to be --
21 there are hearings and basically there is
22 input, considerable input from OMH.
23 So we have had this issue for a
24 variety of issues. Sometimes it's a clinic,
31
1 sometimes it's inpatient beds. And if those
2 beds were needed, we would do everything
3 possible to keep them open, and we've been
4 successful in keeping them open against
5 pressures, at times, from voluntary
6 institutions.
7 ASSEMBLYWOMAN GUNTHER: Just on a side
8 bar, I know that, you know, as far as my
9 Assembly district, it's very, very long. And
10 we had a call from a mother who the child had
11 suicidal ideation. And we called Rockland
12 Psych; to get an inpatient, there was -- we
13 called Four Winds, we called Rockland Psych,
14 and we couldn't get that child placed.
15 So the mother, who had three other
16 children, had to sit with this child, because
17 of the suicidal prior attempt, for close
18 to -- for two to three days before she ever
19 got a bed.
20 So, you know, sometimes I'm like kind
21 of confused when I get calls like that
22 personally -- and also people know that I'm
23 the chair and I have a lot to do with mental
24 health. But there are children waiting in
32
1 the wings. I know, representing Sullivan
2 County, how many pediatric beds we have, I
3 know how many pediatric beds are at
4 Four Winds and the catchment areas.
5 So I think when a child has suicidal
6 ideation -- and we are recognizing those
7 diagnoses much earlier than you and I when we
8 were in a hospital situation.
9 COMMISSIONER SULLIVAN: Mm-hmm.
10 Mm-hmm. Mm-hmm.
11 ASSEMBLYWOMAN GUNTHER: So, you know,
12 sometimes it's -- I don't understand. And,
13 you know, when we talk about the outside, the
14 community -- you know, if -- and in some
15 areas, maybe New York City. But you travel
16 to the middle of upstate New York, and you
17 know what, the psychiatrists are few and far
18 between, our department of healths, our
19 community departments of health don't have
20 much money to have a psychiatrist, social
21 workers. They're few and far between. Even
22 our schools have very few.
23 And I think that the closure of
24 beds -- and sometimes when a child is in
33
1 crisis, they need that inpatient stay. And
2 also I think it not only educates the child,
3 but it also educates the parents on what to
4 do when you leave that facility.
5 So we're doing a lot of closures at
6 this point, and I just -- you know, I want to
7 know about the community reinvestment. I
8 know that we talk about it, but I like nuts
9 and bolts. That's what I'm all about. Like
10 exactly where is the money going, and exactly
11 how are we going to deal with the increase in
12 the diagnosis and the incidence of mental
13 health? And we all know it takes a lot of
14 years.
15 And now people are talking about a lot
16 more, but -- we have an increase, but yet
17 we're not -- we say we're increasing in the
18 community, but there's other people out there
19 that I'm not really feeling it.
20 COMMISSIONER SULLIVAN: Well, the
21 increase in services from reinvestment has
22 really been considerable. We've instituted
23 about -- an additional 250 home-based crisis
24 service waivers. So we've increased
34
1 home-based crisis waiver services. That's
2 the most intensive outpatient, home-based
3 services.
4 We've also opened up four respite
5 centers. We've increased mobile crisis
6 capacity for children and youth. And we've
7 increased clinic slots across the state. And
8 there's a whole breakout of exactly where
9 this has happened and where the dollars have
10 been invested.
11 If you put the right kind of community
12 services out there, it doesn't mean you need
13 an inpatient bed, by any means. But you
14 certain can decrease the number of inpatient
15 beds that are necessary, and you can often
16 reach more people in the community.
17 So these services are real, they are
18 up and running for kids. And I think we can
19 give, you know, the listing of exactly where
20 they are. That's in the report, so we can
21 show exactly where those services are.
22 And of the reinvestment dollars, at
23 this point in time $61 million is actually
24 being spent serving those additional 20,000
35
1 individuals, and we've allocated $69 million.
2 So the other $8 million is out there to be
3 actually implemented within the next year.
4 But these services are real and they're going
5 out.
6 And sometimes it can also take a
7 little time for the community to readjust a
8 little bit with the services and inpatient
9 beds. But yes, you're right, that when a
10 child needs an inpatient bed, it should be
11 there.
12 ASSEMBLYWOMAN GUNTHER: Really
13 quickly, we have a $5.5 million community
14 reinvestment. Where has it been invested?
15 And the other thing I wanted to know
16 is about the reduction of the OMH
17 underutilized and low-performing clinics.
18 What's happening with that?
19 COMMISSIONER SULLIVAN: Well, the
20 clinics, we haven't -- we're going to be
21 looking at all our clinics.
22 We're actually -- when we've done a
23 very brief across-the-board look, it's looked
24 like some of our clinics are underproductive.
36
1 So now we're going to be delving down into it
2 to be sure, and we're going to be making sure
3 that if we do any changes in the clinic
4 structure, it's to make it more efficient and
5 more accessible to our clients.
6 So nothing has been done yet. We're
7 going to begin looking at that and studying
8 that right after the budget.
9 ASSEMBLYWOMAN GUNTHER: Thank you.
10 CHAIRWOMAN YOUNG: Thank you.
11 CHAIRMAN FARRELL: Thank you.
12 CHAIRWOMAN YOUNG: Thank you,
13 Commissioner.
14 Just a few questions. So you
15 referenced -- you talked a little bit with
16 Senator Ortt and with Assemblywoman Gunther
17 about the 85 clinics, and you said you don't
18 know whether or where certain clinics would
19 be closing.
20 COMMISSIONER SULLIVAN: Right.
21 CHAIRWOMAN YOUNG: So there's this
22 administrative action proposed by the
23 Governor. But if there were clinics that
24 were deficient, underperforming in the past,
37
1 why weren't they dealt with, and why now this
2 wholesale approach?
3 COMMISSIONER SULLIVAN: Well,
4 actually -- it's a good question. I think
5 that we have known for a period of time that
6 perhaps our clinic system could be more
7 efficient. I think we've been preoccupied
8 with dealing with lots of other things,
9 including some of the reinvestment
10 transitions on the adult side. And so we
11 have started to look at the clinics.
12 I think that, you know, our clinic
13 system serves very complex patients and some
14 seriously mentally ill patients. But we also
15 have a wide network of community-based
16 clinics out there also that can sometimes
17 serve the same population. So we're looking
18 at it. We're looking at it at --
19 CHAIRWOMAN YOUNG: Excuse me,
20 Commissioner. Are you looking, then, to
21 shift services provided by the state to these
22 nonprofits? Is that the plan?
23 COMMISSIONER SULLIVAN: Not
24 particularly, no. There might be some areas
38
1 where, if we were to close or reduce the
2 clinic, we would be confident. We wouldn't
3 do that unless we were confident also that
4 there were enough services in the area. And
5 some of those services we will be looking at
6 will also be the community-based.
7 CHAIRWOMAN YOUNG: So you and I have
8 had many, many discussions about lack of
9 mental health services across the state.
10 There are places that are totally
11 underserved. There are so many people who
12 have mental health concerns who can't get
13 treatment, and they may be in an urban
14 setting, they may be in a suburban setting,
15 they may be in a rural setting. And so, you
16 know, I get a little bit concerned when I
17 think about the possibility of actually
18 losing services that are being provided right
19 now.
20 So in the event there are clinic
21 closures, what would be done to make sure
22 that there isn't any loss of access? Because
23 access is key.
24 COMMISSIONER SULLIVAN: Absolutely.
39
1 CHAIRWOMAN YOUNG: Actually, we need
2 to expand mental health services, in my
3 opinion.
4 COMMISSIONER SULLIVAN: We'll be
5 working with the communities where the
6 clinics are. And we'll be working with the
7 local government units, we'll be working with
8 the providers in those communities. And if
9 there's any question that we cannot close the
10 clinic or reduce the size of the clinic
11 because of access issues, we will not.
12 CHAIRWOMAN YOUNG: Okay, thank you.
13 Now, also in the Governor's proposal
14 he's looking to reduce the number of
15 state-operated residential beds by 140 and
16 replace them with 280 community-based
17 scattered-site supportive housing units. And
18 we've talked a little bit about that today
19 also.
20 But does this represent kind of a
21 future trend of shifting these state-operated
22 services into other nonprofit providers? And
23 you kind of said no, there was no plan with
24 the 85 clinics. But is there a plan with
40
1 this FTE reduction?
2 COMMISSIONER SULLIVAN: I think it's a
3 different issue with the housing. There have
4 been federal moves, on something called
5 Olmstead and others, that basically
6 individuals with mental illness should be in
7 the community.
8 These institutions -- I shouldn't call
9 them institutions. These residences are very
10 institution-like, so they are really not
11 embedded in the community. So for good
12 clinical reasons, it makes sense to -- if we
13 can -- move some of those beds into the
14 community so individuals can be fully
15 integrated.
16 Also, it's more economical. But it
17 also serves to really fulfill some of the
18 federal mandates to kind of be moving
19 individuals who have spent a long time on our
20 campuses in housing out in the community.
21 For the 140 beds that we will close,
22 we will be able to open up 280 supported
23 apartments with the services that individuals
24 need and really help integrate them more into
41
1 the community.
2 CHAIRWOMAN YOUNG: Thank you.
3 Switching gears now a little bit, the
4 Governor proposes increasing collaboration
5 between OMH and DOCCS, the Department of
6 Corrections and Community Supervision, in the
7 treatment of sex offenders. And the Governor
8 anticipates that this will result in sex
9 offenders completing treatment programs
10 before the end of their prison terms,
11 resulting -- theoretically -- in a decrease
12 in the transfer of individuals to OMH secure
13 facilities for treatment. So I have a couple
14 of questions about that.
15 First one, how does the current
16 treatment protocol for sex offenders in the
17 correctional facilities compare to the
18 treatment of these same individuals in OMH
19 facilities?
20 COMMISSIONER SULLIVAN: The basic
21 clinical structure of the kinds of groups,
22 the cognitive work, et cetera, will be the
23 same. Basically, these individuals have --
24 in the past would have waited until they were
42
1 leaving prison to then be examined to decide
2 whether or not they needed to go into civil
3 commitment. We're now moving, in essence,
4 the same kind of programming into the prison
5 so those individuals, if successful, may not
6 need to go to civil commitment. They are
7 still evaluated at the point that they would
8 be leaving their sentence, whether or not
9 they would need to go to civil commitment.
10 CHAIRWOMAN YOUNG: So you're saying
11 that DOCCS' treatment protocols are different
12 than OMH's right now, but you're looking --
13 COMMISSIONER SULLIVAN: No, they're
14 very similar. They will be very similar.
15 They will be very similar. There's some
16 difference --
17 CHAIRWOMAN YOUNG: They will be, but
18 you're saying they're different now?
19 COMMISSIONER SULLIVAN: No.
20 Basically, this kind of intensive treatment
21 for sex offenders is not there right now in
22 the prison system.
23 CHAIRWOMAN YOUNG: That's my question.
24 COMMISSIONER SULLIVAN: Yes.
43
1 CHAIRWOMAN YOUNG: So it's not there
2 at DOCCS right now, so how will it get --
3 COMMISSIONER SULLIVAN: Well, we've
4 already -- I'm sorry, it is there. We've
5 started with the special prisoner-based
6 program. That has started, and we will be
7 expanding it. But before that, it was never
8 in DOCCS. So it's been about a year and a
9 half or so. Before that, it was never in
10 DOCCS.
11 CHAIRWOMAN YOUNG: Okay. Thank you.
12 So currently there is a statutory process
13 where certain sex offenders nearing the
14 completion of their prison term are assessed
15 for risk and for mental abnormalities. And I
16 know you're very familiar with that.
17 Under the Governor's proposal, will
18 prisoners in the DOCCS system who have
19 completed their treatment program and who are
20 pending release from prison undergo an
21 assessment from OMH to determine whether
22 there's a need for referral to the New York
23 State Attorney General to seek civil
24 management?
44
1 COMMISSIONER SULLIVAN: Yes.
2 CHAIRWOMAN YOUNG: There will be.
3 COMMISSIONER SULLIVAN: Yes.
4 CHAIRWOMAN YOUNG: Could you expand on
5 that, please?
6 COMMISSIONER SULLIVAN: Basically,
7 they will have the same examination done as
8 they would have had had we not had that
9 program in the prison. So everyone who would
10 leave would still be examined by one of our
11 qualified psychologists and psychiatrists to
12 determine whether or not civil commitment is
13 necessary.
14 CHAIRWOMAN YOUNG: Okay, thank you.
15 And finally, I wanted to ask about
16 telehealth -- and as you know, I've been very
17 involved in bringing telehealth services
18 across the state -- but expanding it into
19 telepsychiatry, because, as we spoke about
20 earlier, it is so crucial to get more
21 services into the communities for people with
22 mental health concerns.
23 Could you tell me about what's going
24 on at the agency right now?
45
1 COMMISSIONER SULLIVAN: Yes. Thank
2 you so much for your support for this. It's
3 really wonderful, and we're very excited and
4 engaged in expanding telepsychiatry across
5 the state. We have reviewed the regs so now
6 telepsychiatry can be billed in multiple
7 settings through Medicaid.
8 Basically, our clinics, we have
9 several clinics in -- OMH clinics in the
10 rural areas where we are doing telehealth.
11 There are several -- through DSRIP, we have a
12 number of emergency rooms who are taking on
13 telehealth, so that basically individuals can
14 be examined remotely in the emergency rooms,
15 helping to make decisions about admission or
16 discharge.
17 We have looked at the -- we are
18 looking at telehealth for nursing homes, to
19 be able to kind of do evaluations.
20 So I think we're looking for
21 telepsychiatry in just about every area that
22 it could be utilized. The science shows that
23 it is just as effective as having
24 face-to-face interviews, especially for
46
1 consultations and evaluations. And we are
2 also looking at it for ongoing treatment. In
3 certain clinics we're beginning to pilot so
4 that telepsychiatry can be a psychiatrist who
5 would continue to see, through
6 telepsychiatry, a client on an ongoing basis.
7 So we're very excited about expanding
8 telepsychiatry across the state.
9 CHAIRWOMAN YOUNG: Great. And so I
10 have partners in the Assembly who are very
11 interested in expanding telepsychiatry. So
12 we do have legislation, but we'll be talking
13 to you about that in the future.
14 COMMISSIONER SULLIVAN: Great. Thank
15 you.
16 CHAIRWOMAN YOUNG: And I do want to,
17 finally, associate myself with the strong
18 support that was displayed by Senator Ortt in
19 keeping services constant, the way they are,
20 at the Western New York Children's Center. I
21 think that is such an important issue. And
22 you've been in discussion with us now for a
23 couple of years about it, but our position
24 hasn't changed. And we believe very strongly
47
1 that things should not change in the manner
2 that -- moving it to the BPC. And I just
3 want to reaffirm that.
4 So thank you very much.
5 COMMISSIONER SULLIVAN: Thank you.
6 CHAIRMAN FARRELL: Thank you.
7 We've been joined by Mr. McDonald.
8 Next, Mr. Kearns.
9 Oh, and Didi Barrett is here. I'm
10 sorry, there she is.
11 CHAIRWOMAN YOUNG: And, Mr. Chairman,
12 I'd like to point out -- I just noticed that
13 we've been joined by Senator David Carlucci.
14 ASSEMBLYMAN KEARNS: Thank you,
15 Mr. Chairman, for giving me this opportunity
16 today.
17 Thank you, Commissioner. I'll be
18 brief with my remarks.
19 As you know, we've been talking about
20 the Western New York Children's Psychiatric
21 Center for over three years. And I want to
22 thank the chairman of our Assembly committee
23 for coming out to Buffalo and doing an
24 excellent job in meeting with the parents and
48
1 advocates.
2 Recently, I sent out a survey and
3 within three weeks, I've received 1200
4 responses. And what I can't understand is
5 why we are doing this. Why are we trying to
6 fix something that isn't broken? The
7 community, the professionals, going back to
8 1965, the New York State Planning Committee
9 stated that the units for children should be
10 separated from the mainstream of adult
11 patients in separate buildings or cottages.
12 But my question is this. One of the
13 things that they're concerned about,
14 especially the families, is the safety of the
15 children going into these facilities. So if
16 you could just answer this one question:
17 Right now, how many adults convicted of
18 sexual assault are housed at the Buffalo
19 Psychiatric Center, as we move those children
20 and close down that facility in West Seneca,
21 which has been rated one of the top
22 facilities in the state, the lowest
23 reinstitutionalization rate?
24 The Western New York delegation -- why
49
1 are we doing that? And if you can answer
2 that question, currently today, right now,
3 how many convicted sexual predators are
4 within that facility?
5 COMMISSIONER SULLIVAN: Right now
6 there is one sexual predator -- one person
7 convicted of sexual -- inpatient in Buffalo
8 Psychiatric.
9 ASSEMBLYMAN KEARNS: Were any moved
10 prior this year? How many were there this
11 year? Were any --
12 COMMISSIONER SULLIVAN: I believe we
13 had four. So we have moved three.
14 ASSEMBLYMAN KEARNS: And will any be
15 able to have access to that facility, even on
16 an outpatient basis?
17 COMMISSIONER SULLIVAN: Yes. There
18 are some -- I think there are four on an
19 outpatient basis. And basically our
20 commitment, and I truly -- this is an
21 absolute commitment -- is that none of those
22 individuals will be there in the event that
23 we move West Seneca to Buffalo.
24 ASSEMBLYMAN KEARNS: I just want to go
50
1 on the record and I want to thank the
2 chairman for giving me this latitude of
3 speaking on this issue on behalf of the
4 Western New York community, on behalf of the
5 families.
6 I could read testimony after testimony
7 of people that don't want this facility
8 closed. You know that. I just think it's an
9 abomination. I had an opportunity to ask the
10 Governor himself. And my final question is,
11 have you asked the Governor -- is the
12 Governor aware that this facility is going to
13 be closing?
14 COMMISSIONER SULLIVAN: The Governor's
15 office has been briefed about this. And I am
16 charged with bringing to the Governor -- to
17 discuss all your concerns that have been
18 stated over the various periods of time. So
19 I will be discussing those concerns, and they
20 will be reviewed with the Governor's office.
21 ASSEMBLYMAN KEARNS: The Governor
22 himself?
23 COMMISSIONER SULLIVAN: With the
24 Governor's office.
51
1 ASSEMBLYMAN KEARNS: The Governor
2 himself?
3 COMMISSIONER SULLIVAN: It's my
4 understanding, when I hear from the
5 Governor's office, that that is my -- that's
6 the place I speak to. So with the Governor's
7 office.
8 ASSEMBLYMAN KEARNS: Well, thank you,
9 Mr. Chairman, for that, for giving me that
10 time.
11 I just want to leave you with this,
12 and I hope you remember. There's a road
13 going into that facility called Hope Way.
14 And when the kids leave, after leaving, they
15 leave their handprints on the wall and they
16 leave encouragement for future people. Just
17 think of that as we go forward and we discuss
18 this issue.
19 COMMISSIONER SULLIVAN: Thank you.
20 ASSEMBLYMAN KEARNS: Thank you.
21 Thank you, Mr. Chairman.
22 COMMISSIONER SULLIVAN: And I do
23 appreciate your concerns. But just to state
24 one more time, that our goal here is to
52
1 really serve even more individuals in Western
2 New York. A thousand additional families
3 could be served. I just wanted to just
4 emphasize that. Thank you.
5 CHAIRWOMAN YOUNG: Thank you.
6 Senator Akshar.
7 SENATOR AKSHAR: Commissioner,
8 welcome. It's always good to be in your
9 company. Welcome today.
10 I want to bring you to the Southern
11 Tier; specifically, to the Greater Binghamton
12 Children and Youth Services. The last time
13 we spoke, you said there were no plans to
14 reduce the amount of bed space. And I see in
15 the Executive's proposal this year, in 2017,
16 there's a plan to reduce the bed space by
17 three.
18 Can you just explain to me what has
19 changed, so I can properly represent your
20 position, and the Governor's, to the
21 constituency that I serve?
22 COMMISSIONER SULLIVAN: Thank you.
23 Basically, whenever we've reduced
24 beds -- and that includes the beds in
53
1 Binghamton -- it's by our agreement with the
2 Legislature, that those beds have been vacant
3 for 90 days. I think when we were there, we
4 didn't have any beds that were vacant for
5 90 days. When those beds do become vacant
6 for that period of time, we do close the
7 beds.
8 But we're doing it very gradually. If
9 we should notice that at some point we needed
10 to reexpand those beds, we would. But at
11 this point in time, we have not had to expand
12 or replace those beds. They've been staying
13 vacant. So there was a difference at that
14 point.
15 SENATOR AKSHAR: So currently the need
16 is not there?
17 COMMISSIONER SULLIVAN: Currently the
18 need is not there, yes. Thank you.
19 SENATOR AKSHAR: You made a reference
20 a few minutes ago to in making decisions you
21 look at the economics of it, right, in making
22 those decisions. And from a macro
23 perspective, help me understand when we're
24 talking about savings and reinvestment, in
54
1 your mind, the savings that we find, are we
2 properly reinvesting those dollars into the
3 system?
4 Because clearly there is a need to
5 provide mental health services throughout
6 this great state. And I would respectfully
7 offer, to something Senator Young said a few
8 minutes ago, we need more of it. So in your
9 mind, are we properly reinvesting those
10 dollars?
11 COMMISSIONER SULLIVAN: Yes, I think
12 we are. And we're not doing it in isolation.
13 All the reinvestment planning has been done
14 with the local communities and with the LGUs
15 in those areas. So, for example, a lot of
16 the reinvestment has gone towards supported
17 housing, which individuals who are leaving
18 the psych centers, that decreases the need
19 for beds because our patients don't have to
20 wait as long in the psych center to get the
21 housing.
22 We've also opened up, for children,
23 respite beds. For adults, we've also done a
24 lot of mobile crisis work. When you have a
55
1 mobile crisis team or a mobile integration
2 team that wraps services around an
3 individual, that can avoid admissions, and
4 avoid admissions both to the state but also
5 to the voluntary hospitals. So it really
6 enables us to enable those beds to close
7 because we have the right services, including
8 clinic services, which have expanded also in
9 some areas.
10 But those crisis mobile integration
11 teams and the ability to have the right
12 housing for individuals has made a
13 significant difference in our ability to have
14 less inpatient beds. Individuals who are
15 better can now leave sooner and get into
16 apartments and have the services they need
17 wrapped around them and not get readmitted.
18 SENATOR AKSHAR: So the reinvestment
19 in terms of the services is from a global
20 perspective --
21 COMMISSIONER SULLIVAN: Yes, it is.
22 SENATOR AKSHAR: -- it's ensuring that
23 we're paying the staff the appropriate amount
24 of money so they can continue to work and
56
1 provide the service that the people need, and
2 that the beds are there and the facilities
3 are there.
4 COMMISSIONER SULLIVAN: Yes. Yes.
5 SENATOR AKSHAR: Thank you,
6 Commissioner.
7 CHAIRWOMAN YOUNG: Thank you, Senator.
8 CHAIRMAN FARRELL: Didi Barrett.
9 CHAIRWOMAN YOUNG: Before that, I
10 would like to announce that we've been joined
11 by Senator Todd Kaminsky.
12 Thank you.
13 ASSEMBLYWOMAN BARRETT: Hello. As you
14 probably know, I have in my district the
15 Hudson Correctional Facility, which is now
16 the younger facility for 17-year-olds and
17 18-year-olds.
18 I'm wondering -- we had a visit
19 recently there. I was pretty alarmed to see
20 that they have a solitary program there
21 which -- in fact, the young man that was in
22 solitary had come directly from a psych
23 facility. I'm wondering how much you're
24 working with that population or intend to be
57
1 working with that population to make sure
2 that mental health services are a significant
3 and robust part of that program.
4 COMMISSIONER SULLIVAN: We are working
5 very closely to make sure that the right
6 mental health services are there and to
7 evaluate the needs of the individuals that
8 are there, and to hopefully have the use of
9 solitary as little as possible.
10 I think that we had received funding
11 and planning and we're continuing to look at
12 what kind of innovative services we could put
13 there to really make a difference in the
14 lives of these youth. So yes, we are looking
15 at it very closely, and we will continue.
16 It's still a relatively new program, but we
17 are invested in these youth because it's a
18 critical point in their lives.
19 ASSEMBLYWOMAN BARRETT: And it's sort
20 of hard to imagine that anybody who's dealing
21 with emotional issues and isn't an
22 adolescent, basically, which is what they
23 are, it would be appropriate for them to be
24 in solitary. Do you have a position on that?
58
1 Have you --
2 COMMISSIONER SULLIVAN: You know, I
3 think the use of solitary is really something
4 that the Department of Corrections is very --
5 we have not taken an absolute position. But
6 clearly, we would want to keep as many
7 individuals out of that environment as
8 possible.
9 ASSEMBLYWOMAN BARRETT: Well,
10 especially when you're focusing on a program
11 that's addressing youth, and youth in this
12 stage. And, I mean, mainstream, normal,
13 healthy, if there's such a thing as --
14 adolescents, you know, act in a lot of
15 impulsive ways. So it just was astonishing
16 to me to see that going on there. And I
17 would encourage you to sort of be as active
18 and engaged in that facility and making sure
19 that that is used as little as possible.
20 COMMISSIONER SULLIVAN: Yes, we will.
21 Thank you.
22 ASSEMBLYWOMAN BARRETT: Thank you.
23 CHAIRWOMAN YOUNG: Thank you.
24 Senator Brooks.
59
1 SENATOR JACOBS: Commissioner, could
2 you address any initiatives in the plan that
3 you have as far as veterans who are in need
4 of mental health services?
5 COMMISSIONER SULLIVAN: Yes. You
6 know, throughout our system, actually, our
7 entire clinic system across the state, we
8 serve about 20,000 veterans in various pieces
9 of our service system.
10 But we also do a lot of training of
11 clinicians, because working with veterans
12 requires a special skill set. So the
13 department has done a lot of training with
14 staff across the state to work on that.
15 And then we have also begun to have
16 some of our housing dedicated to veterans
17 with serious mental illness. And I was just
18 at a lovely opening on Long Island for
19 housing really specially earmarked for
20 veterans with serious mental illness.
21 And also, in our research institutes,
22 we are continuing to do work on how to spread
23 good practices for the treatment of PTSD.
24 So I think we are trying to do a great
60
1 deal for veterans. I think you can always do
2 more. But we do have them involved in many
3 ways in our system of care.
4 SENATOR BROOKS: Okay, thank you.
5 CHAIRMAN FARRELL: Assemblywoman
6 Jaffee.
7 ASSEMBLYWOMAN JAFFEE: Thank you,
8 Commissioner.
9 A question in general. One of the
10 things that I hear on a regular basis in the
11 community is lack of psychologists, access to
12 counseling, social workers that provide
13 assistance in terms of mental health. And
14 this is a major issue for our communities.
15 And for instance, I was approached
16 regarding the mental health issues for a
17 kindergarten child. And in Rockland
18 County -- and I understand this is in
19 general, throughout the state, there are
20 areas -- there was not one psychologist that
21 could respond to the needs of that child. We
22 had to reach out into New York City to see if
23 we could find some staff, somebody who could
24 respond and assist the family and the child.
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1 This is a very serious issue
2 throughout the state, not just in Rockland
3 County, because I've reached out to inquire.
4 Can we put forward some initiative, some
5 effort to encourage our youth to move into
6 that area of psychology, encourage our SUNY
7 schools to provide that kind of training?
8 Can we put together a financial initiative to
9 be able to encourage them to move forward in
10 those areas, perhaps, you know, beyond their
11 college degree to a master's or a Ph.D.?
12 We need to provide that support for
13 our children and our communities, our
14 families. So I just wanted to raise that as
15 a really major issue.
16 COMMISSIONER SULLIVAN: Thank you very
17 much. I think the workforce issue is
18 critical in mental health. And it has -- I
19 obviously agree with you that we don't have
20 enough individuals going into the training
21 and then coming out of the training. So I
22 obviously agree with you, I think we will be
23 very happy to kind of consider workforce.
24 You know, we recently, with one of our
62
1 state psych centers, are working with Mercy
2 College to have some of their students kind
3 of rotate through our services. So, for
4 example, a social worker might then pick
5 mental health versus something else that a
6 social worker could be involved with. And I
7 think we have to do much, much more of that.
8 We have to expose students to the wonderful
9 work that you can do in mental health. Often
10 they don't even get to see it, and so they
11 choose other things.
12 So I absolutely agree with you. I
13 think it's a critical workforce issue and
14 something that the whole nation is facing.
15 And I think working with the universities is
16 very important, and we'll be glad to work on
17 that.
18 ASSEMBLYWOMAN JAFFEE: So maybe we can
19 work together and get this moving forward. I
20 will reach out.
21 COMMISSIONER SULLIVAN: Yes, that
22 would be terrific. Because I do think
23 it's -- and incentives, I think, do help. So
24 we should talk, we should work and see what
63
1 we can do. That would be terrific. Thank
2 you.
3 ASSEMBLYWOMAN JAFFEE: Okay, thank
4 you.
5 CHAIRWOMAN YOUNG: Thank you very
6 much.
7 We've been joined by Senator Patrick
8 Gallivan. And just so every Senator knows
9 what the order is, next is Senator Kaminsky,
10 then Senator Carlucci, and then Senator
11 Gallivan.
12 So Senator Kaminsky.
13 SENATOR KAMINSKY: Thank you. I
14 really want to echo Assemblywoman Jaffee's
15 comments on workforce development. For me,
16 it's a real priority. When you talk to
17 hospitals, they can't find providers. And it
18 really adds to the whole atmosphere of mental
19 health kind of being put in on the back
20 burner constantly in terms of how it's
21 treated all over.
22 And I heard a really great story on
23 the radio about how the State of Oregon has
24 an incentive program where it doesn't -- you
64
1 know, in other words, I heard your comments
2 before about workforce development and was
3 encouraged, but I think we need to put a
4 little muscle into it. And what Oregon does
5 is it has an incentive program where it will
6 pay for your education if you are committed
7 to doing certain work in the mental health
8 field for a certain period of time for a
9 municipality or another governmental entity.
10 And I think it makes a lot of sense to
11 encourage people to go into fields where we
12 need them to go. And we hear all the time
13 from professionals in the field who say, Why
14 is this the only area where it's better to be
15 on Medicaid than have commercial insurance?
16 And why is this the only area where you can't
17 find a mental health provider?
18 And I think, you know, wanting to
19 expose students is nice, and we should
20 certainly do that. But I think we're going
21 to have to put a little money where our mouth
22 is here and I think that helping develop some
23 type of incentive program might be a way to
24 go. At least studying what another state has
65
1 I think is a thing that we should do.
2 And like Assemblywoman Jaffee, I
3 certainly stand ready to help in any way I
4 can, because I think it's a huge void that
5 I'd love to help fill.
6 COMMISSIONER SULLIVAN: Yes, I
7 absolutely agree.
8 And I also think, on the commercial
9 side, there is an issue of payment too. So I
10 think people are not that interested
11 sometimes in going into a field where
12 sometimes the commercial rates and the
13 payment are not what might really entice
14 people to do this kind of work.
15 Just as example, in our clinic system
16 Medicaid pays better than commercial payers
17 in our clinic system. So there has been this
18 disparity in mental health, not just in terms
19 of parity for service, but parity for payment
20 for decades. Centuries, perhaps. And I
21 think that has to be looked at. Because it's
22 enticing people to come into a field. We
23 want to get them excited and do the work, but
24 we also have to, especially sometimes on the
66
1 commercial side, think about payment that is
2 kind of on par with what you would get for
3 other specialties.
4 SENATOR KAMINSKY: Sure. And whether
5 it's the financial issues or insurance issues
6 or other issues, I would like to suggest that
7 you think about coming up with a task force
8 on how to come up with ideas on this. I know
9 that we would certainly like to be a part of
10 it. I'm sure it would be a good bipartisan
11 way to start thinking about this. Because I
12 think having a commission put forth some
13 serious recommendations is necessary soon,
14 and I hope I can work with you on that.
15 COMMISSIONER SULLIVAN: Mm-hmm. Thank
16 you.
17 SENATOR KAMINSKY: Thank you.
18 CHAIRWOMAN YOUNG: Thank you, Senator.
19 CHAIRMAN FARRELL: Assemblyman
20 McDonald.
21 ASSEMBLYMAN McDONALD: Commissioner,
22 good to see you.
23 Thank you, Mr. Chairman.
24 I guess where I want to go with this
67
1 question -- I think it's budget related, to a
2 degree. Obviously there's a lot of
3 facilities, a lot of psychiatrists that are
4 employed in many of the programs that you
5 run. And at the same token, when I listen to
6 families, when I listen to patients, there
7 seems to be a challenge in regards to
8 patients being able to access a
9 psychiatrist -- particularly in the Medicaid
10 population, but I think it could be across
11 most disciplines or most insurance options.
12 So I guess my question, are you having
13 a hard time attracting psychiatrists to
14 practice in the facilities that the agency
15 runs?
16 COMMISSIONER SULLIVAN: You know,
17 across the country, actually, there is
18 difficulty in recruiting and training
19 psychiatrists. This has probably gotten
20 worse in the last 10 years than it was that I
21 recall, going back, partly I think because
22 there has been some increased awareness of
23 the need for psychiatrists, but also -- so
24 the shortage has gotten worse.
68
1 In our hospitals and in our clinics,
2 we have had difficulty sometimes recruiting
3 and retaining psychiatrists. One thing which
4 we are very happy about, and we think will
5 begin to bear fruit, is that we now have a
6 loan repayment program for psychiatrists that
7 if they stay with us for five years, they
8 will get a significant amount of dollars
9 towards their loans from medical school,
10 which are quite high.
11 So we had just started that last year,
12 and we're beginning to get some bites from
13 psychiatrists interested in working with us,
14 to join us. I think that those are the kinds
15 of incentives that can sometimes work to help
16 get psychiatrists into the system.
17 That, and also we are working very
18 hard on just trying to make sure that
19 psychiatrists understand what the public
20 sector is. It's not something that they
21 often have experience with when they're
22 training, so it's not their first thought
23 about a job. So we're doing that. But also,
24 I think, the loan repayment plan, which we've
69
1 put in the budget, I think will be very
2 helpful.
3 ASSEMBLYMAN McDONALD: You know, one
4 of the concerns I have is -- and I practice
5 healthcare on a daily basis still. I see a
6 lot of pediatricians, I see some primary care
7 practitioners really probably practicing at
8 the uppermost limit, if not maybe over what
9 their experience has been.
10 And are there any programs or
11 protocols to help those providers get that
12 additional support? Because I can tell you
13 candidly, some of these medications are not
14 to be prescribed indiscriminately, they are
15 very precise, they're very particular, they
16 need a lot of monitoring and following up.
17 And I'm just -- I'm concerned, primarily, for
18 those primary care practitioners.
19 And listen, this is not a rant against
20 psychiatrists. It's a thankless job. They
21 do a wonderful job. But it takes time, a lot
22 of time. And what are we doing to support
23 our community providers that are out there?
24 COMMISSIONER SULLIVAN: You know, one
70
1 of the biggest shortages is child
2 psychiatrists.
3 And something that we have had now for
4 probably about three years, and we're
5 expanding, is something called Project Teach.
6 And Project Teach is open, free -- we pay for
7 it. It's any pediatrician across the state
8 can call for a consultation with a
9 psychiatrist.
10 The psychiatrist hubs -- and we're
11 using telepsychiatry for this -- the
12 psychiatrist hubs are located at usually
13 multiple universities across the state. All
14 the pediatrician has to do is say they want
15 to be involved. We offer a little training,
16 but just as much training as they want to
17 have. We'll train them a lot or a little.
18 But they can call and get a
19 consultation with that psychiatrist and talk
20 about, you know, the child that they're
21 seeing and what the recommendations are.
22 It's been great. We have about 3500
23 pediatricians now; we're planning on doubling
24 that. And we have been serving -- oh, over
71
1 10,000 families is our goal, to go up, to
2 keep increasing.
3 It was a model actually in
4 Massachusetts that we kind of stole but has
5 been very successful in spreading the
6 expertise of child psychiatrists especially.
7 A similar model is something we're
8 thinking of to help primary care adult
9 practices too. We haven't put that in place
10 yet, but we're thinking about that. And
11 we've been talking with some DSRIPs about
12 maybe considering that. Because again, it's
13 a very successful model in terms of providing
14 the expertise and spreading across a wide
15 group of practitioners.
16 ASSEMBLYMAN McDONALD: One final
17 question; I know my time is short.
18 You know, another key component of the
19 overall provision of mental health services
20 is psychologists. And myself, I've been
21 advocating looking at allowing psychologists
22 who have received additional high-level
23 training to have prescriptive authority on a
24 close formulary of medications. My intent
72
1 being there's a lot of unmet need. There's
2 also a greater recognition that there are
3 mental health concerns that are not being
4 treated. And we're at least getting over
5 that stigma, thanks to a lot of the work that
6 your agency has done, and many others.
7 Does the agency have a position on
8 giving prescriptive authority to certificated
9 psychologists for a limited scope?
10 COMMISSIONER SULLIVAN: No, we don't
11 have a position on that at this time.
12 ASSEMBLYMAN McDONALD: Okay. Thank
13 you.
14 CHAIRWOMAN YOUNG: Thank you.
15 Senator Carlucci.
16 SENATOR CARLUCCI: Thank you, Chair.
17 And thank you, Commissioner, for being
18 with us here today and answering our
19 questions.
20 As you know, New York State has had a
21 strong commitment towards research and
22 finding ways to improve the quality of life
23 of people living with mental illness. Could
24 you give us a brief status on the state of
73
1 research with OMH, and particularly how that
2 relates with the agency in general, but also
3 particularly to the Nathan Kline Institute?
4 COMMISSIONER SULLIVAN: Yeah, we have
5 actually two institutes. One is the
6 Psychiatric Institute at Columbia, in the
7 city, and then the Nathan Kline Institute in
8 Rockland.
9 And I think it's a -- I'm extremely
10 proud of this, and I think New York State
11 should be. We are one of the states that has
12 continued these institutes and supports these
13 institutes so that they can do the important
14 work of behavioral health research.
15 Nathan Kline, while not quite as large
16 as Columbia, has gotten some of the most
17 highest-rated grants and is in a position to
18 right now be doing tremendous work relative
19 to geriatrics, to cultural competency.
20 They're also doing some work on -- working
21 with communities about setting up the
22 appropriate services in communities.
23 So they do basic community work, but
24 then they also do some laboratory work to
74
1 look at things like what are the basic causes
2 of things like depression and schizophrenia.
3 Similarly at Columbia, which is one of the
4 highest-grant-funded institutions in the
5 nation for mental health.
6 And so between both our Psychiatric
7 Institute and Nathan Kline, I think we
8 provide more in terms of psychiatric research
9 than any other -- than large groups,
10 including even some of the big universities
11 you hear of across the country.
12 So we're very proud of it, and it's a
13 mixture of basic science, applied work. One
14 of the things our research institutes do is a
15 Center for Practice Innovations, and they
16 have come up with a whole host of curricula
17 which we spread out to best practices to all
18 our clinics and across the state, best
19 practice innovations.
20 So really our institutes are terrific,
21 and I think that we have, thanks to the
22 Governor, have been able to continue to
23 support those efforts.
24 SENATOR CARLUCCI: So we would agree
75
1 that money invested in research, we see that
2 proliferate as other grants are added to
3 that. Is there any move in this budget to
4 increase investment to our institutes?
5 COMMISSIONER SULLIVAN: There's
6 nothing in this budget that increases. But
7 there's nothing in this budget that decreases
8 either. So I think that the commitment is
9 strong.
10 And you're absolutely right, for every
11 dollar that we invest, there's about anywhere
12 from $5 to $6 in grants that is built upon
13 that dollar that we invest. And our
14 institutions have been great in doing that.
15 SENATOR CARLUCCI: So if you were to
16 invest -- increase aid to our institutes and
17 to research in general, where would you
18 prioritize?
19 COMMISSIONER SULLIVAN: That's a
20 difficult question, because there's so many
21 needs. I think that there's a lot of work
22 going on now in imaging, there's a lot of
23 work going on in cultural competency, there's
24 a lot of work going in community-based
76
1 services, and in even some genetics, on the
2 genome, looking at a certain markers.
3 So it's very wide. And I would have
4 to actually pull together my research people
5 and say what's your -- you know, what do you
6 think is the most important.
7 SENATOR CARLUCCI: Thank you,
8 Commissioner.
9 CHAIRWOMAN YOUNG: Thank you.
10 CHAIRMAN FARRELL: Assemblywoman
11 Gunther.
12 ASSEMBLYWOMAN GUNTHER: I'd like to
13 talk about the COLA and the lack thereof.
14 So it's been a decade since the state
15 has committed to a COLA in the budget outside
16 the 0.2 percent last year. And, you know,
17 when we talk about adequate care and we talk
18 about a living wage, I just -- this was also,
19 they generated -- it was generated in the
20 Legislature.
21 So what are your plans to increase the
22 salary for people working in non-for-profits
23 in the OMH community?
24 COMMISSIONER SULLIVAN: Well, first, I
77
1 think -- I just have to say that I do think
2 that the Governor's commitment to the minimum
3 wage is extraordinary, and millions of
4 dollars are being invested in that. Some of
5 those dollars will be coming to mental
6 health, I think it's about $3.5 million, to
7 support the minimum wage.
8 At this point in time, there is
9 nothing in the budget for the
10 not-for-profits --
11 ASSEMBLYWOMAN GUNTHER: I just want to
12 interrupt. Is that for like the
13 non-for-profits, the minimum wage?
14 COMMISSIONER SULLIVAN: Yes, that will
15 include --
16 ASSEMBLYWOMAN GUNTHER: When will that
17 be coming?
18 COMMISSIONER SULLIVAN: There's about
19 $3 million in the budget to support the
20 minimum wage uptick for this year, in this
21 budget.
22 But your other question about more
23 than that, there isn't anything in the budget
24 that would address the COLA. The COLA is not
78
1 in the budget this year.
2 ASSEMBLYWOMAN GUNTHER: The other
3 thing I wanted to talk about, stigma. Last
4 year we had the tax checkoff. And how much
5 money did we accumulate, and what are we
6 doing with it?
7 COMMISSIONER SULLIVAN: There was
8 about $75,000 that came in from the tax
9 checkoff. And we got a group of stakeholders
10 together to decide what to do, and I think
11 we'll be sending out very shortly an RFP for
12 a little -- what the stakeholders decided was
13 to do 15 small grants of $5,000 each that
14 would go to individuals to work on stigma,
15 whether it was education or working with
16 families, working with institutions. But to
17 work on stigma.
18 So small grants. We're looking for
19 innovative proposals. And if some of those
20 small grants look like they are successful,
21 then perhaps next year, when perhaps we'll
22 have more money that will come in -- we would
23 love to get more -- those could be expanded.
24 But that's the plan for the dollars at this
79
1 point. And that should be starting very,
2 very soon.
3 ASSEMBLYWOMAN GUNTHER: I misspoke a
4 little bit when I said minimum wage. There's
5 a compression issue. And there's also -- to
6 pay a DSP what we consider minimum wage, to
7 keep those folks in this profession -- what
8 I'm talking about is additional, beyond and
9 above that. Because this is truly not a
10 minimum wage job.
11 And what are we really doing to keep
12 these professionals in the profession? I
13 think that's what's really important here. I
14 misspoke. Because I know that, you know,
15 we're doing it in increments in upstate
16 New York. But we're talking about a group of
17 non-for-profits that really have been starved
18 over the years.
19 And keeping somebody in the DSP
20 profession, and then you add in the Justice
21 Center with it, it's really, really
22 difficult. It really, really is, you know,
23 in OPWDD and in OMH. But right now, you
24 know, I think that, you know, minimum wage is
80
1 just not going to make it. You know, in
2 order for people to take care of people in
3 facilities and so forth, and in the
4 community, you know, we need to invest more
5 money in that.
6 COMMISSIONER SULLIVAN: You know,
7 there isn't anything in the budget in this
8 year that would address that, an addition to
9 the minimum wage. I think that the
10 Legislature -- this is an important issue,
11 and I think that the Executive will be, as it
12 always does, working with the Legislature on
13 the issues that they feel are important over
14 the course of the budget negotiations.
15 ASSEMBLYWOMAN GUNTHER: Can we use any
16 of the DSRIP money for this?
17 COMMISSIONER SULLIVAN: Oh, that's
18 something that I think you would have to talk
19 to the Department of Health about. The DSRIP
20 dollars are really within the Department of
21 Health.
22 ASSEMBLYWOMAN GUNTHER: Have you
23 suggested it, just because it's so important
24 to this field?
81
1 COMMISSIONER SULLIVAN: I have not,
2 no.
3 ASSEMBLYWOMAN GUNTHER: Thank you.
4 CHAIRWOMAN YOUNG: Thank you.
5 Senator Gallivan.
6 SENATOR GALLIVAN: Thank you.
7 Good afternoon, Commissioner.
8 I'd like to talk about, as you can
9 imagine, the Western New York Children's
10 Psychiatric Center. I apologize that I
11 wasn't here for all of your testimony, but I
12 was at a hearing on the issue of raising the
13 age of criminal responsibility in New York
14 State.
15 Among the proposals, the Governor's
16 proposal, is -- the Governor's proposal deals
17 with a couple of different things:
18 Programming, certainly the courts, Family
19 Court jurisdiction. It also deals with
20 housing. And one of the biggest things that
21 the Governor has called for and that people
22 have testified to is to remove 16- and
23 17-year-olds from adult prisons. Not just
24 separating them by sight and sound in the
82
1 same facility or the same campus, but
2 physically getting them into a different
3 building, into a different structure, and
4 away from the adults.
5 And as you know, I of course disagree
6 with the decision to close the facility and
7 merge it with the Buffalo Psychiatric Center.
8 But for the life of me, I just can't
9 understand on one hand how the Governor can
10 be calling to get convicted criminals out of
11 prisons at 16 and 17 years old and give these
12 juveniles their own facility, and at the same
13 time close the West Seneca Children's
14 Psychiatric Center, where we have kids that
15 are among the most troubled in the state, we
16 have a facility -- the professionals there
17 are among the best in the state, if not the
18 country. By the various metrics where you
19 measure their success, they perform extremely
20 well, if not among the best in the state --
21 and we're putting them back in an institution
22 that they were removed from 40 years ago
23 because the experts at the time said that
24 they should be separated.
83
1 I am just -- I am completely troubled
2 by it. I still have yet to hear any clinical
3 reason for it to take place. And nobody has
4 been able to present that these kids would be
5 better off in that adult setting.
6 We have conducted a number of
7 hearings, as you know. And of course I
8 attended the forums that you put on to hear
9 input from people. Many stood up and made a
10 plea or an appeal to you to keep it open.
11 But I've heard from children and
12 former patients, families, parents, the
13 professionals that work there, various mental
14 health professionals and organizations,
15 members of the community, and every single
16 member of the Western New York legislative
17 delegation who is opposed to this. And I
18 just don't understand how this can be done
19 when there's so many opposed and there is no
20 clinical reason for this.
21 COMMISSIONER SULLIVAN: I appreciate
22 the --
23 SENATOR GALLIVAN: That is not a
24 question. I understand --
84
1 COMMISSIONER SULLIVAN: I know, I
2 know. And I certainly --
3 SENATOR GALLIVAN: But please comment.
4 COMMISSIONER SULLIVAN: -- I
5 appreciate it.
6 The goal here is really to enable a
7 system of care, to enable Mental Health to
8 provide the services that a community needs.
9 In terms of the quality of care, I do
10 not believe there will be any difference in
11 the quality of care -- I know we disagree on
12 this -- in relocating from West Seneca to
13 Buffalo. I think that the plans that we
14 have, the clinical staff, the way it is
15 designed, which is extremely youth-friendly,
16 will provide the same great outcomes that
17 West Seneca has always had.
18 Why do it then? We'll do it because
19 by doing it, we are enabling over $3 million,
20 $3.5 million in investment in community
21 services in that area which are desperately
22 needed.
23 I think when you look at healthcare,
24 this is something that is happening in
85
1 healthcare across the country. People are
2 trying to design systems of care that can
3 make those precious healthcare dollars reach
4 as many people as possible while still
5 providing quality care. That's why we're
6 doing it. I know we disagree, but that's why
7 we're doing it.
8 SENATOR GALLIVAN: I understand.
9 What if we are able to find sufficient
10 funding to cover that?
11 COMMISSIONER SULLIVAN: I think the
12 issue here is spending the dollars well. I
13 mean, I always like extra funding for things,
14 I'm not saying not. But it doesn't make
15 sense to me to not be using dollars in a way
16 that can provide the best service to the
17 widest group of patients and to really serve
18 the community.
19 SENATOR GALLIVAN: I have to respect
20 the rules of timeliness here, so I'm at the
21 end of my time.
22 I do want to say, though, that I do
23 appreciate that you've always been positive
24 in getting back to our office and dealing
86
1 with any of the questions that come up, even
2 though we continue to -- or I continue to
3 disagree about this issue and we'll still
4 continue to work through the budget process
5 to reverse the decision.
6 Thank you.
7 COMMISSIONER SULLIVAN: Thank you.
8 Thank you.
9 CHAIRWOMAN YOUNG: Thank you.
10 Chairman?
11 CHAIRMAN FARRELL: Assemblyman
12 Santabarbara, to close.
13 ASSEMBLYMAN SANTABARBARA: Okay, thank
14 you.
15 I just want to talk a little bit about
16 stigma. We all know there's a tremendous
17 delay, sometimes as much 10 years, between
18 the onset of symptoms and people actually
19 seeking treatment. And we hear that it's one
20 of the biggest factors in this delay.
21 Two years ago we passed a tax checkoff
22 box for mental health stigma. And are there
23 plans now to utilize this resource to combat
24 stigma? And what other actions is OMH taking
87
1 to encourage people to actually get the
2 treatment?
3 COMMISSIONER SULLIVAN: The tax
4 checkoff was about $75,000. We're hopeful
5 this year there will be more. And the plan
6 is to send out 15 small $5,000 grants to an
7 RFP for either local providers, some of our
8 peer groups, some of our individuals to come
9 with a proposal so that we can seed an
10 anti-stigma approach. And then, based on
11 some success with that, we may be able to use
12 money that would come with the anti-stigma
13 checkoff this year to enhance those programs.
14 So we're really very excited about
15 this. We decided to do this with a group of
16 stakeholders which included some providers,
17 included clients and recipients, included
18 families, as to how best to use the $75,000.
19 On the issue of stigma, you're
20 absolutely right, it's a huge issue. I
21 think, my experience -- I've been in this
22 field a long time -- it's getting better, but
23 it's nowhere at all where it needs to be.
24 People are still afraid of seeking services.
88
1 One of the key things that we are
2 doing, though, with individuals -- you're
3 absolutely right about this lag in time of
4 getting treatment. And that lag is
5 particularly onerous for individuals who are
6 diagnosed with schizophrenia. So we have
7 something called the first-episode psychosis
8 program in the state, which we are growing
9 across the state. So that when someone has
10 that very first episode -- because usually
11 they have the first episode and then they get
12 lost for exactly the time period you're
13 talking about -- to engage the family and the
14 client to keep them in school, to keep them
15 working, not to get lost to the system and
16 lose their community supports, which is what
17 has unfortunately happened.
18 So right now we have that in 13 sites
19 across the state. We're going to continue to
20 expand it, hopefully to be able to reach
21 everyone who has that first experience of a
22 psychotic episode, so that they can get the
23 kind of services they need to get into
24 treatment early and continue their lives and
89
1 not get separated, which is a very critical
2 issue.
3 ASSEMBLYMAN SANTABARBARA: Thank you.
4 Just moving back to the workforce, the
5 state workforce, according to the stats that
6 I'm looking at here, 35 percent of OMH
7 employees are working overtime. So just
8 curious how you're addressing this while also
9 eliminating 353 FTEs.
10 COMMISSIONER SULLIVAN: Basically,
11 we're lowering 353, but it would have been
12 453. So 100 are being retained to basically
13 try to deal with the overtime issue.
14 Overtime is complicated. One of the
15 issues is an increasingly acute number of
16 patients that are coming into our hospitals,
17 a lot of one-to-one observations, as we call
18 it. We need to redesign what we do in terms
19 of clinical care so that that may not be as
20 necessary, although you always have to order
21 it if you need it.
22 The other is hiring time. There's a
23 number of Lean projects that the state has
24 taken on to get people on-boarded quicker.
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1 Overtime becomes a real issue if you're not
2 really quickly replacing one individual after
3 the other. And we're also working closely
4 with Civil Service about having exams in
5 perhaps a more timely manner so that we can
6 begin to fill positions quicker.
7 So -- and the other is working with
8 some staff -- I think about 10 percent of
9 staff are out sometimes on leave because of
10 injuries in the workplace. It's all very
11 high in healthcare, higher in psychiatric
12 care. And we're doing a lot of work with
13 teamwork and other things to reduce that so
14 there will be less happening so people won't
15 be out on leave.
16 So there's a number of initiatives,
17 and 100 coming back.
18 ASSEMBLYMAN SANTABARBARA: And just
19 sticking to that topic, so you see a need --
20 is there a need to increase salaries? And
21 what are the stats on the retention, keeping
22 employees?
23 COMMISSIONER SULLIVAN: I think
24 it's -- salaries are very volatile in the
91
1 mental health field right now, whether it's
2 for nurse practitioners or psychiatrists or
3 nurses. Whenever you have staff shortages,
4 salaries go up, kind of supply and demand.
5 So we are looking into multiple pieces
6 of the puzzle as to where we may need to look
7 at salary increases.
8 CHAIRMAN FARRELL: Thank you.
9 ASSEMBLYMAN SANTABARBARA: Okay.
10 CHAIRWOMAN YOUNG: Thank you,
11 Commissioner. That concludes our questioning
12 today. So we truly appreciate your
13 participation, and I'm sure we'll be talking
14 with you very shortly. So thank you so much.
15 COMMISSIONER SULLIVAN: Thank you very
16 much.
17 CHAIRMAN FARRELL: Thank you.
18 CHAIRWOMAN YOUNG: Our next speaker is
19 Helene DeSanto, acting executive deputy
20 commissioner of the New York State Office for
21 People with Developmental Disabilities.
22 Thank you. Welcome. We look forward
23 to hearing what you have to say.
24 ACTING EXEC. DEP. CMR. DeSANTO:
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1 Thank you. Good afternoon, Senator Young,
2 Senator Savino, Assemblyman Farrell, Senator
3 Ortt, Assemblywoman Gunther, and other
4 distinguished members of the Legislature. I
5 am Helene DeSanto, acting executive deputy
6 commissioner for the New York State Office
7 for People with Developmental Disabilities,
8 OPWDD.
9 Thank you for the opportunity to
10 provide testimony about Governor Cuomo's
11 2017-2018 Executive Budget proposal and how
12 it will benefit the more than 136,000
13 New Yorkers with intellectual and
14 developmental disabilities who are eligible
15 for OPWDD services.
16 Under the Governor's leadership, OPWDD
17 continues to make significant strides in the
18 transformation to a more integrated,
19 person-centered system of services and
20 supports for the people we serve. This year,
21 the Executive Budget proposes $4.3 billion in
22 state funding -- $7.3 billion including
23 federal funds -- to support integrated,
24 community-based services and OPWDD's
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1 oversight of state and not-for-profit
2 providers.
3 OPWDD's ongoing systemwide
4 transformation is informed by an
5 unprecedented level of engagement over the
6 past two years with individuals, families,
7 our nonprofit provider partners, and you, our
8 partners in the Legislature. This feedback
9 has led to significant new investments in the
10 2017-2018 Executive Budget.
11 This year's budget proposes
12 significant new investments in integrated
13 OPWDD services, including $120 million in
14 all-shares funding to expand services for new
15 and currently eligible individuals;
16 $27 million in all-shares funding to support
17 provider agencies' compliance with new
18 minimum wage standards, $24 million in new
19 funding to support people's transition from
20 developmental centers to appropriate
21 community-based settings, $15 million in
22 capital funding to expand affordable housing
23 opportunities for OPWDD-eligible people, and
24 a $21 million investment in expansion of
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1 OPWDD's successful START program, our crisis
2 response, intervention and treatment program.
3 In addition, as part of OPWDD's
4 ongoing transition to managed care, the
5 budget provides for OPWDD to access
6 Department of Health resources to cover the
7 administrative costs associated with managed
8 care. OPWDD is committed to reinvesting any
9 savings that are realized from its transition
10 to managed care back into services for people
11 with developmental disabilities.
12 New York funds and operates the
13 nation's largest residential support system
14 for individuals with intellectual and
15 developmental disabilities -- a $5.1 billion
16 annual investment. More than 37,000
17 New Yorkers currently live in OPWDD-certified
18 housing, such as group homes, and another
19 4,200 are eligible for rental vouchers that
20 assist them to live independently within
21 their communities.
22 Still, the need to expand residential
23 opportunities for the people we serve is a
24 major focus for OPWDD. Many families remain
95
1 concerned that there won't be an available
2 housing opportunity when their loved one
3 needs one. With the Governor's support,
4 OPWDD has developed a multiyear housing
5 strategy designed to meet the identified
6 demand.
7 In the next three years, OPWDD
8 anticipates that approximately 4,900
9 individuals currently living at home may
10 require a certified residential opportunity
11 and another 1,400 will seek more independent
12 living arrangements than rental subsidies and
13 other uncertified options can provide. OPWDD
14 will meet this demand using a mixture of
15 existing and newly developed opportunities
16 which will be accessed based on a
17 person-centered process.
18 OPWDD will also participate in the
19 Governor's $20 billion affordable and
20 supportive housing plan and, as mentioned
21 previously, access $15 million in capital
22 funds to help develop independent housing
23 opportunities in communities throughout the
24 state.
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1 Before taking your questions, I would
2 like to acknowledge the concerns related to
3 the people who are the foundation of our
4 service system for New Yorkers with
5 intellectual and developmental disabilities,
6 our direct support professionals. We are
7 engaged in regular and ongoing dialogue with
8 our provider partners on solutions to address
9 their workforce concerns.
10 While the budget includes $27 million
11 in state and federal funding to support
12 increases in the minimum wage for direct
13 support professionals, we recognize the need
14 to continue our focus on efforts that will
15 address recruitment and retention of a highly
16 qualified and stable direct support
17 workforce.
18 Thank you for your continuing support
19 and advocacy. We look forward to working
20 with you, our partners in the Legislature,
21 and all of our stakeholders to achieve real
22 and lasting systemwide transformation on
23 behalf of our friends, neighbors and loved
24 ones with intellectual and developmental
97
1 disabilities.
2 I welcome your questions.
3 CHAIRWOMAN YOUNG: Thank you,
4 Ms. DeSanto. And I do have a few questions.
5 My background is -- I worked at an
6 agency for people with disabilities for many
7 years before I ran for state office, and this
8 whole issue of managed care has me concerned
9 because it's so undefined right now. And you
10 only referenced it in passing in your
11 testimony. And we've tried managed care
12 many, many times over the past many years in
13 the state, and it's never worked.
14 So the Executive proposes to
15 transition all the developmental disabilities
16 population over to managed care within the
17 next five years, and it would start with the
18 development of regional care coordination
19 organizations which would initiate enhanced
20 coordination of care, according to what we've
21 heard so far. And after you develop these
22 organizations, the Governor would transition
23 to a fully capitated rate structure for
24 reimbursement and for voluntary enrollment, I
98
1 believe, which would start in 2019.
2 But those were the only details that
3 we have on the entire plan, so can you
4 provide more specifics as to how you would
5 impose managed care for habilitative services
6 that people with developmental disabilities
7 require? Because as you know, there are many
8 people out there that are vulnerable
9 citizens. They depend on getting the
10 services that they currently have. And so
11 how would you handle this?
12 ACTING EXEC. DEP. CMR. DeSANTO: Thank
13 you. So we are looking at a variety of
14 strategies and working with our provider
15 community to really ensure that we put
16 together a good plan to transform the system
17 and to move to managed care for the
18 population that we support. And as you
19 referenced, the plan would begin with
20 voluntary enrollments in 2019. So we have a
21 couple of years where we really are working
22 with our provider community and moving toward
23 a care coordination approach, which is a
24 central aspect of a managed care system.
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1 CHAIRWOMAN YOUNG: So it's voluntary
2 to start. Would it become mandatory at a
3 certain point?
4 ACTING EXEC. DEP. CMR. DeSANTO: At a
5 certain point it would, over a five-year
6 period beginning in 2019.
7 CHAIRWOMAN YOUNG: So it's voluntary
8 to start for what length of time?
9 ACTING EXEC. DEP. CMR. DeSANTO: It is
10 voluntary to start for -- I want to say it's
11 two years, and then it begins to go into a
12 mandatory approach after that.
13 And it would be rolled out in
14 geographic parts of the state. Where we have
15 greater readiness, probably downstate, we
16 would begin earlier than moving upstate, is
17 the thinking currently.
18 I think what I just want to mention is
19 that what we really see as the benefit of
20 moving to managed care is the flexibility
21 that it will offer us, which is a greater
22 degree of flexibility in our service system.
23 It's where we've been trying to move our
24 services in a transformational approach, and
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1 it certainly holds the promise of some
2 savings that might accrue that would enable
3 us to do further investment in some needed
4 services.
5 So I think that that's kind of the
6 big-picture view of it.
7 We do have a small demonstration
8 project in New York City right now that has
9 been operating for about a year now, and so
10 we have some ways in which we are looking at
11 how best to make the transition and sort of
12 learning from some experience there.
13 CHAIRWOMAN YOUNG: Okay. Thank you.
14 And I'm sure we'll be talking about this as
15 time goes on.
16 You referenced the direct care
17 workers, and we've been very concerned about
18 the minimum wage increase and the fact that
19 there's now a gap with, for example, fast
20 food workers and direct care workers. And
21 you reference a little bit about the
22 recruitment issues. But working, especially
23 with people with severe disabilities, is a
24 very, very, very difficult job. And if you
101
1 could choose between flipping burgers at
2 McDonald's or having to change diapers or
3 maybe taking care of someone who may act out,
4 may bite you, may hit you, whatever it is,
5 most people would probably choose working at
6 a fast food restaurant.
7 So it's always been difficult to
8 recruit direct care workers. I think it's
9 becoming impossible to be able to recruit
10 them, and I wanted to get your thoughts about
11 it, because the Governor includes
12 $14.9 million in state funds, $27.4 million
13 gross, to fund the cost of not-for-profit
14 providers under OPWDD impacted by the
15 scheduled increase in the minimum wage. But
16 as I said, providers are no longer able to
17 offer a better wage than other businesses,
18 and providers are really concerned.
19 I've been hearing about this -- in
20 fact, my office just sent me a resolution
21 that was passed by the board of an ARC in my
22 district, and I just got that this morning.
23 So the Governor's created a situation where
24 the developmental disability providers may
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1 have a tougher time -- they are having a
2 tougher time in recruiting staff.
3 And, you know, one of my concerns also
4 has to do with the fact that quality of care
5 can be compromised if we don't have the right
6 staff members on board. So how are we going
7 to address this? Because I don't see that
8 it's really being addressed right now.
9 ACTING EXEC. DEP. CMR. DeSANTO: So
10 first I want to reiterate, I think, a point
11 that you made which acknowledges the fact
12 that we have very strong support from the
13 Governor, with the $27 million investment
14 this year to make sure that our providers can
15 meet the minimum-wage standard. And I know
16 that that was certainly a great interest to
17 our providers as minimum wage was rolling
18 out.
19 However, we know that that's not, you
20 know, perhaps going to solve all of the
21 issues around recruitment and retention for
22 this workforce. And you're correct, I mean
23 it's a very -- you know, it's a very
24 demanding job, and it is -- the very
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1 foundation of the services that we provide is
2 built upon that direct support workforce, day
3 in and day out.
4 So we have been working with our
5 providers to really look at what kinds of
6 issues they are having with recruitment and
7 retention. We have had a working group
8 established to look at things such as
9 compensation. But, in addition, things that
10 also contribute to workforce satisfaction in
11 our field that have to do with the training
12 that they receive, the career ladders that
13 are available within human services agencies,
14 and some of the things that really, I think,
15 are unique and distinguish the job of direct
16 support in our field compared to maybe some
17 of the other entry-level jobs that you were
18 referencing.
19 So we're looking at a whole variety of
20 factors. And we are, you know, certainly
21 more than willing to work with you during
22 this budget process to see if there are more
23 things that really should be done.
24 CHAIRWOMAN YOUNG: I appreciate that
104
1 answer very much, Ms. DeSanto, but I -- you
2 know, and it's good to look at the entire
3 picture, but unless you can pay somebody a
4 good wage, they're just not going to be that
5 interested in that job. Because you know
6 what, they have to support their families
7 too. And I know you understand that, so
8 thank you.
9 CHAIRMAN FARRELL: Finished?
10 Assemblywoman Gunther.
11 ASSEMBLYWOMAN GUNTHER: Okay, we talk
12 a lot today about percentage changes,
13 millions of dollars here, thousands of
14 dollars there, service cuts, rates and bed
15 values. We also talk in many acronyms --
16 dSRIP, APG, CCO. All this is really talking
17 about people, vulnerable people who need our
18 support to live their lives to the fullest.
19 We are talking about people who take
20 care of those people, their families,
21 friends, and direct support professionals who
22 dedicate, and I repeat dedicate, their lives
23 to providing critical, invaluable care.
24 Why was the $45 million that was
105
1 requested to address the minimum-wage issue
2 and compression issue not included in this
3 budget?
4 ACTING EXEC. DEP. CMR. DeSANTO: Well,
5 what I would say is --
6 ASSEMBLYWOMAN GUNTHER: Remember, I
7 have to say that it's hard, it's hard for
8 me -- you know, I grew up in middle-class
9 America. And when I look at the number
10 $159 billion, and then I look at $45 million
11 to support people that otherwise are going
12 to -- they'll quit their profession.
13 You know, they're trying really hard.
14 And the other side of that equation is most
15 of them are women, and many of them are
16 single women. Many of those are women with
17 children that are also -- could be single --
18 working not one but two jobs. And then you
19 layer on top of it the Justice Center, the
20 Justice Center, and the intimidation that
21 people feel.
22 You know, they have love for their
23 consumers, but they need to feed their
24 family. And so $45 million in terms of
106
1 $159 billion -- I'm not an accountant or a
2 mathematician, but I know it's like spitting
3 into the ocean.
4 ACTING EXEC. DEP. CMR. DeSANTO: So,
5 you know, what I would reiterate again is
6 there certainly is a good amount of dollars
7 that are devoted to the direct support
8 workforce in this budget, as well as a lot of
9 other important initiatives. And I agree
10 with you that, you know, it certainly is an
11 area that needs consideration and focus. But
12 within the limited availability of dollars
13 and the big picture, I think that the budget
14 was not, as it was constructed, did not
15 include the dollars that you're referencing.
16 So at this point I think we can
17 continue to discuss and work together as the
18 budget process goes forward to see if there
19 is, you know, a way to address those
20 concerns.
21 ASSEMBLYWOMAN GUNTHER: You know, we
22 have discussed it over the years. It's been
23 every not-for-profit that I can think of has
24 come in and discussed this issue with so many
107
1 people, have pleaded for these increases.
2 And I think that again, we're talking
3 about a very vulnerable population. You
4 know, I have -- I know one agency, a
5 not-for-profit that talks a lot about our
6 disabled community that's being cared for for
7 much, much more money and out of state.
8 And the fact is, why aren't we looking
9 to save money bringing those people from out
10 of state? And we know where these agencies
11 are, that they're paying probably 40 percent
12 more to send them to out of -- and we do have
13 what we need in New York State to care for
14 these folks. But once we place somebody
15 there, they seem to stay there forever.
16 And I'm saying that we could save
17 money, and it would be better for a family to
18 have your loved one here. But there are ways
19 to save money.
20 But right now, the DSP, there are a
21 lot of professionals, a lot of them go to a
22 lot of classes, they really do. And tie in
23 the fact that the Justice Center comes in and
24 there's an allegation, and then they decide
108
1 what level of allegation it is. And what
2 happens is there's an investigation. The
3 performance improvement person starts the
4 investigation, they send it up to Albany, to
5 the Justice Center -- sometimes people are
6 out six to nine months without any kind of
7 resolution to the issue, and a lot of the
8 times not guilty.
9 And, you know, between that and not
10 giving these not-for-profits -- they're going
11 to go broke. And I think that it should be a
12 priority in the State of New York to make
13 this happen.
14 ACTING EXEC. DEP. CMR. DeSANTO: Thank
15 you.
16 ASSEMBLYWOMAN GUNTHER: That's it, eh?
17 I know. Okay, thank you.
18 CHAIRWOMAN YOUNG: Thank you.
19 Senator Ortt.
20 SENATOR ORTT: Good afternoon. At the
21 risk of beating a dead horse, I'm going to
22 beat a dead horse. Is it OPWDD's contention
23 that DSPs deserve to only make the minimum
24 wage?
109
1 ACTING EXEC. DEP. CMR. DeSANTO: Well,
2 I would say certainly not. We certainly are
3 happy that we are able to bring all of the
4 employees to minimum wage who are not
5 currently there. I think you may know,
6 Senator, that there is a good percentage of
7 the direct support workforce that are already
8 above minimum wage, which is a great thing.
9 But we certainly recognize the type of
10 work that the direct support professionals
11 do. We have had cost-of-living increases
12 over the years because we've recognized, you
13 know, the importance --
14 SENATOR ORTT: Do you know when the
15 last one was?
16 ACTING EXEC. DEP. CMR. DeSANTO: Yes,
17 it was -- actually, the last one was 2015.
18 And there was one the year before that, 2014,
19 both of those being 2 percent. And there was
20 a small cost-of-living adjustment last year,
21 which was based on the CPI, which I think you
22 probably may --
23 SENATOR ORTT: 0.2.
24 ACTING EXEC. DEP. CMR. DeSANTO: --
110
1 recall. Yes, that's correct.
2 So, you know, what I would say to you
3 is no, we would certainly never suggest that
4 our direct support professionals don't
5 provide a very valued service. That really,
6 you know, we would want to do everything we
7 can to ensure that we have adequate
8 recruitment and certainly retention of our
9 workforce.
10 SENATOR ORTT: I'm sure it's not lost
11 upon you or the folks at OPWDD that what
12 we're really talking about, though, here
13 today isn't just the DSPs. We're talking
14 about the people that they service. Because
15 when the wages are low and you've created --
16 because we created a more urgent situation.
17 This was already a problem with recruitment
18 and retention, but now through the state's
19 action last year, and the fact that the
20 Governor was very eager to be out there in
21 front for minimum-wage workers -- and it
22 sends a priority, or it's a signal that the
23 priority certainly is not within this group.
24 And I think that if you listen to the
111
1 speakers who are going to be coming after you
2 who have been in this field for years -- much
3 longer than I've been serving in the Senate,
4 maybe longer than you've been in your current
5 position -- they will tell you that the
6 feeling within the developmental disability
7 community amongst families, amongst workers,
8 non-for-profits, is that quite frankly this
9 administration simply does not prioritize
10 this area.
11 And you can look at the funding. You
12 termed "strong support," $27 million. That's
13 certainly your description. There is not one
14 speaker coming later this afternoon that
15 would term that as strong support. They
16 would look at it as no support, because they
17 would say that the COLA has been deferred,
18 there is no cost -- the $45 million they're
19 looking for. And ultimately, you can't
20 recruit these people.
21 What happens is you get probably a
22 subpar, I'll just say it, a lower-quality
23 worker. It's like any other job or any other
24 industry. You know, someone's going to fill
112
1 the job, but they may not be as good as the
2 people that were trying. And these are
3 people who are working with people's
4 children, very vulnerable people, as you
5 know.
6 So I think when you hear these
7 questions and you hear the concerns, it's not
8 just because -- it's not just the workers,
9 although we want them to have a livable wage,
10 but the good ones, you know, the reality is
11 they're going to go -- they're going to find
12 that wage somewhere. They'll leave this
13 field, they'll go to Burger King, they'll go
14 to Wendy's, they'll go somewhere. They'll go
15 work for a school district.
16 But the person who can't go anywhere
17 is the individual who they're servicing.
18 See, they're stuck. So they need that person
19 to earn a livable wage, so they can continue
20 to provide the service and the care they
21 need.
22 So you're certainly free to comment,
23 but I think that that's a very important
24 point.
113
1 ACTING EXEC. DEP. CMR. DeSANTO: Yeah,
2 I mean, certainly we realize that ultimately
3 it is all about being able to support the
4 people that are reliant on our services. And
5 we know that it's a field where the very
6 health and safety of individuals, day in and
7 day out, rests with our direct support
8 professionals. So there's no question about
9 the valuable role that that workforce plays.
10 And I have to say to you, Senator,
11 that we do talk with providers, parents, and
12 many stakeholders that carry the very message
13 that you are speaking about. So we are
14 acutely aware of it. We certainly also have
15 a lot of service needs that are very well
16 resourced in this budget for which we're very
17 grateful, and we get the support of the
18 Legislature again and again, year after year,
19 for a lot of the service dollars that we do
20 need.
21 So I think we have to continue to work
22 together on this issue and really look to see
23 what can be done that might be able to
24 address the kinds of concerns that you're
114
1 referencing.
2 SENATOR ORTT: I have two more
3 questions -- three more, I guess.
4 According to your report by
5 Comptroller DiNapoli, OPWDD lost 4,341 state
6 employees, or 17.5 percent of its workforce,
7 between 2007 and 2015. How has this
8 reduction affected overtime within the
9 office?
10 ACTING EXEC. DEP. CMR. DeSANTO: Okay.
11 So in the time period that you reference,
12 there was a great deal of progress made in
13 reducing our institutional population, and a
14 lot of the workforce reduction that you
15 reference had to do with being consistent
16 with the loss of services that were provided
17 on our campuses and the move, of course, to
18 more community-based settings, which was a
19 goal certainly of OPWDD and continues to be.
20 During the last year, I'm very happy
21 to say, we have seen a reduction in our
22 overtime hours of 13 percent. So what you
23 will see in the coming reports from the
24 Comptroller will show that we've had a lot of
115
1 success in overtime reduction just in the
2 last year. And we've achieved that by
3 focusing on a number of areas.
4 One of them is getting employees in
5 the door, as we have ongoing vacancies, more
6 quickly, being more efficient in the hiring
7 process for our state direct support
8 workforce. We've also worked to reduce times
9 that people are on leave, because, you know,
10 people on leave obviously results in overtime
11 and takes away from days on the job.
12 And so with those strategies we've
13 been quite successful in seeing overtime
14 reduction. And, you know, we do monitor it
15 very carefully, pay period by pay period, and
16 we look to see also that people are not
17 working extreme schedules. So we also have
18 seen a reduction, and a good reduction, in
19 the amount of overtime hours that any one
20 particular employee might be working within a
21 pay period. And that's also an area where
22 we've seen some success.
23 So we'd love to continue to have
24 conversations with you throughout the year to
116
1 kind of show you the tracking that we're
2 doing and the success that we're having.
3 SENATOR ORTT: The reason I'm asking
4 is because the proposed budget calls for
5 elimination of an additional 253 FTEs. I
6 mean, one would have to believe that that's
7 going to increase overtime costs on current
8 employees. And I guess my question is, why
9 eliminate these positions instead of maybe
10 utilizing them to reduce overtime instead?
11 ACTING EXEC. DEP. CMR. DeSANTO: Yes,
12 well, the positions that you reference are
13 directly related to a decreased census in
14 certain locations in the state.
15 And whenever we have an institution
16 that closes or other downsizing, I'm very
17 pleased to say that we work with the
18 unions -- and we have not had certainly any
19 layoffs, as I'm sure you know -- but we also
20 work very hard to keep people in jobs right
21 in the geographic location where they
22 currently work. So, for instance, for people
23 who were working in a location where an
24 institution may close, they would go into
117
1 work in locations in the community of that
2 same facility.
3 But the reductions that you reference
4 are related to workload, if you want to say
5 reductions in services that are
6 state-operated in those areas.
7 SENATOR ORTT: The last and -- I have
8 to be respectful of our time as well -- my
9 last question at the current time is
10 regarding respite, which I have no doubt
11 you're familiar with, and respite rates.
12 So there is a gap, if you talk to
13 folks at the ground level, between respite
14 that's authorized and respite that's
15 utilized. Because the rates in many cases
16 simply do not -- you know, providers are
17 losing money on respite and, ergo, they're
18 not offering it.
19 For many families, respite is a
20 lifeline without in-home supports or without
21 placement options. And so I hear from family
22 member after family member, We need more
23 respite, we need actual respite that's
24 offered in the area.
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1 We need to look at respite
2 utilization, which -- there is that gap. Can
3 you explain the gap or speak to the gap and
4 tell me what OPWDD is looking at to offer
5 more respite? Because I really think this
6 would do a huge -- it would perform a huge
7 function to reduce that tension on the
8 placement side if you had respite, which
9 would be the community support.
10 ACTING EXEC. DEP. CMR. DeSANTO: Yes,
11 and that's absolutely correct, Senator. You
12 may recall that when we did our report a year
13 ago, now, in February on the residential
14 request list, that was one of the very
15 significant findings.
16 We had families who were on that
17 request list -- that you all I think are
18 aware of -- tell us that if they had
19 available to them more respite opportunities,
20 they would not necessarily be looking to have
21 their family member move, at least not yet.
22 And we have done a lot of work in the last
23 year, really, looking at respite -- the fees
24 that providers are paid, and doing some work
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1 in that area to better define some of the
2 respite services and to work on the different
3 respite payments.
4 And that's a work in progress. We
5 actually have been working with all of our
6 providers to gather information. We have
7 another webinar with our respite providers
8 later this week. At that, we'll talk with
9 them some more about the different ways that
10 we're working to fund the amounts of payment
11 that providers receive, particularly for
12 individuals who have high needs.
13 We're trying to recognize within our
14 rates a better approach to meeting high
15 needs, because as you might imagine, a family
16 with a family member at home who has these
17 high needs, they're particularly needy in the
18 area of having respite. We are looking at
19 ways in which we can ensure that people
20 receive the respite services that they're
21 authorized for and receive them in a more
22 efficient and timely manner. So we're doing
23 a number of things in that area as well.
24 SENATOR ORTT: Thank you.
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1 ACTING EXEC. DEP. CMR. DeSANTO:
2 You're welcome.
3 CHAIRWOMAN YOUNG: Thank you.
4 CHAIRMAN FARRELL: Thank you.
5 Assemblyman Crouch.
6 ASSEMBLYMAN CROUCH: Thank you.
7 What's the status of the workshops at
8 this point in time? The Governor proposed
9 eliminating the sheltered workshops back in,
10 I think, 2013, and the doors were shut as far
11 as any new intake. What's the status at this
12 time?
13 ACTING EXEC. DEP. CMR. DeSANTO: So
14 the status of the workshops is that we have
15 been working over the past year and a half
16 with providers to go more toward an
17 integrated business model, and providers are
18 working on plans. We have actually received,
19 from most of our 80 workshop providers, plans
20 for them to go forward with the transitions
21 that we discussed.
22 And you may know that providers do
23 have a period of years to make that
24 transition, so it is until the year 2020 that
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1 providers would have to make those
2 transitions happen.
3 We have done an awful lot of work with
4 our workshop providers. We do get good
5 feedback that our providers of workshop
6 services are, you know, moving along toward
7 the types of services that we had been
8 planning with them, and actually we get some
9 very good family, individuals, stakeholder
10 feedback as well at this point.
11 So I think we're well along the way to
12 the point where we were originally discussing
13 with our goal for the workshop programs.
14 ASSEMBLYMAN CROUCH: So will they
15 ultimately close, then? Or this business
16 plan will salvage the workshops?
17 ACTING EXEC. DEP. CMR. DeSANTO: It
18 will ultimately transition the types of
19 services that are offered there to make them
20 more integrated, and we also have come up
21 with some different services within our
22 system that will ensure that people who are
23 there in the workshop will be able to
24 continue to receive the types of day-to-day
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1 supports that they were interested in.
2 So I think we did a lot of work, given
3 all the input that we received from members
4 of the Legislature and our stakeholders, to
5 really get to a place that I think people are
6 satisfied with in terms of the transition.
7 ASSEMBLYMAN CROUCH: Is there intake
8 now, then? Or is the intake still stopped
9 until you've come up with this other plan?
10 ACTING EXEC. DEP. CMR. DeSANTO: At
11 the point at which the plans are approved,
12 the intake continues to go forward. So I
13 think we're at a point where we're able to
14 begin to receive people again into those
15 types of services that they're looking for.
16 ASSEMBLYMAN CROUCH: So you are taking
17 new people in?
18 ACTING EXEC. DEP. CMR. DeSANTO: We
19 are in the process of reviewing the plans,
20 and when we have an approved plan, that is
21 the point at which we would be taking people
22 into the services.
23 We also have, though, a number of
24 services that have been introduced over this
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1 past year and a half, and people have
2 continually been received into those
3 services. So there's been no one who has not
4 had a service available to them.
5 ASSEMBLYMAN CROUCH: What about the
6 people from 2013 to 2017 that would have
7 liked to have gotten into the workshops for
8 services, what's happening with them? Are
9 they currently just sitting at home, or are
10 they able to receive some different type of
11 service?
12 ACTING EXEC. DEP. CMR. DeSANTO: They
13 are receiving services, so that we had always
14 had available a variety of services that
15 people could be offered.
16 We now have a community pre-vocational
17 service that might be available to some of
18 them, if that would be their choice for what
19 they would want to go into.
20 We have a new service called Pathway
21 to Employment that enables people to explore
22 the types of jobs that they may be interested
23 in, and we have a number of people who went
24 into the Pathway program.
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1 And of course we have our supported
2 work program, so some people may have chosen
3 to go right into the supported work area.
4 ASSEMBLYMAN CROUCH: What if the
5 individual does not want to leave the
6 workshop? If they're perfectly happy with
7 their job at the workshop, are they able to
8 stay?
9 ACTING EXEC. DEP. CMR. DeSANTO: Yeah,
10 sure. So the whole goal of the workshop
11 transition was to create opportunities within
12 that same type of setting, but to get that
13 setting to be a more integrated type of
14 employment than what it had traditionally
15 been. So we had always been committed to not
16 telling individuals who were currently
17 working there that there was a point where
18 they would have to leave that setting, and
19 that has not happened.
20 CHAIRWOMAN YOUNG: Thank you.
21 ASSEMBLYMAN CROUCH: Is there money
22 to -- I'm just -- I have one quick question.
23 Is there money allotted to help these
24 transitions to the workshops?
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1 ACTING EXEC. DEP. CMR. DeSANTO: There
2 is certainly funding that is connected to the
3 various types of services that we're speaking
4 about, and we have worked with our providers
5 on their transition plans and the transition
6 processes.
7 We do have a good amount of federal
8 dollars that are referred to as Balancing
9 Incentive Program dollars, or BIP is the
10 acronym there, and those dollars were
11 provided for the very reason of
12 transformation and transforming services into
13 more integrated services. So a number of
14 providers received dollars that related to
15 this very issue of workshop transition and to
16 assist them in that regard. So there were
17 investments made there.
18 ASSEMBLYMAN CROUCH: Thank you.
19 CHAIRWOMAN YOUNG: Thank you.
20 Senator Krueger.
21 SENATOR KRUEGER: Thank you.
22 Good afternoon. Just to reiterate
23 what already has been said just one more
24 time, you can't stop the COLA from going
126
1 forward at the same time as we've increased
2 minimum wage and the pressure on providers to
3 actually get people to work for them and stay
4 in these very difficult jobs. It's a
5 lose-lose proposition. So you've heard it a
6 million times here today, so just please
7 urge -- go back to the Governor and say this
8 is just not an option that can be considered.
9 You talk about, in your testimony,
10 when you add up 4,900 individuals currently
11 living at home may require a certified
12 residential opportunity and an additional
13 1,400 will seek more independent living
14 arrangements than rental subsidies and other
15 uncertified options can provide -- so that's
16 6,300 people, I think, that you're saying are
17 in need of residential facilities.
18 So I represent Manhattan, parts of
19 Manhattan. I get visits and calls from
20 people all the time begging for help to get
21 residential placements -- not next year, but
22 now. People who have been waitlisted, people
23 in their 50s, 60s, 70s, 80s caring for OPWDD
24 adult children who can't do it anymore and
127
1 live in hopes of finding a secure, safe place
2 for their adult children to move to.
3 Of these 6,300 that you're defining,
4 when are we getting them into the correct
5 placements? And, two, give me an estimate of
6 how many of those are in New York City,
7 because I feel like we have a desperately
8 high waitlist.
9 ACTING EXEC. DEP. CMR. DeSANTO: Sure.
10 So in developing the multiyear strategy, we
11 looked at various points of information. You
12 probably know we have that large residential
13 request list which is statewide and is just
14 that, it's a list where at some point people
15 have requested or said that they may have an
16 interest in residential support.
17 But then what we also have in our
18 regional offices is a process, a very dynamic
19 process whereby we receive information from
20 families and/or their case managers that are
21 probably the people that you described, who
22 are saying "I am ready now, and I need
23 services now."
24 So each of our regional offices,
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1 including our regional office in New York
2 City, maintains that list and they work on an
3 ongoing basis with providers in their area as
4 vacancies in our system come up, or to
5 develop new residential opportunities that
6 may need to be created. And, you know, you
7 might realize that in such a large system as
8 we have, which is 37,000 individuals, there
9 is a good amount of turnover on an ongoing
10 basis within a system so large as ours.
11 So it's a two-pronged process of
12 looking at how to make sure that we make the
13 best use of that large system that we have
14 invested in. And it's a very large system in
15 New York City. You're probably aware of many
16 of our providers there who operate many
17 different types of residential supports, as
18 well as, as I said, looking at the creation
19 of new opportunities.
20 Now, I know that many families are
21 concerned, that they feel that there's a need
22 for a greater number of new opportunities to
23 be created. And so part of this multiyear
24 strategy actually does increase the number of
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1 new opportunities that are created for family
2 members who are caring for a loved one at
3 home.
4 This past year, we devoted $10 million
5 on a dedicated basis to individuals who have
6 family members that they're caring for at
7 home, and we had a stakeholder process where
8 people recommended to us how to invest those
9 dollars around the state. And we're coming
10 to a conclusion of that process, which should
11 see approximately 170 new opportunities of
12 various types created around the state in
13 various areas.
14 I mean, I could certainly arrange to
15 sit down with you and more specifically look
16 at our New York City information that we
17 have. And we'd love to hear what information
18 you have, because we always want to make sure
19 that we are as accurate as we can be and that
20 we're being responsive in all parts of the
21 state.
22 SENATOR KRUEGER: So just globally,
23 you have 37,000 residential slots in OPWDD.
24 You have stated there's approximately 6,300
130
1 units needed by people on lists. And you
2 talk about turnover. How many people turn
3 over in your system per year?
4 ACTING EXEC. DEP. CMR. DeSANTO: About
5 -- I'm trying to do the math quickly in my
6 head. It's about 1,800, I believe, that
7 would turn over within that existing system
8 of 37,000.
9 SENATOR KRUEGER: So current demand
10 is, at minimum, three times what your
11 turnover is.
12 ACTING EXEC. DEP. CMR. DeSANTO: Well,
13 over that three-year period. So the 6,300 is
14 anticipated over a three-year period to be --
15 SENATOR KRUEGER: Over a three-year
16 period.
17 ACTING EXEC. DEP. CMR. DeSANTO: Yes.
18 That's correct.
19 And the other thing I just want to
20 point out is that we also have other types of
21 housing supports now that we did not have for
22 many years. For many years it was a
23 one-size-fits-all system where we would
24 create your classic group home, for lack of a
131
1 better way perhaps to say it, but not a lot
2 of more integrated or individualized
3 opportunities such as apartment types of
4 settings, vouchers that help people who want
5 to live more independently to do that. And
6 now we have those types of options that
7 people are accessing to a much greater
8 degree.
9 When we did that outreach a couple of
10 years ago to the people on our list, we
11 actually found that many of them were telling
12 us they wanted to know about these new and
13 different types of opportunities. They
14 weren't just necessarily saying, you know,
15 that the group home was the only option that
16 they would consider. So there are people on
17 that list, you know, who are capable and
18 really desirous of having different types of
19 opportunities that we're now able to also
20 develop that were not there before.
21 SENATOR KRUEGER: Not to play the
22 devil's advocate totally, but I assume those
23 people actually, then, can get those services
24 so they wouldn't be on this list.
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1 ACTING EXEC. DEP. CMR. DeSANTO: Well,
2 actually, people with all levels of need are
3 on our list. But certainly some people may,
4 as you experience or say that people tell
5 you, wait longer than others. People who
6 need a highly specialized service, obviously
7 that sometimes could take longer to match
8 people to.
9 SENATOR KRUEGER: Thank you,
10 Commissioner.
11 ACTING EXEC. DEP. CMR. DeSANTO: Thank
12 you.
13 CHAIRWOMAN YOUNG: Thank you.
14 Assembly?
15 ASSEMBLYWOMAN GUNTHER: Michael
16 Cusick.
17 ASSEMBLYMAN CUSICK: Thank you.
18 Thank you. I'm going to just -- I'm
19 going to follow up on the Senator's question
20 on housing. Housing seems to be one of the
21 bigger issues in the OPWDD community, not
22 only in Staten Island, where I represent, but
23 statewide when I meet with folks here up in
24 Albany.
133
1 I see in the testimony about the
2 housing strategy that's put forward by your
3 agency. I just want to start with the
4 Executive's proposal of including $15 million
5 in capital investments to supportive housing
6 for people with disabilities. Could you just
7 run through with us as to how that's going to
8 work? What's the timeline on that? And
9 could you also -- how many affordable housing
10 units currently exist in OPWDD?
11 ACTING EXEC. DEP. CMR. DeSANTO: So
12 currently we have 4,200 people who receive
13 some kind of housing subsidy. And within our
14 funding we do provide housing subsidies to
15 help people with their rental and other
16 housing-related costs. They access housing
17 supports of all kinds.
18 So they may be out there renting an
19 apartment that's not necessarily one that was
20 specifically created through an affordable
21 housing funding, but many of them are also
22 part of the affordable housing initiatives.
23 I can't tell you exactly the number of
24 supportive housing apartments that are out
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1 there today, but the way the process works is
2 that there is a request for proposals process
3 that we engage in, and we receive proposals
4 from developers that are interested in
5 creating these affordable housing units. And
6 we have a whole review process that we engage
7 in that looks at the proposal itself, the
8 need in the area, and so on.
9 So within the coming year we will be,
10 as we have in the past couple of years,
11 soliciting those proposals and making those
12 approvals for those supportive housing units
13 to be created --
14 ASSEMBLYMAN CUSICK: And this is
15 capital money to construct these facilities,
16 right?
17 ACTING EXEC. DEP. CMR. DeSANTO:
18 That's correct.
19 ASSEMBLYMAN CUSICK: And is there a
20 mechanism yet in place, or is that still in
21 the planning stages of identifying which
22 counties will be selected for -- to dovetail
23 on the Senator's comments, $15 million
24 doesn't seem to be a lot, particularly for
135
1 the entire State of New York. I'm sure we
2 could use $15 million alone in Staten Island,
3 hint, hint.
4 (Laughter.)
5 ASSEMBLYMAN CUSICK: But that's what
6 I'm concerned about, is how is the process
7 going forward in identifying which counties
8 and what areas qualify or have the greatest
9 need.
10 ACTING EXEC. DEP. CMR. DeSANTO: So as
11 we solicit the proposals, you know, we look
12 at who is interested. And, you know, we
13 don't necessarily get a proposal from
14 developers in every part of the state. But
15 we look at those proposals, what they're
16 proposing to do, you know, how it fits in
17 with our priorities. And there's really a
18 whole review process that we undertake, you
19 know, to determine where to make the
20 investments.
21 ASSEMBLYMAN CUSICK: Is this in effect
22 right now, or is that still being planned on?
23 ACTING EXEC. DEP. CMR. DeSANTO: For
24 this coming year, it's in the planning
136
1 stages, but it will go forward fairly soon.
2 We also, as was mentioned briefly -- I
3 think that we will be able to have our
4 providers make applications for the
5 $20 billion in the Affordable Housing
6 Initiative of the Governor.
7 ASSEMBLYMAN CUSICK: And that was last
8 year's -- in last year's budget, correct, the
9 $20 million in affordable housing? How much
10 of that $20 million is actually going to
11 OPWDD for supportive housing for people with
12 disabilities?
13 ACTING EXEC. DEP. CMR. DeSANTO: Well,
14 it's actually $20 billion, I believe.
15 ASSEMBLYMAN CUSICK: Twenty million?
16 ACTING EXEC. DEP. CMR. DeSANTO:
17 Twenty billion. In the Affordable Housing
18 Initiative that I'm referring to, which is in
19 addition to the $15 million that we were
20 speaking of a moment ago.
21 And I think, when you say how much of
22 that is available, it really depends on how
23 the process progresses with applications from
24 our providers. So there's not a set amount,
137
1 not a set-aside amount.
2 ASSEMBLYMAN CUSICK: Well, again, I
3 know my time is running out, but I just want
4 to stress how important this is, this issue
5 of supportive housing for people with
6 disabilities.
7 We have families, as mentioned before,
8 who are growing older and they're frightened
9 as to figuring out what's going to happen to
10 their child, who is also getting older, and
11 where they're going to live, who's going to
12 take care of them. And I really think that
13 we're in an emergency situation here and we
14 need to come up with not only -- not only go
15 through with the existing money that we're
16 mentioning here, but we need to come up with
17 more money.
18 Thank you.
19 ACTING EXEC. DEP. CMR. DeSANTO: Thank
20 you.
21 CHAIRWOMAN YOUNG: Thank you.
22 We've been joined by Senator George
23 Amedore.
24 And our next speaker is Senator
138
1 Kaminsky.
2 SENATOR KAMINSKY: Good afternoon.
3 ACTING EXEC. DEP. CMR. DeSANTO: Good
4 afternoon.
5 SENATOR KAMINSKY: I speak to a lot of
6 parents of children who are -- or young
7 adults, I should say, who are no longer in
8 school, and they're very worried about aging
9 out and whether there will be appropriate
10 dayhab facilities and other programs that
11 will meet their needs. Some wait very long
12 on waiting lists only to find that, for some
13 reason, either the program is cut or it
14 doesn't qualify for some reason.
15 I'm hoping you could tell me what
16 assurances I could give to those parents that
17 OPWDD is working hard to provide appropriate
18 services for those deserving individuals.
19 ACTING EXEC. DEP. CMR. DeSANTO: Thank
20 you. You know, certainly every year we work
21 with a group of individuals and their
22 families across the state who are graduating
23 from school, and we work very hard to try to
24 find out early on in the process of
139
1 transition so that we can do appropriate
2 planning.
3 We have, in our new service dollars
4 each year -- and again, thank you for all of
5 the support we have had over the years with
6 those new service dollars -- a percentage of
7 that money is utilized to look at the varying
8 needs of people leaving school. So we look
9 to make sure that we have the right kinds of
10 adult day supports, whether it be employment
11 for some or for others that need a more
12 structured kind of day habilitation
13 experience.
14 But we try to ensure that we have the
15 right services in the localities where they
16 are needed, and our regional offices work
17 very hard to make sure those transitions
18 happen in a timely manner and that the
19 services that are needed are developed and
20 available.
21 SENATOR KAMINSKY: I'd love to
22 continue to work with you on making that an
23 even more efficient process.
24 When it comes to the adult housing
140
1 situation, I really echo the sentiment of a
2 lot of my colleagues. And I think when you
3 talk to parents who are now themselves
4 getting older, they're really worried that if
5 something happens to them, who is going to
6 take care of the children that they love so
7 much? And they're especially worried that
8 there's going to be a gap between the time
9 that something is ready for them and the time
10 when, God forbid, something happens creating
11 an urgent situation.
12 So I was hoping that you could address
13 that and tell me what steps that your agency
14 is taking to make sure that it's a much more
15 streamlined and efficient process and that
16 these parents can know that New York will
17 step in if they can no longer take care of
18 their children.
19 ACTING EXEC. DEP. CMR. DeSANTO: Yes,
20 and that is the reason why we did create the
21 multiyear housing plan that we have this year
22 in the budget. We used a lot of information
23 that we have gathered over a period of a
24 couple of years that really tries to look at
141
1 where families are located, who needs the
2 services, where we have individuals living
3 with caregivers who are getting older, and
4 try to factor that in in the development of
5 the plan to meet the needs of the 6,300 over
6 three years.
7 We think that's a good number, and we
8 hope that we're going to be able to identify
9 and work with these families over this period
10 of years to provide them with more confidence
11 for a more planned and timely transition and
12 availability to residential supports. So
13 that really is the goal.
14 We have heard -- as you have,
15 obviously -- our stakeholders raising a lot
16 of concerns. And within the plan there is
17 the development of new opportunities in
18 addition to the use of existing
19 opportunities, and that's been something we
20 have heard from families that have been
21 concerned about the development of new
22 residential settings that they may find to be
23 more appropriate or more fitting the needs of
24 their family member. So that was recognized
142
1 within the plan.
2 SENATOR KAMINSKY: Okay. Well, that's
3 good to hear. And to the extent we could
4 emphasize that more, I look forward to
5 working with you. And whether it's on the
6 funding end or on gathering information on
7 what's going on in Nassau County or anything
8 else, I look forward to working with you to
9 make that a priority.
10 You know, this, to families, is the
11 only thing that they think about when they go
12 to sleep at night, and I'd love to help make
13 them feel more secure, as much as I can.
14 ACTING EXEC. DEP. CMR. DeSANTO: Sure,
15 we appreciate that. Thank you.
16 SENATOR KAMINSKY: Thank you.
17 CHAIRWOMAN YOUNG: Thank you.
18 ASSEMBLYWOMAN GUNTHER: Assemblywoman
19 Miller.
20 ASSEMBLYWOMAN MILLER: Hi.
21 ACTING EXEC. DEP. CMR. DeSANTO: Hi.
22 ASSEMBLYWOMAN MILLER: I represent an
23 area with Senator Kaminsky. And being the
24 mother of a handicapped child myself, I seem
143
1 to attract lots of questions from peers and
2 fellow family members that have children with
3 special needs. And something that I've been
4 asked a lot about is self-direction.
5 So I have a couple of questions about
6 self-direction. It seems to be something
7 that's troubling many people -- myself
8 included, because my son is 17. So there
9 seems to be some slowdown, for lack of a
10 better phrase. This program, if you're lucky
11 enough to find a Medicaid service
12 coordinator, which there are a sparsity of,
13 then you would have to get a broker. And
14 from what I understand, the family member can
15 train to become a broker, or you can hire a
16 broker, and there is a lot of question about
17 the follow-up of these brokers.
18 Obviously you would, you know, expect
19 that you can trust a family member who's a
20 broker, but what is the follow-up of a
21 non-family-member broker? Are they monitored
22 at all? Six months later? A year later?
23 Because I've heard nightmare stories of some
24 families who have gotten a broker and then
144
1 that broker takes their case and then that
2 broker disappears, and their budget is never
3 launched.
4 And then if you are lucky enough to
5 get the Medicaid service coordinator and the
6 broker, there seems to be a significant
7 problem getting to the third step, the fiscal
8 intermediary. And there's a moratorium -- in
9 fact, a list came out just today of the most
10 recent fiscal intermediaries and the
11 moratorium placed on these fiscal
12 intermediaries that's saying they're not
13 taking on new cases until further notice.
14 So what are these families supposed to
15 do? What are we supposed to do when we can
16 not effectively transition our children?
17 ACTING EXEC. DEP. CMR. DeSANTO: So
18 I'm sorry, you know, to hear that you
19 experienced and that you're hearing that
20 others are experiencing difficulties with
21 self-direction.
22 We have been doing a lot of work on
23 ensuring that the fiscal intermediaries are
24 appropriately compensated, because there was
145
1 an issue around payment to them that we've
2 been working on. And also trying to work
3 together on broker services with those that
4 are providing them.
5 We do have over 10,000 people who are
6 at some point in self-direction plans and are
7 self-directing, many of them very
8 successfully so. So what I would offer to
9 you is if you would want to have an
10 opportunity for us to come and have a meeting
11 with some families around self-direction, we
12 have done that successfully in some other
13 parts of the state where we have some people
14 who are really quite knowledgeable in
15 self-direction. We've gotten wonderful
16 feedback when we've had those family
17 meetings --
18 ASSEMBLYWOMAN MILLER: I would
19 appreciate that. I think --
20 ACTING EXEC. DEP. CMR. DeSANTO: And I
21 think that that might be a good next step,
22 perhaps.
23 ASSEMBLYWOMAN MILLER: I think that
24 would be wonderful, but I also fear that --
146
1 and this is a concern of mine personally, but
2 I think for many families. Self-direction is
3 wonderful for a population, but as with many
4 things in this population of the disabled,
5 it's not one-size-fits-all. It's far from
6 one-size-fits-all. I happen to have a child
7 who does not fit most, and this will not work
8 for him. It does not work for many families.
9 And what happens if it is working for
10 you very well, and then something happens?
11 What happens if something happens to the
12 caretaker? Or what happens if a baseline
13 changes? There are so many variables, so
14 many places where this can fall apart -- and
15 then what happens?
16 ACTING EXEC. DEP. CMR. DeSANTO: Yeah.
17 And I, you know -- certainly we have heard
18 concerns of families very similar to what
19 you're expressing.
20 I know that we have very actively been
21 thinking about the type of thing that's
22 referred to as a safety-net kind of
23 availability for people who are in these
24 types of service arrangements. But I would
147
1 also really just echo and reinforce what you
2 were saying, is there really is not a
3 one-size-fits-all approach for people.
4 Hopefully you're not experiencing
5 situations where families are only given a
6 certain option, because we really do want to
7 look at each person's individual needs in a
8 person-centered way and try to --
9 ASSEMBLYWOMAN MILLER: But when you
10 look at the alternative, which is removing
11 the workshops into an integrated -- which is
12 what the state is doing -- we're not left
13 with too much in the middle.
14 ACTING EXEC. DEP. CMR. DeSANTO:
15 For -- you're saying for the day supports,
16 when your family member might leave school?
17 ASSEMBLYWOMAN MILLER: So that's a
18 scary future.
19 Thank you.
20 CHAIRWOMAN YOUNG: Thank you very
21 much.
22 Senator Brooks.
23 SENATOR BROOKS: Thank you. Good
24 afternoon.
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1 ACTING EXEC. DEP. CMR. DeSANTO: Good
2 afternoon.
3 SENATOR BROOKS: We've been conducting
4 a number of community meetings in my district
5 over the last few weeks, and in many of the
6 meetings we have people with developmental
7 disabilities coming forward and indicating
8 that the county has cancelled various bus
9 routes they were using for transportation,
10 making it impossible for them to get to
11 certain meetings. And in some cases their
12 providers are unable to get to where they
13 are, because they're individuals on reduced
14 income.
15 How does your agency monitor changes
16 in the environment as far as the elimination
17 of transportation or other issues along those
18 lines?
19 ACTING EXEC. DEP. CMR. DeSANTO: In
20 terms of -- I'm sorry if I'm not maybe
21 catching exactly the question. In terms of,
22 you're saying, discontinuation of certain
23 types of service?
24 SENATOR BROOKS: Well, in this case,
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1 bus routes have been cancelled by the county,
2 that people no longer have a means of
3 transportation to get anyplace.
4 ACTING EXEC. DEP. CMR. DeSANTO: Yes,
5 I see. Well, we provide funding within many
6 of our service types that include
7 reimbursement to providers for
8 transportation. So I can't say that we
9 directly monitor, if you will, public
10 transportation changes, although we certainly
11 hear about it as a service coordination
12 function that we perform.
13 So what we would try to do in those
14 instances where we become aware of a
15 difficulty that someone may have in getting
16 to a service is work with that particular
17 provider of the service to see if there's a
18 way that we can provide assistance, either
19 through some type of adjustment to the rate
20 that the provider receives -- you know, we
21 try to look to see if that's a possibility,
22 if we become aware of it.
23 SENATOR BROOKS: Okay. So if a
24 municipality or a city or a county was
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1 considered eliminating transportation that
2 provided a service to disabled people, they
3 have no obligation to let you know of those
4 changes?
5 ACTING EXEC. DEP. CMR. DeSANTO: Not
6 that I'm aware of.
7 SENATOR BROOKS: Should they?
8 ACTING EXEC. DEP. CMR. DeSANTO: A
9 public transportation entity wouldn't, that
10 I'm aware of, need to call us and say, you
11 know, we're changing a bus route. They may,
12 often because they know the providers that
13 individuals are traveling to -- so that may
14 happen informally, but I don't know of a
15 requirement for that to happen, if it's a
16 county or other type of transportation
17 service.
18 Unless it's a Medicaid service -- I
19 don't know if you're referring to a Medicaid
20 type of transportation or if it's more like
21 some other type of vendor.
22 SENATOR BROOKS: Well, what we ended
23 up with -- probably a half a dozen informed
24 me, that came forward that had disabilities,
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1 where the bus service had been eliminated and
2 they had no way to get anywhere.
3 ACTING EXEC. DEP. CMR. DeSANTO: So,
4 you know, maybe we could be in touch with you
5 and work on the specifics of what you're
6 referencing.
7 SENATOR BROOKS: Okay. Great, thanks.
8 ACTING EXEC. DEP. CMR. DeSANTO: Okay.
9 Thank you.
10 SENATOR BROOKS: Thank you.
11 CHAIRWOMAN YOUNG: Thank you.
12 ASSEMBLYWOMAN GUNTHER: Ellen Jaffee.
13 ASSEMBLYWOMAN JAFFEE: Thank you.
14 What did -- you raise an issue
15 regarding similar proposals that I understand
16 are being made revising the respite rate
17 reimbursement, directly in discussion with
18 many of the organizations, huge
19 not-for-profits that really provide services.
20 I'm truly concerned, because they believe
21 that it would negatively impact their ability
22 to serve the children with disabilities and
23 for respite services.
24 So one of the organizations -- and
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1 this is repetitive in terms of the many
2 conversations I've had -- they do provide
3 respite for children with disabilities ages
4 about 6 to 11. Also they provide -- those
5 are after-school programs for them. They
6 also provide respite during school vacations
7 for the preschool children with disabilities,
8 before and after their programs, their
9 special education programs. And the families
10 truly need these kinds of services, because
11 their childcare programs generally do not
12 provide properly -- the care for these
13 children. So it is an issue.
14 The current proposal for the rate of
15 reimbursement for before- and after-school
16 respite and vacation respite will be cut --
17 it cuts them almost $8 an hour, which is what
18 is being proposed at this point. And --
19 which is significant in terms of the programs
20 being able to be sustained. However, when
21 they give them Saturday or Sunday respite
22 programs, they are getting funded for that,
23 which is very strange in how that
24 determination has been made.
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1 So, you know, it is really very
2 serious. The adult respite programs also
3 would be reimbursed at a higher rate. So the
4 change is going to be an enormous loss of
5 almost 30 to 40 percent in funding to these
6 major not-for-profit organizations and force
7 them to close programs, and the parents are
8 then left with very little opportunities to
9 provide that -- they're working to provide
10 that after-school programs or even vacation
11 programs. So it's not a luxury, it's
12 something that really is desperately needed.
13 So I wanted to raise that issue. And
14 in the conversations, I took some notes and
15 I -- in my conversations with the
16 organizations -- I wanted to share that
17 concern.
18 ACTING EXEC. DEP. CMR. DeSANTO: Thank
19 you for sharing it.
20 I'll just say very briefly that we
21 have been working very hard to ensure that
22 there are no interruptions to respite
23 programs. We have heard providers' concerns
24 about some of the changes that are happening
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1 to the rates, and honestly, some of the rates
2 are actually going to be better for
3 providers.
4 And there are new categories of
5 respite within our rate structure, and I
6 think in some instances we're really working
7 to make sure providers know which service
8 they provide and how it fits into the rate
9 structure.
10 Because we think there's also a lot
11 of -- I don't want to call it misinformation,
12 but people don't yet totally understand the
13 way these respite programs are now going to
14 be falling into categories and funded. So we
15 have been doing a lot of work with providers,
16 both individually and also collectively.
17 I think I mentioned earlier we're
18 going to do a webinar with them again -- this
19 is the second time, but later this week --
20 and we've done a lot of outreach to make sure
21 that those providers who are concerned that
22 they will not be able to continue to provide
23 the service, that that, you know, does not
24 happen.
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1 Certainly we agree with you that it's
2 just a crucial service and we can't afford to
3 lose one program of respite. So we're
4 thinking --
5 ASSEMBLYWOMAN JAFFEE: I also just
6 want to follow up on the conversation earlier
7 regarding the assistance to ensure that we
8 have the salaries for our workers within
9 these facilities. They're really essential.
10 They're required to have certification,
11 they're required to -- even the teaching
12 assistants have to have certain
13 certification. And their salaries are in
14 many cases almost at the poverty level,
15 literally.
16 So we need to provide that kind of
17 funding so that these really dedicated
18 educators in these programs are provided with
19 the funding to be able to assure that they
20 have the salaries to maintain them. Because
21 what happens is they leave, they go to the
22 public schools where they can get the health
23 insurance as well. So -- and this is very
24 high need areas and programs.
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1 So I just wanted to share that in
2 terms of the funding availability for the
3 programs, the not-for-profits.
4 Thank you.
5 ACTING EXEC. DEP. CMR. DeSANTO: Yes.
6 Thank you.
7 CHAIRWOMAN YOUNG: Thank you.
8 Senator Savino.
9 SENATOR SAVINO: Thank you, Senator
10 Young.
11 Good afternoon, Commissioner.
12 I'm sure that you've heard from many
13 of my colleagues about the concern about the
14 staffing issues, so I'll try and not be
15 repetitive. But I just want to make the
16 point that I know for the last six years,
17 every year the Governor's call letter to the
18 agencies is asking them to submit their
19 budget with a zero, a zero percent growth
20 budget, which -- astounding enough as it is,
21 but even in light of that, this agency
22 somehow or other, after seven years, is
23 spending $134 million less than it was when
24 the Governor first took over, in an agency
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1 that is dealing with probably the most
2 vulnerable of our citizenry.
3 And now we have the added complication
4 of the increased minimum wage. And I have
5 said this many, many times: The fact that we
6 even consider this work as minimum wage work
7 is appalling enough as it is. The direct
8 support professionals should be recognized
9 for the fact that they are in fact
10 professionals. And we're not taking care of
11 widgets, we're not putting hamburgers in a
12 bag, we're taking care of incredibly
13 vulnerable populations.
14 But we're not providing sufficient
15 resources to this nonprofit sector who we
16 rely on to take care of our most vulnerable
17 population, to be able to do so and to be
18 able to retain and train and keep these
19 direct support professionals. And the
20 reality is that we're looking at a vacancy
21 rate and a turnover rate in some of these
22 agencies that just in the past two years has
23 jumped from 7.76 percent to 11.8 percent.
24 Now, I can't imagine that that's not
158
1 going to get worse, the pressure on these
2 agencies to not just meet the minimum wage.
3 Because we're not providing sufficient funds
4 for it is going to make it even harder.
5 There's the wage compression issue
6 that they're now going to have to deal with,
7 and I foresee a real crisis in this sector if
8 we are not -- if we don't adequately provide
9 funding for it.
10 So I'm just curious as to -- as the
11 person who's sent here to justify the budget,
12 how do you guys explain to the Governor's
13 office that his demand for a zero-growth
14 budget is, one, unrealistic for the
15 population that you're serving here and, two,
16 really does a tremendous disservice to the
17 workforce and the work that they do?
18 I mean, as a state, we can't on one
19 hand say that, you know, working in a fast
20 food restaurant and taking care of the
21 developmentally disabled are equal work.
22 They are not. They just simply are not. And
23 I think it's time that we recognize that and
24 we begin to adequately provide funding for
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1 the workforce, because if not, we know -- you
2 know, I used to be a caseworker -- when you
3 disrupt the workforce and you disrupt the
4 care providers, it has a serious effect on
5 the people that you're taking care of. If
6 they're in occupational health and if there's
7 a setback emotionally, there's a setback.
8 So I'm just curious as to how you
9 think we're able to provide this type of
10 service to people who really depend upon it
11 with basically no money.
12 ACTING EXEC. DEP. CMR. DeSANTO: Well,
13 you know, I would say again that there
14 certainly is a significant investment that's
15 made this year to ensure that we can meet the
16 minimum wage requirements for our providers.
17 I think that's an important step.
18 There is a lot of support in this
19 budget for many types of services, and over
20 the years we certainly have made investments
21 in this workforce for the cost of living.
22 But certainly we recognize and agree that the
23 direct support professional job is a very --
24 it's a very demanding job, and it is critical
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1 to the services that we provide.
2 So we certainly want to go forward and
3 do everything that we can, looking at
4 compensation and other factors, to make sure
5 that the workforce that's needed can be
6 recruited and that there's good retention in
7 our direct support workforce. I think we
8 certainly would agree with that. We'd want
9 to work with you on that going forward.
10 SENATOR SAVINO: Well, I'm sure you
11 believe that. The problem for you, I guess
12 someone in your position, is that your agency
13 is not making that known to the bean counters
14 at the Division of Budget. Because they
15 certainly don't realize -- they either don't
16 realize it or don't believe it, or they
17 believe that with a zero-growth budget for
18 the past seven years that you're able to
19 accomplish all of these things for the most
20 vulnerable population without needing any
21 extra money. And I don't -- I just don't
22 think that that's realistic.
23 And I think that it becomes incumbent
24 upon you and your team to convince the
161
1 Governor's office that they're wrong, that
2 asking you for a zero-growth budget is just
3 unrealistic, unfair, and quite frankly, it's
4 inhumane to the population that you're
5 serving.
6 So while there might be in this
7 budget, and I think that's still debatable,
8 the funding to provide -- I'm going to stop
9 soon -- for the minimum wage, it doesn't
10 accommodate for what we know is the wage
11 compression issue for the people who are
12 right above it. And that continues to
13 denigrate the workforce. Because why would
14 anybody want to stay if they can work
15 somewhere else, in a fast food chain
16 restaurant, and go home every day after an
17 eight-hour shift and not have to worry about
18 whether or not a consumer that they were
19 taking care of is suffering or not?
20 Believe me, if it were up to me, I
21 would not want to do this work. You have to
22 worry about the Justice Center, you have to
23 worry about the people you're taking care of.
24 It's just -- it's unrealistic to think that
162
1 we're going to be able to recruit and retain
2 quality people to stay in this job if we
3 don't acknowledge the work that they're
4 doing.
5 So I just ask that you and those of
6 you who really know this work fight a little
7 harder for the people who really, really need
8 it. Thank you.
9 ACTING EXEC. DEP. CMR. DeSANTO: Thank
10 you.
11 CHAIRWOMAN YOUNG: Thank you.
12 ASSEMBLYWOMAN GUNTHER: Assemblywoman
13 Rosenthal.
14 ASSEMBLYWOMAN ROSENTHAL: Thank you.
15 First thing, I agree with Senator
16 Savino, as probably all of us on this board
17 do.
18 I want to ask you about START, OPWDD's
19 increased community-based crisis intervention
20 and prevention services for people with
21 intellectual and developmental disabilities
22 and co-occurring mental health and behavior
23 health needs.
24 Last year the State Legislature
163
1 appropriated $50 million for the budget for
2 START, and this year OPWDD is requesting
3 $12 million to expand START in the downstate
4 region. Can you describe how START is
5 working, and maybe explain how many people
6 have been served both upstate and downstate?
7 ACTING EXEC. DEP. CMR. DeSANTO: Sure.
8 So the START program, as you referenced, is a
9 program that assists people who have
10 behavioral health needs in addition to
11 developmental disabilities. And I think
12 we've all seen that many of these individuals
13 can have crisis situations that hopefully can
14 be avoided through a more proactive and
15 therapeutic approach, which is what the START
16 model brings about.
17 So we began the START program both in
18 the Hudson Valley and in Western New York.
19 Those are the most established START
20 entities. We went into New York City last
21 year, we'll go into Long Island this coming
22 year, and then, finally, we'll go back
23 upstate to the Southern Tier and Central
24 New York area.
164
1 I don't have the exact number of START
2 participants; there are hundreds of them.
3 But we do have some information to show that
4 we are able to prevent people who had
5 previously had to go to hospital situations
6 to be supported when they were in crisis,
7 we've been able to prevent that type of thing
8 from happening. So we are seeing a lot of
9 success as we continue to implement the
10 model.
11 One of the things that we will be
12 setting up soon are crisis centers which are
13 actually -- you might relate to them more as
14 respite types of settings, where people can
15 go actually for short periods of time who
16 need that type of ability to get away from
17 the situation that they live in in order to
18 become stable. So we are seeing a lot of
19 success with the model, and we're very
20 pleased that we'll be able to be supported to
21 continue to move it into other parts of the
22 state this year.
23 ASSEMBLYWOMAN ROSENTHAL: So it's in
24 the five boroughs in the city, but how is
165
1 it -- how are the personnel divided?
2 ACTING EXEC. DEP. CMR. DeSANTO: Well,
3 it's just this past year was when we really
4 began to get up and running in New York City.
5 And so I'm not sure when you say the
6 personnel -- or how does it go about serving
7 all of the five boroughs?
8 ASSEMBLYWOMAN ROSENTHAL: Right.
9 ACTING EXEC. DEP. CMR. DeSANTO: Yes.
10 We have a couple of different providers who
11 are engaged in the services there. I'm
12 sorry, I don't know off the top of my head
13 the number of staff that are dedicated in the
14 boroughs, but we divided it up into two areas
15 in New York City to be able to meet the --
16 what we anticipate to be the number of people
17 who will need to be supported there.
18 And it's really just kind of beginning
19 to get off the ground, so maybe we could at a
20 later point in time report back to you on
21 some of the -- some of what we're finding
22 there in terms of numbers of people and their
23 needs.
24 ASSEMBLYWOMAN ROSENTHAL: Right. I'd
166
1 appreciate that. Thank you.
2 ACTING EXEC. DEP. CMR. DeSANTO: Thank
3 you.
4 CHAIRWOMAN YOUNG: Anyone else?
5 ASSEMBLYWOMAN GUNTHER:
6 Mr. Santabarbara.
7 ASSEMBLYMAN SANTABARBARA: Yes, thank
8 you.
9 I have a question about rate
10 rationalization. We heard from a provider
11 agency recently about their experience with
12 the rate rationalization. And this was an
13 upstate provider, their budget runs from
14 January to December. In November of 2015,
15 they were notified of an anticipated rate
16 which would have been retroactive to July of
17 that year. On December 31st they were
18 notified by OPWDD that their rate was
19 actually higher than that anticipated rate,
20 giving them a surplus. So since the new
21 rates are based on the previous odd-number
22 year, when the rate for 2017 is figured from
23 the previous odd-number year, they're going
24 to see a different rate, a lower rate. So
167
1 they're kind of going to be penalized because
2 of that delay in providing that information.
3 So I just wanted to ask, have you
4 heard of this happening before? How often
5 does it happen? And are there plans to
6 address this sort of disconnect?
7 ACTING EXEC. DEP. CMR. DeSANTO: Yes.
8 So rate rationalization was a move in our
9 system that was something that CMS, our
10 federal agency, required, which was to go to
11 cost-based rates. And we had previously had
12 something called budget-based rates.
13 With a cost-based rate, as you kind of
14 referenced, the amount of money that you
15 receive for a service is based upon cost
16 reporting that you provide to the state. And
17 then at some point in the future it's
18 reconciled in one way or another with your
19 actual costs, and your rate change is based
20 upon that.
21 So it has certainly been a significant
22 change for our providers in terms of how they
23 had been operating, and it was also a
24 significant change for New York State to be
168
1 administering the rates in this way. So
2 hopefully we're getting to a point where we
3 are more timely in giving providers
4 information about the rates and how they will
5 be changing.
6 They, by the way, are telling us
7 feedback about how they feel. The process
8 maybe could be adjusted to work better for
9 them, and we are working with our providers
10 as well as the Department of Health, which is
11 actually responsible for rate setting. For
12 our providers, we're engaged in many ongoing
13 conversations about this, both with our
14 providers and the Department of Health, and
15 we have several proposals in front of us from
16 providers as to what they'd like to see in
17 terms of some changes to the system.
18 ASSEMBLYMAN SANTABARBARA: Okay. So
19 we can look to see some changes to address
20 this in the near future?
21 ACTING EXEC. DEP. CMR. DeSANTO: We
22 are considering ways in which they would like
23 to see us make improvements in that.
24 ASSEMBLYMAN SANTABARBARA: Okay.
169
1 Thank you.
2 ACTING EXEC. DEP. CMR. DeSANTO: Okay.
3 CHAIRWOMAN YOUNG: Well, I think we're
4 all set. So thank you so much for testifying
5 today, and we truly appreciate it.
6 ACTING EXEC. DEP. CMR. DeSANTO:
7 You're very welcome. Thank you for the
8 opportunity.
9 CHAIRWOMAN YOUNG: Thank you.
10 Our next speaker is Arlene
11 Gonz·lez-S·nchez, commissioner of the
12 New York State Office of Alcoholism and
13 Substance Abuse Services.
14 Welcome. Okay, glad to have you here.
15 We have a copy of your testimony, and you can
16 start any time, Commissioner.
17 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
18 you so much.
19 Good afternoon, Senator Young,
20 Assemblymember Farrell, Senator Amedore,
21 Assemblymember Rosenthal, and distinguished
22 members of the Senate and Assembly
23 committees. My name is Arlene
24 Gonz·lez-S·nchez, and I am commissioner of
170
1 the New York State Office of Alcoholism and
2 Substance Abuse Services, known as OASAS.
3 I want to begin by thanking you for
4 your support of our mission at OASAS and for
5 giving me the opportunity to present
6 Governor Cuomo's 2017-2018 Executive Budget
7 as it pertains to OASAS.
8 As you know, OASAS oversees one of the
9 nation's largest addiction services systems.
10 It includes more than 1,600 programs that
11 assist nearly 100,000 New Yorkers on any
12 given day. In addition, more than 336,000
13 school-age young people receive prevention
14 services annually.
15 Before I discuss the specific details
16 of the upcoming OASAS budget, I want to
17 highlight what we have accomplished in the
18 past year.
19 In 2016, I served, together with
20 Lieutenant Governor Kathy Hochul, as co-chair
21 of the Governor's Heroin and Opioid Task
22 Force. The Task Force held listening forums
23 statewide to hear from individuals, families,
24 providers, and community leaders about their
171
1 local needs for combating this epidemic.
2 With your support, Governor Cuomo signed
3 landmark comprehensive legislation
4 recommended by the task force to end the
5 opioid epidemic.
6 Our collaborative efforts have, among
7 other things, ended prior insurance
8 authorization, to allow for immediate access
9 to inpatient treatment, as long as such
10 treatment is deemed necessary by a physician.
11 In addition, utilization review by
12 insurers can begin only after the first
13 14 days of treatment, so as to ensure that
14 every patient receives at least two weeks of
15 uninterrupted care -- of course, if it's
16 deemed necessary by a physician.
17 To expand access to Naloxone, we now
18 require insurance companies to cover the full
19 costs of Naloxone when prescribed to people
20 who are addicted to opioids, as well as to
21 their covered family members on the same
22 insurance plan.
23 To reduce unnecessary access to
24 opioids, we have limited initial opioid
172
1 prescriptions for acute pain to no more than
2 a seven-day supply, with the exception for
3 chronic pain and other conditions. To ensure
4 that prescribers understand the risks
5 presented by prescription opioids, part of
6 their ongoing continuing medical education
7 requirements will now include three hours on
8 addiction, pain management, and palliative
9 care.
10 And to improve consumer awareness
11 about opioid risks, we now require
12 pharmacists to provide educational materials
13 to consumers about the risk of addiction,
14 including information about local treatment
15 services.
16 With the $25 million increase in the
17 current year's budget, we have launched a
18 number of new initiatives. We awarded 80 new
19 residential treatment beds and 600 new opioid
20 treatment program slots. We issued
21 procurements to fund 10 new regional
22 community coalitions and partnerships, as
23 well as 10 new peer engagement programs and
24 10 new family support navigator programs. We
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1 now have a total of 20 of each of these
2 programs statewide. Additionally, we opened
3 seven adolescent clubhouses and nine recovery
4 community centers.
5 As you can see, we have been very busy
6 advancing our key priorities and implementing
7 new programs to address this crisis, but
8 there is still much more work to be done.
9 The Governor's 2017-2018 Executive
10 Budget proposes $693 million that will allow
11 OASAS to continue to support existing
12 prevention, treatment, and recovery services.
13 In addition, this will allow us to expand our
14 key initiatives by adding eight adolescent
15 clubhouses, bringing the total up to 15
16 statewide; adding five new recovery community
17 centers, for a total of 14 centers across the
18 state; increasing treatment beds and opioid
19 treatment capacity; and continuing to advance
20 the Combat Addiction Public Awareness and
21 AntiStigma Campaign.
22 This budget supports OASAS' ability to
23 respond to needs identified by our
24 constituents throughout the state, including
174
1 the opening of ten 24/7 access treatment
2 centers and the development and planning of
3 two new recovery high schools.
4 The Executive Budget also includes
5 funding to support additional gambling
6 treatment and prevention services. These
7 funds come from the slot machine and gaming
8 table fees charged to all new casinos
9 operating in New York State.
10 So to conclude, Governor Cuomo's
11 2017-2018 Executive Budget enables us to
12 further reinforce our treatment system, boost
13 our statewide prevention efforts, and
14 strengthen our recovery programs so that all
15 New Yorkers have access to the system of care
16 they deserve.
17 We look forward to your continued
18 partnership as we advance these priorities.
19 Thank you for your time today.
20 CHAIRWOMAN YOUNG: Thank you,
21 Commissioner.
22 Our first speaker is Senator George
23 Amedore, who chairs the relevant committee.
24 Senator Amedore.
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1 SENATOR AMEDORE: Thank you, Senator
2 Young.
3 And thank you for being here today,
4 Commissioner. It's always great to see you.
5 No question that the Senate has taken
6 a lead in the addiction issue that we face in
7 the State of New York, and we have also
8 focused in on the heroin/opiate epidemic, and
9 it certainly remains a top priority.
10 I do have a few questions for you
11 today about and with the current Executive
12 Budget proposal. And as you have said in
13 your testimony, last year, after the addition
14 by the Legislature, we had approximately --
15 there was approximately $190 million that was
16 dedicated to the heroin/opiate fight.
17 Now we see the Executive Budget
18 proposing around $200 million. We also
19 understand that last year's appropriations
20 were not fully spent, nor are all of the
21 programs up and running. So can you tell us
22 which and how many of the programs authorized
23 last year have not yet been online, made
24 online?
176
1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
2 could certainly get you a list of those, but
3 what I will tell you is that all the dollars
4 that were appropriated have been committed.
5 So there may be a handful of programs
6 that are in the pipeline. And as you know,
7 sometimes the RFP processes really are
8 lengthy. But for the most part, the programs
9 are out the door. I mean, we've been very
10 busy around the state, you know, opening all
11 kinds of different types of support services
12 throughout the state. But I'll be more than
13 glad to give you the list of those that are
14 in the pipeline. But within the next couple
15 of months, all of the programs will be out.
16 SENATOR AMEDORE: Okay. Well, can you
17 tell us how much of the $200 million in this
18 year's budget is actually new funding, or is
19 some of it remaining in last year's budget?
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
21 Thanks for the question and the opportunity
22 to explain those numbers.
23 So the $200 million actually
24 represents -- based on admission information
177
1 that we have of folks coming into our system
2 in this year, we have projected that
3 47 percent, which comes out to $200 million
4 of our funds for treatment, will be dedicated
5 to treat this epidemic. That's where the
6 $200 million comes in.
7 If you notice, last year the figure
8 was 189 -- but due to some cash flow and
9 timing issues, the real figure was 174.
10 So when you add the $30 million, which
11 is the projection of how much we're going to
12 spend more, that comes out to that 204.203
13 that's in the book.
14 SENATOR AMEDORE: Okay.
15 I'd also like to know when we can
16 expect to hear the results of the initiatives
17 that we've already put in place. Last year
18 we had a whole array of new initiatives.
19 Given prior years, more money added to the
20 budget to fight addiction problems, there
21 seems to be a lack of either finding the
22 results -- because we continue to see reports
23 showing more overdoses, more Naloxone being
24 used, more admissions to the ERs with people
178
1 who have to go through the detox process.
2 So can you elaborate a little bit
3 about that?
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.
5 So, Senator, I guess what I could say
6 is that we have implemented really innovative
7 programs, and most of them haven't even been
8 operational for a full year. You know, some
9 of them have been operational for a couple of
10 months, so it's hard to tell the impact. We
11 anticipate that by the end of, I guess, next
12 year or this year, we will have better
13 information.
14 But, you know, the peer support
15 programs that we have put in place, which is
16 going to be crucial to work with individuals
17 that, you know, have been reversed, have had
18 an overdose reversed -- instead of being sent
19 out into the community without that
20 additional support, these individuals will
21 now work with that person to bring them into,
22 hopefully, a crisis intervention center,
23 where they could get the treatment that they
24 need.
179
1 So it's going to take a little bit to
2 really feel the outcomes of these new
3 innovative models that we're putting in
4 place. But I believe that we are going to
5 see a great improvement in the service.
6 SENATOR AMEDORE: Well, we always
7 would like to see some type of measurable
8 results when we're talking about hundreds of
9 millions of dollars being spent, taxpayer
10 dollars being invested in helping the service
11 providers and helping the peer-to-peer
12 services, whether in the multipronged
13 approach that we've been talking about and
14 investing in in the state, whether it's
15 prevention or treatment, recovery services
16 that we haven't seen before.
17 This last year's budget was huge in
18 recovery services, which I'm grateful for,
19 and also with the law enforcement side of
20 this issue. But we have to get to a point
21 where it's very tangible in the forms of
22 measuring the results so that we can best
23 find where we should be targeting the
24 necessary funds.
180
1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And I
2 agree. And all I can say is that we too are
3 very interested in -- and we are monitoring
4 and we will document outcomes, because I
5 agree. I mean, we have to know that we're
6 putting monies in the right direction and in
7 the right services. So we will do this.
8 SENATOR AMEDORE: Commissioner, can
9 you elaborate a little bit and explain the
10 recovery high schools that the Governor has
11 proposed in the budget?
12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.
13 So the recovery high schools is an
14 innovative, multiservice high school model
15 where adolescents or young adults that are in
16 recovery could go to continue their education
17 in a fairly sober, safe, supportive
18 environment where they could develop the
19 supports necessary that they need to succeed,
20 not only academically but also vocationally,
21 educationally, and in the community. And
22 that's the intent of these sober homes.
23 SENATOR AMEDORE: Okay, so I believe
24 there's two being proposed, one upstate, one
181
1 downstate. But how would the state site
2 these recovery high schools? Would there be
3 local community input?
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: There
5 will be community input. There will be local
6 community input, SED, family members, young
7 folks in the community. Of course, yeah.
8 SENATOR AMEDORE: Okay. And how would
9 students be protected and kept safe such that
10 these schools do not -- so that they will not
11 become targets from drug dealers or hindered
12 by other students in recovery?
13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
14 that's specifically the idea why we're
15 calling them recovery schools. They will be
16 in a setting where they'll be with other kids
17 that are in recovery, there will be supports
18 there, there will be counselors, there will
19 be teachers -- it's not part of the
20 mainstream school environment.
21 SENATOR AMEDORE: So once a student is
22 admitted to the school, will he or she stay
23 there until graduation --
24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.
182
1 SENATOR AMEDORE: -- or will they
2 return to their home school once they get to
3 a point --
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.
5 The idea is to stay in the recovery high
6 school until they graduate.
7 As a matter of fact, there's a great
8 model in Boston that has shown that
9 75 percent of the young people that have gone
10 through the recovery school have maintained
11 sobriety, and 80 percent have actually
12 graduated and gone on to college. So it
13 seems to be a very, very good model for both
14 academic as well as sobriety in keeping --
15 recovery.
16 SENATOR AMEDORE: I want to kind of
17 shift the topic a little bit from heroin and
18 opiates and still stay on addiction.
19 We in the State of New York now are
20 starting to see the casinos opening, as well
21 as a new one that's going to open on
22 Wednesday right here in the Capital Region,
23 in Schenectady. What is your agency doing to
24 proactively respond to the possibility of
183
1 increased gambling addiction?
2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So, as
3 you well know, the Governor has ensured that
4 we get -- this year we're getting
5 $3.3 million from the fees that are attached
6 to the table machines and the gaming
7 machines, a total of $3.3 million once all
8 the four casinos are open.
9 And the idea is to use that money to
10 develop what we're calling Gambling Resource
11 Centers, or Centers of Excellence, that will
12 particularly work with individuals who have
13 problem gambling issues. They will be able
14 to do assessments, they will be able to do
15 counseling and target in on those individuals
16 primarily.
17 SENATOR AMEDORE: Okay. Well, my time
18 has expired here, but I want to thank you for
19 your testimony.
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
21 you.
22 CHAIRWOMAN YOUNG: Thank you.
23 Assembly?
24 ASSEMBLYWOMAN ROSENTHAL: Okay. I'm
184
1 Assemblymember Linda Rosenthal. Thank you
2 for being here, thank you for your work.
3 I'd like to say at the outset that the
4 amount of money in the budget for OASAS is so
5 low when there is a heroin and opioid crisis
6 ravaging the state. And we hear all about
7 that, that -- even in press releases, that
8 there is such an epidemic, yet the amount of
9 money budgeted for treatment, recovery, all
10 of that is pitifully low. And I just want to
11 register my shock that it continues to be so
12 low.
13 And I would urge everyone to try to
14 put more funding here. Those who have access
15 to a lot of funding should direct it here,
16 because this is a scourge that is killing
17 future generations. We know that. We see
18 kids earlier and earlier getting addicted to
19 drugs, whether it's opiates, pills they steal
20 from their parents' or their friends'
21 cabinets in the bathroom, or when they
22 graduate to heroin on the street. It's
23 really kind of reprehensible.
24 So -- but thank you for your work on
185
1 this issue. I wonder if you could tell me a
2 little bit about the development of community
3 treatment beds. Can you tell me how OASAS
4 determines where to place the new beds, and
5 what types of beds are being developed around
6 the state?
7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
8 So we get input from local government, we use
9 also statewide national data, CDC data as
10 well as our own data that we collect from the
11 communities, and we develop a sense of where
12 the needs are for not only treatment beds but
13 programs in general. That's how we actually
14 determine where programs are needed.
15 ASSEMBLYWOMAN ROSENTHAL: So I've
16 heard many stories, particularly from upstate
17 regions where people have to travel long
18 distances in order to access available
19 treatment beds. Is there any form of
20 transportation aside from, you know, their
21 support system's car, their friend's car,
22 their family's car, their own car? Is there
23 any kind of transportation within the state
24 for people who decide now is the time that I
186
1 have to go get myself to a detox center, a
2 treatment center?
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We
4 don't have any type of transportation per se
5 in our system, but I'll get back to that
6 thought of something that we're envisioning
7 doing as we move forward.
8 But, you know, I want to remind
9 everyone that we do have that link on our
10 website that now, by the way, includes all of
11 our treatment programs. Last year when I
12 testified in front of you, it was only
13 including inpatient beds. Now it includes
14 all treatment services. So that gives people
15 an idea of where the beds are or where the
16 treatment programs are available.
17 At any one time, you know, when you
18 look in that system, you see that there is
19 treatment available throughout the state.
20 Now, I have to be honest and say that
21 treatment is not always right down the block
22 from the individuals, and that's what we also
23 take into consideration as we move forward in
24 doing our planning.
187
1 But to answer your question, the state
2 does not provide any type of transportation
3 per se. But those 24/7 centers that I
4 mentioned -- that are part of this new
5 initiative going forward that we're looking
6 to establish 10 of -- will be sort of like a
7 hub where individuals, when they are ready,
8 when they've said "I am ready, I need
9 treatment," they could go to that location
10 and they will be assessed, they will be
11 stabilized and then referred to whatever
12 other treatment they need.
13 In other words, now, right now, what
14 I've been hearing -- and I'm sure you hear
15 the same -- as I go throughout the state is
16 that, you know, people don't decide that
17 they're ready to go into treatment between
18 9:00 and 5:00. Most of the time, it's on a
19 Sunday at 3 o'clock in the morning, and the
20 only thing really available is your local
21 emergency department.
22 So we want to change that. And we're
23 proposing those 24/7 -- 24 hours, seven days
24 a week -- hubs that will provide that level
188
1 of care.
2 ASSEMBLYWOMAN ROSENTHAL: And where
3 would they be located?
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We're
5 going to do an RFP, and it's going to be
6 determined based on need. So wherever the
7 greatest needs are, that's where we plan to
8 develop the programs.
9 ASSEMBLYWOMAN ROSENTHAL: But it's 10
10 throughout the state?
11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
12 Throughout the state.
13 ASSEMBLYWOMAN ROSENTHAL: Yeah. I
14 mean, that's -- it's a good idea, but 10 is a
15 paltry number when you look at how many
16 people are coping with substance abuse
17 disorders.
18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
19 agree. But, you know, we have to start
20 somewhere.
21 ASSEMBLYWOMAN ROSENTHAL: Well, that's
22 certainly true.
23 So we did a quick search on the
24 dashboard to see where there were beds
189
1 available, and here are just a few examples.
2 Within a 50-mile radius of Rochester,
3 there are 30 beds available. And within a
4 50-mile radius of Utica, there are 44 beds
5 available. I mean, it sounds like a very
6 small number. Can you speak to that? I
7 mean, the dashboard is good if you meet the
8 criteria for the open bed. But if you don't,
9 then you have to go further, or not go at
10 all.
11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
12 I guess it would help me to understand what
13 level of treatment we're talking about. That
14 would be helpful. I mean, the fact that we
15 have 40 beds and 33, we have capacity within
16 the system for treatment beds. Not everyone
17 needs that level of care, so --
18 ASSEMBLYWOMAN ROSENTHAL: Okay. Can
19 you talk a little bit about residential
20 redesign, and how many providers have been
21 approved and what services they're providing
22 and where they're located?
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
24 We have a total of I want to say 26 or 29
190
1 providers that are -- can apply for this
2 redesign. To date, I believe we have maybe
3 13 or 14. I don't have the numbers, but I
4 will give them to you.
5 ASSEMBLYWOMAN ROSENTHAL: Okay.
6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: The
7 idea of this redesign is to establish a
8 one-stop shopping in our treatment continuum.
9 Currently people go into, let's say, an
10 outpatient clinic. They are a residential
11 program. They stay there and they need to be
12 there from point A to point B.
13 What the redesign does is it really
14 addresses the need of the individual once
15 they come in the door. In other words, if
16 the individual does not need three or four
17 months of stabilization before they go into
18 the next level, then they just get a month of
19 stabilization, go to the next level, which is
20 integration, and then work on going back into
21 the community. It's a really
22 patient-centered model that looks at the
23 needs of the individual.
24 Currently what we do is that if a
191
1 person comes into most of our treatment
2 programs, they have to stay there for, let's
3 say, a year or 18 months, and they go through
4 that same process. But there are individuals
5 that don't need that level of care. And so
6 that's what the redesign does. It really
7 focuses on the need of the individual that
8 comes in the door. It focuses on the level
9 that they need, and then graduates the
10 individual out of the program.
11 ASSEMBLYWOMAN ROSENTHAL: Okay. I
12 want to ask you about Naloxone. Can you say
13 where you think Naloxone should be available?
14 For example, pharmacies have it, doctors have
15 it, and more and more just regular people are
16 getting access to it because you never know
17 when you might need it.
18 What areas do you think need to have
19 more access or cheaper access to the kit?
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
21 I think that we're all -- the Department of
22 Health has -- well, Dr. Zucker and myself
23 feel that, you know, everyone -- we're
24 aggressively out there talking about
192
1 Naloxone, and wherever people are interested,
2 we are there to do the training. So if it
3 was up to me, I think Naloxone should be
4 available to everyone and anyone who wants it
5 and who may need it.
6 ASSEMBLYWOMAN ROSENTHAL: Okay, I see
7 my time is up. That's it for right this
8 moment. Thank you.
9 CHAIRWOMAN YOUNG: Thank you,
10 Assemblywoman.
11 Commissioner, I had a few questions.
12 As you know, last year the Governor's
13 proposed budget had $164 million in funding
14 for the heroin and opioid crisis, and the
15 Legislature worked with the Governor in the
16 final enacted budget to increase that amount
17 to $189 million.
18 Could you please provide a
19 clarification, because I didn't really hear
20 it when Senator Amedore was asking. The
21 Governor is characterizing in his budget that
22 there's $30 million in new programming. It's
23 not clear what's new and what's being carried
24 over and being billed as new from 2017. I
193
1 believe that Senate Finance has asked for a
2 clarification a few weeks ago; we haven't
3 received it yet.
4 So could you please tell us today
5 which programs are new and which ones are
6 existing or being expanded on?
7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
8 so I -- in my testimony I indicated the
9 clubhouses, the peer support programs, the
10 prevention, the recovery support services --
11 CHAIRWOMAN YOUNG: Weren't those in
12 the 2017 budget, though?
13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Part
14 of them were, yes. And then we added
15 additional ones in this past year.
16 But what I could do is provide you a
17 list that will show you exactly where we are,
18 which is what I agreed to do with the
19 Senator, so that it's clearer what programs
20 are in the works and which have already been
21 operationalized.
22 CHAIRWOMAN YOUNG: Thank you.
23 How many people have been served so
24 far in the programs from the increased
194
1 funding that we provided last year? Or this
2 year, 2017.
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
4 don't have that number, but I will get that
5 to you.
6 CHAIRWOMAN YOUNG: Okay, thank you.
7 The Governor also proposes that the
8 increased funding will be used for 10 new
9 regional 24/7 urgent access centers that
10 offer substance abuse disorder services, and
11 the formation of 10 new community coalition
12 programs. There was a federal grant for the
13 community coalition programs that was awarded
14 in 2014 for 10 counties. Just to be clear,
15 is this that federal funding, and it's been
16 held off and now it's finally being utilized?
17 Or is this new funding?
18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No,
19 this is new funding.
20 CHAIRWOMAN YOUNG: Okay. Thank you.
21 You've launched the overdose
22 prevention kits and Combat Heroin and Talk to
23 Prevent campaigns. Can you explain how
24 you're measuring the effectiveness of the
195
1 campaigns? You know, are you tracking
2 websites, unique individuals, people taking
3 action? How are you --
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So
5 there's a couple of ways. I mean, it's a
6 little tricky to get actual data, but what we
7 do is we track how many hits we get on our
8 website. We also have the HOPEline that
9 really usually gets a lot of the referral
10 calls, and we monitor those calls.
11 And we also monitor by word of mouth
12 what people are telling us. You know, I walk
13 around and people say, We've been seeing the
14 campaigns, your PSAs, you know, in the
15 theaters, on the radio. It's really working,
16 people are really coming out, opening, they
17 feel comfortable -- so there are various ways
18 that we are monitoring the effectiveness of
19 the campaign.
20 And I have to tell you, you know, I
21 really feel that the campaign has made such a
22 huge difference. I don't know if you feel
23 the same way as you see it, but you know,
24 recently there's been a large number,
196
1 primarily of parents that before would never
2 come out and talk and say, My child -- or my
3 loved one, or my husband, my sister,
4 whoever -- has a problem. I've been getting
5 more and more of those calls.
6 Confidentially, of course.
7 But I think it's because the campaign
8 is out there and people are getting to
9 understand that there's no reason why you
10 should be ashamed. This is a disease, and
11 we're here to help. So a lot -- some of it
12 is a little anecdotal, but we do have some
13 numbers, and if you would like I will share
14 that with you as well.
15 CHAIRWOMAN YOUNG: I'm glad to hear
16 that. And generally -- oftentimes agencies
17 provide a report to the Legislature on
18 results of certain funding or programming
19 that we're doing, so I don't know if there's
20 something you could do along those lines so
21 that we would have that information. That
22 would be helpful.
23 The other thing is I represent a very
24 rural area, and access to services is always
197
1 a challenge. I was at a school a few months
2 ago to honor the football team, and the kids
3 said to me, very matter-of-factly, "Another
4 one died last week." Meaning one of their
5 classmates died from an overdose. And it was
6 horrifying, because it's gotten to be so
7 routine for them.
8 But you talk about stigma and that
9 sort of thing. It's the feeling, in the
10 rural counties especially, that the figures
11 are severely underreported. And I think it's
12 for a variety of reasons as to who's actually
13 dying from overdoses. It is a stigma. Maybe
14 there's -- maybe the overdose caused heart
15 failure, and it's being reported that way
16 rather than a drug overdose. Maybe it's the
17 families don't want to have that.
18 But, you know, in Cattaraugus County
19 we had a meeting a few months ago, and they
20 were talking about a very low figure of
21 people actually dying from overdoses. So is
22 there any other way that we can have more
23 accuracy in what's being reported?
24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
198
1 as you know, the Department of Health is the
2 one who gets and coordinates that data. I
3 think that's a question that we should talk
4 to Dr. Zucker about.
5 CHAIRWOMAN YOUNG: I know we also
6 think, you know, that the days of silos --
7 but especially for a crisis like this -- that
8 it should be your agency and the Department
9 of Health working together on these issues.
10 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And I
11 didn't want to give you the impression that
12 we weren't. We are. But the issue of not
13 being reported -- I think there may be some
14 lag time in the reporting, and the one who's
15 really looking at the accuracy of the report
16 is the Department of Health, which is why I
17 raise that.
18 But yes, we work hand in hand with the
19 Department of Health to get the data. But I
20 think it may be a good thing to raise with
21 Dr. Zucker, he may have additional
22 information that I don't.
23 CHAIRWOMAN YOUNG: When your agency is
24 deploying resources for certain programs, do
199
1 you look at that data as to how you make
2 decisions on where funding should go?
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.
4 CHAIRWOMAN YOUNG: Okay. So that's
5 why it's so crucial, and that's why I'm
6 raising it. So I think that getting
7 everybody on the same page would be very
8 helpful. And I appreciate you saying that
9 DOH, they understand that. But I think we've
10 got to work together on these issues.
11 So thank you.
12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
13 you.
14 CHAIRMAN FARRELL: Mr. Oaks.
15 ASSEMBLYMAN OAKS: Yes, thank you.
16 One of the things that we're seeing,
17 just to follow up some on Senator Young's
18 questioning related to the opioid crisis that
19 we have, is finding that some of the
20 ambulance providers and other first
21 responders who now have been given or have
22 access to Narcan so that they can provide
23 that to individuals who might overdose -- the
24 costs of that are escalating as we're seeing
200
1 more use of that.
2 And so I guess the question would be,
3 then, are your resources coming from the
4 state which we budgeted last year, are those
5 being used for those purposes, actually of
6 reimbursing or providing the Narcan to those
7 providers?
8 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes,
9 absolutely. We do -- on our own do a lot of
10 training through our addiction treatment
11 centers, our own facilities, and everyone
12 that comes to the training leaves with a kit.
13 So yes, we continue to support those kits,
14 yes.
15 ASSEMBLYMAN OAKS: After they're used
16 and if there's ongoing issues, for instance,
17 an ambulance might come into contact with
18 that a number of times -- after they've been
19 trained and stuff, are those costs then back
20 on those individual departments? Or is the
21 state involved in reimbursing them?
22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Again,
23 that would be a question for DOH, because
24 this is where the dollars are. The Narcan
201
1 kits are there, so I would think that that
2 would be an -- and if it involves ambulances
3 and hospitals and EMTs, it would be under
4 DOH, not under my department.
5 ASSEMBLYMAN OAKS: Thank you very
6 much.
7 SENATOR KRUEGER: Senate?
8 Senator Kaminsky.
9 SENATOR KAMINSKY: Good afternoon,
10 Commissioner.
11 I'd like to echo the sentiments of a
12 lot of my colleagues. I'm in Nassau County,
13 in Long Island, and it's -- we're in some
14 very troubling times. The quick anecdote
15 that I like to tell, because it so succinctly
16 sums up the problem, is there's a principal
17 of a local middle school who's maybe a year
18 older than me -- so in the scheme of things,
19 hasn't been around all that long -- and she
20 told me that she went to the funerals of
21 three former students over a previous summer.
22 So we're really struggling with this crisis,
23 and we look forward to continuing working
24 with you on that.
202
1 Along those lines, one of the issues
2 we hear from a lot of our first responders in
3 my area -- that's for the most part volunteer
4 firefighters and police officers -- is that
5 they're administering Narcan -- so for
6 example, the City of Long Beach, where I'm
7 from, had about 40 separate incidents where
8 Narcan was administered last year. Many
9 times they're giving Narcan to the same
10 person over again, and no one is really sure
11 once it's administered what then happens to
12 the person, what then happens to the patient.
13 In other words, are they then
14 enveloped in some type of system that will
15 guarantee them some type of access to
16 treatment or support going forward? And so
17 we're definitely encountering people who need
18 help in the very first and obviously most
19 critical incidents, and I'm worried that
20 we're losing connection after that.
21 And I'm wondering if you could talk
22 about what your agency is doing to ensure
23 that we're able to not just save people when
24 they're in the most urgent need, but get them
203
1 to the healthy recovery that we're hoping
2 for.
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So
4 thank you. So that's what the peer navigator
5 program is all about. It's about having
6 peers working with the local emergency
7 departments in a particular region so that
8 when an individual is brought into the
9 emergency room after having been reversed,
10 that peer is automatically called. And then
11 that peer will start engaging the individual
12 during the 12 to -- six or 12 hours that that
13 individual is in the hospital being
14 stabilized.
15 Traditionally what happens is they
16 stabilize the individual, they may or may not
17 give them a referral to a treatment program.
18 The reality -- we know the reality, that
19 individual is not thinking about going into
20 treatment, he's just thinking about where am
21 I going to go and get my next hit, because
22 they don't want to go through withdrawal.
23 So that's why the peer is so
24 important. The peer will then engage that
204
1 individual, it would be that warm handoff
2 that will get that individual into a crisis
3 intervention setting and work with that
4 individual to convince that individual to go
5 into treatment rather than to go back into
6 the neighborhood and we know what happens.
7 SENATOR KAMINSKY: Certainly on
8 Long Island I would encourage us to meet
9 more, especially with the emergency room
10 providers, the hospitals -- I'm not really
11 sure at this very moment that they are up to
12 speed on what they should be advising people,
13 and I am hearing firsthand from some people
14 in the emergency rooms that people are just
15 kind of being discharged and kind of walk out
16 into the night.
17 So I'd love to work with you on
18 getting people together and making sure
19 everyone knows where they need to be.
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
21 Absolutely. Thank you.
22 SENATOR KAMINSKY: One great thing I
23 think that your agency has done is provide
24 local funding for the different community
205
1 coalitions. And I say all the time that it's
2 a problem that can't be -- you know, I used
3 to prosecute narcotics cases. We can't
4 prosecute our way through this. It's going
5 to take everybody pulling together -- our
6 churches, our schools, our community leaders,
7 student involvement, and certainly law
8 enforcement too. And you have provided
9 really nice grants to have these community
10 coalitions.
11 So down by me, whether it's Long Beach
12 or Rockville Centre, you are getting
13 religious leaders, school leaders, students,
14 law enforcement all together around the room
15 to figure these problems out. And I think
16 it's tremendous. And you definitely see
17 certain communities grappling with this
18 better than others, and I appreciate that and
19 hope you make them more available and
20 widespread, because a lot of communities
21 would love to avail themselves of that
22 resource.
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We're
24 thinking of expanding as well in this coming
206
1 year, so thank you. It's great to be --
2 SENATOR KAMINSKY: Sure. And lastly I
3 do want to especially point out that this is
4 a critical area that has had good bipartisan
5 collaboration, and needs to.
6 So first of all, I want to thank
7 Senator Amedore and Senator Akshar, who -- on
8 either side of me today -- certainly Senator
9 Boyle on Long Island. You know, there's not
10 time for partisanship here. We're drowning,
11 and everybody needs to pull together to help
12 here. So we all need to work together.
13 Please count on me as a resource for
14 whatever your agency needs, whether it's
15 information or anything else, and I hope we
16 can all work together to fight this. The
17 worst part of my job so far has been talking
18 to parents who have lost loved ones, and they
19 tell you about those last moments. And if
20 you're not moved by that or you're not
21 willing or resolved to do everything you can
22 to fix the problem, then you don't belong
23 here.
24 So I want to try, and I'd like to work
207
1 with you to continue to do that.
2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
3 you.
4 CHAIRWOMAN YOUNG: Thank you.
5 CHAIRMAN FARRELL: Thank you.
6 Assemblyman Cusick.
7 ASSEMBLYMAN CUSICK: Thank you,
8 Mr. Chair.
9 Commissioner, it's good to see you. I
10 want to first thank you and your team for
11 being on Staten Island many times. You're no
12 stranger to the folks I represent and the
13 people on Staten Island and to the issue of
14 the opioid and heroin epidemic that's going
15 on throughout the state.
16 But in my district and throughout
17 Staten Island, it's been -- you've worked
18 with all the elected officials, and the
19 Governor's resources have been very helpful.
20 And I just wanted to publicly acknowledge
21 that, because it's important that people know
22 that we need people in government to help us
23 in this epidemic.
24 My colleagues have talked about the
208
1 funding and where we're going with a lot of
2 these numbers. I wanted to ask a question on
3 treatment. Treatment is a big issue. I
4 think that treatment is the important cog in
5 this fight against the epidemic. We have
6 many qualified treatment facilities
7 throughout New York State, New York City, and
8 many dedicated professionals in that field.
9 A question I have for you is
10 particularly after we cut down on the usage
11 of opioid pills, prescription pills, with
12 I-STOP and the increase in heroin use -- are
13 there numbers that we know of, has there been
14 an increase in people seeking treatment in
15 the last year or two?
16 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
17 Actually, our data has shown that people
18 seeking services, inpatient services, have
19 increased for heroin and opioids and actually
20 decreased for all the other substances. So
21 yes, we have seen an increase in people.
22 ASSEMBLYMAN CUSICK: So we have seen
23 it working --
24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.
209
1 ASSEMBLYMAN CUSICK: And we have seen
2 the --
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes,
4 absolutely.
5 ASSEMBLYMAN CUSICK: That's very
6 important. I know that many of my colleagues
7 have been talking about seeing that the
8 funding that we put together is working, and
9 that's what I'm very interested in knowing,
10 is are people seeking treatment and are
11 people using it. And that's good to hear.
12 On that point too, one of my
13 colleagues brought up -- a couple of my
14 colleagues brought up Narcan. And Narcan has
15 been used as a tool -- particularly there are
16 many overdose cases in our borough and
17 throughout New York City. The question on
18 Narcan is how many folks who are administered
19 Narcan, how many of those -- are there
20 numbers that are available that show how many
21 of them then go to treatment after they are
22 saved from an overdose?
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
24 could see if we have that data. I'm not sure
210
1 right now if we actually do, but I will
2 certainly be collecting that. I mean, that's
3 something we need to be looking at, and
4 certainly moving forward we are going to,
5 so --
6 ASSEMBLYMAN CUSICK: Right. Because
7 again, I think it was my colleague Senator
8 Kaminsky that brought up that there are many
9 people who are being administered Narcan many
10 times, and I think it's -- we need to know
11 how many folks. Because we all know, and we
12 have -- on Staten Island, we have many of
13 these Narcan training events, and hundreds of
14 people come because it's mainly parents of
15 families who are scared to death. But we
16 point out that this isn't -- this saves them
17 from the OD, but from that point they need to
18 go get treatment.
19 And so I think if you could get us
20 those numbers, that would really be important
21 to us, particularly in this budget process
22 coming up.
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
24 think moving forward we'll have better
211
1 numbers because that's exactly what the peers
2 will be doing. And as you know, the peer
3 program has just started to become
4 operational.
5 Certainly we could get numbers from
6 the EDs where they say, you know, we've
7 released them and we've given them a
8 referral. The question is not so much the
9 referral, the question is if they make it to
10 the referral. So that's where the peers
11 would be ideal in collecting that data.
12 ASSEMBLYMAN CUSICK: And I just want
13 to add to the chorus here that the Senate and
14 the Assembly and the Legislature, in adding
15 money in last year's budget, I've seen the
16 dividends, I've seen the product of it.
17 We just opened up an adolescent
18 clubhouse in Staten Island. You've been out
19 on Staten Island, there have been many
20 roundtable discussions, but there is a strong
21 need for more funding. And I will urge my
22 colleagues -- I don't think there needs to be
23 much urging, but we will fight for more
24 funding.
212
1 Thank you.
2 CHAIRWOMAN YOUNG: Thank you,
3 Assemblyman.
4 Senator Krueger.
5 SENATOR KRUEGER: Good afternoon,
6 Commissioner.
7 So I represent a section of Manhattan,
8 and my district has a task force working with
9 the police department and the Department of
10 Homeless Services to deal with street
11 homelessness issues. We hear constantly from
12 the police and Department of Homeless
13 Services that there are homeless people who
14 need drug treatment who ask for it, who say,
15 Yes, I'll come in off the streets to go to
16 it, and they rotate through a three-day detox
17 and they can never get a slot in a
18 residential drug treatment program.
19 Now, these are going to be
20 Medicaid-eligible people, not private
21 insurance, and they're going to be people who
22 historically probably had a lot of trouble
23 getting any kind of medical records because
24 they are in fact homeless and on the streets.
213
1 There is often an overlap between mental
2 illness and substance abuse for people on the
3 streets. Both agencies are begging, How do
4 we get these beds that we need if you're a
5 street homeless person in New York City?
6 So you have funds for new residential
7 programs, you have a commitment to help
8 people with longer-term residential treatment
9 when the short-term models aren't working.
10 How do I get these folks into treatment?
11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So to
12 that I'd like to say that we are working hand
13 in hand with the Department of Homeless
14 Services in New York City, together with OMH
15 and ourselves, to identify shelters.
16 I believe there are a number of
17 shelters that have been identified as
18 high-needs shelters that do have a high
19 number of mentally ill and addiction
20 individuals. And we're in the process of
21 developing or -- not developing, we are
22 working through the process of assigning
23 shelters to our community-based
24 organizations. As a matter of fact, I'm
214
1 going to say two months ago or so I had a big
2 meeting in the New York City office where I
3 brought our community-based providers, our
4 addiction community-based providers, together
5 with the shelter operators so that they could
6 get to know each other so that when an
7 individual appeared at the shelter that
8 needed our services, that they knew who to
9 communicate with, whom they could reach out
10 to.
11 And so, you know, we have just started
12 establishing that relationship. Because I've
13 been hearing that, you know, there are
14 homeless individuals that need SUD
15 services -- but interesting enough, the
16 shelters didn't know that we had
17 community-support SUD providers that were
18 there to provide that service. So --
19 SENATOR KRUEGER: So I'm still
20 confused. So this is -- if someone goes into
21 a shelter, they can get referred into one of
22 your residential facilities?
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We
24 have -- what we have is community-based
215
1 providers that will either go out into the
2 shelters to do assessments off-site, because
3 now we're able to go out of the four walls of
4 the clinic and do assessments, and if we find
5 that there are people that are appropriate
6 for clinical treatment services, we could
7 refer them and treat them because of Medicaid
8 and so on and so forth.
9 So we have identified individuals that
10 will be, for the lack of a better word,
11 attached to a particular shelter, and they
12 can go once, twice -- you know, I don't know
13 the details of how often they'll go to the
14 shelters and do the actual assessments of
15 individuals and identifying the individuals
16 that may need additional care and engage them
17 to go into care.
18 SENATOR KRUEGER: Okay. So I think
19 we're talking about two different
20 populations. Because if you're somebody who
21 is homeless and in the shelter system, there
22 may be one pathway. But there are enormous
23 numbers of people who are homeless on the
24 streets who will not go into the shelters
216
1 because of the combination of being mentally
2 ill and substance abusing.
3 So the Department of Homeless Services
4 has a separate system of outreach workers who
5 coordinate with the police precincts, and
6 those people don't seem to be getting any
7 access to residential treatment.
8 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
9 So I need to be made aware of where, who,
10 and -- who they are. Because we too are
11 having -- we do outreach as well, now. The
12 peers are also going out and doing outreach
13 to the people in the street, like you say,
14 not people in shelters, people especially
15 around the 125th Street area, that whole
16 area, doing outreach to actually engage some.
17 But if there're others, please let me
18 know. I'll be more than glad to see how we
19 could be helpful.
20 SENATOR KRUEGER: Great. So you have
21 people who can come out, work with the
22 outreach teams and the police, and direct
23 people into treatment who say they want it?
24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We
217
1 have providers that will be able to do that,
2 yes.
3 SENATOR KRUEGER: So the peer
4 counselors, I think that's the term you use,
5 they actually have the authority to move
6 people into treatment slots?
7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: They
8 don't have the authority to move them, they
9 have the ability to engage them and get them
10 to agree to come into treatment, and then we
11 will provide the treatment that they need.
12 SENATOR KRUEGER: Okay. So yes, I
13 would love to know who in your office can
14 coordinate with us on the --
15 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
16 Absolutely.
17 SENATOR KRUEGER: We actually have
18 people who say, I want this, and nobody can
19 get them in -- not Department of
20 Homeless Services, police department,
21 nobody. So we want that access.
22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Great.
23 SENATOR KRUEGER: Thank you.
24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
218
1 CHAIRWOMAN YOUNG: Thank you.
2 Anyone?
3 CHAIRMAN FARRELL: Assemblyman
4 McDonald.
5 ASSEMBLYMAN McDONALD: Thank you,
6 Mr. Chair.
7 And Commissioner, thank you for your
8 great work. You and your team are always
9 very responsive to our needs. And, as I
10 always say, it's very difficult to catch the
11 wave when it's already been three or four
12 feet ahead of you. So we're working on it,
13 day by day and program by program.
14 I think Member Rosenthal kind of
15 started to get into this, and you -- I think
16 you called them hubs, these urgent access
17 centers?
18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.
19 ASSEMBLYMAN McDONALD: So I'm not
20 terribly familiar with them. Are they
21 currently in place in the state?
22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.
23 This is a brand new model that we're
24 introducing as part of this Executive Budget.
219
1 ASSEMBLYMAN McDONALD: Okay. I
2 remember -- is that what you were mentioning
3 as the hubs to --
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.
5 ASSEMBLYMAN McDONALD: Okay. And I
6 remember you saying that, you know, that's
7 going to be statewide, you're going to put up
8 an RFP to kind of see where the need is, and
9 then hopefully that will work out.
10 I guess the question is, do you
11 envision this being run by -- who are the
12 eligible entities? Is it a nonprofit, is it
13 a hospital system, is it a medical practice?
14 Do we have an idea of what it would be to --
15 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We
16 don't limit it, but I think the -- I think we
17 would like it to be a community-based
18 provider, but it's not limited to a
19 community-based provider. We're welcome to
20 see what proposals or responses we get.
21 Different areas may have different needs, may
22 have different setups, so we don't want to
23 limit any of the options that we have in
24 place.
220
1 ASSEMBLYMAN McDONALD: So is there
2 going to be -- and so I imagine it will be
3 not only for a physical site but also
4 staffing?
5 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Oh,
6 yes.
7 ASSEMBLYMAN McDONALD: Right?
8 Obviously. And is there going to be any
9 minimal clinical requirements for like a
10 nurse to be on duty? Or is it just going to
11 be clinical coordinators, is it going to be
12 social workers --
13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
14 it's going to be a clinical model. So, you
15 know, we'll develop the model as we go along.
16 But if it's a 24/7 urgent care, I don't know
17 that you're going to require to have an MD on
18 site.
19 ASSEMBLYMAN McDONALD: Right.
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: But
21 there will need to be access to an MD in the
22 event that you get an individual at three in
23 the morning that has to be stabilized, or a
24 nurse practitioner or a physician assistant
221
1 as we move forward. So it is going to be a
2 clinical model, but it's also going to have
3 other kinds of supports as well.
4 ASSEMBLYMAN McDONALD: And I imagine
5 it could be, you know, there are real -- in
6 the other medical world, there are urgent
7 care centers which are kind of like more a
8 family practice or primary -- you know,
9 emergency but not an emergency room.
10 Would they be excluded from that? Or
11 would they be able to -- or has that not
12 gotten that far enough down the road yet?
13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: You
14 know, I haven't thought about that. But, you
15 know, we have to look at the model and see.
16 If it works in certain areas because of the
17 limitation of the providers or the limits of
18 what we have in place, it may not be a bad
19 idea.
20 Right now we're not excluding
21 anything. We're open to proposals.
22 ASSEMBLYMAN McDONALD: Good. Thank
23 you.
24 As you mentioned earlier in your
222
1 testimony, there's a lot of different impacts
2 from last year's legislative session. One
3 was a leaflet that pharmacies are required to
4 give patients which is very complete, it
5 covers -- it's a great collaboration between
6 your agency and the Department of Health as
7 to really the dos, don'ts, the wants and
8 needs.
9 You know, one of the things that I've
10 always harped on is that the heroin epidemic
11 has been fueled by legally prescribed opioids
12 that are in the households. And that is part
13 of the information that's on those leaflets,
14 which is good.
15 The question that comes up is,
16 patients many times are saying, Well, what do
17 I do with this? How do I dispose of them?
18 And as we all know, pharmacies can take them
19 back. A lot are hesitant to, because you
20 have to worry about reverse distribution of
21 the drugs, the whole nine yards. Are there
22 any programs that are being supported through
23 OASAS to assist the community or the
24 community pharmacies or healthcare providers
223
1 to help facilitate disposal of legally
2 prescribed prescription drugs, to get them
3 out of the waste stream? Because as we know,
4 70 percent of heroin addicts started with
5 those prescriptions.
6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.
7 OASAS does not, but I understand that maybe
8 DOH may, because this really does fall under
9 their jurisdiction. But we currently do not.
10 ASSEMBLYMAN McDONALD: Okay. Thank
11 you.
12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
13 you.
14 CHAIRMAN FARRELL: Thank you.
15 CHAIRWOMAN YOUNG: Thank you.
16 So just -- we can go through the
17 lineup. Next is Senator Krueger. Wait.
18 Senator Brooks, that's right. Senator
19 Brooks, then Senator Akshar, and finally
20 Senator Ortt.
21 So Senator Brooks.
22 SENATOR BROOKS: Thank you.
23 First, to a point that's been made by
24 a number of the members, I think the problem
224
1 is being greatly understated. As a first
2 responder, we're seeing it on an
3 ever-increasing basis, and there are a number
4 of cases where we have people that we're
5 visiting multiple times. I think it's
6 important that we really get a handle on how
7 big this problem really is if we want to
8 address it and if you're going to prepare a
9 budget that's going to address the problem
10 itself.
11 But I think it really is still hidden
12 in many cases, and a lot of attention has to
13 be given to quantifying just how many cases
14 are out there.
15 But to move to a different area for a
16 moment, can you address programs that you're
17 currently undertaking to address veterans in
18 terms of problems with substance abuse?
19 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So we
20 currently do have a variety of
21 veteran-specific programs. Off the top of my
22 head I can't tell you exactly where they are,
23 but we do have programs that are specific to
24 do treatment and also recovery services. But
225
1 I must say that all of our programs, all of
2 them, serve veterans.
3 I mean, if we have -- we ask the
4 question "Who do you serve" as part of the
5 data that we collect on a regular basis, and
6 often all of the programs seem to have
7 several veterans in there.
8 So we do have programs that are
9 specific for veterans. Also, for women vets,
10 we have at least two residential treatment
11 programs for women vets. And we also have
12 for males, but I don't have them off the top
13 of my head. But --
14 SENATOR BROOKS: Well, when you have
15 reports that, as you put it, all of them
16 involve veterans, isn't that a signal to you
17 that you need to look at that group and
18 concentrate on what's happening with them?
19 The fact that they appear on every report to
20 me would suggest that you might want to have
21 a program that's geared at that segment of
22 our society directly.
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And we
24 do, we do have -- and I'll be more than glad
226
1 to share the number of specific vet programs
2 that we have in the system. But I think, and
3 maybe I'm opening a can of worms here, there
4 is an issue with TRICARE where veterans can
5 go and get their treatment, and that usually
6 hampers veterans coming to our system,
7 because the military won't pay for the
8 services.
9 But setting aside from that, we do
10 have specific programs for vets. And if
11 you'd like to get a list, I will be more than
12 glad to give them to you.
13 SENATOR BROOKS: Okay. Thank you.
14 CHAIRWOMAN YOUNG: Thank you.
15 Assembly?
16 CHAIRMAN FARRELL: Assemblyman
17 Santabarbara.
18 ASSEMBLYMAN SANTABARBARA: Yup thank
19 you.
20 Just a quick question about some
21 concerns of doctors not having training or
22 time with the increased amount of treatment
23 they've had to do with opiate use. I just
24 wanted to ask if we were keeping track of how
227
1 many doctors are actually authorized to
2 prescribe the medication for assisted
3 treatment.
4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: If we
5 have a number -- I believe we do, yes.
6 ASSEMBLYMAN SANTABARBARA: And is that
7 something we could find somewhere, that you
8 can report to us?
9 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I
10 could give you that report.
11 ASSEMBLYMAN SANTABARBARA: All right.
12 Thank you.
13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: You're
14 talking about doctors in our system? Or
15 outside of our system?
16 ASSEMBLYMAN SANTABARBARA: Actually,
17 both would be good, just to keep track of how
18 many people are actually authorized to
19 prescribe the medication needed.
20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
21 Sure.
22 CHAIRWOMAN YOUNG: All set?
23 Okay, Senator Akshar.
24 SENATOR AKSHAR: Great, thank you,
228
1 Madam Chairwoman.
2 Welcome, Commissioner. It's always a
3 pleasure to be with you, and I publicly want
4 to thank you and your team for being so
5 receptive when we have issues in the
6 Southern Tier.
7 Let me start with community-based
8 providers. You're very familiar with
9 Fairview Recovery Services in the
10 Southern Tier. And are we addressing the
11 cost-of-living adjustment anywhere in the
12 Executive's proposal? Fairview, for an
13 example, has had a 70 percent, 70 percent
14 turnover in 2016 because of the low pay. Are
15 we dealing with that issue specifically?
16 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
17 Senator, there's no cost-of-living increase
18 in any of the budgets. There's no reason why
19 it would be in my budget.
20 So the answer is no, we don't have a
21 cost-of-living increase or a cost-of-living
22 adjustment in our budget. You know, I do
23 want to emphasize the fact that we understand
24 and we take our workforce very seriously.
229
1 It's not to say that we undermine the work
2 that they do, that we don't value the work
3 that they do. It's quite the contrary,
4 especially in the addiction system.
5 But at the same time, the Governor has
6 put in millions of dollars in the budget to
7 address the minimum wage. And I understand
8 that the minimum wage and what we're talking
9 about, the cost of living, are somewhat
10 different from where I stand. We in our
11 system have $5 million that was put in to
12 address the minimum wage in our
13 community-based organizations.
14 So what that is telling me that's
15 currently -- even with the COLA adjustments
16 that we have had, as you've heard, you know,
17 in the last three consecutive years there's
18 still -- it's quite -- there are still quite
19 a few people that are doing way below the
20 minimum wage in our system of care. So, you
21 know, I support the fact that these
22 individuals have to be brought up to the $15.
23 With respect to the cost-of-living
24 adjustment, what I could say is that, you
230
1 know, I will continue to monitor the
2 agencies, work with the agencies, as I have
3 done in the past, to ensure that they can
4 still function within our parameters. And I
5 look forward to continuing my discussion with
6 the Legislature with respect -- you know, in
7 the context of the budget discussion.
8 SENATOR AKSHAR: Thank you.
9 What happened to the Technical
10 Assistance Unit that used to help providers
11 with documentation compliance? One thing I
12 hear from providers is that, you know, the
13 regulatory requirements are somewhat
14 difficult and OASAS doesn't provide case
15 model documents that accompanies the new
16 regulations. Do you do that? Am I being
17 given good information?
18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
19 I'm not sure that's accurate information. I
20 mean, if there's anyone that needs technical
21 assistance, we're there to give technical
22 assistance, so --
23 SENATOR AKSHAR: Do you still have a
24 particular unit called the Technical
231
1 Assistance Unit?
2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Not
3 per se. But our field office will be able to
4 assist.
5 SENATOR AKSHAR: Let me ask a question
6 about Narcan that's been brought up by
7 several of my colleagues. I, for one, am a
8 proponent of ensuring that there is more than
9 enough Narcan in the community. Senator
10 Young mentioned statistics being
11 underreported.
12 Is there somewhat of a concern that,
13 you know, first responders are required to
14 fill out certain documentation so we know it
15 was deployed, on whom -- because we're
16 putting so much Narcan into the system, could
17 we be underreporting statistics? We have to
18 set some form of benchmark in order for us to
19 determine whether we're successful or not,
20 right?
21 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Right.
22 I agree. And again, I think that's a
23 question better suited for the Department of
24 Health, as they are the ones that get the
232
1 actual documentation.
2 SENATOR AKSHAR: Okay, let me make
3 just two more points, if I may. I just want
4 to publicly bring up retrospective review, as
5 we've discussed in our conversation last
6 week. I just want to put that on the radar
7 and ensure that it stays on the radar and
8 that we do our due diligence in ensuring that
9 insurance providers are not abusing that,
10 because the last thing I'd want to see is
11 healthcare providers being reluctant to
12 provide that service that we're working so
13 hard --
14 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
15 Absolutely. And that's what we're focusing
16 on this coming year, to really look and make
17 sure that all the regulations that have been
18 put into place are being implemented. And
19 like I said to you, if you get any actual
20 cases, please report them to us.
21 I think what's been happening is that
22 sometimes the providers also do not submit
23 enough information to the managed care
24 company, enough so that the managed care
233
1 company can make a true evaluation and
2 determination of the case, in which case then
3 they will say, Okay, so now I'm going to go
4 retroactive.
5 So I think we need to be open to both
6 sides and we need to monitor that both the
7 insurance managed care company as well as the
8 providers are doing each their share. And
9 like I said, if you find instances where that
10 is occurring, please let us know. We would
11 like to intervene immediately.
12 SENATOR AKSHAR: Thank you. I know my
13 time is up. I have one last question, if the
14 Chairwoman would be so kind.
15 The Criminal Procedure Law allows for
16 asset forfeiture, and a portion of that asset
17 forfeiture by law enforcement requires a
18 portion of that money to go into the
19 Substance Abuse Services Fund. My question
20 is two parts. Do you know how much money is
21 currently in the Substance Abuse Services
22 Fund? And if so, what is it?
23 And then the second part of my
24 question is, how much money in this year's
234
1 executive proposal for OASAS is coming from
2 the Substance Abuse Services Fund?
3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So the
4 first question is, you know, the actual
5 amount fluctuates from year to year, based on
6 court proceedings and what happens in the
7 courts.
8 And in terms of how much money comes
9 into OASAS, we fund our campaign out of that,
10 we do some of our peer supports, we do some
11 of our SBIRT interventions. I don't have the
12 exact number, but I will try to get that
13 number for you.
14 SENATOR AKSHAR: The only reason I ask
15 is because, you know, obviously we have such
16 a major issue. It's an epidemic, that we all
17 agree upon, and there's no sense in leaving
18 money sitting in that account if we don't
19 have to. In my humble opinion, we should be
20 spending it.
21 I want to thank you for your service
22 and all your work on this issue. It's
23 incredibly complex, and if there was a simple
24 answer, any one of us up here or you or your
235
1 team would offer to solve it. I agree with
2 Senator Kaminsky, it's a community issue that
3 requires a community's response. I think
4 we're there, we're all headed in the right
5 direction, and we need to continue to do
6 that.
7 So again, I publicly thank you for
8 everything that you're doing.
9 CHAIRWOMAN YOUNG: Thank you, Senator.
10 Senator Ortt.
11 SENATOR ORTT: Thank you very much,
12 Commissioner. I think I'm last, so I'll try
13 to be brief because I know we still have
14 several other speakers who have to go
15 through.
16 First of all, I want to thank you for
17 your assistance over the last two years,
18 because I served as a co-chair of the task
19 force, going around the state, doing a lot of
20 good work, having a lot of good
21 conversations, some of them challenging. But
22 I want to thank you for your assistance.
23 You know, it's more of a statement,
24 and maybe you can offer a response. I know
236
1 it's been brought up already a little bit,
2 but I think it's important to note, when you
3 leave here today, one of the real challenges
4 that I feel as a legislator and that I hear
5 from a lot of folks in my district and across
6 the state is when it comes to the beds and
7 the funding for the beds, and even funding
8 for in-community -- you know, supports in the
9 community or services in the community, many
10 of these seem to exist on paper, but they're
11 not getting -- whenever I talk to folks in
12 the community, they're still having a hard
13 time getting into inpatient treatment.
14 And so while we can point to these
15 beds and the existence of these beds and the
16 existence of this funding for it, you know,
17 I'm a big believer that if it's not -- if
18 people aren't seeing it, if it's not getting
19 to the areas that it's needed, then it's
20 almost like it didn't happen.
21 And so I just think it's very
22 important that we get these funds out the
23 door as soon as possible and get these beds
24 online as soon as possible. Because you
237
1 certainly understand that there is a list, a
2 waiting -- you know, a waiting tide for these
3 services as we sit here and speak today.
4 I don't know if you want to comment on
5 that. If not, that's okay.
6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No, I
7 guess what I would say is I agree
8 100 percent, and that's what we have been
9 trying to do.
10 In terms of some treatment programs in
11 certain areas, you know, we have a big
12 challenge with community opposition which,
13 you know, I didn't raise. But, you know, I
14 really need to raise it, because that's a
15 reality for a lot of the things we do.
16 Just this past year, trying to open
17 certain programs in certain areas was really
18 extremely difficult. So I just want to put
19 it in the context that of course we want to
20 get the services out, that's what we're
21 interested in. And we will continue to try
22 to do that to the best of our ability.
23 SENATOR ORTT: Is this budget -- and
24 it may have been touched on; I don't think it
238
1 was. You know, across the state there's been
2 programs -- I know it was mentioned about
3 prisoners, you know, folks who are in prison
4 who are recovering addicts. And one of the
5 drugs or treatment that I've been very
6 interested in is Vivitrol. And I know there
7 are pilot programs, I know here in Albany
8 County and other parts of the state that
9 certain sheriffs are doing it in their
10 prisons, you know, for certain prisoners.
11 Is there any interest or any funding
12 to assist localities, local sheriffs, with
13 some kind of program like that? You know,
14 one thing that interests me about Vivitrol is
15 that it's not a narcotic, and there's not
16 addictive qualities -- you know, no one's
17 going to get addicted to Vivitrol, but
18 unfortunately sometimes you can become
19 addicted to methadone or another type of
20 narcotic.
21 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Right.
22 Right. So we are providing funding.
23 Currently I think we have 19 or 17 programs
24 with local sheriffs throughout the state.
239
1 And we are providing funding for personnel to
2 carry out these programs in the Vivitrol.
3 SENATOR ORTT: And how is that funding
4 decided and then handed out?
5 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: How is
6 it decided?
7 SENATOR ORTT: Like, where is it
8 going, over the 19 counties?
9 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,
10 it's voluntary, so if there's a sheriff that
11 says, I would like to implement this program,
12 they speak to us. And we have a set amount
13 of money that we have been funding all the
14 other programs who want to keep it within
15 that parameter, and yeah, we will support
16 them if we're able to.
17 SENATOR ORTT: If you're able to as
18 far as the parameters or the funding?
19 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: The
20 funding.
21 SENATOR ORTT: Could I get a list of
22 the 19 that are being funded right now?
23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.
24 SENATOR ORTT: And where they are?
240
1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.
2 Sure.
3 SENATOR ORTT: And are you familiar
4 with the proposal, the House of Hope proposal
5 in Erie County?
6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
7 Fairly, yes.
8 SENATOR ORTT: Okay. Are you fluent
9 enough to speak to it, at least whether you
10 think it's a worthwhile model to pursue or
11 not?
12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I'm
13 not at that point yet, no.
14 SENATOR ORTT: Okay. I would
15 encourage you to take a second look at it.
16 You know it is supported, of course,
17 by Avi Israel, whose Save the Michaels of the
18 World obviously is -- he knows this topic
19 probably as well as a lot of people who've
20 spent their whole lives in it. But I think
21 it's something that could be looked at as a
22 potential model or pilot program or something
23 the state could partner with to support, kind
24 of like a self-direction on the OPWDD side.
241
1 This would be obviously on the --
2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:
3 Absolutely. Avi has been a great supporter.
4 And yes, I am familiar but don't have the
5 details. But I will be looking into it.
6 SENATOR ORTT: Please do. Thank you.
7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.
8 Thank you.
9 CHAIRWOMAN YOUNG: Thank you,
10 Commissioner. We appreciate your testimony.
11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank
12 you.
13 CHAIRWOMAN YOUNG: The next speaker is
14 Jay Kiyonaga, executive deputy director,
15 New York State Justice Center for the
16 Protection of People with Special Needs.
17 Welcome.
18 EXEC. DEP. DIR. KIYONAGA: Thank you.
19 CHAIRWOMAN YOUNG: How did I do with
20 the pronunciation of your name?
21 EXEC. DEP. DIR. KIYONAGA: I think you
22 did better the first time. It's Kiyonaga.
23 CHAIRWOMAN YOUNG: Oh, I did? okay.
24 Sorry about that.
242
1 EXEC. DEP. DIR. KIYONAGA: Jay is
2 fine.
3 CHAIRWOMAN YOUNG: Okay.
4 EXEC. DEP. DIR. KIYONAGA: Good
5 afternoon. My name is Jay Kiyonaga. I am
6 the executive deputy director of the Justice
7 Center for the Protection of People with
8 Special Needs. I would like to thank you for
9 the opportunity to testify today regarding
10 Governor Cuomo's 2017-2018 Executive Budget
11 proposal for the Justice Center.
12 Under the leadership of
13 Governor Cuomo, and with the full support of
14 the New York State Legislature, New York
15 became the first state in the nation to
16 create an independent state agency dedicated
17 to safeguarding people with special needs.
18 Before the Justice Center, there were no
19 consistent definitions of abuse and neglect
20 across the systems providing care to service
21 recipients. There was no mandated reporting
22 of abuse and neglect. Many systems lacked
23 independent investigations of abuse and
24 neglect, and police and district attorneys
243
1 did not have the dedicated resources to
2 effectively investigate and prosecute these
3 very challenging cases.
4 Today, approximately 1 million adults
5 and children who receive services are now
6 protected by the Justice Center. On June 30,
7 2013, the Justice Center began serving as the
8 state's central reporting agency for
9 incidents of abuse, neglect and other serious
10 incidents. The Justice Center works closely
11 with six state oversight agencies who are
12 responsible for licensing, operating and
13 certifying the services provided to these
14 individuals.
15 Our primary responsibility is to
16 ensure that people with special needs are
17 protected from abuse, neglect and
18 mistreatment. We recognize that the Justice
19 Center may have created anxiety for some
20 providers and staff members. However, it is
21 important to remember that our investigations
22 are triggered by someone calling the
23 Justice Center to report that abuse and
24 neglect may have occurred. We have a legal
244
1 obligation to investigate these reports, and
2 we make our best efforts to minimize any
3 disruption of services that may result from
4 our investigations.
5 Our efforts over the past three and a
6 half years have made facilities and programs
7 safer for both individuals with special needs
8 and the dedicated men and women who provide
9 services. Still, abuse and neglect in these
10 settings continues to be a serious problem.
11 In 2016, the Justice Center received
12 reports of over 10,000 suspected cases of
13 abuse and neglect. Most of these reports
14 were made by staff members, service
15 recipients, or their family members. Every
16 one of these incidents is thoroughly
17 investigated. Approximately one-third of all
18 abuse and neglect cases result in a
19 substantiated finding. In many cases, the
20 Justice Center identifies areas of concern
21 and works with State and provider agencies on
22 corrective actions to prevent future abuse.
23 Now, people receiving services and
24 their family members can take comfort in
245
1 knowing that employees who are found
2 responsible for the most serious or repeated
3 acts of abuse and neglect may no longer work
4 with service recipients in settings under our
5 jurisdiction. Since 2013, more than
6 300 staff members have been placed on a Staff
7 Exclusion List. The workers on this list
8 have committed offenses such as hitting,
9 choking, punching and sexually abusing
10 service recipients. Permanently removing
11 these workers from the service system
12 promotes a safer environment.
13 Workers who report abuse and neglect
14 can now be certain that their reports will be
15 taken seriously. Workers who are named as
16 subjects of an allegation can have the
17 confidence that a professional independent
18 investigation will be conducted. They can
19 also be confident that their legal and union
20 rights will be honored, and that they can
21 appeal any finding made against them.
22 The Governor's Executive Budget
23 supports the Justice Center's comprehensive
24 system for incident reporting,
246
1 investigations, employee discipline and
2 prosecutions. With the support of state
3 funds, the Justice Center has accomplished a
4 number of goals since it began operations:
5 We conduct approximately 94,000
6 pre-employment checks each year to ensure new
7 employees do not have a criminal history that
8 would jeopardize the safety of people with
9 special needs;
10 We ensure that mandated reporters and
11 others can easily report allegations of abuse
12 and neglect by maintaining a toll-free
13 hotline, which is staffed 24 hours a day,
14 7 days a week;
15 We educate mandated reporters about
16 their responsibilities;
17 We support high quality and timely
18 investigations across the state through the
19 operation of 15 regional offices;
20 We promote quality investigations by
21 offering extensive training for investigators
22 employed by the Justice Center, as well as
23 investigators working for state and private
24 providers;
247
1 We hold workers who engage in criminal
2 conduct against vulnerable service recipients
3 accountable. In 2016 alone, the Justice
4 Center led 69 prosecutions. We also
5 collaborate with local district attorneys by
6 notifying them of alleged abuse and neglect
7 occurring in their jurisdiction, and by
8 providing assistance in prosecuting these
9 cases;
10 We promote efforts to prevent abuse
11 and neglect by collaborating with our
12 Advisory Council and stakeholders. This has
13 resulted in a model abuse prevention policy
14 for providers, along with guidance on best
15 practices to promote abuse-free environments
16 for people with special needs.
17 In 2016 alone, the Justice Center's
18 Individual and Family Support Unit provided
19 support and information to over 3,500
20 individuals and families.
21 During our first three years, emphasis
22 was necessarily placed on establishing an
23 incident management call center, an
24 investigations unit, and a prosecutor's
248
1 office. There will be continued attention
2 given to process improvements in these areas,
3 including efforts to complete quality
4 investigations in less time by adopting
5 administrative changes. For example, we are
6 working to implement protocols to assess,
7 within 72 hours, whether a report of alleged
8 abuse and neglect should, based upon
9 additional facts, warrant further
10 investigation.
11 During 2017, a greater emphasis will
12 also be given to other components of the
13 agency and its mission. With the support of
14 existing funds, such efforts will include a
15 focus on abuse prevention and statewide
16 outreach initiatives for workforce members.
17 With your continued support, we have
18 been able to meet our mission of protecting
19 the health, safety, and dignity of some of
20 New York's most vulnerable people. The
21 Justice Center looks forward to working with
22 our partners in the Legislature, the state
23 oversight agencies, and all of our other
24 stakeholders to continue to strengthen
249
1 protections for people with special needs.
2 Thank you for the opportunity to
3 provide testimony. I would be glad to answer
4 any questions you may have.
5 CHAIRWOMAN YOUNG: Thank you, Jay.
6 How is the system different than it
7 was prior to the Justice Center?
8 EXEC. DEP. DIR. KIYONAGA: I think the
9 system is very different now, as opposed to
10 before the Justice Center. First of all,
11 there are standardized definitions of abuse
12 and neglect across all the service delivery
13 systems under the Justice Center's
14 jurisdiction. There are strict mandated
15 reporting requirements for custodians. We
16 operate a 24/7 hotline to receive those
17 reports of abuse and neglect. And we have
18 investigators to investigate the -- to
19 provide independent investigations of any
20 alleged abuse and neglect in the system.
21 CHAIRWOMAN YOUNG: So thank you.
22 Specifically, are all individuals who
23 engage in abuse or neglect identified,
24 prosecuted, and banned from providing
250
1 services to people with special needs?
2 EXEC. DEP. DIR. KIYONAGA: Are all
3 people who abuse people with special needs
4 identified?
5 CHAIRWOMAN YOUNG: No, are -- well,
6 are they -- those who engage in abuse or
7 neglect, are they identified, prosecuted and
8 banned from providing services to people with
9 special needs?
10 EXEC. DEP. DIR. KIYONAGA: If someone
11 reports abuse and neglect of a service
12 recipient, it is fully investigated. And if
13 it warrants criminal investigation or
14 criminal prosecution, we would pursue that,
15 either alone or with a local DA.
16 CHAIRWOMAN YOUNG: Conversely, has the
17 triage process that the Justice Center uses
18 experienced misclassifications of the
19 appropriate actions that have resulted in
20 incidents of abuse or neglect that should
21 have been avoided?
22 EXEC. DEP. DIR. KIYONAGA: I think
23 early on, there was misclassifications. We
24 had a very short time frame to get our call
251
1 center up and running and staff trained and
2 accustomed to the electronic case management
3 system we had.
4 But we've worked very closely with the
5 state oversight agencies to better define the
6 types of activities that would fall into a
7 reportable incident, whether it be abuse and
8 neglect or a significant incident. And there
9 are procedures for providers or state
10 agencies to contact the Justice Center to
11 review the information we receive to see if a
12 reclassification is appropriate.
13 CHAIRWOMAN YOUNG: Staff who are being
14 investigated as a result of a complaint may
15 be placed on administrative leave or
16 terminated, and the length of time for
17 investigation forces providers to hire new
18 staff, and employees then can be left in
19 employment without pay until the situation is
20 resolved. So this may lead to a significant
21 amount of time.
22 The question is, what actions has the
23 center taken in response to the numerous
24 complaints regarding the length of time for
252
1 investigations?
2 EXEC. DEP. DIR. KIYONAGA: We've taken
3 a number of actions since June 30, 2013, to
4 try to ensure that we provide a quality
5 investigation in a timely manner.
6 Some examples of that would be
7 additional investigative staffing. We've
8 added a lot more staff out in the regions.
9 We've also instituted more regional offices
10 to make sure that our investigators can
11 arrive at the destination, a facility where
12 they need to do the investigation, in a more
13 efficient manner.
14 As I said in my testimony, we also
15 have instituted a 72-hour protocol which
16 we'll be rolling out broader over the new
17 year. What that does is when we get certain
18 reports of abuse and neglect, we -- before we
19 launch an investigation, we work with the
20 provider to gather more information to see if
21 we can determine whether or not a
22 reclassification is appropriate.
23 CHAIRWOMAN YOUNG: Thank you. So
24 anything you can do to expedite the process I
253
1 think would be very beneficial.
2 There also have been numerous
3 complaints that the Justice Center has a law
4 enforcement approach for all investigations,
5 regardless of the nature of the complaint.
6 And this has led to fear and anger among
7 provider staff.
8 How do you respond to these
9 allegations, and what actions have been
10 taken? Because obviously if it's a really
11 serious, serious allegation versus something
12 that may be minor -- I think that in the
13 past, all of the allegations have been
14 treated the same, and it's led in some cases
15 to people feeling like there was an
16 overreaction. So what have you done to
17 change that?
18 EXEC. DEP. DIR. KIYONAGA: Clearly we
19 take every allegation of abuse and neglect
20 very seriously, as we should. I think that
21 things have changed since before the Justice
22 Center. I think that our investigations are
23 more formal and more focused and independent.
24 I think that's different than what the system
254
1 was used to before.
2 And I assume you're talking about, you
3 know, private providers. But I can assure
4 you that a very small percentage of the cases
5 that are reported to us end up being a
6 criminal case; about 1 percent lead to arrest
7 or a prosecution. And so the other, you
8 know, 10,000 or so are going to be handled on
9 our administrative side.
10 And again, those would not involve our
11 criminal administrators generally, they would
12 be our administrative investigators. And on
13 the private side, if the Justice Center is
14 investigating, it's going to be a fairly
15 serious allegation of abuse and neglect. We
16 do delegate investigations back to providers
17 to investigate. They all come back to us for
18 review and final determination, but the
19 lesser allegations of abuse and neglect on
20 the private provider side are usually
21 delegated back.
22 CHAIRWOMAN YOUNG: Okay, thank you.
23 CHAIRMAN FARRELL: Thank you.
24 Questions?
255
1 ASSEMBLYWOMAN GUNTHER: Yes.
2 Thank you very much for coming today.
3 So I have a few questions, and I just want to
4 understand like the proper reporting process.
5 ASSEMBLYMAN McDONALD: Aileen, hit the
6 microphone.
7 ASSEMBLYWOMAN GUNTHER: Oh, sorry. We
8 have to do sharing around here. Okay, thank
9 you very much.
10 So first of all -- I just want to ask
11 you just a few questions. First of all, how
12 has the existence of the Justice Center
13 improved the quality of care for vulnerable
14 people?
15 EXEC. DEP. DIR. KIYONAGA: Well, with
16 respect to abuse and neglect, clearly, for
17 those victims, about 4,000 substantiated
18 cases a year, I think that they feel that
19 they would have justice as a result of
20 Justice Center investigations and the
21 creation of the Justice Center.
22 ASSEMBLYWOMAN GUNTHER: Well, before
23 your existence, when you say 4,000, can you
24 tell me about that? I mean, were they --
256
1 tell me the process before the Justice Center
2 was created.
3 EXEC. DEP. DIR. KIYONAGA: Sure. I
4 mean, each agency had different processes.
5 The definitions for abuse and neglect varied
6 across those different systems. And also the
7 reporting requirements were very different
8 across the systems.
9 So with the Justice Center, there was
10 consistent definitions of abuse and neglect,
11 there was consistent reporting
12 requirements -- you know, specifically the
13 mandated reporting requirement -- and then
14 there's a call center to centrally receive
15 all of those reports.
16 With respect to how we prevent abuse
17 and neglect, I think I mentioned in my
18 testimony that we do 96,000 pre-employment
19 criminal background checks each year --
20 ASSEMBLYWOMAN GUNTHER: I'm going to
21 interrupt you. Give me your definition of
22 abuse and neglect. What is your -- like are
23 there different categories? Like let me
24 understand the definitions of Category 1,
257
1 Category 2, and Category 3.
2 EXEC. DEP. DIR. KIYONAGA: I mean,
3 abuse and neglect is defined in the statute.
4 There are four categories of abuse and
5 neglect. So when -- abuse and neglect is a
6 general definition. But once an abuse and
7 neglect allegation is substantiated, our
8 counsel's office assigns a category in
9 accordance with the law.
10 Category 1 is going to be the most
11 serious case of abuse and neglect, where
12 there is usually serious injury. These
13 things may even rise to a criminal level.
14 Category 2 isn't as serious as Category 1,
15 but there's a great risk of harm or serious
16 injury. Category 3 is abuse and neglect but
17 does not rise to the level of Category 2.
18 And then Category 4 is more of a systemic
19 issue. Category 4s are levied against a
20 provider and reflect when there is either no
21 individual culpability determined or there's
22 a systemic problem that allowed that abuse
23 and neglect to happen.
24 ASSEMBLYWOMAN GUNTHER: If you would
258
1 just allow me to -- you know, I have gone
2 from place to place to kind of find out about
3 the Justice Center and about non-for-profits.
4 And, you know, before the Justice Center was
5 created, a good non-for-profit had a quality
6 improvement, and someone that already did
7 some sort of research. And normally, I mean,
8 if you ever got surveyed by a state agency,
9 they were prepared for a survey and kind of
10 knew. And of course there are things that
11 are outliers and do go wrong.
12 So I'm just going to tell you what
13 I've learned just from talking to different
14 people. And I think it's -- I find this is
15 something that we're going to improve the
16 quality of care across the board, and that's
17 why I'm here and that's why you're here.
18 So they said inconsistent
19 categorizations, a lengthy wait of time for
20 an investigation, re-delegation without
21 notice. Lack of direct communication.
22 Agency staff must still contact all relevant
23 parties, but with significantly less
24 information.
259
1 There's precious time needed to
2 collect evidence; it's lost during this
3 phase. So between Phase 1 and Phase 2, often
4 people's image of what they saw or like, you
5 know, three people might remember it just a
6 little bit different if they're the witness.
7 They said the communication at the
8 Justice Center is inconsistent. And I'm
9 telling you this and going through this
10 because I think that we definitely care about
11 the developmentally disabled community, and
12 we care about these investigations and we
13 believe in quality of care. But we're also
14 talking about very poor non-for-profits,
15 people that are DSPs, and their feelings.
16 And I think that, you know, we can only get
17 better and this is, to me, a class in how can
18 we improve the quality of care and the
19 quality of work we're doing.
20 The timeliness of collection. The
21 agency, in allegations of physical abuse,
22 sexual abuse, suspends the target of the
23 investigation. Which I guess you have to.
24 About the length of time of staff
260
1 suspension, they also talked about sometimes
2 six to nine months. And after it's all said
3 and done, they're found not guilty of
4 whatever they were accused of, and it kind of
5 goes on and on.
6 Just to give you an instance, the
7 Justice Center has taken seven investigations
8 at a certain place. And the inception was
9 June 30th of 2013. Of the seven
10 investigations, four are currently complete.
11 If you're guilty or not guilty, only four are
12 currently complete. And between the
13 initiation and a closure letter, 153 days.
14 So that's a long period of time.
15 So my question is, to you, after like
16 me going out to the different agencies, what
17 do you think you really did to really improve
18 the quality of care? And also, what did we
19 do to improve the quality of the workforce
20 that are taking care of people with
21 disabilities?
22 EXEC. DEP. DIR. KIYONAGA: Again, our
23 mission is to protect people with special
24 needs, fully investigate reports of alleged
261
1 abuse which are reported to us, in a timely
2 and thorough manner. And again, I don't know
3 the details, you know, which providers or
4 which cases you're referring to there. I'd
5 be more than willing to talk to you about
6 that in greater detail separately.
7 But we are -- I think our interests
8 are aligned. You know, I do want to make
9 this system safer. We do want to make sure
10 that people who shouldn't be working with
11 people with special needs are not doing that
12 in the future. And, you know, that's the
13 mission of the Justice Center. We abide by
14 the statutory requirements that were passed
15 by the Legislature and signed by the
16 Governor.
17 And again, there's a number of ways
18 which I could explain that I think that the
19 system is safer. I mean, quality of care --
20 I mean, abuse and neglect is only one part of
21 quality of care, and I think you sort of went
22 into the whole, you know, QA area there. But
23 we have broad mandates there.
24 And again, prevention is something
262
1 that we're also very concerned about. I
2 mean, I'm concerned that an investigation is
3 very reactive. Right? Someone may have
4 already been abused. And not that we
5 shouldn't take it seriously, and not that we
6 don't, but prevention is also something
7 that's important. Which is why for every
8 abuse and neglect case that is reported to
9 us, we ensure that the provider and the state
10 oversight agency do a review to see if
11 there's any corrective action that's
12 required.
13 And I think that sort of speaks to the
14 QA piece you were just referring to. We want
15 to make sure, if there's any compliance
16 issues that need to be addressed -- and a lot
17 of times that is like training or other
18 things like that -- that the provider and the
19 state oversight agency is working to
20 implement those so people will be safer.
21 ASSEMBLYWOMAN GUNTHER: So
22 statistically, how have you decreased the
23 incidence, and what education have you
24 provided? So sometimes we find things that
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1 are really, absolute mistakes, they weren't
2 done intentionally. What do you do to, like,
3 retrain people? Or what is your -- do you
4 bring a program into, you know,
5 non-for-profits to tell them what to do and
6 what your feelings are and what the
7 corrective action should be?
8 EXEC. DEP. DIR. KIYONAGA: Well, I
9 think every allegation of abuse and neglect,
10 whether it's substantiated or not, is an
11 opportunity for improvement. And that's why
12 we require that providers and state agencies
13 look at every case, regardless of whether
14 it's unsubstantiated or not, to see if there
15 isn't some corrective action that could make
16 that facility safer.
17 ASSEMBLYWOMAN GUNTHER: Do you have a
18 quality improvement or report that you could
19 share with all of us so that we would see
20 like the efficacy of the office and also like
21 the changes, the improvements over the last
22 three years?
23 EXEC. DEP. DIR. KIYONAGA: We issued
24 our annual report recently, and that has some
264
1 statistics about the outcomes of our
2 investigations.
3 It also talks about a number of the
4 other things that the Justice Center does
5 beyond abuse and neglect investigations, and
6 that is, you know, we do forensics reviews,
7 we do this corrective action plan monitoring.
8 We have a prevention work group. So we do do
9 a number of other things beyond our primary
10 role, which is to investigate abuse and
11 neglect.
12 ASSEMBLYWOMAN GUNTHER: Thank you.
13 CHAIRMAN FARRELL: Thank you.
14 Senator?
15 CHAIRWOMAN YOUNG: Thank you.
16 Senator Ortt.
17 SENATOR ORTT: Jay, earlier it was
18 asked of you do you think it's --
19 CHAIRWOMAN YOUNG: Mic.
20 (Discussion off the record.)
21 SENATOR ORTT: Jay, earlier you were
22 asked by Senator Young about are things
23 different today than before the Justice
24 Center. And you said yes, and you listed
265
1 some, I think, things that are important, but
2 there are also things that -- there are
3 things that we talk about here in Albany, you
4 know, like that are, you know, the
5 definitions of this and this. Not that
6 that's not important, but I think on the
7 ground level a lot of people don't see the
8 difference. Or, if they see a difference,
9 it's worse. Okay?
10 And what I mean by that is so, you
11 know, when I talk to families, when I talk to
12 providers, people on both sides of sort of
13 the issue, on the one hand people will say,
14 you know, the Justice Center, the
15 investigations take so long. I think by your
16 own testimony, you said most of the reports
17 come in from staff. Two-thirds of them are
18 unfounded. That seems to be a high number.
19 And I say that in a variety of ways.
20 One, that's a large number of things
21 that your folks are having to spend time on
22 that turn out to be unfounded. And I guess
23 my question would be, why do you think that
24 is? What is your assessment on why
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1 two-thirds are unfounded? Why are you having
2 such a high number or volume called in that
3 are unfounded?
4 EXEC. DEP. DIR. KIYONAGA: I mean, I
5 can't explain it case by case. You know, I'd
6 have to review those. But generally there's
7 a few reasons why a case may be
8 unsubstantiated. In our statute, it's
9 substantiated or unsubstantiated.
10 You know, sometimes there are false
11 reports that are made to us. We know that.
12 It just didn't happen. That's what our
13 72-hour protocol is trying to get to. We do
14 realize that sometimes things are misreported
15 or falsely reported, and we think that
16 through, you know, a quick review and some
17 basic facts, maybe we can avoid the need for
18 a lengthy investigation. Because you're
19 right, you know, I don't want to investigate
20 something that should never have been
21 classified as abuse and neglect in the first
22 place. Because, again, it is my resources or
23 provider resources, and obviously it's a
24 stress on the system that we would like to
267
1 avoid. So again, our 72-hour protocol is
2 trying to get to that.
3 But the other reasons I think that
4 things are unsubstantiated is maybe we just
5 can't find enough evidence to substantiate
6 that case. Our evidentiary standard is
7 preponderance of the evidence, which is more
8 likely than not to have happened. Sometimes
9 we just can't get there.
10 So I think that those are really the
11 two major reasons. Either something may have
12 been misreported or overreported, and then in
13 some cases our investigation just cannot
14 achieve the evidentiary standard required to
15 substantiate that allegation.
16 SENATOR ORTT: Let me ask you, so your
17 folks have training, obviously -- a lot of
18 them are law enforcement background or some
19 type of investigative background --
20 EXEC. DEP. DIR. KIYONAGA: Twenty
21 percent have a law enforcement background.
22 SENATOR ORTT: Okay. Do any of them
23 have a background in the jobs that they're
24 investigating -- you know, in human services,
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1 working with folks that might have a
2 developmental disability or something along
3 those lines?
4 EXEC. DEP. DIR. KIYONAGA: Yeah. I
5 mean, beyond the basic educational
6 requirements and the investigative
7 requirements, experience requirements, a lot
8 of our investigators, many of them, have
9 actually worked in the facilities which we
10 oversee. A lot of them also have family
11 members or loved ones who have disabilities
12 as well.
13 I mean, that's what we're looking for.
14 We really want investigators who understand
15 the systems, understand our mission, and if
16 they don't -- and most do -- we also provide
17 training. And we also look to the state
18 oversight agencies and providers to provide
19 training to our folks too.
20 SENATOR ORTT: I think it would be
21 helpful to see that grow, just because -- you
22 know, I think one of the things that
23 certainly would be a benefit, not only to you
24 and your folks but also to the people that
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1 we're trying to service, is if the folks who
2 are doing the investigating had at least some
3 understanding -- you know, real world
4 understanding. Obviously, some of it's
5 gleaned over -- I'm sure over years as they
6 do this work. But if they come into it with
7 some background in some of these areas --
8 because as you know, it's a very -- in ways,
9 it's a very unique level of work and sort of
10 what goes in and the individuals they're
11 working with. So I think that's -- I would
12 like to see that number or that percentage
13 increased, not just education in a classroom,
14 but real-world experience.
15 Do you know how many -- roughly how
16 many people currently might be out on
17 administrative leave as the result of a
18 Justice Center investigation?
19 EXEC. DEP. DIR. KIYONAGA: I don't
20 know.
21 SENATOR ORTT: Okay. Is there a
22 way -- I mean, can you -- is that data
23 available?
24 EXEC. DEP. DIR. KIYONAGA: We don't --
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1 I don't -- I don't have access to that data.
2 SENATOR ORTT: You don't have access
3 to that data?
4 EXEC. DEP. DIR. KIYONAGA: Yeah, we
5 don't collect that data. Let me put it that
6 way.
7 SENATOR ORTT: And I know a lot has
8 been made about the amount of time that it
9 takes to conduct these investigations. What
10 would you -- I may have missed it. What
11 would you say is an average time? Or what
12 is, I guess, a time that you would like to
13 see an investigation concluded?
14 I realize -- I mean, I know that you
15 could give an answer that says, Well, every
16 one is different. But, I mean, is there a
17 certain time frame that you think is a
18 reasonable amount of time to be able to make
19 a determination to either close an
20 investigation or prosecute?
21 EXEC. DEP. DIR. KIYONAGA: I would say
22 our goal is to complete a thorough
23 investigation as quickly as possible. I
24 mean, that's what we owe -- we owe that to
271
1 all of our stakeholders. Whether it's the
2 victims or the families or the provider or
3 the subject of the investigation, a thorough
4 investigation as quickly as possible.
5 But as you had said, there's a wide
6 range of cases we get there. And, you know,
7 I don't want to necessarily put a time frame
8 on any individual case. I mean, again, if --
9 as I said earlier, if it's a false report and
10 we can determine that very quickly, you know,
11 someone is accused of doing something and
12 they're not even at work that day, we should
13 be able to close that very quickly. And I
14 would hope that, you know, my staff or the
15 agency staff would close that as quickly as
16 possible.
17 On the other end, you know, some of
18 these criminal cases can take a while. You
19 know, they can take over a year in some
20 cases. And so, again, we have a wide range.
21 But we do have -- you know, we are working
22 with the law of large averages here, right?
23 We are talking about 10,000, 11,000 cases a
24 year.
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1 The statute speaks to, you know, a
2 60-day time frame; I think people are aware
3 of that. Again, they say that we should
4 strive to complete a case within 60 days.
5 And if it's not completed in 60 days, we need
6 to make a note of the reason in our database,
7 in our case management system, and we do do
8 that. But obviously since people are looking
9 at 60 days, you know, I guess we would try to
10 achieve things within 60 days.
11 SENATOR ORTT: How much assistance do
12 you get from local DAs? I mean, how much
13 cooperation do you get from local DAs in your
14 investigations? Or how much do you seek?
15 EXEC. DEP. DIR. KIYONAGA: Well, I
16 mean, we notify DAs of any allegation of
17 abuse and neglect that occurs within their
18 jurisdiction. They get those reports daily.
19 We have multiple touch points, multiple
20 collaborations with local DAs from there on.
21 Again, if we're investigating and we
22 think that the case rises to a criminal
23 level, our criminal investigators are
24 prosecutors and will be working with local
273
1 law enforcement and/or that DA to vet that
2 case. And again, if it's going to be a
3 criminal prosecution, you know, we're going
4 to collaborate and coordinate with that local
5 DA to make sure that they're aware of the
6 case.
7 And again, we would encourage local
8 DAs to prosecute these cases. I mean, this
9 is a crime that has happened in their
10 jurisdiction, so first and foremost, you
11 know, we would encourage them to do that.
12 But if for whatever reason they aren't and we
13 feel strongly about that, we'll work with
14 them to allow us to prosecute it.
15 SENATOR ORTT: Does that happen a lot,
16 where the local DA makes a determination not
17 to and you feel strongly enough to move
18 forward?
19 EXEC. DEP. DIR. KIYONAGA: I don't
20 know if it happens a lot. I'm sure there's
21 instances. I mean, when you look at our
22 statistics, I think that in 2016 there were
23 over 110 prosecutions, and I think we did a
24 majority of those. But local DAs, they do
274
1 their share. I mean, I think we'd like to
2 see them do more. I think we always think
3 that if -- you know, given that it's a crime
4 that occurred in their jurisdiction, it would
5 encourage them to do that. But I recognize
6 that they have resource issues, we have
7 resource issues. These are very challenging
8 cases. And, you know, sometimes they just
9 don't see the inside of a courtroom.
10 SENATOR ORTT: Thank you.
11 CHAIRWOMAN YOUNG: Thank you.
12 CHAIRMAN FARRELL: Thank you.
13 Assemblyman McDonald.
14 ASSEMBLYMAN McDONALD: Hi, Jay, how
15 are you?
16 EXEC. DEP. DIR. KIYONAGA: Fine.
17 ASSEMBLYMAN McDONALD: There we go, I
18 think we're there now. Thank you.
19 And Jay, thank you.
20 CHAIRMAN FARRELL: (Inaudible.)
21 ASSEMBLYMAN McDONALD: I will. I
22 will. Thank you, Mr. Chairman. I'll move up
23 closer.
24 Thank you, as always. The Justice
275
1 Center has always made themselves available
2 to at least the members locally, I imagine
3 around the state as well.
4 And I have like a far-ranging comment
5 before I get to probably what is a question.
6 Sometimes I'm called with the whole -- the
7 Justice Center, I think, has done some great
8 things. It's established consistency in
9 regards to instances, for the most part.
10 It's established some good training, which I
11 think is important. You know, and of course
12 you're reaching across many vulnerable
13 populations, but all different types of
14 vulnerable populations.
15 So I understand the complication. And
16 I also understand, as a healthcare
17 professional, the importance of internal
18 compliance within each organization. In
19 other words, organizations do have to have
20 their own policing of their own self to make
21 sure that they have good protocols and
22 operations.
23 And at the same token, we hear from
24 individuals that we're not doing enough, that
276
1 more neglect is happening that we don't know
2 about. And in that same token, it's not
3 always easy to get good prima facie evidence
4 of that.
5 I have a very large concern for the
6 providers. Primarily it's the nonprofit
7 community that I hear from. I don't hear
8 much from the state agency organizations, I
9 hear it mostly from the nonprofit community
10 about a couple of different things.
11 First of all, you know, this approach
12 that I think was prevalent early on but has
13 kind of dissipated a little bit is this
14 marshal-in-town-type mentality, which scares
15 a lot of these $9.50 and $10 an hour
16 employees. Now, I fully recognize that's not
17 the Justice Center's issue of what people are
18 being paid, but it's a symptom of a greater
19 disease that we're not funding those entities
20 properly from the state, because they're
21 there to do the work the state can't do. But
22 at the same token, we've descended upon them
23 with this process which, when you say to a
24 21-year-old, You're guilty of obstruction of
277
1 justice, they're like petrified. And
2 honestly, I don't know if that's very helpful
3 in the process.
4 I was talking to -- and I think you
5 talked to them today as well -- a local
6 director who said that they had an incident,
7 they did everything they were supposed to do,
8 they forgot to notify the Justice Center
9 because it was -- they did everything they
10 were supposed to do, and now there's a fear
11 they're going to be rung up for obstruction
12 of justice. Which I'm sure it will be
13 addressed and dealt with appropriately.
14 But I guess, you know, the largest
15 concern I had, and I shared these
16 conversations with Jeff when he was in the
17 position before, is there just seems to be a
18 whole lot of cases and calls being reported,
19 and I don't know how, humanly, your
20 individuals are able to do it. I know you've
21 been working at it and working at it. But,
22 you know, many of the organizations have made
23 a suggestion, and I'd really like to get some
24 thoughts from the Justice Center about some
278
1 changes that they think will have a positive
2 impact -- not lessen the process, but really
3 allow your folks, particularly your officers,
4 to focus on what they should be doing. And
5 it's to look at revising Category 3.
6 Those incidents are usually the lowest
7 level of substantiation possible for an
8 individual, and they're talking about
9 allowing that to go back to the agencies --
10 obviously, in consult with the Justice
11 Center -- which would allow you to focus more
12 on the more serious cases of neglect.
13 So I'm curious to see, you know, what
14 the position is of the center on that type of
15 opportunity.
16 EXEC. DEP. DIR. KIYONAGA: Yeah, I
17 mean you raised a lot of good issues there.
18 Before I speak to the Cat 3 issue you just
19 raised, I would like to just speak to, you
20 know, our feelings about mandated reporters,
21 you know, and the staff that do this good
22 work.
23 I mean, we know that a vast majority
24 of these workers are good workers. They do
279
1 this job, as you just said, not for the money
2 but because they care about the people that
3 they work with. And I think that's very
4 important to recognize, and we do recognize
5 that.
6 And of course that creates a tension
7 for us. Because as you just said, you know,
8 these people are afraid of us. But at the
9 same time, the law requires that they report
10 to us. If I don't get the reports, I don't
11 hear about abuse and neglect, and I can't
12 protect people with special needs.
13 So to that end -- and, I mean, we're
14 in our -- we've been open about three and a
15 half years now, and during the first couple
16 of years we necessarily were focused on
17 making sure that the state agencies, the
18 executive directors of not-for-profits and
19 private providers and their QA people knew
20 exactly what was required under the statute
21 and with implementation of the Justice
22 Center.
23 Starting in 2016, and certainly
24 continuing on to 2017, we have had a much
280
1 stronger focus on hearing directly from the
2 direct support professionals. We have sort
3 of aggressively worked with the National
4 Alliance for the Direct Support
5 Professionals, we've worked with all of the
6 state oversight agencies to have direct
7 meetings with direct support staff so we can
8 hear their feedback directly. And I'll tell
9 you, it's been eye-opening. And, you know,
10 we hear it both ways, to be honest. Some are
11 pleased we're here; some will say: "I'm so
12 happy you're here. You know, I know that if
13 I report abuse and neglect, there will be an
14 independent investigation. I wasn't always
15 sure that would have happened if I report
16 internally in my agency." And we get that.
17 We've also heard that people are
18 scared of us. We heard that, you know, "I
19 don't know what to expect if I call your
20 hotline." And so we've implemented things
21 like putting a sample recording on our
22 website, or playing it for direct support
23 professionals.
24 We heard that our poster was
281
1 intimidating to people, that poster we
2 originally put out. I don't know if you -- I
3 think you probably saw it. It had a phone
4 hanging, it was red, kind of scary. We've
5 sort of shifted our view on that, and we've
6 issued new posters which really show the
7 collaboration that we expect from direct
8 support professionals and the people they
9 serve, the people with special needs we all
10 want to support.
11 So I did want to address that concern,
12 that we are aware of that and we are taking
13 sort of aggressive initiatives to try to
14 address some of those concerns where we can.
15 You also then raised -- I think which
16 was really the point of your question, was
17 the Category 3 and can we look at that. And
18 again, I think Category 3 is broadly defined
19 in the statute. But I think the real issue
20 here is that, you know, we don't assign a
21 category until something is substantiated and
22 we're closing the case. Our protocols for
23 assignment might sort of align with the
24 concept you're talking about. Like I said,
282
1 you're mostly focused on the private
2 providers. And for the private providers,
3 the Justice Center only retains those cases
4 which involve the most serious or egregious
5 allegations of abuse and neglect. Those are
6 going to be assaults with harm, they're going
7 to be something sexual in nature, they're
8 going to be some sort of potentially
9 criminal -- criminal neglect, criminal
10 action. Those are the ones we're keeping.
11 The other ones we do delegate back to the
12 state oversight agency and generally, from
13 our experience, we simply delegate them back
14 down to that private provider.
15 So I'd have to look at the numbers,
16 and maybe we could talk separately. But I
17 would guess that -- and, you know, we could
18 probably pull this -- we could probably see,
19 of the Cat 3s that are substantiated, how
20 many of those were done with the Justice
21 Center and how many were done by the
22 privates.
23 But ultimately it may also turn out
24 that something serious was alleged, you know,
283
1 we took that case on, and it turned out it
2 wasn't quite as serious. But we could
3 certainly look at that.
4 CHAIRMAN FARRELL: Thank you.
5 ASSEMBLYMAN McDONALD: Thank you.
6 CHAIRMAN FARRELL: Mr. Santabarbara.
7 ASSEMBLYMAN SANTABARBARA: Just to
8 circle back, I know we touched on this
9 before, but just in terms of improving the
10 quality of care for a vulnerable population,
11 how has the existence of the Justice
12 Center accomplished -- how are you working to
13 accomplish that goal?
14 EXEC. DEP. DIR. KIYONAGA: You know,
15 quality of care is pretty broad. You know,
16 our main mandate is really to protect people
17 with special needs from abuse and neglect.
18 And I think I can, you know, clearly point to
19 the 340 people on our staff exclusion list.
20 These are people who have committed the most
21 serious and egregious acts of abuse against
22 people with special needs. They were
23 substantiated of Category 1, which is the
24 most serious level of abuse and neglect.
284
1 They were put on the staff exclusion list
2 that we maintain. They will be on the list
3 for the rest of their lives, and they will be
4 prohibited from ever working with people with
5 special needs in any facility under our
6 jurisdiction.
7 And so it's unfortunate that someone
8 had to be abused to that level in order for
9 us to identify and take action against these
10 staff. But I think that, you know, for the
11 victims of those cases, they would say that
12 they would be safer now that this person is
13 no longer able to work with anybody with
14 special needs.
15 ASSEMBLYMAN SANTABARBARA: And can you
16 speak to the experience, particularly in
17 healthcare, that the Justice Center
18 investigators have or need to have?
19 EXEC. DEP. DIR. KIYONAGA: The minimum
20 requirements for our investigators are -- is
21 an educational requirement, and then there's
22 an investigatory experience requirement.
23 But as we interview, as we're seeking
24 candidates, we are looking for people who
285
1 have experience in the facilities that we
2 oversee. We find that that's invaluable.
3 They really do need to understand not just
4 the people with disabilities that they're
5 going to be interacting with, they really
6 need to understand the service delivery
7 systems as much as they can as well.
8 And as someone had noted, we serve a
9 broad number of different facilities. I
10 mean, a developmental center is very
11 different than a youth detention facility,
12 which is very different from a group home or
13 a dayhab. So it's hard to find someone who
14 obviously -- you're not going to find anyone
15 who sort of meets the mark on all those
16 facilities, but we do find people who have
17 worked in these agencies. A lot of our
18 people have that experience.
19 And again, if they don't -- and again,
20 they're probably not going to have experience
21 across all the types of facilities they're
22 going to encounter, or all the types of
23 disabilities -- you know, we provide that
24 training.
286
1 ASSEMBLYMAN SANTABARBARA: And my last
2 question is, of course, you know, we're
3 always looking to improve. What are some of
4 the goals you see for the future? And do you
5 have the resources to actually accomplish
6 those goals?
7 EXEC. DEP. DIR. KIYONAGA: Yeah. I
8 mean, our goals sort of remain consistent.
9 And it's consistent with the goals that you
10 guys have outlined.
11 We really want to try to make sure we
12 continue to complete all investigations in a
13 thorough manner in as little time as
14 possible. So case cycle time, case
15 completion time, that's something we're
16 always going to be focusing on and
17 monitoring. That's probably our number-one
18 priority. That's what our stakeholders want.
19 That's what you want, that's what the
20 Governor's office wants, and that's what
21 we're going to try to achieve.
22 Beyond that, I think that the direct
23 support outreach is critical. I mean, we
24 really do need to hear from our primary
287
1 stakeholder, which is the people who work
2 with people with special needs. They are the
3 people who must report to us, they are the
4 people that we interview as witnesses, and
5 they are the people that we may interview as
6 a subject in an abuse/neglect investigation.
7 So hearing their input, making changes
8 to our processes or our notifications, I
9 think is critical and something we're going
10 to continue to work on.
11 ASSEMBLYMAN SANTABARBARA: Okay,
12 that's all I have. Thank you.
13 CHAIRWOMAN YOUNG: Thank you.
14 Senator Krueger.
15 SENATOR KRUEGER: I guess -- it's not
16 a question, it's simply to point out you're
17 hearing a lot of questions and I think the
18 sense that people are concerned about your
19 existence now. And I just want to go on
20 record saying I hear both sides of it from
21 people, and I think that reflects that you're
22 doing exactly what you need to be doing.
23 These are tough issues. When people
24 who are the most vulnerable in our society
288
1 are at risk of being harmed by the people we
2 entrust their care to, it's our obligation as
3 a civilized government to make sure that we
4 are overseeing correctly, we are training
5 correctly, we are fixing the problems.
6 And the numbers, as you were asked,
7 show that there's a lot of unsubstantiated --
8 but people are going to have to do those kind
9 of reports in order for you to figure out
10 where the problems are and how you need to
11 intervene. And that hopefully, within a
12 matter of years, we're all going to be able
13 to say New York State has the model programs
14 for making sure that people who are under our
15 care, whether it's in a government facility
16 or in a community-based facility, are being
17 treated with the highest respect and that the
18 people who are hired to provide those
19 services actually know and understand where
20 the lines are.
21 So it's a very difficult job you and
22 your people are doing. I'm sure you're not
23 perfect at it. But I, for one, am very glad
24 that you're out there doing that. So thank
289
1 you very much.
2 EXEC. DEP. DIR. KIYONAGA: Thank you,
3 Senator.
4 CHAIRWOMAN YOUNG: Thank you.
5 That's it? Okay. Well, thank you for
6 coming in today. We truly appreciate it and
7 appreciate your input.
8 We have two groups who are appearing
9 together, and that's Michael Seereiter,
10 president and CEO of the New York State
11 Rehabilitation Association, and Ann Hardiman,
12 executive director of the New York State
13 Association of Community and Residential
14 Agencies. Thank you.
15 MS. HARDIMAN: Hi. Thank you. I'm
16 Ann Hardiman, the executive director of
17 NYSACRA. I'm going to turn it over to
18 Michael first this time.
19 MR. SEEREITER: Hi, good evening.
20 Thank you for the opportunity to testify.
21 Senator Ortt I think was quite
22 prescient, maybe, in his comments earlier
23 about what you are likely to hear from the
24 rest of us after hearing from OPWDD and
290
1 others about the issue of workforce. That is
2 what we are going to concentrate our comments
3 on here today.
4 These are two organizations that are
5 part of multiple campaigns that are focused
6 on workforce issues, one being the Restore
7 Opportunity Now campaign, and the other being
8 the #bFair2DirectCare campaign. We are both
9 very active in those campaigns because
10 workforce has become the only issue, in many
11 ways, that is important to us at this point.
12 The fields that we represent are in a
13 crisis mode at this point. There's a
14 recruitment and retention crisis the likes of
15 which I think we've not really seen in the
16 better part of several generations if not
17 lifetimes.
18 The service expansions that we have
19 seen in, for example, the OPWDD budget this
20 year are appreciated. However, quite
21 frankly, they mean very little if there is an
22 inability, as currently exists right now, to
23 recruit and retain qualified people to do
24 this work. If we can't hire people to do
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1 this work, we simply cannot expand supports
2 and services.
3 Recently the #bFair2DirectCare
4 campaign wrote a letter to the Governor
5 requesting a meeting with him personally, in
6 which we outlined three pieces of the crisis
7 that we as a system face. The first piece
8 really focused on the issue of the workforce
9 and the workforce crisis.
10 We've seen, I think as several people
11 have mentioned earlier, the vacancy rates for
12 providers of services to people with
13 disabilities have increased, the staff
14 vacancy rate has increased 20 percent on a
15 year-to-year basis, from 2014 to 2015. The
16 use of overtime within these organizations
17 has increased 13.5 percent from '14 to '15.
18 And we've seen a 21 percent increase in the
19 one-year turnover rate in staff.
20 Quite frankly, those are unsustainable
21 numbers in any system, let alone those that
22 are so dependent on public resources to be
23 able to recruit and retain the qualified
24 workforce they need.
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1 The second piece of the crisis that we
2 outlined was indeed a quality crisis. The
3 issue that relates to this is that we are
4 unable to hire qualified individuals and
5 therefore cannot ultimately end up meeting
6 the needs that are placed upon us as
7 organizations that provide services to people
8 with disabilities. Those can be even some of
9 the most rudimentary health and safety
10 quality issues.
11 And that then brings about a third
12 crisis, which I think really is the one that
13 we're starting to face across the system,
14 which is a systemwide, indeed, crisis, where
15 you have organizations that can no longer
16 provide some of those health and safety
17 bare-minimum requirements. I think that
18 there's now a position in this system where
19 the organizations that do provide services
20 are no longer equipped to be able to take on
21 new service capacity, as one organization may
22 no longer be able to provide services.
23 That's a huge issue for the State of
24 New York. The State of New York has the
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1 statutory responsibilities to provide the
2 services and supports to these populations,
3 not the providers of these supports that
4 contract with the state to do so. So as we
5 see this budget taking place, the lack of the
6 investment in the workforce is by far the
7 number-one issue. Quite frankly, we can't
8 see beyond that crisis to some of the other
9 priorities that have been articulated in this
10 budget or articulated by the administration,
11 including the move toward managed care.
12 Those become increasingly less clear as we
13 are unable to meet the bare-bones minimum on
14 a day-to-day basis.
15 We need to be able to create a living
16 wage for people who do this work. We need to
17 increase the value, the societal value of
18 this work and thereby also increase the wage
19 that is paid for this work. It is very
20 difficult work, and we need that to take
21 place in both fields that we're representing
22 here.
23 In the developmental disabilities
24 system, that's a $45 million investment that
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1 we're looking for for a period of six years,
2 over a -- each year, for a period of six
3 years. And a similar investment in the
4 mental health system of $50 million for six
5 years. That's what's necessary to bring
6 these jobs up to a living wage, something
7 that, as several of you have noted earlier,
8 does not require people to have two, two and
9 a half, three jobs just to make ends meet.
10 CHAIRWOMAN YOUNG: Thank you.
11 MS. HARDIMAN: I'll be really quick.
12 I want you to know that direct support
13 professionals wind up working more than one
14 shift, oftentimes leading to weary, tired
15 staff members delivering services. And their
16 supervisors are now working shifts. And so
17 good supervisors are really important for
18 providing what DSPs need, and they're not
19 there for them.
20 Three emblematic quick stories right
21 now that represent what's happening on the
22 ground. One, an executive director told me
23 that he and his leadership staff get together
24 every morning and decide what's going to be
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1 covered today, where are we going to pull a
2 staff person from to cover health and safety,
3 what medical appointment needs to happen.
4 The quality things that Michael talked about
5 are not able to happen in many cases.
6 The second thing is another executive
7 director telling me that the direct support
8 professional people they are hiring right
9 now, that are the pool to hire from, need as
10 much mentoring and support as the people with
11 disabilities that are living with them. And
12 that's really striking and shocking.
13 And the third thing is an example I
14 heard from one of my members. A person with
15 a disability with very complex physical
16 needs, sitting in a person-centered planning
17 session with his circle of support, said --
18 and they're talking about what he wants for
19 his life. And he said, "Well, you know, over
20 the last year, 40 different DSPs have seen my
21 private parts in the bathtub, and I want that
22 to change. I want more staff that are
23 regular, and not so many."
24 So -- he said something more graphic
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1 than I did, but it's emblematic of what's
2 going on. Yes, I won't go further.
3 So DSP work is complex and it requires
4 skills that respect the dignity of people.
5 And it's not a minimum-wage job. So we ask
6 you, respectfully, to support including
7 $45 million in the budget for a living wage.
8 Thank you very much.
9 CHAIRWOMAN YOUNG: Thank you.
10 ASSEMBLYMAN OAKS: Thank you.
11 CHAIRWOMAN YOUNG: I don't believe
12 there's any questions, and I think you have a
13 lot of people very sympathetic to your cause.
14 So thank you.
15 MS. HARDIMAN: We understand. Thank
16 you.
17 CHAIRWOMAN YOUNG: The next speaker is
18 Steven Kroll, executive director of NYSARC.
19 Greetings. Thank you for being here.
20 MR. KROLL: Good afternoon, Senator.
21 And good afternoon, everybody. Thank you so
22 much for inviting us to speak today.
23 You have my written statement, and
24 appended to my written statement is also the
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1 testimony of the #bFair2DirectCare Coalition.
2 And Ann and Michael spoke a little bit
3 about the workforce shortage. I'd like to
4 just make two points today.
5 First, any one of us has an elderly
6 neighbor or a couple or maybe a widow or
7 widower that lives down the road or you can
8 see from the house, that you've watched them
9 age, struggle as they age. So you send your
10 kids out to help them shovel the walk because
11 they're so self-reliant they shovel the walk
12 themselves. And then you see them carrying
13 the groceries up the stoop and, you know, you
14 go help them carry the groceries. And you
15 watch them age and struggle to maintain their
16 lifestyle.
17 Now, imagine if that couple or that
18 individual was the caregiver to a
19 developmentally disabled child and is not
20 only struggling with their own life but
21 struggling to support a child because they
22 can't secure residential support for that
23 child.
24 That's where we are today. We don't
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1 have to imagine that. And there are
2 thousands of them.
3 So all these parents are asking for is
4 a residential placement so their child is
5 loved, their child is safe, and the child is
6 part of a community that will take care of
7 them when they're gone. And we put them on a
8 waiting list. And they sit on the waiting
9 list for years.
10 They have no hope today unless they
11 lose all capacity, such as have a stroke or
12 they pass away, and then their child will be
13 helped. And we have tons of excuses --
14 money, bureaucracy, just plain saying no.
15 So it's late in the day, and there are
16 not a lot of people here watching the
17 hearing, though some might be watching us on
18 the web. But there's so many other things
19 that we're doing right now, whether it be
20 signs on the Thruway or waiving snowmobile
21 fees or clearing the way for hemp farming and
22 other important priorities for the state --
23 and we're leaving these parents out there and
24 hanging. So I ask, is that the kind of
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1 New York we live in?
2 So I was listening to the testimony of
3 the executive deputy commissioner, and I was
4 doing some number-crunching. So we're
5 talking about 6300 new spots over three
6 years. Well, about 1800 turn over every
7 year. So if you take 1800 and you multiply
8 it by three, we're talking about creating
9 less than a thousand new slots over the next
10 three years. So 300 or so slots a year for a
11 waiting list that's 10,000.
12 So essentially we're saying to
13 somebody who passes away that we'll find a
14 home for your child after you pass away. And
15 we've got some terrible, horrible tragedies,
16 one I described for this committee last year
17 that occurred right before the hearing, where
18 a child's family had tried to find him a
19 home -- the child was a 50-year-old man --
20 but tried to find him a home, and they found
21 a home right after mom passed away.
22 And so is that our New York? Do we
23 wait until people suffer tragedies, or do we
24 try and find homes for their -- residential
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1 supports for their children while they're
2 still well so they can -- I always like to
3 say, so they can go and visit their child in
4 their new home every evening or every couple
5 of evenings and tuck their child into bed,
6 knowing their child is safe and secure and
7 loved. Is that too much to ask for? Right
8 now, in New York, it is.
9 So that's my first point.
10 My second point is to the DSP and
11 workforce crisis. And Michael and Ann did a
12 great job of describing, and you'll hear from
13 some other speakers about that. I'll just
14 direct you to a chart in my testimony. It's
15 on the third page, it's a color chart. And
16 this chart takes two agencies, and it shows
17 in red their starting wage in 2006 and their
18 starting wage 10 years later, the minimum
19 wage in 2006 and the minimum wage 10 years
20 later, and the fast food minimum wage.
21 So the top chart is a large agency in
22 upstate New York. They paid 39 percent above
23 minimum wage to their starting employees in
24 2006. Today they pay 3 percent above the
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1 minimum wage, so essentially a minimum wage,
2 and 7 percent below the fast food minimum
3 wage, because the Fast Food Wage Board has
4 moved the wage up faster than the Governor's
5 transformation.
6 So it's very simple. We've been
7 frozen for seven of the last eight years.
8 The Governor has proposed to freeze us for
9 eight out of nine. And so you can work 70 or
10 80 hours as a DSP to take care of your
11 family. You may be on food stamps. You may
12 give it up and say, You know what, there's a
13 casino opening in Schenectady, I'm going to
14 go apply for a job as a blackjack dealer.
15 Or, You know what, it's a lot easier to run a
16 cash register than it is to support people.
17 I'd have to work on Christmas and on
18 Thanksgiving.
19 The chart below is a large New York
20 City agency. Same story. Sixty-three
21 percent above the minimum wage in 2006, at
22 minimum wage today, and 9 percent below the
23 fast food minimum wage.
24 So every agency has a different story,
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1 but these are two. We now have an average
2 11 percent vacancy rate in New York State.
3 Michael talked to you about how that's
4 continued to increase. There are agencies
5 that are now well above 20 percent. Eleven
6 percent is the average. And so Ann and
7 Michael were not kidding, where every week or
8 every morning the staff gets together and
9 says, What are we going to get done today,
10 and what's not going to happen?
11 And so people can become prisoners in
12 their own homes. Because if there's not
13 enough staff, they're not going to get out
14 into the community. They're not going to be
15 able to be involved in activities. And it's
16 going to be like institutional care in their
17 home. We're getting there, we're getting
18 there quickly. That's why #bFair2DirectCare
19 is together. And we are grateful that the
20 Legislature and the Assemblymembers, the
21 Senators, have all rallied to support. And
22 we would love the Governor to put it in his
23 30-day amendments. I don't know whether that
24 will happen or not. But if not, we just ask
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1 that the Legislature, in the one-house
2 budgets, put the money in to get us started
3 towards a living wage for DSPs, and hopefully
4 we can achieve that over the next several
5 years.
6 So I thank the members of the
7 committee for visiting with us today and
8 especially for all of your support, and I'd
9 be glad to answer any questions.
10 CHAIRWOMAN YOUNG: Thank you very
11 much, Steve. Thank you.
12 ASSEMBLYWOMAN GUNTHER: Thank you.
13 ASSEMBLYMAN OAKS: Thank you very
14 much.
15 CHAIRWOMAN YOUNG: Our next speaker is
16 Glenn Liebman, CEO of the Mental Health
17 Association in New York State.
18 Thank you for being here.
19 MR. LIEBMAN: Thank you, Senator.
20 Good evening, everybody.
21 CHAIRWOMAN YOUNG: Good evening.
22 MR. LIEBMAN: Thank you for the
23 opportunity to testify at the hearing today.
24 My name is Glenn Liebman. I'm the CEO
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1 of the Mental Health Association in New York
2 State. We're comprised of 26 affiliates in
3 50 counties throughout the state. Our
4 members provide community-based mental health
5 services to over 100,000 New Yorkers with
6 mental health challenges.
7 Our organization is also involved in
8 advocacy, education, and training. Our core
9 mission is to advocate for the greater good
10 of the mental health community and to help
11 eradicate the stigma of mental illness.
12 This is the 14th year I have had the
13 opportunity to present testimony. Over these
14 years, especially in more recent years,
15 there's been great progress made in the fight
16 to end the stigma of mental illness. Now,
17 none of us are naive. We know we have a long
18 way to go. But I really want to thank all of
19 you for all you've done in recent years,
20 especially our chairs, Assemblymember Gunther
21 and Senator Ortt, because you've all
22 listened, and you've acted.
23 In recent years there have been some
24 real hard-earned successes for people with
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1 mental health issues, through prevention,
2 education, and public awareness efforts.
3 This past year we had the passage, for the
4 first time in the country, of a mental health
5 education bill. And thank you for all your
6 leadership on that.
7 There was great reference today to
8 also the mental health tax checkoff, also
9 landmark legislation, first in the country to
10 actually talk about public awareness of
11 mental illness on income tax forms.
12 So we're really moving the needle.
13 And also what happened, which was a great
14 victory, on New Year's Eve, we found out on
15 New Year's Eve about the bill passing for
16 step therapy. And thank you, Senator Young,
17 for your sponsorship of that. That was
18 really a great victory for all consumers
19 across New York State.
20 So we're really pleased, and we really
21 think that things are -- as frustrated as we
22 all get, and I think we're all very
23 frustrated, and I'll certainly share my
24 frustration. But there is some really good
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1 progress being made around a lot of
2 mental-health-related issues, especially
3 around public awareness.
4 Usually when I come and testify I
5 usually do a slipshod approach, because we at
6 the Mental Health Association, again, because
7 we're involved in advocacy on so many
8 different levels, we talk about a lot of
9 different issues. We talk about veterans'
10 issues, we talk about mental health first
11 aid, we talk mental health education, we talk
12 about -- you name it, we talk about it --
13 crisis intervention teams. We're always
14 trying to talk about what we think is the
15 most relevant issues around mental health
16 care.
17 But like my predecessors, I want to
18 talk specifically today about the cost of
19 living adjustment and -- the COLA and the
20 workforce issues, because they're so relevant
21 to us.
22 As I referenced, this is my 14th year
23 of presenting. And in all the years, I've
24 never seen a greater need for a well-trained
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1 and well-compensated workforce. I think of
2 it -- you know, Steve did a great job of
3 talking about it from a personalized
4 perspective, but I also think about it from
5 an agency perspective. You have to run an
6 agency -- I know our MHAs across New York
7 State do this -- with the expanding cost of
8 healthcare and other ancillary costs of
9 running a not-for-profit business.
10 You have to deal, in our case, with
11 the transformation of the mental health
12 system into a Medicaid managed care
13 environment and the new expectations put on
14 the workforce -- and I'll get into that in a
15 minute, because it's not a bad -- there are
16 some things in the transition that can be
17 very positive. But again, it's all about the
18 workforce.
19 Then you're dealing with the impact of
20 the minimum wage, which we've heard about all
21 day. A not-for-profit isn't McDonald's. We
22 can't raise hamburger prices by a nickel to
23 pay for the minimum wage. Without additional
24 state funding, we would be unable to pay for
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1 minimum wage increases.
2 According to work done by our
3 colleague Doug Cooper -- who I know is
4 speaking later -- from the Association for
5 Community Living, as Michael Seereiter said,
6 we estimate that there would be about a need
7 of $50 million over six years to help pay the
8 cost of minimum wage in mental health.
9 Our colleagues in the
10 #bFair2DirectCare campaign have similar
11 numbers on the developmental disabilities
12 side. And just as an aside, they've done a
13 great job of raising this issue, they really
14 have. And, you know, credit to them for
15 working so hard and being in every community
16 in the state and talking about this issue.
17 But that's only one part of the story.
18 The other part of the story is there's
19 virtually no additional funding support from
20 New York State. In mental health we've
21 received only two COLAs in the last decade,
22 and one was last year, at 0.2 percent --
23 0.2 percent, which is akin to about a dollar
24 a week for most employees.
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1 This year again, sadly, the COLA is
2 deferred. How many more years can a COLA be
3 deferred before the workforce is completely
4 decimated? At some point the logjam has to
5 end. Our workforce can tell you, point
6 blank, that things have never been more
7 difficult in the nonprofit sector.
8 Now, we're part of a campaign called
9 the Restore Opportunities Now campaign that's
10 comprised of over 350 not-for-profit
11 organizations across the state that call for
12 crucial investments and systemic changes in
13 New York's nonprofit services sector. The
14 impact of the lack of funding for the
15 nonprofit sector is seen across New York
16 State, and they've done a wonderful report in
17 terms of poverty numbers, individuals with
18 disabilities, and food insecurity for both
19 children and adults.
20 Many of the Governor's bold
21 initiatives in the State of the State include
22 things around expansion of indigent legal
23 services, affordable housing programs,
24 high-quality pre-K for 3- and 4-year-olds,
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1 SNAP benefits, fighting food insecurity,
2 mental health services for individuals who
3 are homeless, et cetera, et cetera -- all
4 important, and all things that are very
5 significant and that we very much support.
6 But to work on these programs and to
7 put these programs forward, you need the
8 support and tireless efforts of the nonprofit
9 sector to succeed. We must fund living wages
10 that are competitive and keep pace with the
11 increasing cost of living in the future.
12 Now again, from my own perspective at
13 the mental health association, the issue is
14 especially acute in the mental health sector.
15 The workforce, like all the other workforces,
16 are incredibly mission-driven. People know
17 when they enter the mental health workforce
18 it's not for the money, but it's for helping
19 vulnerable people get better and move forward
20 in their lives. Yet good feelings and
21 mission-driven work does not pay the rent or
22 student loans.
23 Again, we talked about Medicaid reform
24 and the integration of health and mental
311
1 health. Who wouldn't want that? As a mental
2 health advocate for many years, and as a
3 family member, we would love to see the full
4 integration of health and mental health. And
5 that's what we're moving forward with,
6 hopefully, in the Medicaid managed-care realm
7 and around DSRIP and, you know, around
8 value-based payments.
9 However, as progressive as the systems
10 of care may be, you need a sophisticated and
11 well-compensated and well-trained workforce
12 to operationalize these changes. We must
13 have a workforce enhancement if we are to
14 continue to run quality programs and support
15 for people with mental health issues to live
16 in the community.
17 I'll just talk about three
18 recommendations. The first one is fund the
19 minimum wage increase through state contracts
20 and Medicaid reimbursements.
21 The second is through the leadership
22 of you in the Legislature, there was a COLA
23 for the mental health workforce three years
24 ago. That was very helpful. We need your
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1 support to ensure that there is funding for
2 another COLA for the mental health workforce.
3 And third, and there was --
4 Assemblywoman Gunther, we appreciate you
5 asking this -- there was a discussion -- you
6 know, you asked Commissioner Sullivan about
7 workforce funding through the DSRIP waiver.
8 This is an $8 billion waiver over a five-year
9 period that has a specific set-aside of
10 $1.08 billion for workforce and enhanced
11 behavioral health services. Much of the
12 money dedicated to behavioral health of the
13 $1.08 billion has not been expended.
14 How is that money being utilized? And
15 wouldn't there be an ability to redesign the
16 waiver to ensure that the funding was going
17 to go to the behavioral health -- not
18 necessarily workforce, but behavioral health
19 in general, rather than lose the funding from
20 the waiver?
21 I think those are really important
22 questions that have to be asked, because the
23 specific language of the waiver says "This
24 funding will support health home development
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1 and investments in long-term care, workforce
2 and enhanced behavioral health services."
3 Our colleagues at NYAPRS, the New York
4 State Coalition of Children's Services, and
5 the New York State Council for Community
6 Behavioral Healthcare all support this
7 important initiative.
8 And in final comments, we know that a
9 very small percentage of the DSRIP dollars
10 have been flowed to community providers. We
11 want to make sure to incent the workforce by
12 insuring DSRIP contracts with these providers
13 for outcomes necessary to keep people out of
14 the hospital and in the community.
15 The workforce is in desperate need of
16 help and support, and utilizing the DSRIP
17 waiver can help provide resources to the
18 sector with no impact at all to the state
19 budget and to middle-class taxpayers. We
20 urge the Legislature to work with the
21 Governor on this initiative.
22 And I could go on for another hour,
23 but I'm sure you have a lot of work to do, a
24 lot of people to hear from. So thank you
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1 very much. Any questions?
2 CHAIRWOMAN YOUNG: Thank you, Glenn.
3 I think Assemblyman Oaks has a
4 question.
5 ASSEMBLYMAN OAKS: Yes, Mr. McDonald.
6 CHAIRWOMAN YOUNG: Oh, I'm sorry.
7 ASSEMBLYMAN McDONALD: So, Glenn,
8 thank you for your continued advocacy and
9 work. Going back to the DSRIP, I'm
10 assuming -- I just want to make sure of
11 this -- that organizations like your own and
12 local providers were invited to the
13 participate in the PPSs. Is that correct?
14 MR. LIEBMAN: Correct, we are.
15 ASSEMBLYMAN McDONALD: As we know, the
16 DSRIP is a very complicated process. You
17 know, there's some that feel that it's
18 primarily built for the hospital systems, for
19 capital improvements, but it is really about
20 transforming and moving towards a value-based
21 payment system and value-based care.
22 MR. LIEBMAN: Correct.
23 ASSEMBLYMAN McDONALD: So are they not
24 providing any nibbles? Or what will -- where
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1 is the shortfall?
2 MR. LIEBMAN: Well, I think -- and
3 there was just a hearing last week with the
4 Department of Health and the five PPS teams
5 across the state. And I think that the issue
6 that they heard really consistently from -- I
7 was one of them who testified -- from all 30
8 folks who testified, where the reality right
9 now is that a lot of this money is not going
10 to the downstream providers. So the PPSs are
11 holding a lot of that money, and these
12 downstream providers are getting frustrated
13 by the fact money has not flowed to them.
14 We're three years in, almost; we only
15 have two years left. We have to start really
16 working into the movement to transition to
17 value-based payment, and the only way we're
18 going to be doing that successfully is if we
19 have this funding and downstream providers
20 can demonstrate their efficacy in this new
21 world.
22 And I think, given the money -- and I
23 know many of my members are frustrated --
24 given the money, I think that we could show
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1 how efficacious we are as small
2 non-for-profits in keeping people embedded in
3 the community and not in the hospitals. So
4 yes.
5 ASSEMBLYMAN McDONALD: For example, is
6 it infrastructure? Technology? What is it
7 that providers would be asking for? I mean,
8 for those who haven't seen a DSRIP, the PPS
9 plans, they are quite elaborate. They are
10 very comprehensive. But the question is what
11 is it, what is it that they need or what
12 would -- to help them get --
13 MR. LIEBMAN: Well, I guess it's two
14 questions. I've got two answers. One is the
15 investment piece that I think the downstream
16 providers, if they could get funding for
17 their community intervention programs, the
18 things they're doing with community supports
19 in the program, whether it's peer programs,
20 crisis programs, family engagement programs,
21 those kinds -- supported education, supported
22 employment. Those are the kinds of programs
23 that keep people in recovery and moving
24 forward in their lives. And I think that's
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1 really important, that the downstream
2 providers start getting some of that funding.
3 And the other piece, Assemblyman, is
4 that we do have a workforce -- as we know,
5 we've heard from everybody, and we'll hear
6 for the rest of the night about the
7 frustration of the workforce, how they're
8 underfunded and undertrained and
9 undercompensated, that there are DSRIP
10 dollars out there -- not necessarily
11 specifically dedicated for that need. And
12 it's very hard, I get that, because you've
13 got to go through a waiver, you have to go
14 through the feds and all that -- but just to
15 recognize how important that is to be able to
16 maybe put some funding towards those
17 downstream providers as part of PPSs, who
18 would be part of the DSRIP network. It's
19 just a -- it's an idea around specifically
20 let's look at some of the funding here and
21 figure out a way to work with the
22 administration to -- you know, nobody is
23 hiding anything, but just work with the
24 administration to try to get this funding
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1 moving forward.
2 ASSEMBLYMAN McDONALD: Thank you.
3 MR. LIEBMAN: Sure.
4 CHAIRWOMAN YOUNG: Thank you. Thank
5 you so much for your testimony.
6 MR. LIEBMAN: Sure. Thank you.
7 CHAIRWOMAN YOUNG: Our next speaker is
8 Harvey Rosenthal, executive director of the
9 New York Association of Psychiatric
10 Rehabilitation Services, Inc.
11 How are you?
12 MR. ROSENTHAL: Good, Senator.
13 CHAIRWOMAN YOUNG: That's good. Thank
14 you for being here.
15 MR. ROSENTHAL: Well, thank you to the
16 chairs and the members of the committees for
17 the opportunity to submit the concerns of the
18 thousands of New Yorkers that are represented
19 by the New York Association of Psychiatric
20 Rehabilitation Services.
21 NYAPRS is a very unique and nationally
22 acclaimed partnership, very unusual in that
23 we represent the needs and bring together
24 folks with mental illnesses and the providers
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1 who work with them across the state. And
2 under this big tent we've been able to
3 accomplish so much over the last, what, 36
4 years. We've brought recovery values to the
5 center of our system, we've protected and
6 expanded funding for community recovery
7 focused services and our workforce, we've
8 advanced peer support and human rights and
9 fought prejudice and discrimination, we've
10 expanded access to housing, employment and
11 transportation, and we've helped win landmark
12 criminal justice reforms.
13 State mental health policy is a very,
14 very personal thing to me and our staff and a
15 lot of our members because, as Mrs. Gunther
16 knows, I have a mental illness and I tell her
17 every day about that.
18 So we are in the midst of one of the
19 most dynamic Medicaid and broader healthcare
20 reform transformations in the nation. Over
21 the past years we've integrated behavioral
22 health benefits within Medicaid managed care
23 plans. We have facilitated the creation of
24 new local and regional health home and DSRIP
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1 healthcare networks aimed at helping those
2 with the most serious conditions to reduce
3 their use of hospital and emergency services
4 and to improve their health and their lives.
5 And we are moving rapidly towards a
6 value-based environment where providers'
7 efforts will either be rewarded or penalized
8 for their ability to demonstrate measurable
9 improvements in individual and community
10 health.
11 New Yorkers with moderate to extensive
12 behavioral health conditions have been a
13 central focus of these reforms, especially
14 because our community makes up an extremely
15 large percentage of those who needlessly fill
16 our hospitals and emergency rooms and our
17 homeless shelters and correctional facilities
18 and who die 25 years earlier than the general
19 public.
20 Now, I've been proud to serve on many
21 of the Medicaid redesign activities. I was
22 on the Medicaid Redesign Team, I've served on
23 the Behavioral Health Work Group, and I'm on
24 the steering committee of the value-based
321
1 payment exercise. And I've done this because
2 the state has clearly articulated values that
3 promote wellness and recovery, prevention and
4 diversion and an unprecedented commitment to
5 addressing the social determinants of health
6 and addressing poverty, hunger, homeless and
7 social isolation.
8 Throughout, I believed that these
9 reforms would be building on the unique and
10 essential expertise and innovation of our
11 community mental health and behavioral health
12 systems that have decades of experience in
13 knowing how to engage and serve individuals
14 with the greatest needs.
15 Yet after years of hopeful and hard
16 work, I come here today to say that our
17 recovery sector and our workforce is as
18 threatened as it's ever been, as you've heard
19 today, even as our state reforms are failing,
20 at the same time, to serve the very
21 individuals that we understand the best and
22 who trust us the most.
23 While billions of dollars are being
24 invested in the transformation of our
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1 Medicaid healthcare systems, a shameful
2 trickle of dollars have been invested in
3 helping our recovery sector to play the
4 central role for which we were created.
5 While Medicaid redesign was intended
6 to reduce reliance on costly hospitals, it's
7 the hospitals themselves that are getting
8 billions to oversee and to work to get people
9 out of hospitals. It seems rather strange.
10 And they're meant to oversee and offer care
11 to groups that, all too often, they simply
12 don't know and don't know how to help as well
13 as we do.
14 In a landmark measure, Medicaid
15 funding has been extended to pay for recovery
16 services, the home and community-based
17 services sector that Glenn talked about --
18 employment, education, and peer support --
19 yet only a handful of individuals have been
20 able to access those services. And those
21 services have reserved $645 million, and we
22 have two years to spend it, and we're -- it
23 looks -- at this moment, it really looks
24 grim.
323
1 We've seen a succession of new funding
2 streams to build organizational
3 infrastructure, but our sector is only
4 getting $100,000 or so per agency, while more
5 traditional networks are getting tens of
6 millions of dollars. Hospitals, if you go up
7 to Albany Medical, if you go to any of these
8 organizations, they've spent millions of
9 dollars building -- you know, building
10 buildings and hiring staff. But where the
11 people are, and where the services are, that
12 money is not going.
13 Simply put, our state is allowing our
14 recovery sector to fail to keep up with the
15 rapid pace of change and to retain a quality
16 workforce on whom successful healthcare has
17 always relied. In doing so, they are
18 jeopardizing the survival of some of our most
19 important programs and organizations.
20 Now, I'm not going to tell you that we
21 need a COLA, because you've heard that with
22 every speaker. And I won't have to tell you
23 that we were denied a COLA again this year,
24 and that denied us $9 million. We absolutely
324
1 join all the speakers here in saying that we
2 must have a COLA, and we urge to work with
3 the Governor to supply that.
4 We also join our friends at the
5 Association for Community Living in seeking
6 $50.5 million in OMH funding per year, for
7 the next five years, to support the impact of
8 the incremental increases to the minimum wage
9 that were approved last session. In doing
10 so, we can also address the impact of the
11 changes to the New York State Department of
12 Labor rules for exempt employees and
13 overtime.
14 It's really important that we pay for
15 the workforce. Our work is really about
16 relationships. Our ability to engage folks
17 and get them to trust us and make the changes
18 that are necessary depends on those
19 relationships. If staff are unable to stay
20 in those jobs and those relationships, as
21 good as they are, have to end, then we are
22 betraying the folks that we're here to serve.
23 NYAPRS urges the state to set aside 25
24 percent of the $6 billion in DSRIP Medicaid
325
1 waiver dollars that, as I said, are currently
2 going primarily to hospitals and hospital-led
3 networks. Twenty-five percent is what we're
4 asking for, while tens of millions of dollars
5 are going to hospitals and not to the
6 community sector.
7 As Glenn pointed out, there was a
8 hearing last week and we learned, once again,
9 it turns out to be 1 percent of all the money
10 that's been put in this waiver is going to
11 community-based organizations, only
12 $12 million, while millions and millions of
13 dollars -- I would say billions of dollars --
14 are going to the hospital networks. We must
15 preserve the community recovery sector, and
16 those monies need to flow there.
17 We have, as I said earlier, almost
18 $600 million in waiver funds that are
19 expressly dedicated to these kinds of
20 services. And we only have two to three
21 years left, and we're not spending it. We
22 have a number of ideas to share with
23 government about that, and we urge them to
24 work with us.
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1 NYAPRS joins our colleagues in urging
2 that 25 percent of the proposed $500 million
3 capital projects fund for construction,
4 equipment and other nonbondable purposes be
5 afforded the community and behavioral health,
6 and actually the greater healthcare sector.
7 I live in Washington County, not far
8 from Warren County, and I must say out loud
9 that Glens Falls Hospital has received I
10 think $5 million of capital infrastructure
11 grants, and they're using them to build the
12 kind of services that we already have in the
13 community and ought to be expanded. They're
14 building services instead of buying our
15 services. That's unconscionable. We're
16 eroding the service system we have while big
17 institutions are rebuilding them, and they
18 don't know how to run them. And that's why
19 we're here.
20 On reinvestment, while we laud the
21 Governor and OMH for the proposal to reinvest
22 $11 million, there is $110 million in managed
23 care savings. Very little of it is going to
24 the community sector.
327
1 So we come to you for funds for a
2 COLA, but there are funds in the budget, as
3 Glenn pointed out, that won't cost the
4 taxpayers and won't require you to find money
5 that has to go into this sector.
6 In terms of housing, you'll hear more
7 about that from our colleagues. But I'll cut
8 to the chase. While there's $10 million to
9 raise housing rates and fund 280 additional
10 beds, we join ACL in seeking $28 million more
11 to raise housing rates, recognizing that
12 critically needed housing programs require
13 $38 million a year for the next three years
14 to remain sustainable.
15 We must take care of our housing
16 programs. Our consumers rely on them.
17 Housing for the homeless. We know
18 last year that the Governor and the
19 Legislature were discussing and considering
20 the Governor's plan to allocate $2.5 billion
21 that would, in our world, build 6,000 new
22 units of supportive housing. We got very
23 little of that last year. We await a
24 memorandum of understanding between the
328
1 Governor and the Legislature to fund these
2 beds, and we urge you and your leadership to
3 work with the Governor to do so.
4 I would say criminal justice
5 reforms -- and I have to point out I'm here
6 today talking to you in the Mental Health
7 Committee, but a lot of what I'm talking
8 about is really in the Health Committee and
9 in the Corrections Committee, because that's
10 where a whole lot of what we care about is
11 housed.
12 And so I'm talking to you about it
13 today hoping you'll go back to your
14 colleagues and make changes in those areas.
15 We need that so badly.
16 Criminal justice reform, we have
17 champions here, Mrs. Gunther and Senator
18 Ortt. You've been with us, in the last few
19 years you've helped fund $3.4 million worth
20 of crisis intervention teams. We can't thank
21 you enough, but we will ask you for more for
22 the coming year.
23 I will say, because I'm really trying
24 to run through this here a little bit, crisis
329
1 intervention teams are critical because they
2 keep people out of the system and they keep
3 folks safe. So it's incredibly important
4 that we train our police, and this program
5 really works.
6 Perhaps the most compelling thing to
7 me, after the workforce, is the torture in
8 our prisons. We have thousands of people
9 with mental illnesses who are sitting right
10 now in solitary confinement, in a box,
11 23 hours a day in a box. We passed a law --
12 you passed a law some years ago, at our
13 request, the SHU exclusion law, but still
14 hundreds of folks, I think 900 individuals
15 with severe mental illnesses, are in the box.
16 That's why we're joining again with
17 our colleagues to urge your support for HALT
18 legislation that's been sponsored by
19 Assemblyman Aubry and Senator Perkins that
20 will end the torture for so many. It will
21 prohibit segregation of young and elderly
22 people, people with physical or mental
23 disabilities, pregnant women, new mothers,
24 and LGBTQI individuals. It will end
330
1 long-term solitary confinement by placing a
2 limit of 15 consecutive days and a limit of
3 20 total days in a 60-day period that a
4 person will spend in the box.
5 It will enhance conditions in
6 segregated confinement. It won't use the
7 box, it will create these new residential
8 rehab units, which are segregated, but will
9 really be trauma-informed and rehabilitative
10 in nature. So we urge you to look at that.
11 I'm out of time, aren't I?
12 CHAIRWOMAN YOUNG: You are.
13 MR. ROSENTHAL: So I will just end by
14 saying we also would like to see the age of
15 criminal liability raised from 16 to 18, and
16 that there's money in the correctional system
17 to fund the services that the kids need to be
18 in the community.
19 Thank you very much, and I'm sorry I
20 went over.
21 CHAIRWOMAN YOUNG: Thank you very much
22 for participating.
23 SENATOR KRUEGER: Thank you.
24 ASSEMBLYWOMAN GUNTHER: Thank you,
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1 Harvey.
2 CHAIRWOMAN YOUNG: Our next speaker is
3 Wendy Burch, executive director, and Irene
4 Turski, government affairs, National Alliance
5 on Mental Illness, NAMI New York State.
6 Thank you for being here.
7 MS. BURCH: Thank you.
8 Good evening. My name is Wendy Burch,
9 and as the executive director for the
10 National Alliance on Mental Illness New York
11 State, I represent thousands of New Yorkers
12 living with mental illness and their
13 families, whose hope of recovery hinges on
14 many factors --
15 ASSEMBLYWOMAN GUNTHER: Would you pull
16 your mic closer? I'm so sorry.
17 MS. BURCH: Is this better?
18 ASSEMBLYWOMAN GUNTHER: Yes, much
19 better.
20 MS. BURCH: -- many factors, in
21 particular a safe and affordable place to
22 live, adequate services, and, when
23 psychiatric emergencies do occur, first
24 responders with crisis intervention training
332
1 and adequate inpatient facilities.
2 With me is Irene Turski, a family
3 member of someone with serious mental
4 illness, who has firsthand knowledge in
5 dealing with our mental health system.
6 Irene's family story is all too similar to
7 that of many families who have a loved one
8 with serious mental illness.
9 You have copies of our written
10 testimony, so in interests of time I will be
11 brief.
12 CHAIRWOMAN YOUNG: Thank you.
13 MS. BURCH: First I would like to
14 thank Senator Ortt and Assemblywoman Gunther
15 for their leadership, and I would like to
16 acknowledge Senator Young for her
17 championship of the step therapy reform bill
18 recently signed into law.
19 Ensuring that people with a mental
20 illness get the medication their doctors
21 believe to be the most effective is a key
22 component to recovery. Equally important is
23 having prescriber prevails in place for those
24 treating people through the Medicaid system.
333
1 Psychiatric medications are not
2 interchangeable, and many living with serious
3 mental illness having their healthcare met
4 through Medicaid. We ask that the
5 Legislature restore prescriber prevails to
6 the final budget.
7 NAMI New York State operates a
8 helpline for those seeking mental health
9 resources. A significant amount of calls
10 received deal with housing concerns. Housing
11 availability is woefully inadequate to meet
12 the needs of New Yorkers with serious mental
13 illness. I urge you to heed the figures
14 presented in our written testimony, and from
15 our colleagues at the association for
16 community living. Only with available
17 housing with wraparound services, and
18 continuity of care, can our loved ones hope
19 for the chance of meaningful recovery -- and
20 I know that's something everyone's been
21 talking about today.
22 The other issue most often brought to
23 light by our helpline callers is those with
24 serious mental illness caught up in the
334
1 criminal justice system. We must continue to
2 fund crisis intervention training for first
3 responders. We must ensure that mental
4 health courts are expanded so that the unique
5 needs of those with mental illness can be
6 addressed appropriately. We must raise the
7 age of criminal responsibility, as detailed
8 in the Executive Budget.
9 And finally, Assisted Outpatient
10 Treatment, known in New York as Kendra's Law,
11 has proven to reduce long-term
12 hospitalizations, homelessness,
13 incarcerations, harm to self, and dependency
14 on drugs and alcohol. We urge the
15 Legislature to continue to fund AOT and, in
16 fact, pass legislation to make Kendra's Law
17 permanent. Again, we acknowledge Senator
18 Young's championship of this.
19 Everyone testifying this afternoon
20 will tell you about the shortage of mental
21 health services. Kendra's Law ensures that
22 the ones who need services the most have
23 first access to the limited services that do
24 exist, including housing. And now I'd like
335
1 Irene to share a bit of her story.
2 MS. TURSKI: Thank you.
3 I speak to you today not solely in my
4 role as government affairs chair, but as a
5 family member and an unpaid advocate for
6 those with serious mental illness. This is
7 an advocacy role I did not choose. The
8 decision was made for me upon witnessing the
9 experience of my sister, who has
10 schizophrenia. She has lived within the
11 state hospital system and is now in a
12 community residence program.
13 I assure you, the only reason she has
14 been able to live in the community is because
15 she resides in a program that incorporates
16 the necessary support services to keep her
17 healthy.
18 I have three concerns for those being
19 transferred from inpatient beds into the
20 community. Number one, people coming from
21 inpatient psychiatric hospitals usually have
22 serious mental illness and have lived for
23 years under institutional control.
24 Transition from a hospital to a residential
336
1 program is challenging. One of the many
2 obstacles was ensuring my sister took her
3 medication properly.
4 People such as my sister are not
5 statistics or patients, they are human beings
6 with complex needs who are not equipped to go
7 into supported and supportive housing
8 programs that do not offer the level of
9 intensive care they would receive in a
10 hospital setting. They must have the
11 necessary support services, which are
12 provided in a community residence type of
13 housing, to teach them how and when to take
14 medications and, in the most serious cases,
15 basic needs such as personal hygiene and how
16 to feed themselves.
17 On top of this, some of them are
18 suicidal and a danger to themselves. Some
19 suffer from anosognosia and do not know they
20 are ill. Many who have been on antipsychotic
21 medications may also be suffering from
22 tardive dyskinesia, which causes involuntary
23 movements of the tongue, lips, face, trunk
24 and extremities. Tardive dyskinesia must be
337
1 addressed as early as possible, as the
2 effects can be permanent and disabling.
3 Continuity of care for this population
4 is essential. Only someone providing
5 continual care would be able to notice the
6 slight changes in a person which could
7 indicate serious ailments. Continuity of
8 care is only possible if providers can hire
9 and retain qualified and caring staff members
10 who build the types of relationships
11 necessary to drive recovery. It is
12 impossible to form these relationships if
13 staff is constantly changing.
14 Number two. We have heard that
15 housing providers received additional dollars
16 for accepting people from inpatient beds for
17 a two-year period. Since these individuals
18 usually have serious mental illness, what
19 happens after the two-year incentive? If
20 this is true, is there any monitoring in
21 place by OMH to ensure these people still
22 have homes after the two-year period?
23 Number three. Despite the excellent
24 care my sister received in her residential
338
1 program, she recently required a short
2 inpatient stay in an OMH psychiatric
3 hospital. While hospitalized, we found out
4 that because her stay was OMH funded, she
5 would lose her bed, her home, because it also
6 was funded by OMH. Luckily, this was worked
7 out, and she was able to return to the place
8 she views as her home.
9 As anyone impacted by psychiatric
10 disorders knows, the road to recovery is
11 rarely straight, and hospital usage is
12 sometimes needed. Those who need short-term
13 hospital stays should not have to worry about
14 losing their home. Hospitalizations can be
15 traumatic by themselves, and this should not
16 be compounded by the fear of not being able
17 to return to the home you are comfortable in.
18 Being displaced can be a serious
19 detriment to recovery. This is why I beg you
20 to have OMH address this practice and
21 introduce stipulations that a person's bed in
22 a housing facility be held for them for an
23 agreeable amount of time if they need
24 short-term care in an OMH psychiatric
339
1 hospital. My sister and others, who have
2 suffered a great deal throughout their lives,
3 deserve nothing less.
4 Thank you.
5 CHAIRWOMAN YOUNG: Thank you very
6 much. Thank you for your advocacy for
7 Kendra's Law also.
8 MS. BURCH: We appreciate the
9 opportunity.
10 ASSEMBLYMAN McDONALD: Thanks, Wendy.
11 ASSEMBLYWOMAN GUNTHER: We agree with
12 you. That's right, we do.
13 CHAIRWOMAN YOUNG: The next speaker is
14 Kelly Hansen, executive director of the
15 New York State Conference of Local Mental
16 Hygiene Directors.
17 Welcome.
18 MS. HANSEN: Good evening. Thank you,
19 everyone, for hanging in there. Chairwoman
20 Young, Senator Savino, Assemblymember Bob
21 Oaks, and a former boss at one point in my
22 career, Chairwoman Gunther.
23 CHAIRWOMAN YOUNG: What we're going to
24 ask everybody to do is not to read everything
340
1 verbatim, in the interest of time, because I
2 know people have been here a long time. We
3 still have a lot of speakers to get through.
4 So if you could summarize and --
5 MS. HANSEN: Understood.
6 CHAIRWOMAN YOUNG: Thank you.
7 MS. HANSEN: Thank you all for letting
8 me come and give you our testimony today on
9 the Governor's Executive Budget.
10 My name is Kelly Hansen. I'm the
11 executive director of the Conference of Local
12 Mental Hygiene Directors. The conference
13 represents the county mental health
14 commissioners. And the job of the county
15 mental health commissioner is very different,
16 and I'm going to be talking to you about
17 things that you have not heard today, so
18 there's something completely different.
19 But the responsibility of the DCS,
20 county mental health commissioner, also
21 referred to as the local governmental unit,
22 is an oversight and planning and local role
23 to ensure that the mental hygiene system, in
24 watching all the moving parts -- to make sure
341
1 that there's services, they do the planning,
2 the development and the oversight for
3 individuals in the community, adults and
4 kids, with mental illness, substance abuse
5 disorder, and developmental disability.
6 One of the things I just want to
7 stress is that the LGU is responsible for
8 services for everyone, not just Medicaid.
9 As part of this, they're very embedded
10 in the community. So the DCSs have linkages
11 to inpatient providers, clinic providers,
12 housing, shelters, DSS, law enforcement,
13 criminal justice system, judges, family
14 court, and the sheriffs. So it's from that
15 view that I talk to you about a few things
16 that are in the budget.
17 As you know, the other commissioners
18 mentioned that we've moved to Medicaid
19 managed care for the behavioral health
20 population. Harvey referenced it before; we
21 do have concerns about how that rollout is
22 working, or very low numbers of individuals
23 getting HCBS services. But the reason I
24 bring it up today is because there's been
342
1 another cut to the funding that was put in
2 place to help get the system ready. And the
3 Executive says that this cut is for one year
4 only, only because the children's Medicaid
5 state plan services have not been approved
6 and therefore would not be drawing down those
7 funds.
8 What we would like to see is that that
9 money is restored and invested in getting the
10 system -- continue to get ready, especially
11 on the children's side. There is a lot of
12 work to be done. It's a complex transition.
13 There's workforce development, there's
14 infrastructure that needs to be put in place.
15 And to us it doesn't make sense to cut that
16 funding as an investment because the state
17 plan services aren't up when it makes sense
18 to get everybody ready so when the state plan
19 services in the waiver are approved, they're
20 ready to hit the ground running.
21 So we would ask the Legislature that
22 you restore that cut in funding to the
23 Behavioral Health Transformation Fund.
24 A couple of other things we want to
343
1 talk to you about today. You've heard from
2 others that there is a proposal to look at
3 all of the OMH state-operated clinics to see
4 if they are viable, et cetera. It's a good
5 idea. They are in a tough position.
6 From the oversight standpoint for the
7 LGU, we're not opposing those closures or
8 downsizing; what we want to make sure of is
9 that that resource is funneled back into the
10 community based on what the needs are in the
11 community. We don't want duplicated services
12 and we don't want unneeded services to help
13 the state fit into specific positions that
14 they need to be phasing out.
15 So again, we're asking for a
16 collaboration with the LGU. We expect we
17 will -- we have a good relationship with OMH
18 that will continue, but we want to make sure
19 the resource isn't lost and that it's used
20 based on local need.
21 Same situation with the -- looking at
22 the closures of the higher-end housing, the
23 what are referred to as SOCRs and ROCRs.
24 These are residential facilities that are
344
1 operated by the state. Many of them are
2 located right on the state grounds of a
3 psychiatric center.
4 This is a very high level of care, and
5 it's still needed in the community. These
6 facilities or residences serve people who
7 have a repeated history of psychiatric
8 hospitalization, criminal justice
9 involvement, co-occurring substance use
10 disorders, and homelessness.
11 In turning over those slots completely
12 to supported housing with wraparound, we
13 don't think that that will fit the need of
14 what these facilities provide now. And
15 they're state-operated; people can stay as
16 long as they need the service. So from the
17 county standpoint, we want to make sure for
18 the system that that resource is not lost and
19 that we still have access to that level of
20 care in the community.
21 We also are supporting the $10 million
22 in funding to increase the rates of
23 reimbursement for the residential providers.
24 Residential is a key component for the LGU.
345
1 The assisted outpatient treatment program is
2 administered by the LGU. And as you know,
3 those individuals on court-ordered AOT go to
4 the front of the line in terms of being able
5 to access housing and the highest level of
6 case management, or now called Health Home
7 Coordination. So it's critical to us that
8 the housing providers are in place and
9 staffed to be able to serve this population.
10 Moving to another piece that's in the
11 budget, and this has to deal with the
12 jail-based restoration project that would --
13 competency restoration, that would allow
14 counties to voluntarily restore individuals
15 to competency in the jail.
16 So let me just kind of explain how
17 this works. So there's individuals who we
18 refer to as 730s. That's 730 of the Criminal
19 Procedure Law. And these are individuals who
20 have committed a felony and have been found
21 basically not competent to be able -- because
22 of their mental illness or developmental
23 disability. We get folks from OPWDD as well.
24 So there's two things. Because of
346
1 their disability, they are unable to
2 understand the charges against them and aid
3 in their own defense. What happens next is
4 they are then transferred to the custody of
5 the commissioner of the Office of Mental
6 Health or the commissioner of OPWDD, and then
7 they are moved to an inpatient forensic bed
8 at a state psychiatric center or two of the
9 developmental centers to be restored to
10 competency --
11 ASSEMBLYWOMAN GUNTHER: That's like
12 Mid-Hudson Psych Center?
13 MS. HANSEN: Yeah, it's Mid-Hudson,
14 Kirby, Rochester and Central New York. And
15 then for OPWDD it's Sunmount up in Franklin
16 County and Valley Ridge in Chenango County.
17 So what the Executive has proposed --
18 and we've had many conversations with the
19 Office of Mental Health on this, quite
20 lively. And what the Executive has proposed
21 is that these individuals could be restored
22 to competency in a jail. And the argument is
23 that the counties -- we pay 50 percent of the
24 cost on a per-diem rate for competency
347
1 restorations.
2 The Executive would indicate that the
3 counties are paying $40 million a year in
4 competency restoration costs. This would
5 save money.
6 We're taking cost completely off the
7 table here. Our first concern, and why we're
8 opposing, is that a jail is not a therapeutic
9 setting to do competency restoration. The
10 jails are not physically -- they don't have
11 the physical plant that would be able to do
12 this. They don't have the staffing, the
13 clinical staffing -- psychiatric, psychology,
14 social work, et cetera. They don't have the
15 programming to do what would need to be done,
16 four to six hours of programming, I think a
17 week, for restoration.
18 And one of the other pieces is that in
19 the jail, the jail does not and cannot go to
20 court to medicate over objection. And we
21 know that medication is one of the, you know,
22 foundations of being able to help restore
23 people to competency.
24 So -- but the other thing that you
348
1 absolutely need is the sheriff. This is a
2 sheriff's department decision. It's not the
3 decision of the mental health commissioner,
4 it's the sheriff's department. They run
5 their jails, they know their jails, they know
6 who's in there, they know what they need to
7 do.
8 So to our knowledge, and we've had
9 extensive -- there's not a single sheriff in
10 the state that is interested in pursuing
11 jail-based competency restoration. But the
12 budget books $2.2 million in annual savings.
13 So we think that's inaccurate. And
14 what we would instead like to see is a
15 more -- we'd like to see the Office of Mental
16 Health take a leadership role in terms of
17 bringing together those individuals that move
18 along the 730 process. So it's obviously the
19 sheriff, the district attorneys, the public
20 defenders, the judiciary, the LGU and others.
21 Because it would do several things.
22 It would help this wait time that we have for
23 730s. You know, the basis of this whole
24 thing is my members tell me, my county
349
1 commissioners tell me, You can't get a 730
2 bed. You have to wait. And at any given
3 time, there's 50 to 60 people waiting for a
4 competency-restoration bed. And they're in
5 our jails and, you know, with very high
6 mental health needs. And we can't get these
7 730 beds. So --
8 ASSEMBLYWOMAN GUNTHER: Can I ask a
9 question?
10 MS. HANSEN: Sure.
11 ASSEMBLYWOMAN GUNTHER: Are there many
12 competency restoration beds that are
13 available around New York State?
14 MS. HANSEN: I don't think there are
15 any open beds for 730s, I think because there
16 is a waiting list to be able to get a 730 bed
17 for competency restoration.
18 ASSEMBLYWOMAN GUNTHER: Okay. Sorry.
19 MS. HANSEN: Anyway, moving on, so
20 what we would do is ask for your support in
21 urging the Executive to first of all not take
22 a $2.2 million cut for a project that we
23 don't see any savings or any benefit to, and
24 instead be able to support a collaborative
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1 process to help really, you know, get to more
2 the root of this and be able to treat folks
3 as we need to.
4 CHAIRWOMAN YOUNG: Okay. Thank you.
5 ASSEMBLYMAN OAKS: We have a question
6 here.
7 CHAIRWOMAN YOUNG: Okay.
8 ASSEMBLYWOMAN GUNTHER: I just wanted
9 to know about the competency restoration
10 beds. Is that Mid-Hudson Psych Center? Is
11 that a --
12 MS. HANSEN: Yes, there's beds at --
13 there's forensic beds -- and so that's the
14 type of bed the individual is in. There's
15 forensic beds at Mid-Hudson, Kirby in Orange
16 County -- or Manhattan, I'm sorry.
17 Mid-Hudson in Orange County, Kirby in
18 Manhattan, Rochester Psychiatric, and Central
19 New York Psychiatric.
20 ASSEMBLYWOMAN GUNTHER: I only know
21 the one in my area.
22 MS. HANSEN: Mid-Hudson, yup.
23 ASSEMBLYWOMAN GUNTHER: Yeah. And if
24 you were to ask me if that's a therapeutic
351
1 environment, I'd have to say "Wowzer."
2 MS. HANSEN: Well, what the Executive
3 is proposing is that we do restorations in
4 our jails instead of at a psychiatric center.
5 ASSEMBLYWOMAN GUNTHER: There's got to
6 be something in the middle that's better than
7 that. But that's my opinion, after going in
8 and taking a tour. I mean, people do the
9 best they can, but that place is a
10 thousand -- I mean, I don't know how old that
11 building is.
12 MS. HANSEN: I've never toured
13 Mid-Hudson, so I don't have a reference on
14 that. Toured many jails, but --
15 ASSEMBLYWOMAN GUNTHER: They're
16 actually regulated by the Joint Commission,
17 versus the Correctional. They're like
18 considered a hospital, so they're not
19 regulated -- they're regulated by --
20 MS. HANSEN: Not by the state
21 Commission on Correction, it's JCAHO instead?
22 ASSEMBLYWOMAN GUNTHER: It's the Joint
23 Commission. It's treated like a hospital,
24 and they get a Joint Commission inspection.
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1 So it's completely different.
2 MS. HANSEN: Understood.
3 All right, thank you.
4 CHAIRWOMAN YOUNG: Thank you so much,
5 Ms. Hansen.
6 Our next speaker is John Coppola,
7 executive director of Alcoholism and
8 Substance Abuse Providers of New York State.
9 Again, we're going to ask that people
10 stick within the deadline of speaking,
11 because we have others waiting.
12 So welcome. Thank you for being here.
13 MR. COPPOLA: Good evening. I want to
14 just start out by just sharing with you, as I
15 was looking up at the panel here, I was
16 feeling very grateful that each one of you
17 has, I think, personally become dramatically
18 more familiar with the substance use
19 disorders issue over the course of the last
20 couple of years. And based on your
21 questions, it's clear to me that you
22 understand the gravity of the issue.
23 I want to just recall that last year
24 when I testified, I came expressing a concern
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1 that we have a crisis and an epidemic, and I
2 think this year I come with the same concern.
3 And I want to point out, you know, over the
4 weekend I was at a meeting in New York City
5 with the New York Society of Addiction
6 Medicine. And as the New York City
7 Department of Health gave a report about
8 opiate-related overdoses in New York City,
9 the graph was -- the trajectory was in the
10 wrong direction.
11 So in spite of all that we've done
12 over the course of the last two years, we
13 haven't done enough to stop the acceleration
14 in the number of deaths and the amount of
15 addiction associated with heroin and
16 prescription opiates.
17 So the bottom line is we absolutely
18 have to do more. There is nothing to suggest
19 that the momentum is going to go in another
20 direction.
21 I was alarmed -- I mean, I've worked
22 in this field for many more years than I'd
23 care to share at this point, but I was
24 alarmed over the weekend when we started
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1 looking at something like fentanyl and the
2 degree to which fentanyl is now a part of
3 many of the overdose deaths. And fentanyl
4 is -- I think it's a hundred times the
5 strength of morphine. So not that that's not
6 bad enough, but carfentanil is starting to
7 appear on the scene nationally: 10,000
8 times, 10,000 times the strength of morphine.
9 And, you know, it defies the imagination to
10 think what could -- this is a tranquilizer
11 used for large game animals, right, that is
12 now finding its way into the heroin that is
13 being distributed across the country.
14 So this is alarming, and it's an
15 indication that if things are not addressed,
16 it will be a much more serious public health
17 problem, and that's hard to imagine.
18 I want to just state that, you know, I
19 personally have been to a number of wakes in
20 the last year. Most recently, a 22-year-old
21 young man, and before that, a 34-year-old
22 young man, both of whom were very productive
23 citizens and students at one point not too
24 long ago, both of whom died from an opiate
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1 overdose. And I think probably all of you
2 know somebody in your district, or more than
3 one somebody, who has been impacted by this
4 issue. And I'm sure that that contributes to
5 the urgency.
6 I want to suggest that the litmus test
7 for are we doing what we need to do is the
8 following. Is the magnitude of our response
9 to this problem on par with the magnitude of
10 the problem itself? So when the commissioner
11 spoke to you about all the new initiatives
12 that they're doing -- so whether it be peer
13 navigators or these urgent care centers, when
14 we look at them under a microscope -- and
15 believe me, I think she is doing an
16 incredible amount with extraordinarily
17 limited resources. When you start talking
18 about 10 new navigator programs, what exactly
19 does that mean?
20 So how many hospitals are there in New
21 York State? So we're going to now pick 10 of
22 them and we're going to put two or three peer
23 navigators in the emergency department to
24 help people get into treatment instead of
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1 being discharged into the street.
2 So again, that is not even remotely
3 close to being something of the magnitude
4 that is necessary. Right? So are we
5 thinking about peer navigators in every
6 single emergency department in the State of
7 New York, yes or no? Right?
8 So again, it's not going to happen
9 overnight, but 10 is not enough. And I think
10 Assemblywoman Rosenthal's characterization
11 that the funding is pitifully low is an
12 accurate assessment. It is not possible to
13 address this problem to the magnitude that's
14 necessary if the conversation's context is a
15 2 percent budget cap. That is flat out not
16 an acceptable context to have to have a
17 conversation about a raging epidemic.
18 I'd like to suggest that, you know,
19 when Assemblyman Cusick asked about the funds
20 that we've invested, are they working, that's
21 the right question. That's the right
22 question, are we pointed in the right
23 direction. Right?
24 The commissioner failed to brag a
357
1 little bit, I think, when asked a question
2 about what's going on. She literally has
3 established probably close to 10,000 new
4 medication-assisted treatment slots across
5 New York State that previously did not exist.
6 That's a thousand people that are currently
7 not on a waiting list. Right? So she's
8 really to be commended for doing that, in
9 addition to some of these other new projects.
10 But again, the magnitude is the problem.
11 And Senator Krueger, when you were
12 talking about the people that you're
13 concerned about who are, you know, in the
14 streets and not particularly interested in
15 going into what probably are absolutely
16 unacceptable living conditions in many of our
17 shelters, right, I would suggest to you that
18 we increasingly look to folks that are very
19 knowledgeable about mental health and
20 addiction services and ask the following
21 question: Do they have any expertise that
22 they could lend us as we contemplate what to
23 do with homeless people who have got serious
24 mental illness or serious addiction issues?
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1 Do they have anything to contribute at all?
2 And I would submit to you that if you
3 look at some of the housing programs in
4 New York City over the course of the last
5 five, six years, we're learning that a huge
6 majority of folks who come into housing
7 through a treatment program wind up in
8 permanent housing, wind up with jobs, and
9 wind up back in school.
10 So I would suggest to you that the --
11 if we look at how we're addressing many of
12 these sort of tangential issues that result
13 from people having serious addiction -- child
14 abuse, neglect, domestic violence, various
15 kinds of crime, et cetera -- and say is there
16 something that the addiction treatment and
17 mental health community can bring to bear on
18 this issue, I would submit that there you
19 might find resources and be able to move
20 those resources from less effective programs
21 into more effective programs, and that might
22 be a good place to start.
23 But again, I think the whole question
24 about magnitude -- it is not acceptable that
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1 anybody that is willing to sit down with
2 somebody and get into a treatment program,
3 that it's not an acceptable answer that we
4 don't have a bed, it's not an acceptable
5 answer to say that there's a waiting list,
6 it's just flat out not acceptable.
7 And again, I think when we get to
8 addressing this issue to the magnitude that's
9 required and necessary, you won't have that
10 in any of your districts.
11 I want to just highlight a major issue
12 that I think is really important, and that
13 is, you know, as others have talked about,
14 workforce.
15 It has been correctly pointed out to
16 me that, in part, waiting lists exist not
17 only because there are not enough beds,
18 period, they also exist because there are
19 empty beds that are not staffed. So
20 programs are not able to recruit the staff
21 necessary to guarantee patient safety and
22 that somebody is actually going to get
23 treatment. So there are empty beds in
24 programs because they don't have the staff to
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1 provide the treatment. That's not
2 acceptable.
3 And it's a direct result of what some
4 of my peers have talked about, which is, you
5 know, as we're putting up these demonstration
6 projects in hospitals and communities, one of
7 the -- the vast majority of the programs
8 across the state have not seen, you know, a
9 penny to help support their staff. And so
10 you adopt a new initiative with a new salary,
11 and you're paying more than the people that
12 are already working for you.
13 So we have to look at the workforce
14 issue. And we're recommending, first, that
15 we add staff for prevention in schools in
16 New York City and schools across New York
17 State as well as in the community. And we
18 have a very specific recommendation that
19 you'll see in the text.
20 Same thing for treatment, that we need
21 additional staff. So this is about
22 fundamentally what does it cost us to add one
23 staff person to a treatment program upstate
24 or downstate. Let's do the math, and let's
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1 get the resources and let's do it.
2 And very similarly with recovery and
3 the use of peers in our system. There's no
4 infrastructure for it right now. In the
5 mental health system you've got a state -- if
6 you want to be a peer advocate in the mental
7 health system, you get free training, free
8 testing, free registration, free
9 certification. You come into the OASAS
10 system, none of that exists. If you want to
11 become a recovery peer advocate, you pay for
12 your training, you pay for your test, you pay
13 to apply, you pay for everything. Right?
14 So again, I think that that's an
15 important workforce thing. Which I think
16 when Senator Akshar mentioned the asset
17 forfeiture fund, I think if you do a little
18 bit of homework, what you'll find is every
19 single year there's a little nest egg sitting
20 in that bank account while we're in the
21 middle of a crisis. There is nothing that's
22 more unacceptable than that, to have the
23 money sitting in a substance abuse services
24 fund that's not being utilized in this
362
1 environment.
2 So I would say, if -- and again,
3 understood, we've heard it every single year,
4 this is one-time money. You know, it's money
5 that doesn't -- you know, we can't count on
6 it for next year, so let's not use it for
7 recurring costs because what if there's no
8 asset forfeiture from one year to the next,
9 we'll have a problem.
10 Okay, so let's use it for student loan
11 forgiveness, let's use it for tuition
12 assistance, training and support,
13 scholarships, things like that for the
14 workforce -- which, if the money isn't there,
15 guess what, we don't have the expense.
16 If we can afford to do it, let's do
17 it. So I think the investment in workforce
18 is huge.
19 I want to just end by saying thank
20 you. Were it not for the Senate, Senator
21 Amedore and his leadership, Assemblywoman
22 Rosenthal, Senator Young and Mr. Farrell, we
23 would not have had the $25 million in the
24 budget last year. And you are -- Senator
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1 Young, when you were asking questions about
2 this money, I think you were all on target.
3 Because if you look at it for a second and
4 say, What does this mean when the Governor
5 says we're spending $200 million on the
6 addiction crisis? The commissioner told you,
7 well, how it gets calculated is we go to all
8 of the people who are currently going through
9 treatment, we ask ourselves the question, How
10 many of those folks had an addiction to
11 heroin, and we calculate what the cost of
12 their treatment was.
13 A very different question is, How much
14 new revenue have we invested in the treatment
15 system as we have seen an increased demand
16 for treatment because of this crisis? And
17 the answer for last year was the $25 million
18 that you put in there.
19 And for this year, it looks like
20 there's an additional $25 million in the
21 OASAS budget. Coincidentally, there's a
22 $25 million increase in federal funds. So I
23 do think that there is a lot more that we can
24 be doing in the State of New York. And I do
364
1 want to end by saying thank you to all of
2 you, thank you to OASAS, and thank you to the
3 Governor as well for what has been done, but
4 so much more is needed.
5 CHAIRWOMAN YOUNG: Thank you very
6 much, Director Coppola.
7 ASSEMBLYMAN OAKS: Thank you.
8 CHAIRWOMAN YOUNG: All set. Okay,
9 thank you.
10 SENATOR KRUEGER: The Assemblymember
11 has a question.
12 ASSEMBLYMAN McDONALD: Can I ask one
13 question, please?
14 CHAIRWOMAN YOUNG: Sure.
15 ASSEMBLYMAN McDONALD: Thank you.
16 What struck me was your -- when you
17 mentioned the fact that there are empty beds
18 because of staffing. Did I characterize that
19 comment properly?
20 MR. COPPOLA: Mm-hmm.
21 ASSEMBLYMAN McDONALD: So I guess my
22 question is, if I'm looking on the Combat
23 Heroin site and I see empty beds, slots open,
24 are some of those slots because of staffing?
365
1 MR. COPPOLA: Absolutely. I mean, and
2 again, if you go to the site -- and, you
3 know, they've done an incredible job of
4 upgrading that site, because I think their
5 first attempt was better than nothing, and
6 right now it's much better than it was. But
7 if you were to have a specific concept in
8 mind -- I have an adolescent, 17 years old,
9 and I live in Batavia and I'm looking for a
10 residential treatment site, where is the
11 closest bed for that particular person? Is
12 it in Watertown, is it on Long Island, is it
13 in Albany? I mean, where is the closest
14 place to that?
15 So if you had -- for a woman who has a
16 child or for a young adult, for a working
17 person, et cetera, et cetera -- you know,
18 once you sort of -- if you understand the
19 different kinds of beds and you look at those
20 beds, some of them are beds for people who
21 are coming out of treatment or reentering the
22 community. They're not appropriate for
23 somebody who's seeking treatment or somebody
24 who needs detox.
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1 So when you say that today we have a
2 thousand beds available, okay, great, that
3 might be good. Let's drill down. Let's pick
4 up the phone call, since there's a thousand
5 beds, let's call all thousand numbers and see
6 whether the person that I need to get into
7 treatment can get into any one of them, and
8 how many are real. I mean, how many of them,
9 when I call the program, will they be able to
10 admit anybody, much less the person that I
11 had?
12 ASSEMBLYMAN McDONALD: It's a false
13 positive, in some aspects. I don't think
14 that's the intention of OASAS.
15 MR. COPPOLA: Of course.
16 ASSEMBLYMAN McDONALD: But the reality
17 is -- part of the trauma is the parent is
18 calling, trying to find someplace to put
19 their Johnny or their Jessie, and, you know,
20 they just don't know --
21 MR. COPPOLA: The tool that they do
22 have online right now is dramatically better
23 than it was, and they have the ability to
24 continue to improve it. So I'm like really
367
1 optimistic that as people go to that site,
2 they'll have a pretty good sense right away
3 about whether a bed is available that would
4 suit them.
5 ASSEMBLYMAN McDONALD: Thank you.
6 ASSEMBLYMAN OAKS: Thank you.
7 CHAIRWOMAN YOUNG: Thank you. Thank
8 you for your advocacy.
9 Our next speakers are Edward Snow, PEF
10 Regional 7 Coordinator, and Virginia Davey,
11 council leader. Thank you for being here.
12 MS. DAVEY: Thank you for having us.
13 MR. SNOW: I guess I'm going to -- can
14 you hear me all right? I guess I'm going to
15 start.
16 Before I start, I just want to say
17 thank you for taking the time tonight to
18 listen to us, and I just want to say "Wow."
19 So I know you've had a long day of listening
20 to a lot of people and --
21 CHAIRWOMAN YOUNG: So if you could
22 summarize, too, we'd --
23 MR. SNOW: Absolutely. I'm going to
24 make it relatively short.
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1 I represent the Labor Management
2 Committee of OPWDD, which is the -- I'm the
3 labor person who represents the union and
4 coordinates all that.
5 The OPWDD budget talks about a
6 $120 million investment into services in the
7 coming year. The concern we have is that the
8 services primarily are going to
9 private-sector services, yet our concern is
10 that in the past budget year, some of those
11 same services were recommended to go to
12 private agencies and they were unable to
13 perform those services.
14 Specifically, the Long Island DDSO
15 had -- there's the need to get away from the
16 ICFs under the Olmstead Act, and they moved
17 those -- the proposal was to move the Rainbow
18 Commons people to a private provider, and
19 that they would take over the services of
20 those individuals. That never occurred,
21 because they couldn't find a private provider
22 that was -- had the adequacy to do it to take
23 them on.
24 Now, in this year's budget there's
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1 another proposal for another 100 people to
2 leave the remaining ICFs at the Long Island
3 DDSO and again be picked up by a private
4 provider.
5 Realistically, it doesn't look like
6 that's going to happen. They're still
7 waiting for the first group to be placed, and
8 now they've got a second group right behind
9 it.
10 The other issue that they're proposing
11 is that downstate, Long Island, that they
12 want to start a START program, which is a
13 crisis program to address crisis issues so
14 that you don't have to have
15 institutionalization and to aid people in the
16 community. They started that program in the
17 Hudson Valley, basically two years ago. It
18 was fully funded last year, operated by state
19 employees that were former members of the
20 Taconic DDSO.
21 This year they're proposing that they
22 want to do it again, through a private
23 provider, on Long Island. We, as the public
24 employees union, question whether they have
370
1 the ability to do, that can they find a
2 private provider to do that. We, as state
3 employees, have a history of doing that
4 service, and we believe that that service
5 should be allocated to state employees versus
6 private-sector employees.
7 Our third concern is relative to a
8 56-person ICF reduction at the Sunmount DDSO.
9 The proposal was for a five-year plan to have
10 the population between the two forensic
11 facilities, Valley Ridge and Sunmount, to 105
12 at the end of the fiscal year, March 31,
13 2017. The population at Valley Ridge is at
14 45, which is the proposal right along. The
15 population at Sunmount, as of today, is about
16 160, I believe.
17 So they want to again propose that
18 they're going to decrease the population at
19 that site, yet you've heard today from many
20 people issues about 730 beds. Those are
21 primarily the beds at Valley Ridge and at
22 Sunmount, the 730s. It does not look
23 realistic that you're going to have that
24 reduction in this fiscal year again, yet the
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1 mode is that we push towards that.
2 The concern for the professional
3 employees across the board is that when
4 you're pushing for the privatization, you're
5 pushing to get people out of these
6 specialized beds, that you're often pushing
7 so hard to get to your goal that you're kind
8 of losing a little bit along the way. And
9 our members are concerned when that happens,
10 because sometimes people are pushed more than
11 what they should be, and they're putting
12 people and communities in jeopardy, when our
13 members believe that maybe you should slow it
14 down, that you should have a little better
15 plan at times, and that doing that, you kind
16 of safeguard the communities, you safeguard
17 the people we're serving.
18 Our system certainly -- I've testified
19 over the years, our system has really served
20 some people well in the community. It's
21 great for people to be able to move out of
22 institutions, institutional living, and move
23 into the community. That is the goal. The
24 agency has attained that goal, and continues
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1 to, but our concern is the speed and the
2 process that's being involved to do that.
3 In my testimony there is a brief
4 discussion about the Justice Center. I
5 always kind of feel an obligation to have
6 some discussion about the Justice Center.
7 You heard a lot today about it. I was kind
8 of happy to see the executive director of the
9 Justice Center here, kind of giving his
10 points of view.
11 One of the concerns we have with the
12 Justice Center is the kind of frequent
13 allegaters {sic} -- and the director kind of
14 spoke about that today. But there really is
15 not -- within a system where you have people
16 in these specialized units, you oftentimes
17 will have someone who will frequently
18 allegate {sic} against a number of people.
19 I'll give an example that's in my
20 testimony. Recently we had, at Sunmount, one
21 of these frequent allegaters allegate that
22 nine different staff people, who were women,
23 had actually had a sexual encounter with him
24 in the hall. Now, you know it's kind of
373
1 unlikely that that happened, yet the Justice
2 Center took that call and processed that as a
3 legitimate situation. The nine people were
4 placed on restrictive duty, and that costs
5 money.
6 And our concern is that at one time
7 they had a talk of having a frequent
8 allegater program. They used it once, and
9 then, poof, it went away. So our concern is
10 that that -- that the Justice Center still is
11 in need of refining some of those issues.
12 So that's basically my testimony in a
13 nutshell. I'm going to leave the OMH side to
14 Virginia.
15 MS. DAVEY: And in the interest of
16 attaining your goal of having this be short,
17 believe me, the way I talk, reading it is
18 going to work out better for us. So I'll
19 read through it quickly, as quickly as I can,
20 and then take any questions that you might
21 have.
22 Good afternoon. Thank you for having
23 us here today. My name is Virginia Davey,
24 and I'm happy to have been selected by
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1 President Wayne Spence to speak with you on
2 behalf of the Public Employees Federation.
3 I mean the statewide labor management
4 cochair of the OMH PEF Committee. Today I
5 bring concerns, insight, and proposed
6 recommendations from those who work on the
7 front lines with the patients that we serve.
8 I cannot help but find parallels between the
9 hearing today and the daily charge of our
10 members. As the Senate and Assembly leaders,
11 you have taken on a huge task today, with
12 several people bringing their concerns to you
13 and hoping that you can say something or do
14 something to help them to feel better. Based
15 on the number of important people who have
16 landed at your doorstep, I think you have
17 experienced a bit of what our counselors face
18 on a daily basis.
19 Like today, the number of patients at
20 our doorstep is ever-increasing. One of the
21 most pressing concerns identified in our OMH
22 system is the task of serving an
23 ever-increasing outpatient population without
24 a corresponding increase in the budget
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1 appropriations.
2 Although the shifting of employees
3 from inpatient to outpatient care served to
4 increase the numbers of counselors available
5 for outpatient, that well is quickly running
6 dry. The shift has not kept pace with
7 community needs. This has resulted in
8 caseloads that make it more and more
9 difficult to provide quality care.
10 Exacerbating the recruitment and
11 retention efforts in OMH has been the role of
12 the Justice Center. Many are opting to work
13 in different environments or worksites that
14 are less likely to put their licenses and
15 livelihood in jeopardy. Unfortunately, our
16 system is not well in this capacity.
17 This fact makes it more and more
18 unlikely that nurses who come to OMH will
19 stay at OMH. Many OMH facilities are unable
20 to meet their fill levels. Until the
21 compensation packages can compete with
22 private sector employees, we will continue to
23 suffer the consequences of understaffing.
24 More money has to be dedicated to getting OMH
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1 online, because Commissioner Sullivan cannot
2 correct this issue on her own.
3 Although PEF respects Commissioner
4 Sullivan greatly, we still have some
5 differences of opinion related to some of the
6 proposed efforts to consolidate services
7 and/or move services into the private sector.
8 The gutting of OMH-provided inpatient
9 services and the state workforce does not
10 always settle well with PEF or the patients
11 and communities that they serve.
12 I think by now you have all heard
13 about the ongoing efforts to keep the Western
14 New York Children's Psychiatric Center a
15 stand-alone unit. OMH promised that these
16 stakeholders would be given a seat at the
17 table to determine the community need. These
18 stakeholders and this community have spoken
19 out loud and clear. At a time when we are
20 trying to get buy-in from those with mental
21 illnesses to avail themselves of much-needed
22 services, we need to provide it on their
23 terms, in their buildings, and in the
24 locations that they choose.
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1 We ask that you help them to keep
2 their faith in OMH and the services they
3 provide. We know this cannot be done without
4 more money in the budget to offset the
5 anticipated savings potential of combining
6 the adult psychiatric center in Buffalo. The
7 stakeholders are counting on us to find a way
8 to put a moratorium on any efforts to upset a
9 system of care that they have come to trust
10 and rely on.
11 Likewise, we would ask that the effort
12 to shift Hutchings Psychiatric Center
13 services to Article 28 hospitals also involve
14 all the stakeholders. If this endeavor moves
15 ahead, it may be precedent-setting and be
16 duplicated across the state. For this
17 reason, we believe the Mental Health and
18 Developmental Disabilities Committee and
19 other supporters of healthcare should also
20 weigh in on behalf of our patients.
21 Although Article 28 hospitals may
22 provide good short-term care, longer-term
23 care may need to be left to the OMH. PEF
24 members are some of the staunchest advocates
378
1 for our patients, and we too need to be at
2 the table during those deliberations.
3 With regard to the restoration-to-
4 competency specialized units, PEF believes
5 that the care of those who are in need of
6 mental health treatment is best delivered in
7 a nurturing environment outside the razor
8 fences of a jail or a correctional facility.
9 We would gladly accept the $890,000 to
10 enhance services to not only those being
11 restored to competency but to those who have
12 served jail and prison terms and have been
13 released into our communities. This would
14 allow for a broader use of allocated funds.
15 PEF has brought issues to the table
16 regarding concerns that our staff has not had
17 proper training, resources and security unit
18 designations to best serve this patient
19 population. This solution could be a win for
20 the community and the OMH patients at large.
21 Thank you for your time.
22 CHAIRWOMAN YOUNG: Thank you very
23 much. I don't believe we have any questions.
24 Thank you.
379
1 ASSEMBLYMAN OAKS: Thank you.
2 C0HAIRWOMAN YOUNG: Our next speaker
3 is Paige Pierce, CEO of Families Together in
4 New York State.
5 MS. PIERCE: Good evening.
6 CHAIRWOMAN YOUNG: Good evening.
7 Thank you for being here.
8 MS. PIERCE: Thanks for sticking with
9 us.
10 I think everybody up here knows me,
11 but I'm Paige Pierce. I'm the CEO of
12 Families Together in New York State. We
13 represent families of kids with behavioral
14 health needs across New York State. We're a
15 family-run, family-governed organization,
16 meaning that over two-thirds of our board of
17 directors and most of our staff, including
18 myself, are parents of children with
19 behavioral health needs.
20 We have -- I've given my written
21 testimony, which is really just a two-pager,
22 so I don't need to read a ton. I'm just
23 going to highlight a couple of the bullets
24 for you.
380
1 One of the things that's most
2 important to us is the notion that, you know,
3 "Nothing about us, without us," that families
4 have lived experience as peers that we can
5 help share with other family members to help
6 them navigate the multiple systems that our
7 kids wind up in.
8 So when we have the kind of peer
9 support that Families Together's members
10 provide, we can help save money in many of
11 the systems, particularly the mental health
12 and substance abuse systems. Because the
13 families who are entering those systems are
14 at a loss, and the families who have
15 navigated them in the past have a lot to
16 offer.
17 And we have training and credentialing
18 for those family peer advocates that can help
19 all of our systems as they transform into
20 Medicaid managed care and DSRIP and the like.
21 So I want to just make sure I hit on
22 the important things. You know, families who
23 have lived experience are experts in
24 engagement. And you've heard over and over
381
1 again, with everything related to better
2 healthcare, that engagement of the recipients
3 is critical. We are experts on engagement,
4 because we know what works. We have a level
5 of trust and credibility because we're fellow
6 family members, and we can engage families in
7 a way that people with a lot of letters after
8 their name can't.
9 I tell the story often about how we
10 had a family peer advocate in a local county
11 clinic, mental health clinic, and the family
12 peer advocate was assigned to the parents
13 when they came in, and they helped them
14 navigate, helped them with everything from,
15 you know, what do you need to make it to your
16 next appointment, what kinds of barriers do
17 you have to accessing services.
18 And the no-show rate in that clinic
19 went way down once they had family peer
20 advocates working with the parents. That's
21 actual money. That's, you know, time at the
22 county level, at the clinic, being saved.
23 And we would submit that those kinds
24 of savings could be reinvested into more
382
1 community-based peer kinds of services that
2 will help provide even more savings in the
3 future.
4 Kelly Hansen talked a little bit about
5 the state plan amendments that are part of
6 the 1115 waiver that New York State is
7 applying for with CMS. Until that happens,
8 OMH still has money that they had put in the
9 budget last year, and money for this year,
10 that we're asking to please utilize this
11 year. Don't wait for the federal government
12 to give the thumbs up on our application for
13 the 1115; it's not necessary. The money is
14 there, and it should be utilized now to shore
15 up our workforce, particularly our peer
16 advocacy workforce.
17 The DSRIP. You've heard a lot about
18 DSRIP today. When DSRIP first rolled out, we
19 kept saying, as family and children's
20 advocates, include us. Like I just said, we
21 can save a lot of money on the end, on the
22 bottom line. Because if you can provide the
23 kinds of services that I just talked about,
24 you won't need unnecessary hospitalizations
383
1 and ER visits.
2 They didn't spend a lot of time and
3 energy on children and families because
4 that's not their high users. It isn't a lot
5 of young people entering the ER
6 unnecessarily. But it is a lot of
7 21-year-olds, 22-year-olds, 23-year-olds.
8 And the DSRIP programs had a five-year plan.
9 So there are kids who are 17 now who, if
10 they're provided the kinds of services they
11 need, their numbers will be better five years
12 from now.
13 So we would contend, spend the money
14 early on, including on children's behavioral
15 health and family peer support. And DSRIPs,
16 insist that the PPSs utilize the existing
17 workforce within the family peer services.
18 And then lastly, I just want to say
19 that Families Together has our legislative
20 luncheon a week from Tuesday, so it's on
21 Valentine's Day, in the Convention Center.
22 And we are recognizing Assemblywoman Gunther
23 as the Legislator of the Year, and Senator
24 Ortt. And you're all invited. You all have
384
1 gotten invitations. And we would love to see
2 you there.
3 We have over 500 families who come
4 from all of your districts, and they're here
5 in Albany to meet with you, but also to hear
6 from you what it is that's happening in
7 Albany that's affecting their families. So I
8 would encourage you to come.
9 CHAIRWOMAN YOUNG: Thank you very
10 much. And thank you for your testimony.
11 ASSEMBLYMAN OAKS: Thank you.
12 MS. PIERCE: Thanks.
13 SENATOR KRUEGER: Thank you.
14 CHAIRWOMAN YOUNG: Our next speakers
15 are Barbara Crosier, vice president for
16 legislative affairs, and John Drexelius,
17 Esq., legislative affairs, from the
18 #beFair2Direct Care Coalition and the
19 Coalition of Provider Associations.
20 Thank you for being here.
21 MS. CROSIER: Thank you.
22 MR. DREXELIUS: Thank you.
23 CHAIRWOMAN YOUNG: So again, if you
24 could --
385
1 MS. CROSIER: We're going to be very
2 brief.
3 CHAIRWOMAN YOUNG: -- summarize.
4 because I just want to remind everybody, you
5 have written testimony that's put into the
6 record. So thank you again, and look forward
7 to hearing what you have to say.
8 MS. CROSIER: Good evening, and thank
9 you so much for staying. My name is Barbara
10 Crosier. I am the vice president of
11 government relations for Cerebral Palsy
12 Associations of New York State, and I am here
13 representing all nine associations on behalf
14 of the #bFair2DirectCare campaign.
15 I think most if not all of you have
16 joined us in various media events, press
17 conferences, rallies, and have been very
18 supportive of our ask. I think you're very
19 familiar with the #bFair2DirectCare. We're
20 asking for a $45 million investment over each
21 of the next six years to be able to begin to
22 start to pay a living wage for the
23 hardworking New Yorkers who support people
24 with developmental disabilities. In the
386
1 scheme of a $150 billion-plus budget, as
2 Assemblywoman Gunther said, it's a spit in
3 the ocean.
4 So you've heard about the vacancy and
5 overtime rates, which are increasing at an
6 alarming rate. Unlike state-operated
7 facilities, where Helene talked about the
8 fact that they're decreasing and they're able
9 to hire, we are going in the absolute
10 opposite direction, because we have not been
11 able to give raises and our costs are
12 increasing. House managers are working
13 overnight shifts. So it's not only the loss
14 of direct care workers, but as it moves up
15 the chain and people are having to do
16 overtime, the shifts are getting burnt out
17 sort of at every level.
18 Assemblywoman Miller asked about
19 self-direction. And I think a lot of the
20 problem with self-direction is also being
21 able to recruit and retain staff. So it
22 really -- it is across all parts of our
23 field.
24 And what we're asking for is less
387
1 than -- it's 0.0288 percent of the total
2 budget. I mean, it's a minuscule amount.
3 Attached to our testimony is an op-ed piece
4 by Margaret Raustiala, who's a mom of a
5 47-year-old man on the autism spectrum from
6 Long Island. I think many of you know
7 Margaret. I would encourage you to read her
8 op-ed piece.
9 And thank you on behalf of the more
10 than half a million New Yorkers with
11 developmental disabilities, their families,
12 and those who serve and support them.
13 CHAIRWOMAN YOUNG: Thank you.
14 MR. DREXELIUS: Hi. I'm JR Drexelius.
15 I'm the government relations counsel for the
16 Developmental Disabilities Alliance of
17 Western New York. And I'm here with Barbara
18 tonight.
19 Winnie Schiff was going to give this
20 testimony from the IAC, but she couldn't be
21 here, so she apologizes for that.
22 We're here on behalf of the Coalition
23 of Provider Associations, or COPA. COPA is a
24 collaboration of five associations -- the
388
1 Alliance of Long Island Agencies, Cerebral
2 Palsy Association of New York State, DDAWNY,
3 the Interagency Council, IAC, and the
4 New York Association of Emerging &
5 Multicultural Providers -- because we really
6 felt we needed to come together as a
7 collaboration. We represent over 250
8 not-for-profit agencies across New York
9 State. We provide supports and services to
10 hundreds of thousands of New Yorkers with
11 developmental disabilities, employ over
12 120,000 dedicated professionals, with a
13 combined operating budget of nearly
14 $5.2 billion.
15 Everything in my testimony has been
16 said tonight. Senator Savino pointed out
17 that -- how this administration can be saying
18 that they've been giving us funding increases
19 for the last four or five years when we're
20 getting $134 million in state dollar cash
21 less than we got in 2012. It's a Ponzi
22 scheme. It's alternative truths. We have
23 not. We have been starved, and we are now
24 facing a real, real crisis.
389
1 Providers of supports and service for
2 individuals with developmental disabilities
3 are facing continuing rising costs, a
4 population whose needs are growing in
5 intensity, aging parents, and caregivers who
6 need to do more for their loved ones with
7 less.
8 I share everything that's been said
9 tonight about the need for a living wage.
10 And it's not the minimum wage; it's not
11 enough. I'm preaching to the choir.
12 In terms of development, many of you
13 up there have already talked about the fact
14 that the, quote, unquote, $120 million which
15 they every year roll out -- and every year it
16 comes out of the hide of us, because it's a
17 negative number at the end of the day -- is
18 not enough. And it is not enough.
19 It also specifically doesn't -- it has
20 very unrealistic expectations with regard to
21 the number of individuals for whom low-cost
22 services are appropriate. They don't
23 recognize that there are significant
24 populations that have higher needs -- the
390
1 sheltered work kind of programs that they do
2 not want to fund. It's just mind-boggling
3 that they're living in this alternate
4 reality.
5 With respect to the OPWDD
6 transformation, while healthcare is getting a
7 $400 million pot to deal with the
8 transformation, again, there's no new funding
9 in this budget to support OPWDD's ongoing
10 transformation agenda. The testimony I've
11 got in here has many examples. I won't read
12 them tonight.
13 With respect to the Justice Center and
14 unfunded mandates and other system costs, all
15 I can say is that we haven't received any
16 increases for cost related to fuel, staffing,
17 insurance, and we have not received the
18 needed regulatory relief for the overwhelming
19 paperwork and system-approved processes that
20 are continually being added to this field.
21 We have expenses related to staff
22 background checks, the OPWDD Front Door
23 process and the Justice Center. They've all
24 grown over time. No new money.
391
1 We recently -- COPA, working together
2 with a number of other developmental
3 disability associations, surveyed the field
4 regarding the impact of the Justice Center.
5 And the report, "Justice Center: Opportunity
6 Missed," clearly articulates the detrimental
7 effect that the Justice Center has had on the
8 staff, supports, and the individuals who it
9 was established to protect. And we would
10 urge you to read that report and contact us
11 with any questions and concerns.
12 And I've been up on that panel before,
13 and I want to stop now because you want me to
14 stop now.
15 CHAIRWOMAN YOUNG: Okay, thank you.
16 ASSEMBLYWOMAN GUNTHER: Any questions?
17 CHAIRWOMAN YOUNG: All set? Okay,
18 thank you.
19 MR. DREXELIUS: Thanks.
20 SENATOR KRUEGER: Thank you.
21 CHAIRWOMAN YOUNG: Next is Christy
22 Parque, CEO and president, Coalition for
23 Behavioral Health.
24 MS. PARQUE: Good evening. I had
392
1 originally optimistically started my
2 testimony with "good afternoon," but I'll say
3 good evening.
4 And I want to say thank you so much
5 for sticking around and your commitment to
6 listening to us and partnering with us about
7 trying to find solutions to help strengthen
8 communities and strengthen the individuals in
9 those communities.
10 I'd also like to say thank you. This
11 is my inaugural testimony as the new CEO of
12 the Coalition for Behavioral Health. I have
13 testified before you all in the past, but not
14 under this hat. So I'm very honored, and I
15 do again appreciate you sticking around and
16 the good questions that you've asked my
17 esteemed colleagues who have testified before
18 me.
19 So the Coalition for Behavioral Health
20 is the umbrella advocacy and training
21 organization for New York City's behavioral
22 health community. We represent over
23 140 nonprofit community-based organizations,
24 and we serve over 450,000 consumers with
393
1 services.
2 And what I want to say to you today is
3 that I'm sitting at this seat with over
4 35,000 workers behind me in spirit. That's
5 35,000 full-time workers, we're probably well
6 over 40,000 workers if you count the per diem
7 and the part-time workers. And I don't take
8 it lightly when I come here to testify on
9 their behalf and the good work that they're
10 doing. And the people who preceded me in
11 their testimony from the developmental
12 community also testified to the hard work of
13 people that run their programs. And that's a
14 lot of what I'm going to talk about, is the
15 workforce and talk about the capacity and the
16 infrastructure that we're facing.
17 So to understand a little bit more
18 about who we are, we offer a whole range of
19 services. Our members comprise an intricate
20 network of safety providers throughout the
21 neighborhoods they serve. And we care for
22 the most vulnerable among us. It is critical
23 that this network remain strong and intact,
24 as the state stretches itself to achieve new
394
1 goals. And we support many of the goals and
2 the directions that they're going in.
3 And we serve New York City communities
4 in Long Island, Westchester, Rockland, Orange
5 County. And now we have a strategic
6 coordination for kids' work across the state,
7 and we're very excited to take that on,
8 because we realize we really need to speak
9 with one voice for those 2 million kids that
10 are on Medicaid in New York State.
11 The coalition's budget priorities
12 really reflect the reality that we're facing
13 as a sector. We strongly support the
14 measures that preserve and strengthen
15 community-based mental health and substance
16 use programs through the reinvestment of
17 resources in community-based services, the
18 continuation of viable rates under Medicaid
19 managed care, the preservation of a
20 sustainable workforce, and the promotion of
21 policies that prioritize consumers.
22 We are happy to see -- again, we
23 support the idea that the state is moving in
24 a holistic approach to serving the people
395
1 that we serve. So that means you'll hear
2 terms like social determinants of health
3 under DSRIP and Medicaid managed care. And
4 we laud that effort, because we see our
5 clients where they're at. We try to see them
6 holistically.
7 So although I'm testifying before you
8 today on substance use and mental health, my
9 members also provide housing and emergency
10 shelter, domestic violence services, and a
11 whole host of other things, because they
12 serve the clients where they're at when they
13 come in, and we know that people have many
14 facets to who they are. And so we want to be
15 able to provide services within a network and
16 within a safety net that sees them as a
17 holistic entity and doesn't shunt them off to
18 one area or a different area depending on
19 whatever challenge they're facing.
20 I want to highlight just some of the
21 specific budget asks that we have for the
22 2017-2018 state fiscal year as they relate to
23 the recently released Executive Budget. You
24 have my entire testimony, and you have a
396
1 one-pager that really summarizes well, I
2 think, the concerns and the areas where we're
3 grateful and the areas where we think that we
4 could be doing a little bit better of a job.
5 So that the main areas that we're
6 talking about, again, are infrastructure and
7 capacity access and workforce. And the
8 biggest ask on the top of that is a
9 $125 million ask for the Healthcare Facility
10 Transformation Program. The Executive's
11 recommendation for that $500 million pot of
12 money was they had set aside $30 million for
13 community clinics. And that's only 6 percent
14 of the funding. And it really fails to
15 recognize the critical role of
16 community-based organizations and the role
17 they play in making and keeping people
18 healthy.
19 In the past, hospital and larger
20 healthcare systems have traditionally
21 received the lion's share of investment funds
22 under this and other state programs. The
23 coalition is asking for your support for this
24 $125 million set-aside for our community
397
1 clinics as part of this Healthcare Facility
2 Transformation Program. We think it's going
3 to be great for your community, it's going to
4 be good for all the communities across the
5 state.
6 So to that point, I just want to say
7 we need a level playing field if we're going
8 to be able to achieve the goals of managed
9 care and DSRIP. And historically, the
10 community clinics have been underresourced
11 and overtapped for services. And so we think
12 it's time now that as we're going towards
13 valued-based payment and other models of
14 coordinating across the state with hospitals
15 and other community services, in order to
16 really see our people and serve them with
17 holistic services, we need to be prepared to
18 be able to demonstrate the services that
19 we're providing, that they have the intended
20 effect.
21 However, we need the resources. It's
22 the health information technology, it's the
23 staffing, it's the physical infrastructure in
24 some places if we're going towards
398
1 integration of physical and behavioral health
2 services. And we have been, frankly, not
3 given enough resources to get to where we
4 need to be. It's unrealistic to think that
5 we can achieve the outcomes that we can with
6 the existing resources.
7 So we're grateful for the $30 million,
8 we're grateful for the money we got last
9 year. But what we're saying is we want
10 25 percent of that $500 million. We think
11 it's fair, it's reflective of the statewide
12 groups serving people in their communities
13 with substance use and mental health
14 services.
15 I do want to -- we're grateful to the
16 Executive Budget for the extension of the APG
17 rates until 2020. We had asked for that
18 before the budget came out. We're grateful
19 for that. We think that's really critical to
20 help get us going towards a value-based
21 payment system. That's going to give us time
22 to work within our programs and bring them
23 closer to where they need to be so that we
24 really understand the impact that we're
399
1 having on the community.
2 And traditionally, as nonprofit
3 providers, we've always come back, whenever
4 there's been a cut or there's been changes to
5 our budget, we say we'll be there, because
6 we're the safety net. And now we are
7 learning to value the work that we're doing,
8 and we're really beginning to see how much
9 the impact has been on our programs and how
10 we have suffered under these cuts to be able
11 to move forward quickly in business models.
12 And we're not just talking about this
13 new paradigm of looking at people
14 holistically about evidence-based practices;
15 we've always embraced proven practices and
16 things like that. We're talking about we
17 have to evolve our business practices to
18 quickly come up to speed under the next two
19 and a half years under DSRIP.
20 I want to highlight in the package
21 there's an article that we included that
22 Politico wrote this week -- it's in your
23 package. And recently it was disclosed that
24 of the money that was made available so far
400
1 under DSRIP, which is about a billion
2 dollars, the total amount that
3 community-based organizations have received
4 is $12.6 million. That's the amount of the
5 money. So of the billion that's flowed, only
6 12 million has -- so it's about 1 percent has
7 flowed to the communities.
8 So you see, again, an example of where
9 community programs are being put to the side
10 when it comes to resources they need to come
11 up to speed and to support their programs.
12 So we encourage that there be more
13 disclosure on how those funds -- and we
14 encourage the Legislature and the executive
15 branch to push the PPSs to release more of
16 those funds back down to our communities.
17 I also want to note that in the
18 Executive Budget we had -- we're happy to see
19 $10 million to support the existing OMH
20 residential housing programs. We think
21 that's great. We want another $28 million.
22 I know my colleague who will be testifying
23 after me will be also bringing that up. We
24 need to have about $35 million over the next
401
1 three years in order to bring our housing
2 portfolio where it needs to be.
3 And what you need to understand about
4 this housing, these are people that we've
5 done the right thing by. They might have
6 come through homelessness, they might have
7 come out of prisons, state hospitals. And
8 we've been able to work with them, stabilize
9 them, build that confidence, and they have
10 strong, stable lives in the community.
11 And what's at risk now is that as
12 rents have gone up, the resources to the
13 providers have gone down because of the value
14 of the rents. So what happens is we have to
15 creep into the cost of providing those
16 services. And so it's really important that
17 if we lose any scattered-site housing, it's
18 very difficult to find more housing. So we
19 don't want to break that social compact that
20 we made with those folks about helping
21 stabilize them in the community. And so we
22 really encourage you to help us get that
23 other $28 million.
24 Also I want to talk about the
402
1 workforce. And again, other folks have
2 talked about this. We need immediate
3 investments in the nonprofit sector. We need
4 to invest in them in the short and the long
5 term. We need to have COLAs.
6 The Executive Budget defers the COLA
7 for one year. We would ask that that be
8 reinstated. Because what is the message
9 we're sending to the people who serve the
10 most vulnerable? Many of our staff
11 themselves are working poor. And what is the
12 message we're sending to them when we defer
13 even small COLAs down the road?
14 We also would like to have the
15 contracts that we have with the state for
16 human services across the state, not just for
17 the O agencies. We're asking the indirect
18 rate be moved up to 15 percent so that we can
19 actually keep our programs running, including
20 not just the operations but also the physical
21 plants of what those look like, and allowing
22 for things like training and other
23 &nbs