Joint Legislative Public Hearing on 2017-2018 Executive Budget Proposal: Topic "Mental Hygiene" - Testimonies

February 07, 2017

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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.

                                                                  61

 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.  

                                                                  90

 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:   

                                                                  92

 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 

                                                                  93

 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 

                                                                  94

 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.

                                                                  96

 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.

                                                                  99

 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 

                                                                  100

 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 

                                                                  102

 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 

                                                                  103

 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 

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 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.

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 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 

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 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 

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 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 

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 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 

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 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 

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 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, 

                                                                  128

 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 

                                                                  129

 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.

                                                                  132

 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 

                                                                  134

 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 -- 

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 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.  

                                                                  148

 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, 

                                                                  149

 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 

                                                                  150

 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, 

                                                                  151

 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 

                                                                  154

 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.  

                                                                  155

 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.  

                                                                  156

 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 

                                                                  157

 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 

                                                                  160

 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 

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 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 

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 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 

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 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.  

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 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 

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 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 

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 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.

                                                                  175

 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 

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 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.

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 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 

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 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, 

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 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 

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 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.  

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 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 

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 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 

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 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 

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 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 

                                                                  266

 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, 

                                                                  268

 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 

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 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 

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 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 

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 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 

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 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 

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 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 

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 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 

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 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 

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 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, 

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 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.  

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 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 

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 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.

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 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 

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 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 

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 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 

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 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 

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 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 

                                                                  299

 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 

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 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 

                                                                  315

 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 

                                                                  316

 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 

                                                                  317

 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 

                                                                  318

 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 

                                                                  320

 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.  

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 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.  

                                                                  326

 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, 

                                                                  331

 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 

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 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 

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 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.  

                                                                  352

 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 

                                                                  353

 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 

                                                                  354

 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 

                                                                  355

 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 

                                                                  356

 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 

                                                                  359

 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 

                                                                  361

 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 

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 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 

                                                                  363

 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.  

                                                                  366

 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.

                                                                  368

 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 

                                                                  369

 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 

                                                                  371

 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 

                                                                  372

 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 

                                                                  374

 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 

                                                                  375

 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 

                                                                  376

 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.  

                                                                  377

 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          opportunities for our staff to grow.

24                 We would like to see the Nonprofit 

                                                                  403

 1          Infrastructure Capital Investment Program 

 2          funded for another year, because last year 

 3          only 40 percent of the 580 applications that 

 4          were submitted were funded.  So clearly 

 5          there's a need.

 6                 CHAIRWOMAN YOUNG:  Okay, could you 

 7          wrap it up, please?  

 8                 MS. PARQUE:  Sure.

 9                 CHAIRWOMAN YOUNG:  Thank you.

10                 MS. PARQUE:  And the last thing is 

11          related to the minimum wage for the 

12          O agencies.  We are asking for $50.5 million 

13          per year for five years to support the impact 

14          of the incremental increases due to the 

15          minimum wage.

16                 And my final point is that for 

17          children's behavioral health, we're asking 

18          for a $17.5 million investment, which is 

19          $7.5 million that was unspent last year to be 

20          reinvested for this year.  And the Executive 

21          Budget shows a $10 million savings this year.  

22          This is not the time to save money on 

23          children's behavioral health.  They've just 

24          moved into managed care.  So we ask that we 

                                                                  404

 1          have the $17.5 million investment.

 2                 And as far as the opioid epidemic, we 

 3          heartily support that.  My predecessor John 

 4          Coppola did a fantastic job.  We support 

 5          everything he has to say.  Listen to him, 

 6          he's a wise man.  

 7                 And we look forward for working with 

 8          you more on that.  You've done a -- the 

 9          Senate and the Assembly has done a great job 

10          on that leadership.  

11                 And thank you for the opportunity to 

12          testify.  You have my full testimony and our 

13          one-pager.  And actually it's our lobby day 

14          today and tomorrow, so you've probably met or 

15          are meeting with many of my members.  

16                 So thank you.

17                 CHAIRWOMAN YOUNG:  Great.  Thank you.

18                 ASSEMBLYMAN OAKS:  Thank you.

19                 CHAIRWOMAN YOUNG:  The next speaker is 

20          Lisa Wickens-Alteri, president of Save Our 

21          Western New York Children's Psychiatric 

22          Center Coalition.

23                 Thank you for being here.

24                 MS. WICKENS-ALTERI:  Hello.  Thank 

                                                                  405

 1          you.  

 2                 I just want to -- you have my 

 3          testimony.  And actually, I'm the president 

 4          of Capital Health Consulting.  It's actually 

 5          a new firm in Albany.  I am here representing 

 6          the Save Our Western New York Children's 

 7          Psychiatric Center.  

 8                 We have been here before.  In the 

 9          beginning of the hearing this morning, you 

10          heard many members of the Western delegation 

11          ask questions and pose similar issues that we 

12          have raised in the past.

13                 The advocates were really disappointed 

14          they couldn't be here.  When the date got 

15          moved up, many of them have adult children or 

16          children they have to have services for, and 

17          they're in Western New York, so they couldn't 

18          make it.

19                 I'm just going to give a few bullets 

20          and highlights to the testimony that we've 

21          already submitted.

22                 The consolidation of Western New York 

23          Children's Psychiatric Center and Buffalo has 

24          been put off for the past two years.  But as 

                                                                  406

 1          you heard earlier today, OMH is already 

 2          moving forward and the project bid is due 

 3          back this month.  Yet the state has yet to 

 4          address the additional staffing and security 

 5          measures that need to be put in place to try 

 6          to prevent commingling between patient 

 7          populations.  

 8                 As the plan has been laid out, it is 

 9          the children's treatment center placed on the 

10          adult campus.  New York can do better.  

11                 Senator Gallivan pointed to moving 

12          young adults in adult prisons away from 

13          adults.  Others have pointed out health 

14          projects that we continue to move forward on 

15          that focus on the care of the pediatrics, 

16          carving them out of the adult population so 

17          they receive the specialty services they 

18          deserve.  They're not just little people.

19                 We have increased the number of 

20          pediatric nursing homes, moving children away 

21          from adults.  January 10th of this year, 

22          Albany Medical Center had their 

23          groundbreaking for a pediatric emergency 

24          department, and the CEO, James Barba, was 

                                                                  407

 1          quoted as saying "It's just not possible to 

 2          keep them completely isolated.  This facility 

 3          will not have adults in it.  It will only be 

 4          for kids, and that is very special."

 5                 Why are the children in Western 

 6          New York any different?

 7                 Today we heard a litany of reasons why 

 8          this consolidation just doesn't make sense, 

 9          but we did not hear why it is completely 

10          necessary.  This facility has the best 

11          outcomes in the state, and continues to have 

12          some.  These children have lived and survived 

13          through abuse at the hands of adults.  We 

14          have heard there will be more outpatient 

15          services to stem the flow of inpatient 

16          services, yet those services are inflexible 

17          to meet the needs of this special population.  

18                 The mobile integration team is a 

19          perfect example.  Children are still ending 

20          up in the hospital, and then the children's 

21          psychiatric center.  Last week there were 

22          seven admissions alone -- seven admissions in 

23          one week.  

24                 New York State has been committed to 

                                                                  408

 1          identifying strong quality programs that will 

 2          care for more people, more individuals, 

 3          through the efficiencies that we've built, 

 4          with strong quality outcomes.  There are new 

 5          innovative ideas being discussed and 

 6          presented on a daily basis.  I'm thankful 

 7          I've actually worked with the Assembly and 

 8          the Senate on the opiate epidemic we're 

 9          having; we're doing a lot for children.  

10          We're doing pediatric ventilators in New York 

11          State, and we're opening new facilities and 

12          new programs. 

13                 But yet here we are, putting and 

14          moving more children to an adult psychiatric 

15          center.

16                 The advocates have presented other 

17          options.  Many of you have been supportive of 

18          them.  The Western delegation has heard new 

19          options, new ideas, and the government and 

20          the state has really liked the ideas.  

21          They've asked us, yes, come back and talk to 

22          us -- but not here.  Not for this site.

23                 Western New York Children's 

24          Psychiatric Center currently services 19 

                                                                  409

 1          counties.  We implore the Legislature to push 

 2          forward for other options.  We're not just 

 3          coming and saying "Don't move them to the 

 4          adult facility" -- we've actually come up 

 5          with other ideas.  

 6                 And so let us make it work.  

 7          Private/public partnerships.  Other ways to 

 8          put specialty services for children wrapped 

 9          around this so that we can actually make some 

10          choices and give some other revenue streams 

11          to support the program.  It's a great 

12          program.

13                 So I ask that everyone comes to the 

14          table.  Hold them accountable.   We hear it's 

15          all moving forward, and every year you keep 

16          putting a stay on it, and yet here we are 

17          again.  And this is it.  We've got to make a 

18          move.

19                 So I thank you for your time.  God 

20          bless you for still being here.  And have a 

21          good night.

22                 CHAIRWOMAN YOUNG:  Thank you very 

23          much.  Thanks for all you do.

24                 ASSEMBLYMAN OAKS:  Thank you.

                                                                  410

 1                 CHAIRWOMAN YOUNG:  The next speakers 

 2          are Arnold Ackerley, administrative director, 

 3          and Clint Perrin, director of policy, 

 4          Self-Advocacy Association of New York State.  

 5                 Thank you for being here.

 6                 MR. ACKERLEY:  Thank you for your 

 7          time, everyone.  

 8                 So I think it's important to begin to 

 9          understand the nature of our organization, 

10          because what we've chosen to focus on is the 

11          #bFair2DirectCare Campaign.  So we will be 

12          brief, as we know you've heard about this.  

13          But I do think it's important to understand 

14          why we feel it's important for our 

15          organization to speak.  

16                 There's something unique about our 

17          organization.  The organization was actually 

18          founded by individuals with developmental 

19          disabilities, for individuals with 

20          developmental disabilities.  And to this day, 

21          our board of directors is comprised entirely 

22          of individuals with developmental 

23          disabilities.  

24                 So as administrative director, I 

                                                                  411

 1          report to them, and today have been asked to 

 2          speak on their behalf with my colleague, 

 3          Clint.  

 4                 So I think it's very important to 

 5          understand that when we talk about the issue 

 6          of fair wages for direct support 

 7          professionals, we're really talking about a 

 8          direct benefit to individuals with 

 9          disabilities as well.  So a decision, you 

10          know, to fund those fair wages is really a 

11          designation to positively impact the quality 

12          of life of individuals with developmental 

13          disabilities.  

14                 I think we will find that quality of 

15          life for many individuals with developmental 

16          disabilities really begins and ends with the 

17          relationship and services that a direct 

18          support professional provides on their behalf 

19          each day.  

20                 I think it's also important to 

21          understand that the capacity of individuals 

22          with developmental disabilities to be 

23          contributing members of their communities and 

24          our economy is directly dependent on some of 

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 1          those services.  Without a direct support 

 2          professional to assist them in many ways -- 

 3          with transportation and some career 

 4          counseling -- they may not be able to retain 

 5          their positions, their jobs.  They may not be 

 6          able to even shop and, in some cases, may not 

 7          be able to vote when it's time to do so.

 8                 And so I'll turn the floor over to 

 9          Clint.

10                 MR. PERRIN:  Hello.  Hello, all.

11                 CHAIRWOMAN YOUNG:  Hello.

12                 MR. PERRIN:  I speak to you today kind 

13          of uniquely.  I'm probably one of the few 

14          people that you've heard from today who 

15          actually receives services.  Yes, I'm a 

16          service recipient.

17                 ASSEMBLYWOMAN GUNTHER:  Can you hold 

18          that mic just a little bit closer?  Thank you 

19          so much.  Because I'd like to hear.  

20                 MR. PERRIN:  I am a service recipient.  

21          And my direct support person is quite 

22          important to me.  I don't think I would be 

23          here speaking to you today if she didn't work 

24          with me.  And I certainly wouldn't -- my 

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 1          apartment certainly wouldn't be as clean or 

 2          as safe as it is.

 3                 That's all.

 4                 CHAIRWOMAN YOUNG:  Okay.  Well, thank 

 5          you for being here.

 6                 MR. ACKERLEY:  So would I be able to 

 7          make one last point?  

 8                 So I think one common experience we've 

 9          heard through our board of directors when we 

10          reviewed this is that too many New Yorkers 

11          with developmental disabilities are really 

12          tired of seeing conscientious, good direct 

13          support professionals leave for higher-paid 

14          positions, when nearly a decade ago that was 

15          not the case.  It was typically, you know, 

16          well above a minimum-wage position.  So we 

17          just ask you to consider that.  

18                 We do understand that the minimum wage 

19          is being budgeted for.  However, the profound 

20          responsibilities of the position and the 

21          importance of the position really merit a 

22          higher wage.  And that's why we have joined 

23          with the #bFair2DirectCare Coalition.  

24                 Thank you for your time.

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 1                 ASSEMBLYMAN McDONALD:  Thank you.  

 2          Thank you, Clint. 

 3                 CHAIRWOMAN YOUNG:  Thank you for 

 4          participating.

 5                 ASSEMBLYWOMAN GUNTHER:  Thank you for 

 6          waiting so long.

 7                 CHAIRWOMAN YOUNG:  Yes, absolutely.  

 8                 The next speaker is Bill Gettman, CEO 

 9          of Northern Rivers Family of Services.

10                 ASSEMBLYMAN McDONALD:  Not here.  He's 

11          not here.

12                 CHAIRWOMAN YOUNG:  Oh, I guess he 

13          left.  

14                 Stephanie Campbell, director of policy 

15          for Friends of Recovery New York.  

16                 Welcome.  Thank you for being here.

17                 MS. CAMPBELL:  Good evening.  Thanks 

18          so much for being here.  It's such a pleasure 

19          and an honor to sit here and talk to the 

20          folks that I actually used to work for.

21                 So I am Stephanie Campbell.  And as 

22          the director of policy for Friends of 

23          Recovery New York, I am honored to be here 

24          today and discuss how we can address the 

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 1          public health crisis of addiction in New York 

 2          State.  And as many of you know, Friends of 

 3          Recovery New York represents the voices of 

 4          individuals and family members living in 

 5          recovery from addiction, families who have 

 6          lost a family member, and people who have 

 7          otherwise been impacted by addiction.

 8                 The stigma and shame that surrounds 

 9          addiction has prevented millions of 

10          individuals and families from seeking help, 

11          and we're dedicated to breaking down the 

12          barriers created by stigma that have resulted 

13          in discrimination and policies that block or 

14          interfere with recovery.  And that's access 

15          to addiction treatment, healthcare, housing, 

16          education and employment.

17                 But I'm also Stephanie Campbell, a 

18          person in long-term recovery.  And what that 

19          means for me is that I have not had to use 

20          alcohol or drugs for over 16 years.  Recovery 

21          has given me the opportunity to be a mother 

22          of two beautiful girls, one who is in her 

23          last year at Sarah Lawrence -- right now 

24          she's in Japan.  I just got back yesterday, 

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 1          so I'm a little jet-lagged; forgive me if I'm 

 2          a little scrambled -- and a teenager in her 

 3          junior year of high school.  

 4                 Recovery has allowed me to be a 

 5          partner, an employee, and a taxpayer instead 

 6          of a tax drain.  It's allowed me to save the 

 7          State of New York millions of dollars because 

 8          somebody made the investment in me and my 

 9          recovery.  And as a result, I went from being 

10          a homeless street kid in New York City to 

11          having a master's degree from Columbia 

12          University and an MSW from New York 

13          University.  Instead of bouncing from jails 

14          to institutions, I now advocate on behalf of 

15          individuals and families impacted by 

16          addiction.

17                 And it's really funny -- I want to 

18          pause here for a second -- I've had a number 

19          of you who I've worked with who, when I came 

20          out as a person in recovery, were shocked.  

21          Right?  Because I look fairly, you know, 

22          normal.  But the truth of the matter is that 

23          there was a time in my life when that wasn't 

24          my story, you know.  And so to sit here now 

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 1          and to advocate and to speak openly as a 

 2          person in long-term recovery about the 

 3          benefits of what happens when the investment 

 4          is made -- I mean, when you think about, you 

 5          know, the first year alone in my recovery, I 

 6          must have saved the State of New York, I 

 7          don't know, $500,000?  I mean, when you think 

 8          about, you know, cycling in and out of 

 9          hospitals, emergency rooms.

10                 So when we think about the investment 

11          I just want to be clear that it's not just 

12          the right thing to do morally and ethically, 

13          right, it's the smart thing to do 

14          financially.  You know?

15                 And so I'm not to go through all the 

16          statistics.  I value your time.  You guys 

17          know what's going on here in the State of 

18          New York.  But I want to mention a couple of 

19          things that we are pretty clear on in our 

20          recommendations.

21                 The first is that -- and I don't know 

22          how many of you have had the opportunity to 

23          read the Surgeon General's report, but he 

24          talks in Chapter 5 about the importance of 

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 1          recovery support services, what he calls RSS.  

 2          And, you know, I believe Senator Amedore had 

 3          talked about the multipronged approach that 

 4          we need to use, right, where we address this 

 5          -- and it's not epidemic, by the way, now.  

 6          It's a pandemic.  There are more people dying 

 7          from this disease than were lost at the 

 8          height of the AIDS crisis in this country.  

 9                 And I was in ACT-UP, by the way, and 

10          we were throwing ourselves in streets and 

11          carrying signs and doing all kinds of stuff 

12          because our people were dying because of 

13          shame and stigma and the lack of resources.  

14          We've now surpassed the 41,000 a year in this 

15          country that were dying from the AIDS crisis.  

16          We're now at 52,000 plus a year.

17                 And you're going to hear momentarily 

18          from two people who were in the trenches -- 

19          one is Pete Volkmann, who heads up the PaRy 

20          program in Columbia County, and the other is 

21          Kristin Hoin, who some of you have seen, 

22          who's a mother who lost her child to this 

23          illness.

24                 We must stop investing in the problem 

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 1          of addiction and start investing in the 

 2          solution, which is recovery.  We support 

 3          prevention and treatment for sure, but we 

 4          have got to, when folks get out of treatment, 

 5          have supports and services available in the 

 6          form of recovery community organizations such 

 7          as the ones that you'll hear about.  We need 

 8          to invest in recovery community outreach 

 9          centers so that when folks come out, they can 

10          reintegrate and reenter their communities.  

11          We need to have family support navigators and 

12          peers.  And you've heard a lot about that 

13          today.  But we've got to have that.  As John 

14          Coppola had said, and others, to have 10 

15          programs in the State of New York is -- I 

16          don't even have the word for it.  It's 

17          abysmal.  It's completely unacceptable.

18                 And so, you know, we're moving in the 

19          direction of really pushing that adequate 

20          resources -- and we're asking for $45.25 

21          million this year, and that's a baseline.  

22          That's bare minimum.  And that would cover, 

23          you know, recovery community outreach 

24          centers, RCOs, youth club houses, peer 

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 1          advocates and recovery coaches and family 

 2          support navigators.

 3                 But I'd like right now to turn your 

 4          attention to Pete Volkmann, who's in the 

 5          trenches as law enforcement, pulling people 

 6          off the streets and getting them into 

 7          recovery.  So Pete?

 8                 CHIEF VOLKMANN:  Thank you.  My name 

 9          is Peter Volkmann, and I'm a person in 

10          long-term recovery.  My last drink was 

11          September 2, 1995.

12                 As police chief of Chatham, New York, 

13          I made a conscious choice to stop arresting 

14          people who have an addiction and to get them 

15          help.

16                 My part-time police department of 20 

17          part-time officers, with a yearly budget for 

18          the whole police department of $157,000 a 

19          year, in seven months has placed 70 people 

20          into treatment, with insurance approval, 

21          within one day.  

22                 So I just did it to help people who I 

23          understood.  And never expecting people from 

24          six different counties, as far as Utica, to 

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 1          travel all the way to Chatham, New York, 

 2          because their parents couldn't find a 

 3          treatment bed.  And we found a treatment bed 

 4          for them.  We are working well with treatment 

 5          centers, and having an understanding of the 

 6          dysfunctionality of both the insurance 

 7          company approval process and the 

 8          dysfunctionality of treatment centers.  And 

 9          the lack of treatment centers. 

10                 But the other piece that we found is 

11          many people relapse and still come back to 

12          us, and we find them a treatment center 

13          again.  And that's where we've collaborated 

14          with Friends of Recovery New York because we 

15          need help.  You could put someone in 

16          treatment all the time, but there's a lack of 

17          continuous care.  

18                 It's a recovery process.  I wouldn't 

19          be here if it wasn't for the support systems 

20          that I was lucky to have in my process.  And 

21          so as people are dying every day in New York 

22          State, I knew no other way, as a person on 

23          the streets as a first responder, than to 

24          start getting people into treatment.  That's 

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 1          the only way to save their life at this 

 2          point.  But we're missing that next process 

 3          of trying to get people into the whole 

 4          recovery life that I have been in.  

 5                 So I was asked to come to speak about 

 6          Chatham Cares 4 U and our program that a 

 7          little part-time police department in 

 8          Columbia County, New York, has placed 

 9          70 people in seven months with insurance 

10          approval.  And the shortest time it took us 

11          was 15 minutes to have a bed with approval, 

12          and the longest time it took us was about 

13          12 hours to find a bed.  We have transported 

14          somebody from Columbia County to Utica.  I'd 

15          rather pay my officers overtime in 

16          transportation than arresting somebody.  

17                 The other piece that is missing is 

18          we're partnering up and we're getting as much 

19          help as we can.  Our officers are now 

20          volunteering their time because our budget is 

21          shot due to this.  Our village mayor and 

22          village board is a hundred percent behind us.  

23          But we are limited, as a part-time police 

24          agency.  And every person is a miracle.  So 

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 1          70 miracles occurred in a little village 

 2          police department.  

 3                 And so I'm here to advocate and to ask 

 4          for you all to please help us, because too 

 5          many people have died.  It is beyond 

 6          comprehension for our first responders and 

 7          the mental anguish that we are all going 

 8          through, and something just needs to be done.  

 9          It is that bad on the streets.  I will 

10          testify to that.  

11                 And so thank you.  

12                 CHAIRWOMAN YOUNG:  Thank you.

13                 MS. CAMPBELL:  Thank you.  

14                 And now I'd like to introduce Kristin 

15          Hoin.

16                 MS. HOIN:  Hi, good evening.  How are 

17          you?  I'm Kristin, and I'm Summer's mom.  

18                 The last conversation that I had with 

19          my daughter was on January 9, 2015.  We spoke 

20          about a sweater.  And six days later, I 

21          buried her in that same sweater.  

22                 I struggle to remember if the last 

23          words that I said to her were "I love you," 

24          as they usually were.  I then had the very 

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 1          difficult conversation with her three 

 2          children -- Ritchie, Caden and Anthony, 13, 

 3          4, and 3 -- letting them know their mother 

 4          had died.  

 5                 Let me take you back 12 years, a 

 6          beautiful sunny afternoon, and I received a 

 7          phone call:  "Kristin, Summer is struggling 

 8          with heroin."  Way before the current heroin 

 9          epidemic that we're in.  The floor crashed 

10          out beneath me, and the hell that is 

11          addiction -- that somebody living in 

12          addiction, and their families, goes 

13          through -- became reality.  

14                 Summer went through a 12-year battle 

15          with this disease, and she fought to live her 

16          life in recovery for those 12 years.  Part of 

17          that time was lived on the street, part of 

18          that time was prostituting, part of that time 

19          was in jail -- interspersed with times of 

20          recovery.  She wanted to be sober.  She 

21          wanted to live her life in recovery.  I have 

22          handwritten journals and prayers begging, 

23          begging God for her life to be lived in 

24          recovery.

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 1                 The irony is that Summer didn't die of 

 2          a heroin overdose, like all of the reporters 

 3          put in the paper because it's the story of 

 4          the moment.  The reality is that addiction 

 5          has always been, and it will always be, long 

 6          after this current heroin epidemic is over.  

 7                 She won her battle with opiates.  But 

 8          like addiction, it was replaced with another 

 9          drug and another drug and another drug.  

10          Periods of treatment, periods of life lived 

11          in recovery, interspersed with relapses, 

12          fighting her way to the top.  Determined to 

13          live her life in recovery.

14                 Why did Summer die that day?  What 

15          happened?  I truly believe that there were 

16          not sufficient recovery resources in New York 

17          State.  Yes, it's difficult to get to 

18          treatment.  Yes, it's difficult to get a bed.  

19          I can speak to 50 times that I took Summer to 

20          the ER and she was kicked out for just being 

21          an addict.  To getting a treatment program, 

22          to being kicked out.  But what happens is 

23          when she was successful, there was not a 

24          culture of recovery to come back to.  There 

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 1          were no resources here to have recovery 

 2          community centers or family support 

 3          navigators.  She had the desire, she had the 

 4          family support, but she didn't have the 

 5          support of New York State.

 6                 I myself have created the Summer Smith 

 7          5K Addiction Awareness Memorial Run to stop 

 8          the stigma that surrounds addiction, to honor 

 9          those we have lost, and to celebrate those 

10          that are currently living their life in 

11          recovery.  Last year we raised $21,000, and 

12          this year we are moving on and hopefully 

13          we'll be raising more money.  

14                 Summer was a student who graduated 

15          from Guilderland with amazing potential, but 

16          I buried her at 31 years of age.

17                 But we can't do this alone.  

18          Individually, we're weak.  Together as a 

19          group, a community, and a state, we're 

20          strong.  We need our tax dollars to be 

21          directed to creating a culture of recovery 

22          where we don't attend and I don't have to 

23          speak at overdose awareness vigils or attend 

24          funerals or comfort moms who have lost their 

                                                                  427

 1          children in Pineras {ph}, where I don't 

 2          become the chapter leader of a grief recovery 

 3          group called GRASP, for those who have lost 

 4          somebody due to substance abuse.  We need to 

 5          be celebrating weddings and children's births 

 6          and graduations instead.

 7                 And I would ask you, if it was your 

 8          child, would you do anything less?  Thank 

 9          you.

10                 CHAIRWOMAN YOUNG:  Thank you.  So 

11          sorry for your loss.  Thank you for sharing.  

12          Thank you for all the good work you're doing.

13                 ASSEMBLYMAN McDONALD:  Thank you.  

14          Thank you, Chief. 

15                 SENATOR KRUEGER:  Bravo, everyone.  

16          Thank you.

17                 CHAIRWOMAN YOUNG:  Our final speaker 

18          is Patrick Curran, steering committee member 

19          and cochair of the Eastern New York 

20          Developmental Disability Advocates.  

21                 Thank you for waiting.

22                 MR. CURRAN:  Thank you guys, very 

23          much.  Thank you for being here, good 

24          evening, and for sticking it out.  I 

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 1          genuinely appreciate it, appreciate the 

 2          opportunity.  I'll respect your time and be 

 3          as brief as possible.  

 4                 And hello to Senator Krueger and 

 5          Senator Young and Assemblywoman Gunther, my 

 6          Assemblyman, Assemblyman McDonald.  Thank you 

 7          all so much, and the other people I've had 

 8          the privilege of working with and knowing for 

 9          a long time.

10                 Tonight I'm here as the father of 

11          Katie Curran, a very beautiful 28-year-old 

12          young woman who was born with profound 

13          disabilities, during a period of time when I 

14          was working in these halls and doing much 

15          what you're doing right now.  

16                 But it's also my privilege to serve on 

17          the steering committee of two relatively 

18          recently founded groups, one regional here in 

19          the Capital District, Eastern New York 

20          Developmental Disability Advocates -- we call 

21          the acronym "Any Day" -- and the larger 

22          statewide group of which we are now a part, 

23          called SWAN, the StateWide Advocacy Network, 

24          which is a collection of, at this point, four 

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 1          such groups from around the state -- DDAWNY, 

 2          in Western New York, GROW, in Westchester 

 3          County, FAIR NYC, and ENYDDA.  

 4                 These are entirely independent parent 

 5          and family all-volunteer organizations, and 

 6          our sole purpose is to educate policymakers, 

 7          the media, and the public on the issues 

 8          affecting our children.  Our only stake in 

 9          this process is their well-being and their 

10          welfare.

11                 Right now our best estimate, and it's 

12          a conservative one, is that our membership 

13          lists and mailing lists consist of thousands 

14          of similarly situated families.  And we're 

15          very confident that we're representative of 

16          tens of thousands of more such families, 

17          which translates into hundreds of thousands 

18          of New Yorkers directly impacted by the 

19          issues we touch on.

20                 You know, I'm not very well schooled 

21          in the Bible.  I do remember that the last 

22          shall be first; that kind of sticks out right 

23          now.  But following such powerful and 

24          effective testimony, as we've just heard -- 

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 1          and really what we've heard all afternoon 

 2          I've been sitting here and kind of skimming 

 3          my notes and flipping stuff out, saying, 

 4          okay, they've heard all this in better ways 

 5          than I can say it.  So I'm going to skip over 

 6          most of what we talked about.  What I really 

 7          wanted to do on behalf of our groups, which 

 8          is what we try to do, is to put the personal 

 9          face on all of this.  Because we're just moms 

10          and dads and brothers and sisters.  We don't 

11          have the resources and the numbers and data; 

12          we rely on providers and others for those.  

13          But we can speak to the reality of both 

14          dealing with the disabled day in and day out 

15          and what that means, even if you've got to do 

16          it at the end of a long night when you're 

17          conducting a legislative hearing that's run 

18          many hours late and you still have to go home 

19          and change the diapers and fix the braces and 

20          provide the medicines and do all those 

21          things.  Because everything else just doesn't 

22          matter.  That stuff still has to be done.  

23                 Then you translate that into the world 

24          of the direct caregivers, who have multiple 

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 1          people at the same time, trying to do those 

 2          same things, with almost an exponential 

 3          increase in the complexities and the 

 4          subtleties and the variations of the 

 5          nutrition and the pharmacology and the 

 6          orthopedics and the nursing care and 

 7          everything else that goes along with that 

 8          job.  It's really quite extraordinary.  

 9          But again, you've heard it expressed better 

10          than I can.  

11                 I think if our kids, if my daughter 

12          Katie could speak, I think she'd want to 

13          leave you with two concepts that stick out as 

14          we try to impact people with the importance 

15          of this:  Toothpicks and continuity.  

16                 Toothpicks because if you take all the 

17          stuff that government does and that 

18          societally we do to help people like our 

19          children, all the programs, the school care, 

20          the respite, the residences, the whole nine 

21          yards, the billions of dollars, the 

22          bureaucracies, it's one great, grand edifice 

23          of stuff that really reflects our best 

24          impulses, what we're trying to do.  And it's 

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 1          all sitting on a foundation of toothpicks.  

 2                 And those toothpicks are the direct 

 3          care workers.  Because every last service, 

 4          every last thing that that constitutes, every 

 5          last dollar that gets spent ultimately 

 6          channels through their hands, physically, to 

 7          these ultimate recipients, to our kids.

 8                 And if they're not there, or they 

 9          can't do that job well, the whole edifice 

10          comes crashing down.  And we're very close to 

11          that.  I mean, it's crumbling now.  It's 

12          getting very difficult.

13                 And that kind of segues to the concept 

14          of the continuity, which you've heard 

15          expressed well and for a lot of reasons.  I 

16          won't belabor it except I think to say that I 

17          don't think there's any other form of service 

18          from one human being to another in which 

19          continuity is as important as in providing 

20          service from a direct care worker to a 

21          disabled person.  And not just for the 

22          mechanics.  You know, most people, we talk 

23          about the mechanics of it all, or what I call 

24          the mechanics.  The physical tending, the 

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 1          medical care.  You know, all that kind of -- 

 2          all the things they have to do.  And it's 

 3          work.  Trust me, it's a lot of work.  Right?  

 4          And it's life-sustaining.  

 5                 But, you know, there's the other part 

 6          that we all kind of aspire to.  You know, you 

 7          want to break through to these people that 

 8          are trapped in these bodies without the 

 9          ability to communicate, with intellectual and 

10          emotional capacities that we don't even know, 

11          because we can't get through to them and they 

12          can't express.  And how long it takes to make 

13          those connections, to give us things we all 

14          need.  You know, we all need that kind of 

15          personal connection and emotional contact and 

16          interaction.  And it takes a long time to get 

17          that with somebody who's got these 

18          disabilities.  

19                 Similarly, or even sort of 

20          compoundingly, it's so much harder when 

21          you're the person with a disability, because 

22          your world is very small and you don't 

23          understand why these things are changing.  

24          You don't understand why the person who gave 

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 1          you the bath yesterday, as I heard someone 

 2          express earlier, isn't there today.  Or why 

 3          this was moved over here.  Or why you can't 

 4          get somebody to give you a drink of juice 

 5          because they give you milk every morning 

 6          because you can't tell them you want juice 

 7          instead of milk.  And so you throw a tantrum, 

 8          and you're labeled as behavior-modified, and 

 9          then you don't get to go to school.  

10                 All that stuff.  It takes years to 

11          break through to that.  But that's the 

12          continuity that is undermined by our 

13          inability, our collective inability to pay 

14          these people enough money to stay in these 

15          jobs for any length of time.  

16                 Now, I appreciate very much that -- I 

17          think -- you know, I see a lot of friends up 

18          here, and I know we're preaching to the 

19          choir.  I mean, I get that entirely.  So -- 

20          and we thank you for that.  God knows we 

21          thank you for that.  And we know we've got a 

22          critical mass of legislative support now.  

23                 But here's the deal.  We all know how 

24          this building works.  Okay?  All this 

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 1          support, it's wonderful.  But it's not 

 2          enough.  You know that, we know that.  What 

 3          it takes is for you all to be able to go to 

 4          your leaders and say, We know we've got a 

 5          finite pot of resources and a finite number 

 6          of asks that we have as legislators and as a 

 7          conference and as an institution, and an 

 8          infinite number of needs.  And so we've got 

 9          to make choices.  Mr. Leader, we want this 

10          funded and we're willing to pay for it.  

11          We're willing to take this out of our pot and 

12          out of our hides.  And we want you, in turn, 

13          to go to the Governor and say, Mr. Governor, 

14          the Senate, the Assembly, we need this funded 

15          or we don't have a budget.  What are you 

16          going to do about it?  

17                 And we all know that nothing short of 

18          that is going to get this done.  Despite all 

19          the talk we've had today, and all the support 

20          that I know is genuine, we all know that 

21          we've got to make that hard call or this 

22          isn't going to happen.  

23                 So that's what we're asking of you.  

24          We know it's a lot.  We appreciate that.  

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 1          We'll do everything we can, our tens of 

 2          thousands of families around here, we'll do 

 3          everything we can to support that and support 

 4          you in that effort.  

 5                 Thank you.

 6                 SENATOR KRUEGER:  Thank you.

 7                 ASSEMBLYWOMAN GUNTHER:  Thank you.

 8                 SENATOR KRUEGER:  And thank you for 

 9          being the last speaker.

10                 ASSEMBLYWOMAN GUNTHER:  Thank you for 

11          waiting so long.

12                 MR. CURRAN:  I appreciate that you 

13          guys are still here.  It's great.

14                 SENATOR KRUEGER:  And this closes down 

15          our budget hearing on mental health and 

16          mental hygiene.  

17                 We have another hearing starting in 

18          this room, 9:30 tomorrow morning, but 

19          everybody should go home and come back.

20                 (Whereupon, at 8:24 p.m., the budget 

21          hearing concluded.)

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