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		                                                               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
           2020-2021 EXECUTIVE BUDGET ON
 5                MENTAL HYGIENE

 6   -----------------------------------------------------

 7

 8                               Hearing Room B
                                 Legislative Office Building
 9                               Albany, New York

10                               February 3, 2020
                                 11:09 a.m.
11

12   PRESIDING:

13              Senator Liz Krueger
                Chair, Senate Finance Committee
14
                Assemblywoman Helene E. Weinstein
15              Chair, Assembly Ways & Means Committee

16   PRESENT:

17              Senator James L. Seward
                Senate Finance Committee (RM)
18
                Assemblyman Edward P. Ra
19              Assembly Ways & Means Committee (RM)

20              Senator David Carlucci
                Chair, Senate Committee on Mental Health and
21               Developmental Disabilities

22              Assemblywoman Aileen Gunther
                Chair, Assembly Committee on Mental Health
23

24
                                                          2

 1   2020-2021 Executive Budget
     Mental Hygiene
 2   2-3-20

 3   PRESENT:    (Continued)

 4              Senator Pete Harckham
                Chair, Senate Committee on Alcoholism
 5               and Drug Abuse

 6              Assemblywoman Linda Rosenthal
                Chair, Assembly Committee on Alcoholism
 7               and Drug Abuse

 8              Assemblywoman Ellen Jaffee

 9              Senator Luis R. Sepulveda

10              Assemblyman Michael Cusick

11              Senator George M. Borrello

12              Assemblywoman Kimberly Jean-Pierre

13              Senator Diane J. Savino

14              Assemblyman Angelo Santabarbara

15              Senator John Liu

16              Assemblywoman Melissa Miller

17              Senator Gustavo Rivera

18              Senator Anna Kaplan

19              Assemblywoman Patricia Fahy

20              Senator Fred Akshar

21              Assemblywoman Nathalia Fernandez

22              Assemblyman Charles D. Fall

23              Assemblywoman Mary Beth Walsh

24              Senator Sue Serino
                                                                  3

 1   2020-2021 Executive Budget
     Mental Hygiene
 2   2-3-20

 3   PRESENT:   (Continued)

 4   Assemblywoman Marianne Buttenschon

 5   Senator Elizabeth O'C. Little

 6   Assemblyman David I. Weprin

 7   Assemblywoman Carmen N. De La Rosa

 8   Senator Robert Jackson

 9   Assemblyman William Colton

10

11

12                     LIST OF SPEAKERS

13                                        STATEMENT   QUESTIONS

14   Ann Marie T. Sullivan
     Commissioner
15   NYS Office of Mental Health              12         17

16   Theodore Kastner
     Commissioner
17   NYS Office for People With
      Developmental Disabilities             102         107
18
     Arlene Gonzalez-Sanchez
19   Commissioner
     NYS Office of Addiction
20    Services and Supports                  161         167

21   Denise M. Miranda
     Executive Director
22   NYS Justice Center for the
      Protection of People with
23    Special Needs                          214         220

24
                                                                4

 1   2020-2021 Executive Budget
     Mental Hygiene
 2   2-3-20

 3                 LIST OF SPEAKERS, Continued

 4                                      STATEMENT   QUESTIONS

 5   Harvey Rosenthal
     Executive Director
 6   NY Association of Psychiatric
      Rehabilitation Services              240
 7
     Glenn Liebman
 8   CEO
     Mental Health Association
 9    in New York State                    245       252

10   Wendy Burch
     Executive Director
11   National Alliance on Mental
      Illness of New York State
12    (NAMI-NYS)                           256

13   Kelly A. Hansen
     Executive Director
14   NYS Conference of Local
      Mental Hygiene Directors             261       267
15
     Kevin Allen
16   Chair
     Donna Tilghman
17   Secretary
     Local 372 NYC Board of Education
18    Employees, DC 37
         -on behalf of-
19   Substance Abuse Prevention
      and Intervention Specialists
20    (SAPIS)                              276       280

21   Angelia Smith-Wilson
     Executive Director
22   Allison Weingarten
     Director of Policy
23   Friends of Recovery New York          284       288

24
                                                             5

 1   2020-2021 Executive Budget
     Mental Hygiene
 2   2-3-20

 3                 LIST OF SPEAKERS, Continued

 4                                   STATEMENT   QUESTIONS

 5   Ken Robinson
     Executive Director
 6   Research for a Safer
      New York                           291       296
 7
     Christine Khaikin
 8   Health Policy Attorney
     Legal Action Center                302       306
 9
     Erik Geizer
10   Deputy Executive Director
     The Arc New York                   309
11
     Lauri Cole
12   Executive Director
     NYS Council for Community
13    Behavioral Healthcare
         -and-
14   Andrea Smyth
     Executive Director
15   NYS Coalition for Children's
      Behavioral Health                 315       324
16
     Yvette Watts
17   Executive Director
     NY Association of Emerging
18    & Multicultural Providers
         -and-
19   Susan Constantino
     President and CEO
20   Cerebral Palsy Associations
      of New York State
21       -for-
     New York Disability Advocates
22       -and-
     Michael Seereiter
23   President/CEO
     New York Alliance for
24    Inclusion & Innovation            331       346
                                                                6

 1   2020-2021 Executive Budget
     Mental Hygiene
 2   2-3-20

 3                 LIST OF SPEAKERS, Continued

 4                                      STATEMENT   QUESTIONS

 5   John J. Coppola
     Executive Director
 6   NY Association of Addictive
      Services and Professionals
 7       -and-
     Amy Dorin
 8   President and CEO
     The Coalition for Behavioral
 9    Health                               354       366

10   William T. Gettman, Jr.
     CEO
11   Northern Rivers Family
      of Services                          372
12
     Antonia Lasicki
13   Executive Director
     Association for Community Living
14       -for-
     Bring It Home Coalition               376       382
15
     Paige Pierce
16   CEO
     Families Together in NYS              384
17
     Jim Karpe
18   NYC FAIR
         -on behalf of-
19   StateWide Advocacy Network
      (SWAN)                               391       395
20

21

22

23

24
                                                       7

 1         CHAIRWOMAN KRUEGER:    Good morning.   My

 2   name is Liz Krueger.   I am the chair of the

 3   New York State Senate Finance Committee and

 4   cochair of today's budget hearing.

 5         Today is the fifth of 13 hearings

 6   conducted by the joint fiscal committees of

 7   the Legislature regarding the Governor's

 8   proposed budget for state fiscal year

 9   2020-2021.   These hearings are conducted

10   pursuant to the New York State Constitution

11   and Legislative Law.

12         Today the Senate Finance Committee and

13   the Assembly Ways and Means Committee will

14   hear testimony concerning the Governor's

15   proposed budget for the Office of Mental

16   Health, Office for People With Developmental

17   Disabilities, Office of Alcoholism and

18   Substance Abuse Services, and the Justice

19   Center for the Protection of People With

20   Special Needs.

21         Following each testimony there will be

22   some time for questions from the chairs of

23   the fiscal committees and other legislators.

24         I will now introduce members of the
                                                         8

 1   Senate, and afterwards Helene Weinstein will

 2   introduce members of the Assembly.

 3            So for the Senate Democrats, we have

 4   Senator David Carlucci, Senator Pete

 5   Harckham, Senator John Liu, Senator Luis

 6   Sepulveda, Senator Diane Savino, Senator Anna

 7   Kaplan and Senator Gustavo Rivera.

 8            And for my Senate Republicans, James

 9   Seward is the ranker on Finance.

10            SENATOR SEWARD:   Thank you, Madam

11   Chair.    I'm pleased to introduce, from my

12   conference, Senator Fred Akshar and Senator

13   George Borrello.

14            CHAIRWOMAN KRUEGER:     Thank you.

15   Assembly.

16            CHAIRWOMAN WEINSTEIN:    We have with us

17   Aileen Gunther, chair of our Mental Hygiene

18   Committee, Assemblyman Cusick, and

19   Assemblywoman Jaffee.

20            And now our ranker, Assemblyman Ra,

21   will introduce members of his conference.

22            ASSEMBLYMAN RA:   Thank you.

23            We're joined by Assemblywoman Missy

24   Miller, our ranking member on the Mental
                                                        9

 1   Hygiene Committee, as well as Assemblywoman

 2   Mary Beth Walsh.

 3            CHAIRWOMAN KRUEGER:   Great.   All

 4   right.    So after the final question-and-

 5   answer period of the relevant government

 6   representatives, there will be an opportunity

 7   for members of the public to briefly express

 8   their views on the proposed budget under

 9   discussion.

10            Just some of the rules of the road

11   here.    We discourage protests that interrupt

12   the flow of the hearing.   If you like

13   something you're hearing and you want to do

14   this (gesturing), that's fine.     If you don't

15   like it, you're of course welcome to testify

16   or let us know in lots of ways, preferably

17   not interrupting the flow of the hearing.

18            Please pay especially close attention

19   to the time clocks if you are one of the

20   people testifying.    Government

21   representatives have 10 minutes to present;

22   members of the public will have five minutes

23   to present.    For both, please don't imagine

24   you're going to read your full testimony.     If
                                                       10

 1   you're showing up with more than two pages of

 2   testimony, you won't get through it.     So you

 3   want to think about bullet-pointing the

 4   critical issues that you want to make sure we

 5   know about.

 6            We are all getting copies of

 7   everyone's testimony.    The testimony is going

 8   up online for anyone to pull up and read and

 9   review.    This hearing is being live-streamed.

10   There's lots of opportunities for you to

11   participate even if you're not here with us

12   today.

13            Chairpersons of the relevant

14   committees have a 10-minute allotment for

15   questions and answers of governmental

16   witnesses; all other legislators who are

17   members of the relevant committees receive

18   just five minutes.

19            And except for the relevant chairs,

20   there will be no second round of questioning.

21   Relevant chairs can have a five-minute second

22   round if they need it.

23            Any legislator who feels the need to

24   ask additional follow-up questions but
                                                       11

 1   doesn't have a second round, please present

 2   them to either Helene Weinstein, my cochair,

 3   or me, and at our discretion we may ask those

 4   questions of the witnesses.

 5            For nongovernmental witnesses, all

 6   legislators only have three minutes to ask

 7   the witnesses.

 8            I think I've covered sort of the rules

 9   of the road.    Oh, one more thing.   Please

10   when you're testifying speak carefully into

11   the microphone as close as you can to your

12   mouth.    We do not have an ideal system.   And

13   also for those of us who are up here on the

14   daises, if you're not speaking into your mic,

15   please turn it off.    Because you don't know

16   that the mic is hot and everyone listening in

17   on their computers somewhere outside of this

18   room is hearing everything every one of us

19   says.

20            So if you don't really want to share

21   that information, make sure your mic is off,

22   because you won't realize what's happening,

23   but people text in and call in saying, "That

24   was so interesting, Liz," "Why were you
                                                     12

 1   saying that, Helene?"   So let's be very

 2   careful.

 3         On that note, I would like to invite

 4   up Commissioner Sullivan, from the Office of

 5   Mental Health.

 6         COMMISSIONER SULLIVAN:   Good morning.

 7   I'm Dr. Ann Sullivan, commissioner of the

 8   New York State Office of Mental Health.

 9         Chairs Krueger, Weinstein, Carlucci,

10   Gunther and members of the respective

11   committees, I want to thank you for the

12   invitation to address OMH's 2020-2021

13   proposed budget.

14         I would like to thank the Legislature

15   for your continued support of reinvestment

16   funding, which emphasizes providing care in

17   community-based settings. Since 2014, with a

18   commitment of more than $100 million in

19   annualized investments to date, OMH has been

20   able to provide services to more than

21   70,000 new individuals, bringing the total to

22   over 800,000 people served in the public

23   mental health system.

24         Examples of the new community services
                                                     13

 1   that have been funded are supported housing

 2   units, child and adolescent crisis/respite

 3   beds, clinic program expansion, additional

 4   OnTrackNY teams, crisis intervention teams,

 5   assertive community treatment or ACT teams,

 6   and long-stay transition support teams.

 7         Because these community services are

 8   available, New Yorkers can get the support

 9   they need to avoid hospitalization, access

10   inpatient services only when needed, and live

11   successfully in their communities.

12         Building on these investments, the

13   2020-'21 Executive Budget recommends

14   significant investments for the OMH

15   not-for-profit workforce.   These investments

16   include resources to leverage over $40

17   million in new annual funding to provide

18   targeted compensation increases to direct

19   care, support and clinical staff, and to

20   support provider costs for minimum wage

21   increases.

22         The Executive Budget increases support

23   for OMH housing initiatives by an additional

24   $20 million for existing residential
                                                      14

 1   programs.    Since 2015, OMH support for these

 2   programs will have increased by $70 million.

 3   Additionally, the budget includes $60 million

 4   in capital to maintain and preserve

 5   community-based residences.    The budget

 6   provides an additional $12.5 million for

 7   certain individuals living in transitional

 8   adult homes in New York City who wish to

 9   transition to more integrated settings in the

10   community.

11         The comprehensive parity reform

12   enacted last year will enhance state

13   oversight of insurers and require them to

14   apply the same treatment and financial rules

15   to behavioral health services that are used

16   for medical and surgical benefits.

17   Importantly, this new law authorizes OMH to

18   review and approve medical necessity criteria

19   used by plans.

20         Additionally, the creation of the

21   Behavioral Health Ombudsman program,

22   otherwise called CHAMP, Community Health

23   Access to Addiction and Mental Health Care,

24   and the enactment of the Mental Health
                                                     15

 1   Substance Use Disorder Parity Reporting Act

 2   have assisted individuals and their families

 3   in accessing behavioral health services.

 4   CHAMP has handled 1,600 cases while providing

 5   education to an additional 5,000 individuals,

 6   family members, caregivers, or providers.

 7         In October 2015, New York State was

 8   one of 23 states awarded a one-year planning

 9   grant and an implementation grant two years

10   later from the federal government to create

11   Certified Community Behavioral Health

12   Clinics.   CCBHCs improve health outcomes

13   through increasing access to care; reducing

14   avoidable hospital use; and providing

15   behavioral health care entities in

16   underserved areas with more financial

17   stability; and integrating mental health,

18   substance use, and physical health services.

19   OMH's experience has been increased access to

20   enhanced behavioral health services and

21   decreased need for acute care for both mental

22   and physical health.

23         School-based mental health clinics are

24   another area where New York State continues
                                                      16

 1   to increase access to treatment by providing

 2   services on-site.   Currently there are 806

 3   school-based mental health clinics in New

 4   York State.   Three years ago, there were less

 5   than 300 such clinics.

 6         Suicide prevention continues to be a

 7   priority issue.   OMH has partnered with state

 8   agencies and communities to implement

 9   recommendations from the Governor's Suicide

10   Prevention Task Force.   The Task Force also

11   identified gaps in suicide prevention efforts

12   and made recommendations to identify at-risk

13   populations where increased engagement

14   efforts are needed, including Latina youth,

15   the LGBTQ community, black youth, veterans,

16   and individuals living in rural communities.

17         The FY 2021 Executive Budget includes

18   a plan to transform the Kingsboro PC campus

19   into a recovery hub facility, focused on

20   shortening lengths of stay and providing

21   centralized community support services,

22   including a step-down transition to a

23   community residence program.   This transition

24   is consistent with OMH's patient-centered
                                                      17

 1   approach to care with an emphasis on

 2   recovery.

 3            Finally, OMH's goal is to increase

 4   access to prevention and community services,

 5   intervening prior to the need for more

 6   intensive and costlier care.     For those who

 7   continue to need inpatient hospitalization,

 8   New York State has the highest number of

 9   psychiatric inpatient beds per capita of any

10   large state in the nation, and we will

11   continue to preserve access to inpatient care

12   as we transform the system.

13            Again, thank you for this opportunity

14   to report on our efforts to support and

15   continue the work that we have jointly

16   embarked upon to transform New York's mental

17   health system.

18            Thank you.

19            CHAIRWOMAN KRUEGER:   Thank you.

20            First up, Senator David Carlucci.

21            SENATOR CARLUCCI:   Thank you, Madam

22   Chair.

23            And thank you, Commissioner Sullivan.

24   Thank you for your commitment to our
                                                      18

 1   community and protecting some of our most

 2   vulnerable populations.

 3          As you know, we've spoken at length

 4   about many of the issues that you're working

 5   on.   I wanted to start off with our

 6   commitment to our workforce.   And, you know,

 7   we've shared conversations about how

 8   important it is that we invest in our

 9   workforce, that we encourage the longevity of

10   our staff, and that we make sure that we

11   don't have this transition that we are

12   consistently having to retrain and also we're

13   providing a lack of service to the

14   individuals we serve if we have that

15   transition consistently.

16          You know, last year we had a victory

17   in including a 2 percent wage increase across

18   the board for our human service workers.    We

19   find now we're hearing from service

20   providers, they tell us that that wage

21   increase has not yet been released.    It was

22   supposed to go out January 1st.

23          Do you know anything about that?    Can

24   you tell us about that?
                                                       19

 1            COMMISSIONER SULLIVAN:   Well, as far

 2   as I know, it's set to be released as soon as

 3   possible.    So I don't know the exact date, I

 4   can't say that to you.    But I can get you

 5   that information afterwards.

 6            But I -- there is another 2 percent

 7   increase in this year's budget as well, which

 8   will be 2 percent and then 4 percent for

 9   direct care workers in April, and another 2

10   percent for clinical care workers.

11            So these increases are very real.    I

12   know that sometimes there might be a delay,

13   but they are very real and they will happen.

14            SENATOR CARLUCCI:   Okay, thank you.

15            And just to get into some of the

16   nuances of the budget, we've worked together

17   on suicide prevention; my colleagues in the

18   Senate, we passed a bunch of different pieces

19   of legislation to try to tackle the increases

20   that we've seen in suicide rates across the

21   board.

22            And one, I want to thank you for the

23   recent report that was put out from OMH on

24   suicide prevention.    We passed the
                                                         20

 1   legislation on the black youth suicide.       And

 2   I know you've been working with Dr. Lindsey

 3   on how we integrate and make sure that we're

 4   working specifically in that area.

 5         Would you be able to give us any

 6   information on what's going on with that,

 7   what you plan to do and what we can see in

 8   this year in terms of outreach to the black

 9   youth community and across the board on

10   suicide prevention?

11         COMMISSIONER SULLIVAN:   For sure, yes.

12   And first of all, I want to thank the

13   legislative members for their interest and

14   for their commitment to suicide prevention.

15   I think everyone who speaks to this helps to

16   decrease the stigma and helps to bring to

17   everyone's attention the importance.

18         On the black youth suicide, we have

19   had conversations with Dr. Lindsey, who is

20   the national expert in this area.    It's a

21   very tragic fact that young black youth, ages

22   -- as early as 10 years old, there's been a

23   significant increase in suicide.

24         They published, through his work, a
                                                       21

 1   report from the national caucus, the

 2   Congressional Black Caucus, which outlines a

 3   whole series of steps to work on how to

 4   address this issue.     Those steps include

 5   things like research -- it's one of the

 6   things he's looking for.    Other things,

 7   though, include working with communities,

 8   working with faith-based organizations, and

 9   doing a great deal of intervention in

10   schools.

11            And what we're going to be doing with

12   Dr. Lindsey is targeting the particular

13   areas.    We have -- through our databases, we

14   can pick out particular hotspots where there

15   have been a number of suicide attempts or

16   particular problems within certain

17   communities, and we'll be doing that in the

18   black youth community.    We'll be working with

19   the schools in those areas, the faith-based

20   organizations, parents, outreach campaigns to

21   increase the community's awareness and

22   understanding of the problem.

23            And we're doing a similar effort with

24   other groups as well.    It's going to be a
                                                         22

 1   similar approach with Latina youth.      We have

 2   Dr. Silva from Rochester who's assisting us

 3   with that.    And we're doing it with rural

 4   issues.     There's a high incidence of suicide

 5   in rural communities.       And we're going to be

 6   doing it for veterans, law enforcement, and

 7   for LGBTQ    communities.

 8          So in addition to the overall suicide

 9   approach, which is general public awareness,

10   which includes a lot of training in

11   schools -- over 25,000 trainings last year,

12   individuals who were trained -- we are also

13   targeting specific high-risk communities, and

14   we will be doing that in conjunction with the

15   various community agencies that work with

16   those groups, with the counties, with

17   everyone else, to ensure that we get the word

18   out.   It's a multifactorial problem, suicide.

19          And the other area -- not to take too

20   much time, the other area we're working very

21   intensely with is the provider, both on the

22   health side and on the mental health side.

23   So for example, there's an initiative now in

24   90 emergency rooms across the state to do
                                                      23

 1   better follow-up after suicide in the --

 2         SENATOR CARLUCCI:   I'm sorry, 90 what?

 3         COMMISSIONER SULLIVAN:    Emergency

 4   rooms, medical emergency rooms across the

 5   state, to do improved follow-up and treatment

 6   of individuals who come in post-suicide

 7   attempt.

 8         SENATOR CARLUCCI:   Could you touch on

 9   -- we were really excited to see, in the

10   Executive Budget, a million dollars dedicated

11   to suicide prevention for veterans and first

12   responders, law enforcement.    We've seen a

13   spike, unfortunately, in law enforcement

14   suicide rates.   Could you tell us about how

15   that money will be utilized?

16         COMMISSIONER SULLIVAN:    Yeah, we're in

17   the process of planning that.   You know, I

18   think that -- first of all, it's very

19   exciting to have the dollars for a campaign

20   for suicide prevention anti-stigma.    But

21   we're going to be working very closely with

22   the law enforcement agencies and the first

23   responders.   They know best how to work with

24   the individuals in their forces.    So we're
                                                        24

 1   working with the State Police, with the New

 2   York City PD, and we're working with all of

 3   the veterans organization, the state veterans

 4   organizations, the Office of Victim Services,

 5   interagency.

 6         And I think within -- probably within

 7   six to eight weeks we'll have a plan that

 8   we'll be able to come out with.    But we

 9   really need the input of those -- they're

10   groups, groups that have worked with those

11   individuals.   When you work with law

12   enforcement, it's very important that

13   individuals who work with them understand the

14   issues of law enforcement.     And so we're also

15   going to be doing some training of staff so

16   that individuals will be available for

17   services.   That's one of the issues, to have

18   enough individuals who understand the issues

19   of law enforcement and first responders in

20   treating individuals who may need treatment

21   in order to prevent suicide.

22         SENATOR CARLUCCI:   Okay, thank you.

23   And we have been working extensively on

24   eating disorder issues and knowing that if we
                                                        25

 1   put the right policies in place, we can help

 2   a lot of people and diagnose them early to

 3   get the treatment that they need.

 4         And I know there's been a move for a

 5   transfer of the Comprehensive Center for

 6   Eating Disorders from the Department of

 7   Health to the Office of Mental Health.     Could

 8   you briefly tell us about that and tell us --

 9   you know, we're really looking for the

10   reassurance that that program will continue

11   and not be at jeopardy now being under the

12   auspice of the Office of Mental Health.

13         Can you tell us, has the money come

14   with it from the Department of Health?    What

15   safeguards will be in place to make sure that

16   that not only continues but expands?

17         COMMISSIONER SULLIVAN:   I think, first

18   of all, it's a great need and there's a

19   commitment on the part of the Office of

20   Mental Health to ensure that it continues.

21         In terms of the dollars, the $118,000

22   that was in the Executive Budget is coming

23   with it.   The other million dollars which

24   traditionally has supported these eating
                                                      26

 1   disorder specialty centers, and there are

 2   three across the state, has been a

 3   legislative add in each year.   So that -- to

 4   the Department of Health, which is a

 5   different agency than the office of OMH.

 6         So there are discussions going on

 7   right now about that additional add, which

 8   has been there over time to support these

 9   centers.   They're very important.   They

10   really are the places -- the three places --

11   I think it's Rochester; it's the city, at

12   Columbia; and it's in the Albany area --

13   where people go for the expert help that they

14   can need for the major eating disorders.

15         They also do a lot of outreach for the

16   general population in terms of obesity and

17   other issues.   So there is a great commitment

18   to continue these.   There is the question of

19   the money, which will be discussed, I think,

20   over the budget negotiations.

21         SENATOR CARLUCCI:   Yeah, it's

22   something I'm very concerned about, because

23   there is that million-dollar reduction and

24   now it's coming from the Department of Health
                                                      27

 1   to OMH.    So that's something we're going to

 2   have to work closely on.   I'm hopeful that

 3   possibly the Governor, in his 30-day

 4   amendments, will include that million dollars

 5   in the OMH budget to make sure that this

 6   doesn't fall off the table.

 7           There's so much we need to talk about,

 8   but I know our time is limited.   We talk

 9   about, in your opening statement, the

10   transition from adult homes to supportive

11   housing.   There's money in there for New York

12   City.   How about the rest of the state?    As

13   well as the Governor said in his State of the

14   State the commitment towards supportive

15   housing.   Where can we point to in the budget

16   that shows us where those dollars are to

17   build the supportive housing that we need?

18           COMMISSIONER SULLIVAN:   Yeah, the --

19   throughout the -- there are points in the

20   budget, I think it's a total of $12.5 million

21   which is going for the adult home in the

22   city.

23           There are an additional 1200 units in

24   the budget, not including those 500, that are
                                                       28

 1   going to be opening up as part of the

 2   pipeline for the rest of the state.    Those

 3   will be distributed across the state.    And

 4   basically that includes a combination of

 5   funding from the ESHI, the Empire State -- it

 6   includes some funding from the old

 7   New York/New York III housing.    So throughout

 8   the budget there are line items which talk to

 9   the amount of dollars that are there.

10         But it will -- and maybe I misspoke

11   for a minute.    I think the 500 are in there.

12   So I think it's a commitment of 1200

13   including the 500, I don't -- yes, including

14   the 500 adult home slots.   But the other 700

15   will be distributed across the state in

16   various areas.   Which is what we have

17   traditionally done with all the housing that

18   has come up.    Basically we look at areas

19   where it's needed, we get developers who

20   hopefully can put up the housing.

21         Also last year we had an additional

22   250 slots for homeless, a number of those

23   slots for apartments.    A number of those were

24   upstate -- in fact, a good number of them
                                                        29

 1   were also upstate.

 2            So we try to distribute as best we can

 3   the housing across the state, and it's all

 4   kind of lined-itemed out in the budget under

 5   the housing sections, so ...

 6            SENATOR CARLUCCI:   As far as OMH, how

 7   many housing units do you believe we will

 8   have?

 9            COMMISSIONER SULLIVAN:   There will be

10   1200 new ones this year.     There were

11   approximately 1200 last year for OMH.       That

12   includes the adult homes and additional

13   housing through ESSHI and New York/New York

14   III.

15            So the total number of housing units

16   in the state now is 47,000, which is really

17   great.    It probably -- not probably, is the

18   largest commitment to supportive housing in

19   the country for the seriously mentally ill.

20            SENATOR CARLUCCI:   I see I'm out of

21   time.    Thank you, Commissioner.

22            COMMISSIONER SULLIVAN:   Thank you.

23            CHAIRWOMAN KRUEGER:   Thank you.

24            Assembly.
                                                     30

 1         CHAIRWOMAN WEINSTEIN:     Thank you.

 2         We've been joined by Assemblywoman

 3   Fahy, Assemblyman Santabarbara, and

 4   Assemblywoman Fernandez.

 5         And we now go to our Mental Health

 6   chair, Assemblywoman Gunther.

 7         CHAIRWOMAN KRUEGER:     And as she's

 8   about to speak, I also forgot to introduce

 9   Senator Sue Serino and Senator Akshar, who

10   both joined us.

11         ASSEMBLYWOMAN GUNTHER:    Thank you for

12   joining us today, Commissioner.

13         I wanted to start off regarding the

14   funding crisis for our mental health

15   providers.    Last year we were able to

16   increase for direct support professionals;

17   however, the increase was still below the

18   rate of inflation, and mental health

19   clinicians only received 2 percent beginning

20   April 1st.

21         As you know, this year the mental

22   health and developmental disability community

23   is united around a 3 percent increase over

24   five years.    We have been seeing raises in
                                                       31

 1   other sectors of healthcare.    We are losing

 2   our workers in this system left and right, as

 3   you well know.   We know that the turnover in

 4   the DSP community is tremendous.

 5         And, you know, as a nurse myself, Ann,

 6   we realize that these DSPs, they create

 7   relationships with their patients and their

 8   loss is a loss to the patient.

 9         My question to you, then, is what can

10   we do to impress upon the second floor that

11   these raises are desperately needed.

12         COMMISSIONER SULLIVAN:     The budget

13   does include a 2 percent increase for direct

14   care workers as of January, and another 2

15   percent in April, and also in April for

16   clinical care workers.    And that's similar to

17   what it was last year, and there was an

18   agreement that that would be in the budget

19   this year.

20         I think that's about $25 million to

21   the Office of Mental Health, including the

22   minimum wage increases.    And basically, it

23   does help significantly, I think, to support

24   in some ways.    There's always a question of
                                                       32

 1   whether more is needed, but I do think this

 2   is a significant contribution to the

 3   workforce on the mental health side.     And

 4   when you add in the -- it's $40 million when

 5   you add in the contributions from the federal

 6   share and the annualization of the dollars.

 7           So that's very real, it's in the

 8   budget, and it will happen this year.     It's

 9   been about -- over five years, about a

10   14 percent increase for direct care workers.

11           ASSEMBLYWOMAN GUNTHER:    Well, I think

12   it's much needed.   But I would say that most

13   of the workforce are women.   And honestly, to

14   have an apartment, it's really not a living

15   wage.   I live in an area where the delivery

16   of care to people with disabilities, most of

17   our employees are connected with those kinds

18   of jobs, mostly women.   You know, we have an

19   issue with daycare.   And also to get an

20   apartment, feed your children, it's just not

21   a living wage.   It's just not.

22           And we've lagged behind for years and

23   years before.    We're doing some catch-up, but

24   we really have to do more, Ann.    I know that
                                                      33

 1   you're on the same page, but I'm hoping that

 2   the second floor will take a look at it

 3   and -- rather than -- this is economic

 4   development, making sure that these doors

 5   stay open.   So rather than invest in new

 6   economic development, keep what we have.    So

 7   my piece.

 8         A recent study by the Council of

 9   School Superintendents showed that more than

10   two-thirds of school superintendents report

11   that improving mental health services is

12   their top priority.

13         I know OMH has done a good job of

14   expanding satellite offices in schools, but

15   I'm wondering why the Executive would decline

16   to continue the enhanced rates for children

17   -- children's behavioral health providers.

18         COMMISSIONER SULLIVAN:   The enhanced

19   rate -- the rates were set, and there were

20   start-up rates initially -- for six months,

21   25 percent, then going down to 12.5 percent.

22   And it was always known that basically those

23   start-up rates would end.   And the

24   start-up-rate date for the start-up rates to
                                                      34

 1   end was January 1st.   So yes, those start-up

 2   rates have been discontinued, the increase.

 3            However, the long-term commitment to

 4   the expansion, which is considerable --

 5   because it's important to remember that these

 6   services were designed to expand services to

 7   youth.    And basically before the legislation

 8   and before this change in services, youth had

 9   to be -- they had to kind of almost fail

10   first to get these services.

11            So basically the redesign has enabled

12   youth and families to get the services sooner

13   and for more to get those services.    So the

14   end result after these services are up and

15   running, over time, is an expectation that

16   there will be a considerable increase in

17   services for kids and a considerable amount

18   of money spent on those services.

19            So that has not changed.   That

20   commitment is still there, even though the

21   start-up dollars, yes, have been discontinued

22   as of January 1st.

23            ASSEMBLYWOMAN GUNTHER:   Thank you.

24            According to the United States
                                                       35

 1   Interagency Council on Homelessness, New York

 2   State has more than 90,000 people

 3   experiencing homelessness.    That's roughly 3

 4   times that of Florida, a state that has about

 5   2 million more people than us.

 6            Granted, not every person who is

 7   homeless has mental illness, but we know many

 8   do.   Most aren't logging onto the OMH website

 9   or calling the field offices to look for

10   service.    How can we better reach these

11   folks?

12            COMMISSIONER SULLIVAN:   Well, we've

13   been doing a lot of outreach in terms of --

14   just for New York City, as an example,

15   there's --

16            ASSEMBLYWOMAN GUNTHER:   So explain --

17   so there's two things I want to know.

18   Explain what we mean by what outreach, and

19   how we're doing it, number one.    And New York

20   City is one area --

21            COMMISSIONER SULLIVAN:   Absolutely.

22            ASSEMBLYWOMAN GUNTHER:   -- but we're

23   looking at low-income areas in the middle of

24   the state and other areas.    So we're not just
                                                        36

 1   going to be tunnel vision on New York City.

 2         COMMISSIONER SULLIVAN:    No.     No.

 3   Absolutely.    I'm sorry to say that.   So I'm

 4   not -- I'm not --

 5         ASSEMBLYWOMAN GUNTHER:    I know, but I

 6   just have to say that, because a lot of times

 7   we talk about New York City.

 8         COMMISSIONER SULLIVAN:    No, I

 9   appreciate that.

10         No, the issue here is that there's

11   various -- well, it's a -- absolutely,

12   homelessness is a complicated issue.     For the

13   seriously mentally ill, the group that often

14   people see and have a lot of questions about,

15   are the individuals who are on the streets.

16   And they are in the streets in many ways, and

17   homeless, not in great situations, throughout

18   the state, not just in New York City.

19         But there's a number of things that we

20   have done.    One is the homeless outreach

21   teams, through county aid to many of the

22   counties as well as the city.   That county

23   aid goes to homeless outreach teams.     What's

24   a homeless outreach team?   These are
                                                     37

 1   individuals who go out to work with the

 2   seriously mentally ill on the streets to help

 3   them try to accept services.    And for a

 4   variety of reasons -- to some extent it's

 5   sometimes the way they see the world, it's

 6   sometimes the way they want to live.   It's

 7   very difficult to engage some of these

 8   individuals.

 9           So we do spend a fair amount -- it's

10   almost $10 million, $12 million across the

11   state, to work on these outreach teams which

12   we fund through county aid.    And we monitor

13   that.

14           The second area is working in the

15   various shelter systems.   To the extent that

16   they can be safe havens is one way -- one

17   name that we have for some of these.   And we

18   do a lot of that work as well.

19           We also have ACT teams that we have

20   funded to work with the homeless, and they

21   help the homeless transition from these safe

22   haven shelters into apartments and give them

23   the kind of wraparound supports that they

24   need.
                                                      38

 1         So that's when you've found someone

 2   who's already homeless and on the streets.

 3   But the bigger piece of this is not to get

 4   people homeless and on the streets and to

 5   help provide the services that prevent that

 6   from happening.    And that we've been working

 7   very diligently with a whole series of crisis

 8   stabilization centers, crisis services,

 9   increasing intensive outpatient services,

10   working with increased diligence on discharge

11   planning when people leave the hospitals, so

12   they don't get to the point where they've

13   decided in some level that their home is on

14   the streets.

15         So there's a number of things that

16   have to happen:    The preservices, to make

17   sure that people don't become homeless; and

18   then if they do, especially if they have

19   trouble accepting services -- and the biggest

20   part of helping people accept services is

21   trust and engagement and connection.   And

22   that takes time.   And that's why we fund

23   these outreach teams that get to know the

24   individuals who live on the streets and
                                                       39

 1   really work intensively with them.

 2         ASSEMBLYWOMAN GUNTHER:     How is the $12

 3   million distributed?

 4         COMMISSIONER SULLIVAN:     I think it's

 5   about 9 million to the city, and then there's

 6   another series of dollars which go to the

 7   counties.    I could get you the exact dollars

 8   for that.

 9         ASSEMBLYWOMAN GUNTHER:     So there's

10   9 million to New York City.

11         COMMISSIONER SULLIVAN:     Mm-hmm.

12         ASSEMBLYWOMAN GUNTHER:     But that's

13   half the population of New York State.     And

14   the other half of the population gets

15   3 million?   If it's 12 million, that's my

16   calculation.

17         COMMISSIONER SULLIVAN:     Well,

18   approximately -- I can get you approximately

19   what it is through county aid.    It depends on

20   the counties and how it's distributed.

21         But again, there's outreach teams and

22   then there are housing.   And the other big

23   piece that we have distributed across the

24   state in housing -- and upstate gets
                                                     40

 1   approximately half of the increases in the

 2   housing that we do in terms of some of the

 3   stipends, et cetera.    That prevents the

 4   homelessness as well.

 5         So the housing -- and it also depends

 6   on the number of street people in each

 7   particular county.   So it can vary from

 8   county to county, depending upon the number

 9   of people on the streets.

10         But the housing is distributed across

11   the state, and that's pretty much distributed

12   by population base in the various counties.

13         ASSEMBLYWOMAN GUNTHER:    We are

14   spending a tremendous amount of money in

15   upstate New York housing our homeless in

16   hotel rooms for big dollars, so much more

17   than if they had stabilized housing.     And

18   also their health isn't good, mental health

19   isn't good.

20         And so to me, if we could look at that

21   in terms of money saving and healthier

22   people -- because right now I represent

23   Sullivan and Orange County.    Most of my

24   homeless population are in less than
                                                         41

 1   adequate, horrible hotels.      Because when

 2   someone is considered homeless, they have

 3   this idea in their head that they're like bad

 4   people.    So certain hotels won't take those

 5   folks or for that rate that the county gives

 6   them.

 7           So I think we could do a lot better

 8   and a lot more if we really provided more

 9   stabilized housing, not only in New York

10   City, but in upstate New York you have

11   Buffalo, you have Syracuse, and we have it

12   all.    You know, we all share part of that

13   population.

14           CHAIRWOMAN WEINSTEIN:    Thank you.

15           We've been joined by Assemblyman Fall.

16           Senate now?

17           CHAIRWOMAN KRUEGER:     Thank you.

18           Senator Pete Harckham.

19           SENATOR HARCKHAM:   Thank you,

20   Madam Chair.

21           Commissioner, good to see you, as

22   always.    Thank you.

23           I just have one question for you.      In

24   my work as chair of Alcoholism and Substance
                                                        42

 1   Abuse -- and with colleagues up here, we just

 2   toured the state focused on the opioid

 3   crisis.    And so much of -- and the science

 4   now ties it with co-occurring disorders, the

 5   nexus of mental health with substance use

 6   disorder, the notion of self-medication.

 7           And I know you and OASAS have been

 8   working closely on the blended license, which

 9   is a step -- a big step in the right

10   direction.   But one of the things that we've

11   heard from people, both providers and from

12   patients all across the state, is there are

13   still obstacles with billing and paying.

14   That they can now go to one treatment center,

15   but they are still treated differently in

16   terms of the billing stream.      So there's

17   seeing a peer for substance use disorder is

18   one bill, seeing a mental health counselor is

19   another bill, seeing a psychologist is one

20   bill, seeing a CASAC is another.

21           We're still not addressing the blended

22   person with holistic treatment and really one

23   bill.   Where are we with that?    What needs to

24   be done?   How close are we?   And are there
                                                      43

 1   things that the legislative body can do to be

 2   helpful?

 3         COMMISSIONER SULLIVAN:     You know, I

 4   think -- you know, we're definitely looking

 5   at that.   Now, I think -- I believe that the

 6   community behavioral health centers that

 7   we've established are easier in that respect

 8   than some of our other Article 31 providers

 9   in terms of the ease with which the billing

10   occurs for the client, for them to experience

11   it.

12         And I think that's the model that we

13   would like to try to use to expand to the

14   other sites.   I think that in some of the

15   sites it's gotten a bit better.   But yes, we

16   have to work -- it's a combination of working

17   with commercial insurers and depending upon

18   what their desires are, then working with

19   managed care through Medicaid.    Sometimes it

20   is difficult to get all the bills straight.

21   We work a lot with the providers about that.

22         So you're right.     And we should be

23   working to make sure that that's kind of

24   seamless for the client.   I realize that's
                                                      44

 1   where we get into trouble here, so the

 2   clients get bills.

 3           So we will continue to work on that.

 4   But the CCBHCs seem to have been able to do

 5   this in a more seamless way than some of the

 6   others, and we're going to try to use that

 7   model to help some of the other centers as

 8   well.

 9           But yes, there can be difficulties

10   sometimes with getting all the bills

11   organized from multiple providers and

12   insurers.

13           SENATOR HARCKHAM:   Great, thank you.

14           Thank you, Madam Chair.

15           CHAIRWOMAN KRUEGER:     Thank you.

16           Assembly.

17           CHAIRWOMAN WEINSTEIN:     We go to

18   Assemblywoman Miller.

19           ASSEMBLYWOMAN MILLER:    Good morning.

20           So I pride myself on being the voice

21   for those who have the quietest voices.      A

22   few of the questions that I'm asking have

23   come directly from those voices, people who

24   live in my district or surrounding districts
                                                       45

 1   who have serious concerns and have asked me

 2   to share.

 3         On Long Island this past week there

 4   was a ceremony for the opening of a mental

 5   health clinic in Rockville Centre.       It's a

 6   collaboration between Cohen Medical Center

 7   and five local school districts.    The clinic

 8   will provide emergency mental health

 9   services, like acutely that day, until a

10   healthcare provider can be located for

11   long-term services.    It's needed, and it

12   sounds great.

13         What we're not acknowledging is that

14   this is necessary because there's a shortage

15   of healthcare professionals who have

16   availability in the first place to see these

17   patients.   Because most mental health

18   professionals, at least on Long Island, don't

19   accept insurance, the few that do are

20   completely booked.    It would be very

21   difficult to find a mental health provider

22   that takes insurance that could fit in a new

23   patient immediately and provide the

24   availability that's needed more than once a
                                                       46

 1   week when first treating a patient for a

 2   person in crisis.

 3           Hospital emergency rooms evaluate

 4   pediatric patients with mental health issues

 5   to see if they're a danger to themselves or

 6   others and, if not, they get referred to

 7   long-term-service providers, who can't take

 8   them.

 9           The clinics, which are collaborations

10   between Cohen and school districts, are

11   needed because there's no place for these

12   pediatric patients with mental health issues

13   to get the immediate attention by medical

14   professionals.   But this collaboration is

15   costing each of these school districts

16   $55,000.

17           We all know that our school district

18   budgets cannot sustain this, and they

19   shouldn't have to.   There are school

20   districts that are in financial distress.    Is

21   it fair that the districts that can squeeze

22   it out of their budget will have that and the

23   school districts that can't afford it

24   shouldn't?
                                                       47

 1         Schools should not have to spend

 2   $55,000 annually to a hospital for immediate

 3   access to mental health professionals for its

 4   students.    It should be done automatically

 5   via our insurance providers or Medicaid.

 6         So what can we do about this

 7   continuous problem that currently exists

 8   where the majority of mental health

 9   professionals don't accept insurance?    There

10   are months-long waiting periods to get an

11   initial appointment, and they don't accept

12   insurance or Medicaid.    If you're lucky

13   enough to have a plan that does allow

14   out-of-network coverage, maybe you can get a

15   percentage of that visit reimbursed.     It's a

16   very real obstacle to seeking and receiving

17   treatment.

18         I can tell you that I've experienced

19   this firsthand myself with both my daughter,

20   who experiences anxiety, and my mom, who has

21   Alzheimer's.    When my daughter began having

22   panic attacks, we could not find a

23   psychiatrist who could see her for three

24   months.     We finally wound up taking her to a
                                                        48

 1   crisis center, who prescribed a medication

 2   that made her feel worse and recommended

 3   therapists for long term, who also didn't

 4   accept insurance and had waitlists.

 5            For my mother, I'm desperately trying

 6   for several months now to find a

 7   psychiatrist.    My mother, who was herself a

 8   clinical psychologist, is very depressed and

 9   frustrated by not being able to remember

10   anything and losing her independence.    I

11   can't even tell you how many doctors I have

12   called.     I've had conversations with these

13   psychiatrists who acknowledge the problem,

14   and they can't schedule an appointment for

15   another two to four months.

16            When I asked what to do if she's

17   having trouble now, I was told to bring her

18   to a crisis center.

19            We are forcing people into crisis by

20   not having the mechanisms in place to help

21   them before they're in crisis.     How do we not

22   see that?    It's certainly evident in our

23   youth.    So how can we start to fix this?

24            COMMISSIONER SULLIVAN:   You know,
                                                      49

 1   first of all, I'm sorry you've had that kind

 2   of difficulty with your family, and I'm sorry

 3   for all the families that do.

 4         There's a critical issue here that I

 5   think has to be faced, and the major one has

 6   to do with commercial coverage for mental

 7   health and substance use.   There's a major

 8   problem here, and it's a parity issue.     And

 9   for a long time commercial insurers have not

10   been covering the kinds of services or

11   covering them with the reimbursement to the

12   extent that is needed to have a workforce

13   willing to take individuals who have

14   insurance.

15         While the Medicaid system is not

16   perfect, there is more access and more

17   availability through Medicaid to get mental

18   health services, often, than through

19   individuals who work and have private

20   insurance.

21         This has been a problem for decades.

22   What the state is doing I think is remarkable

23   in terms of its efforts at this point in

24   terms of parity.   The parity, while it will
                                                        50

 1   take a little more time to get this to

 2   work -- but over the past two years, the

 3   state has made a massive investment in

 4   parity, and we are getting medical necessity

 5   criteria that will be reviewed by the Office

 6   of Mental Health.     We're looking at networks.

 7   Often networks can be phantom networks, which

 8   mean that, you know, you look at your

 9   insurer, it lists 20 psychiatrists, and you

10   call them all up and they all say they're

11   full or they can't see you or they don't have

12   the time.

13           We are looking at all that.   That's

14   all coming through intensive work on the

15   parity side.

16           Now, the important thing about parity

17   is there's a law, but what happened over the

18   years -- the law has been around for like

19   over 10, 12 years -- the enforcement of it

20   has been the issue.    And the money that was

21   in last year's budget that will be continued

22   in this year's budget is the money to do that

23   kind of enforcement.    What we really need to

24   do --
                                                        51

 1         ASSEMBLYWOMAN MILLER:      But we can't

 2   force a physician to join a plan.

 3         COMMISSIONER SULLIVAN:     It's not --

 4   there are physicians sometimes in the plans

 5   that they don't have enough -- you can force

 6   the plans to pay enough to get physicians in

 7   their plan.     That's their responsibility to

 8   have physicians available.     When you pay your

 9   health insurance, if you want a cardiologist,

10   you should be able to get a cardiologist.

11   And if you're in a health plan and you want a

12   psychiatrist, you should be able to get a

13   psychiatrist.

14         So actually the onus on having the

15   network that can provide those services sits

16   with the insurer, and that's where the

17   problem is.   For decades mental health

18   services have been underfinanced by those

19   insurers, and that's what has to change.     And

20   you have to look at the parity laws, which

21   say how do you determine how you allocate

22   your money, you insurer, how much do you use

23   for behavioral health services, what do you

24   use for others, and how do you ensure that
                                                       52

 1   individuals -- when you look across the

 2   country, the out-of-network use for mental

 3   health services is significantly higher than

 4   for any other medical service.      Why?

 5   Because -- I'm sorry.

 6            CHAIRWOMAN WEINSTEIN:    Why don't you

 7   just finish your sentence.

 8            COMMISSIONER SULLIVAN:    Because

 9   basically the networks are not well

10   established by the insurers.      And that's

11   something that the state is working on very

12   hard with parity.    It will take some time,

13   but we hope it will significantly affect

14   this.

15            ASSEMBLYWOMAN MILLER:    Thank you.

16            CHAIRWOMAN WEINSTEIN:    Thank you.

17            Senate?

18            CHAIRWOMAN KRUEGER:     Thank you.

19            We've been joined by Senator Betty

20   Little.

21            And next up on deck, Senator Jim

22   Seward.

23            SENATOR SEWARD:   Thank you, Madam

24   Chair.    And thank you, Commissioner, for
                                                     53

 1   being here and for your commitment to some of

 2   the most vulnerable citizens of New York, and

 3   providing services.

 4          I wanted to identify myself with some

 5   of the comments of my colleagues already this

 6   morning in terms of the salary levels for

 7   those that are on the front lines, our direct

 8   care workers and other staff of our

 9   not-for-profit agencies who provide yeoman's

10   work on behalf of those who are in need of

11   services, and yet, you know, their salaries

12   lag.

13          I know you've mentioned some of the

14   efforts to try to bring them up.   Of course,

15   the Legislature has made a major commitment

16   there as well.

17          I wanted to ask you to comment on the

18   Executive's justification for continuing the

19   COLA deferral for the second year and not

20   restoring that in the Executive Budget.

21          COMMISSIONER SULLIVAN:   The Executive

22   has introduced the 2 percent targeted salary

23   increases, which occur for direct care

24   support workers in January and then will
                                                          54

 1   occur again in April, at 4 percent.     Those

 2   increases are in the budget and are there.

 3   That was in lieu of the COLA last year and in

 4   lieu of the COLA this year.   And that was an

 5   agreement, is my understanding, between

 6   various parties including the Legislature

 7   last year, that as long as those -- that

 8   those targeted salary increases would be this

 9   year and last year, and not the COLA.

10         SENATOR SEWARD:   I see.    The -- there

11   is an advantage of having it run through as a

12   COLA in terms of the long-term stability of

13   their salary levels.

14         COMMISSIONER SULLIVAN:     Yes.   Yeah.

15   Mm-hmm.

16         SENATOR SEWARD:   Shifting gears, we've

17   already discussed the suicide prevention

18   commitment regarding particularly veterans,

19   law enforcement and our first responders.       On

20   the positive side, there's an additional $1

21   million in the Governor's proposal to help

22   along that line.   Can you comment on when

23   this additional funding will be allocated?

24         And considering that the great need
                                                      55

 1   that's out there -- we read it about it

 2   practically every day -- it's important that

 3   this funding be disbursed as soon as

 4   possible.   And I would also -- as you look to

 5   the distribution of these funds, I would urge

 6   you to look toward regional balance of the

 7   funding distribution because we have many

 8   needs in the upstate region.   In many ways

 9   it's even more serious, because of the

10   distances involved.

11         So if you could comment on when these

12   funds will be available and also on the

13   regional allocation.

14         COMMISSIONER SULLIVAN:   Yeah, we're

15   going to try to move these funds as quickly

16   as possible.   It's not so much, I don't

17   think, the availability of the funds as the

18   planning to how to use them.   And I think

19   that's going to take a little time -- a

20   couple of months, probably -- working with

21   law enforcement, working -- we're going to be

22   working with our state troopers across the

23   state, we're going to be working with

24   veterans as well -- this is for veterans and
                                                      56

 1   first responders -- and with various EMS

 2   teams across the state, to discuss where is

 3   it most needed.   Many -- for example, state

 4   troopers already do some work in this area.

 5   But where are the gaps?    What are the things

 6   where we need to enhance?    And what should a

 7   media campaign look like?

 8          And when you talk about working with

 9   getting -- decreasing stigma, it's often very

10   local, just as you said.    You know, the same

11   approach to working with the community in

12   rural upstate New York or middle New York

13   versus, you know, Long Island, it's very

14   different.   So we have to really plan out how

15   we're going to use -- so there's going to be

16   some time for planning.    I don't think it's

17   the allocation, so much, of the funds as

18   making a plan sufficiently in-depth and with

19   the right people to advise us as to how to do

20   it.   And that will take a few months to do.

21          So we're hopeful we'll be able to have

22   something by the summer that will be, you

23   know, able to begin to be launched.

24          SENATOR SEWARD:    Thank you.
                                                      57

 1         Just one final question.    I know

 2   you're familiar with the Joseph P. Dwyer

 3   Veteran Peer-to-Peer Program.    OMH staff has

 4   been invaluable in planning and

 5   implementation of these programs.   And this

 6   has been a long-term commitment and priority

 7   of the Senate, and I'm pleased that that

 8   continues under the new majority as well.

 9         And can you comment on the

10   effectiveness of this program, the Dwyer

11   Peer-to-Peer?    And also, considering the

12   importance of this program, why isn't there

13   any funding in the budget proposal to

14   continue this?

15         COMMISSIONER SULLIVAN:    The Dwyer

16   program has traditionally been funded through

17   a legislative add, and it is in this budget

18   as well.

19         As a program, it is -- yes, it's been

20   shown to be very effective.   It's a peer

21   program, as you well know, where vets talk

22   with vets.   And I think that's probably been

23   shown across the board to be one of the most

24   effective ways to reach veterans, others in
                                                        58

 1   law enforcement, et cetera.

 2            So it's a good program, it's a solid

 3   program, but it has traditionally been funded

 4   by legislative adds.

 5            SENATOR SEWARD:   Thank you.

 6            CHAIRWOMAN KRUEGER:     Thank you.

 7            Assembly.

 8            CHAIRWOMAN WEINSTEIN:    We go to

 9   Assemblywoman Walsh.

10            ASSEMBLYWOMAN WALSH:    Thank you.

11            Good afternoon, Commissioner.    I've

12   been an attorney for 30 years, and a good

13   part of that has been working in Family

14   Court.    For a while I prosecuted abuse and

15   neglect cases, and a great, great number of

16   cases in my caseload involved sexual

17   offenders, sex offenders and intrafamily

18   sexual abuse.

19            So I wanted to ask you about the Sex

20   Offender Management and Treatment Act, SOMTA,

21   and reform in that program.      Can you explain

22   how your proposed Sex Offender Management and

23   Treatment Act reforms are going to be carried

24   out?
                                                      59

 1         COMMISSIONER SULLIVAN:    Yes.   The Sex

 2   Offender -- the SOMTA programs are for those

 3   individuals who are leaving prison who have

 4   been civilly committed to -- now to the SOMTA

 5   program.   The average stay in that program is

 6   something like five years, so most of the sex

 7   offenders are very serious, high-level sex

 8   offenders.

 9         When the legislation was first passed,

10   it was done under the auspices of a

11   hospital-based approach.   And the science in

12   terms of working with this population, as

13   well as our experience over the past years,

14   has been that basically you want more of a

15   psychosocial rehab approach, which helps

16   people change hopefully their behaviors which

17   have led to the sex offender status.

18         So we're really redefining

19   programmatically what's going to be

20   happening.   To do that and do it well, you

21   needed to kind of move the auspices under

22   something called secure treatment and

23   rehabilitation in order to, for example, hire

24   more psychologists, hire more -- others who
                                                       60

 1   are skilled at a certain level of treating

 2   that particular population.

 3         And we're hopeful that by redesigning

 4   it, we can even be more successful.   We've

 5   been able -- some individuals have been able

 6   to leave, very slowly, very carefully, back

 7   into the community.   And we're hopeful that

 8   working with this new model will be even more

 9   effective.   Currently there's about 385

10   individuals in civil commitment.

11         ASSEMBLYWOMAN WALSH:    Okay.   And will

12   these reforms involve the movement of

13   patients from one facility to another, or

14   will patients be just segregated in their

15   current facility?

16         COMMISSIONER SULLIVAN:     They will stay

17   exactly where they are.   They will stay in

18   the same facilities, the same degree of

19   security -- everything will be the same.

20   It's really just the clinical programming

21   that's shifting, not the location or the

22   legal status.   It's the same.

23         ASSEMBLYWOMAN WALSH:    And as I said

24   before, you know, my experience told me that
                                                       61

 1   sex offender treatment is some of the most

 2   difficult treatment that's out there.   It's

 3   very, very difficult to break that cycle.    So

 4   are patients going to be getting any new

 5   treatment that they're currently not getting?

 6         COMMISSIONER SULLIVAN:   It will be

 7   more focused on what we call a psychosocial

 8   rehab approach -- more groups, more ability

 9   to work really on the -- on learned behaviors

10   which you're trying to unlearn.   And more

11   focused on cognitive kind of work.

12         So yes, it will be an enhancement of

13   what they're currently receiving, we believe

14   while being able to move to a certain level

15   of expertise with the clinicians that will be

16   in that program.

17         ASSEMBLYWOMAN WALSH:   And when do you

18   think that that new approach is going to be

19   effective, taking effect?

20         COMMISSIONER SULLIVAN:   Well, we'll

21   start on -- if the legislation is passed,

22   we'll begin right away.   And probably it will

23   take a while to do all the training and

24   things that are necessary.   But I would give
                                                       62

 1   it six months to nine months, we should have

 2   in place the changes, and then we'll evaluate

 3   them.

 4            As you have said, this is a very

 5   thorny issue and we are trying to really

 6   provide the best evidence-based practices for

 7   individuals in the sex offender treatment

 8   program, but that is a very difficult group

 9   to treat.

10            ASSEMBLYWOMAN WALSH:    Thank you.

11            CHAIRWOMAN KRUEGER:    Thank you.

12            Senator Luis Sepulveda.

13            SENATOR SEPULVEDA:    Good morning,

14   Commissioner.    Thank you, Madam Chair.

15            Commissioner, as you may or may not

16   know, the issue of suicide is very personal

17   to me.    When I was 11 years old, my mother

18   committed suicide.    She suffered from mental

19   illness, and unfortunately back then 40 years

20   ago, 45 years ago, we didn't have the

21   services that we have today.

22            But her manifestation started when she

23   was a child.    According to mental health

24   advocates, 54 percent of children with mental
                                                      63

 1   health or behavioral conditions that needed

 2   treatment in the last year did not receive

 3   treatment.   Additionally, suicide is the

 4   second leading cause of teenagers between 15

 5   and 19.   Amongst Latinas, it's the second

 6   leading cause; amongst African-American young

 7   boys, same amount.   Over 40 percent of the

 8   LGBTQ   community also has considered suicide

 9   or engaged in suicide ideation.

10           In 2011 the original Medicaid Redesign

11   Team found that children's mental health

12   services need more resources and capacity and

13   should not be cut.   Nine years later, the

14   Children's Behavioral Health MRT Subcommittee

15   is still working to implement reforms that

16   will expand children's mental health,

17   addiction and care coordination services.

18           So my first question is, should there

19   be a moratorium on children's mental health

20   cuts while the full reform and transition to

21   Medicaid managed care is going on?

22           COMMISSIONER SULLIVAN:   There are no

23   projected at this point in time.    That

24   reduction in the rate that was there for
                                                     64

 1   start-up -- I explained that -- has been

 2   reduced.   But the overall plan, which

 3   includes those services being expanded to

 4   serve even more youth going forward, is still

 5   in place, and the commitment to continue that

 6   expansion of services, which at various

 7   points has been estimated to be an additional

 8   30 to 60 million over the next couple of

 9   years as these services expand.

10         The newer services are very

11   community-based home-based services, and they

12   include things like psychiatric home-based

13   services, other licensed providers being able

14   to go into the home.   All these services are

15   now being started up and are growing.    As

16   they grow, they are expected to increase the

17   services for youth, especially youth at high

18   risk that need intensive services.

19         So at this point in time the growth of

20   that program, which is what -- the way it was

21   planned through the MRT and the way all those

22   services were provided, is continued.    And

23   the investment in that is still in place.

24         SENATOR SEPULVEDA:   So there haven't
                                                         65

 1   been any cuts, or there are no projected

 2   cuts?

 3           COMMISSIONER SULLIVAN:    No, there has

 4   been a cut -- there has been a reduction, a

 5   planned reduction, which was always there,

 6   for the start-up dollars.      Which was supposed

 7   to only last a year.   So those dollars, yes,

 8   have been reduced and have stopped as of

 9   January 1st.

10           But the overall program is still

11   embedded into the Medicaid dollar.

12           SENATOR SEPULVEDA:    Well, I will

13   strongly encourage and implore you not to cut

14   any -- at any level, because, you know, we

15   have to start at the -- when they start

16   manifesting mental health issues at a young

17   age and we don't treat it, any cut to me, I

18   think, is unacceptable.

19           And then will the work of the

20   Children's Behavioral Health MRT Subcommittee

21   be addressed by MRT II?      Or will MRT II be

22   asked to defer to the ongoing work of the

23   children's subcommittee without any sort of

24   inference?
                                                         66

 1           COMMISSIONER SULLIVAN:    Basically

 2   those plans are still being discussed, so I

 3   can't answer that at this time.

 4           SENATOR SEPULVEDA:   They're still

 5   being discussed?

 6           COMMISSIONER SULLIVAN:    Yeah.

 7           SENATOR SEPULVEDA:   And when do you

 8   think --

 9           COMMISSIONER SULLIVAN:    The -- I'm not

10   sure.   Within the next several weeks when

11   various other things are decided about the

12   MRT.

13           SENATOR SEPULVEDA:   All right.    So I

14   can follow up with you on that once we have

15   further information.

16            COMMISSIONER SULLIVAN:   Yes.    I'll be

17   glad to follow up with you, yes.

18           SENATOR SEPULVEDA:   So now my next

19   question is really based as the chair of

20   Corrections.   In the past budgets you've

21   proposed getting rid of 50 mental health beds

22   devoted to jail-based competency restoration,

23   and the Legislature has outwardly rejected

24   it.    Are you again proposing to close 50
                                                      67

 1   beds?

 2           COMMISSIONER SULLIVAN:   We're

 3   proposing jail-based restoration, which would

 4   basically enable a county to decide to do

 5   restoration to competency, the ability to

 6   stand trial.    In a jail, versus having to

 7   transfer that person by statute to a

 8   hospital.    Basically saying based on medical

 9   necessity.

10           You can do outpatient restoration for

11   individuals who are not in the prison or jail

12   system.     So outpatient restoration is

13   something that can be done.    And what we're

14   proposing is that that outpatient restoration

15   be done in an appropriate program which will

16   be staffed appropriately, followed on the

17   best practices in other states.

18           So the jail-based restoration, what it

19   basically does, it enables individuals to be

20   closer to home and to get the services they

21   need in the jail without having to be

22   transported for competency to a hospital if

23   that's not medically necessary that they go

24   to a hospital.
                                                       68

 1            SENATOR SEPULVEDA:   I've seen some

 2   examples of that in some of the facilities,

 3   and I'm completely dissatisfied with what

 4   I've seen.    I don't think that the services

 5   that are provided are adequate in

 6   Corrections.

 7            COMMISSIONER SULLIVAN:   Well, just to

 8   say there is no other jail-based restoration

 9   at this point, though.   This would be a

10   distinctive program, that's all.

11            SENATOR SEPULVEDA:   Right.   But in

12   facilities where they actually provide or

13   attempt to provide --

14            COMMISSIONER SULLIVAN:   Yes, that's a

15   different issue, yes.

16            SENATOR SEPULVEDA:   -- mental health

17   services, I think it's been a complete

18   disaster.    And I've spoken with providers for

19   this; there's not enough money, there's not

20   enough services.   And so that's another issue

21   that I think we should have a discussion

22   about.

23            COMMISSIONER SULLIVAN:   Okay.   Glad

24   to.
                                                        69

 1           SENATOR SEPULVEDA:    Thank you.

 2           CHAIRWOMAN KRUEGER:     Thank you.

 3           Assembly?

 4           CHAIRWOMAN WEINSTEIN:     We go to

 5   Assemblyman Ra for a question.

 6           ASSEMBLYMAN RA:   Thank you.

 7           I just wanted to ask about -- I know

 8   there is an increase of $12.5 million for new

 9   adult home beds, beds and services, in the

10   Aid to Localities budget proposal.     Is there

11   any information on where those might be

12   located in the state?

13           COMMISSIONER SULLIVAN:    The adult home

14   beds are connected to an adult home

15   settlement, which by and large is New York

16   City.   So they're tied to a legal settlement

17   and geographically.   So those particular

18   adult home beds are locked in.     And they're

19   primarily in New York City.

20           ASSEMBLYMAN RA:   Okay.    Thank you.

21           CHAIRWOMAN WEINSTEIN:     So we go back

22   to the Senate now.

23           CHAIRWOMAN KRUEGER:     Thank you.

24           Senator Borrello.
                                                       70

 1            SENATOR BORRELLO:   Thank you, Madam

 2   Chair, appreciate it.

 3            And thank you, Commissioner Sullivan,

 4   for being here today.    It's nice to meet you

 5   in person after talking on the phone several

 6   times.

 7            And first of all, let me say thank you

 8   very much for your involvement and your

 9   team's involvement with a critical issue

10   we're having in my district with Lake Shore

11   Hospital.    And it leads to my question,

12   particularly on mental health services in

13   rural areas.

14            You know, we are now facing a shortage

15   of beds throughout the state, yet the closure

16   of Lake Shore Hospital is going to see the

17   decommissioning of 20 critically needed beds

18   in that region.    On top of the other

19   challenges we face, my question is is that it

20   appears to me -- as a former county executive

21   and a person who lives in that immediate

22   area, it appears to me that the Department of

23   Health and OMH were not in coordination on

24   this.    The left hand of state government
                                                      71

 1   doesn't know what the right hand of state

 2   government is doing.   And we have a crisis in

 3   our rural communities when it comes to mental

 4   health services.   And yet we are closing beds

 5   unnecessarily.   And DOH is being myopic in

 6   their view of the services -- the holistic

 7   view that's required of the services that are

 8   really critically needed in our area.

 9         So my question to you is how can we

10   justify allowing beds to be decertified, and

11   what can be done to preserve those and ensure

12   that in the long run that DOH and OMH are

13   coordinating their efforts to provide vital

14   healthcare services to our regions,

15   especially in the rural areas?

16         COMMISSIONER SULLIVAN:     Thank you.

17   You know, we work very closely with DOH on

18   these issues and on the complement of beds

19   that are needed for a particular area, both

20   on the mental health side and obviously DOH

21   is concerned on the medical side as well.

22         I think that, you know, it's just a

23   historic fact that psych beds, mental health

24   beds do not have the financial margin, by and
                                                        72

 1   large, that other medical beds have.    So

 2   sometimes hospitals decide that, you know,

 3   for financial reasons they need to lower

 4   psych beds.   That's always a serious issue,

 5   because we don't have as many as we might

 6   need, and we need to work very closely with

 7   those hospitals to make sure that there's

 8   enough services in the area.

 9         And that's what we're trying to do in

10   the area which will be impacted by TLC.      And

11   we are looking to see where we might be able

12   to grow other kinds of services.    Sometimes

13   hospitals have been very helpful, even if

14   they close beds, in establishing more

15   outpatient ambulatory services.    So we always

16   work with communities to try to make this

17   happen.   Sometimes hospitals move quickly on

18   this, quicker than we want them to, before

19   plans are available, and then we -- sometimes

20   we resort to regulatory responses to that.

21         But the reality is that we have always

22   worked very hard and worked together across

23   the state to try to provide the services that

24   communities need.
                                                       73

 1         SENATOR BORRELLO:     Let me compliment

 2   you on the work that you have done to help.

 3   But unfortunately the coordination with DOH

 4   wasn't good.   You worked very hard to help us

 5   try to overcome this situation, but at the

 6   end of the day it appeared DOH was singularly

 7   minded in wanting to close that hospital and

 8   really deny those services to their area.

 9   And they gave their closure approval without

10   OMH's approval, which is just, you know, I

11   think unforgivable in that sense.   There just

12   needs to be better coordination, especially

13   the fact that we have a crisis in healthcare

14   in our rural areas.    And it just seems that

15   there was -- you know, DOH moved forward

16   without OMH's, you know, collaboration and

17   approval, clearly.    And having that happen

18   again -- you know, this time it's the

19   hospital in my area.   Next time it's going to

20   be somebody else's hospital.    And it seems to

21   be, you know, not -- it's focused on dollars

22   and cents and not on the needs of the people.

23   And that is a real issue.

24         Thank you.
                                                      74

 1         COMMISSIONER SULLIVAN:    Thank you.

 2         CHAIRWOMAN KRUEGER:     Assembly.

 3         CHAIRWOMAN WEINSTEIN:    We go to

 4   Assemblywoman Gunther.

 5         ASSEMBLYWOMAN GUNTHER:    So I have a

 6   few questions.   The Executive has proposed

 7   removing pre-admission certification

 8   committees to determine a child's need for

 9   residential treatment.   What will the role be

10   of a newly created advisory board within the

11   Council of Children and Families?

12         COMMISSIONER SULLIVAN:    I think that

13   the new advisory board will help us not just

14   with admission criteria and census,

15   et cetera; they'll help us with the design, I

16   believe, of the RTF system.

17         The Council on Children and Families

18   is a very active council, and I think they

19   can talk with us about the needs of

20   communities and the kinds of design that we

21   need in these facilities.   By changing the

22   PACC admission process, it also gives us the

23   flexibility to do some creative work with the

24   RTFs across the state.   And in particular,
                                                       75

 1   many of the upstate RTFs are particularly

 2   happy with this change because it gives more

 3   flexibility in both admissions -- the kinds

 4   of admissions and the kinds of services that

 5   can be provided.

 6         So we think it's a really good move,

 7   and many of the upstate groups such as

 8   Northern Rivers and Parsons are very involved

 9   and are very happy that we've modified the

10   PACC admission process.

11         ASSEMBLYWOMAN GUNTHER:    Can you give

12   me examples of what type of behavior would

13   lead to the insurer being fined?

14         Also, regarding children's behavioral

15   rates, you say that you have start-ups.     But

16   when did they actually begin?

17         COMMISSIONER SULLIVAN:    Excuse me, an

18   individual's being fined, is that relative to

19   parity?

20         ASSEMBLYWOMAN GUNTHER:    Yes.

21         COMMISSIONER SULLIVAN:    Yes.   Well,

22   there will be regulations that will be posted

23   as of October of this year which will clearly

24   outline in great detail the various kinds of
                                                      76

 1   things that insurers must respond to, and

 2   they could possibly lead to fines.   So that

 3   compliance program is in this year's budget.

 4   And it's stated that basically as of October

 5   we'll have those regulations out, which will

 6   make it even clearer what can lead to what

 7   kind of repercussions if you're not following

 8   the parity regulations.

 9         At this point in time we have already

10   received all the medical necessity criteria

11   from the various insurers, we're reviewing

12   them, and how the compliance program will be

13   set up to make sure that they do it should be

14   established by October.   And then we'll see,

15   as a result of those regulations, what the

16   fines will be kind of connected to that.

17         ASSEMBLYWOMAN GUNTHER:    So I think

18   there was about 1.5 million.   Where did the

19   money go?

20         COMMISSIONER SULLIVAN:    No, that

21   hasn't happened yet.   I mean, there was an

22   estimate that that might be the level.     If

23   that money were to occur.

24         ASSEMBLYWOMAN GUNTHER:    So where would
                                                          77

 1   it go, then?

 2          COMMISSIONER SULLIVAN:    It would go to

 3   the ombudsman program, the CHAMP ombudsman

 4   program, which would then use that money to

 5   further the efforts of parity, educating

 6   families dealing with denials, et cetera.       If

 7   it occurs.

 8          ASSEMBLYWOMAN GUNTHER:    You also --

 9   the other thing is like with the rates for

10   housing.   So the new stock, they get an

11   increased rate, where old stock, they don't

12   get the same amount of money for their

13   rentals for people --

14          COMMISSIONER SULLIVAN:    The 20

15   million, though, is going towards older

16   housing which is already there, all types of

17   housing.   In the past sometimes we've limited

18   it to specific housing; now it's any kind of

19   housing can be eligible for that $20 million,

20   and it will also be spread across the state.

21          ASSEMBLYWOMAN GUNTHER:    Okay.      Thank

22   you.

23          CHAIRWOMAN WEINSTEIN:    Senate?

24          CHAIRWOMAN KRUEGER:     Thank you.
                                                        78

 1           Senator Akshar.

 2           SENATOR AKSHAR:   Madam Chairwoman,

 3   thank you.

 4           Commissioner, always good to see you.

 5           Let me go specifically to the Greater

 6   Binghamton Health Center.    Are there any

 7   conversations happening about a reduction in

 8   beds, either adult beds or children beds?

 9           COMMISSIONER SULLIVAN:    No.

10           SENATOR AKSHAR:   Good.   That's good

11   news.   Thank you.

12           Let me move, if I may, to mental

13   health services in the public school system.

14   What type of money are we investing as a

15   state to address that issue?      It's an issue,

16   at least from my perspective, that is at

17   crisis levels.    Any school superintendent you

18   speak to will tell you that they are dealing

19   with mental health crises on a daily basis.

20           So what is our investment to deal with

21   that statewide?

22           COMMISSIONER SULLIVAN:    One of the

23   major initiatives is to increase the number

24   of school-based mental health clinics, which
                                                      79

 1   we've been successful in doing.   What you do

 2   is you work with a community-based provider

 3   who then works with the school to set up a

 4   satellite in that school, on site.    Usually

 5   it's a social worker, but also now some of

 6   these are also using telepsychiatry to beam

 7   in psychiatrists to work in the school, and

 8   they can provide the services on site.

 9         That has worked in 800 schools so far,

10   and we're working with all the school

11   districts to increase that.

12         In addition, the work which is done by

13   the Mental Health Education Act, in

14   conjunction with the schools, has set up an

15   entire ability to begin to look at the

16   social/emotional wellness from early on in

17   the schools, from kindergarten through

18   12th grade.   So all the work on curricula, et

19   cetera, is something which is also jointly

20   done by the Department of Ed and also by

21   Mental Health.

22         In addition, we do lots of crisis

23   trainings in schools, lots of suicide

24   prevention in schools.   We have a whole
                                                      80

 1   suicide prevention plan -- guidelines which

 2   we just printed as of about a month ago and

 3   we're distributing to all these schools as to

 4   how to set up a tiered approach to working

 5   with possible suicide issues in their

 6   schools.   And we're available for all kinds

 7   of technical assistance with them.

 8         We've also done some pilots of some

 9   very intensive work in schools, including

10   something called ParentCorps, which works

11   with the pre-K population and does parent

12   teaching for schools.   It's limited, but it's

13   something that we are looking at to see if it

14   might possibly grow.

15         And we also have, across the state in

16   some schools -- five districts in the state,

17   most of them upstate -- called Promise Zones,

18   where there's an investment in dollars that

19   come to the schools to come together with

20   community-based providers so that schools not

21   only have clinics on-site, but they also

22   understand all the community-based services

23   that are available and work in partnership.

24         So there's a number of initiatives
                                                        81

 1   going on across the state.      But the mainstay

 2   is trying to get more and more satellite

 3   clinics into schools.      Because they not only

 4   -- they see individual kids, they work with

 5   teachers, they help educate the teachers,

 6   they help work together to solve problems.

 7   So that's probably one of the most effective

 8   ways to help the schools.

 9            SENATOR AKSHAR:   Could you quantify,

10   though, in dollars what we're investing in

11   the public school system to address the

12   issue?

13            COMMISSIONER SULLIVAN:   I don't know

14   if I could give you the exact dollars.      I

15   could work on that to give you how all these

16   things add up.    But I don't have it kind of

17   off the top of my head exactly what that

18   would be.

19            But I'll get back to you, Senator.

20            SENATOR AKSHAR:   Let me ask you I

21   guess a more direct question.     Do you think

22   the investment that we're making in the

23   public school system is significant enough to

24   address the underlying issue?
                                                        82

 1         COMMISSIONER SULLIVAN:   I think -- you

 2   know, in some ways you can always do more.     I

 3   think this is a very, very strong beginning.

 4   I really do believe that on-site work -- you

 5   know, there's a lot that can be done with

 6   trainings and education.   But on-site

 7   availability I think is one of the most key

 8   things.

 9         Many years ago I had a school-based

10   program when I worked in Queens, and

11   basically it was marvelous the difference it

12   made in a very troubled junior high school.

13         So I think that on-site capacity is

14   really critical, and so we're putting a lot

15   of our energies into getting that available,

16   so that when you're in a school and you have

17   a youth that you might be concerned about,

18   you have someone you can consult with, go to

19   them, get some feedback, help them get the

20   services.

21         So that's -- we're doing that.     We're

22   doing all the other things too, but I think

23   that's a critical piece.

24         SENATOR AKSHAR:   So I just want to
                                                       83

 1   thank you publicly for all the work that you

 2   are doing in the initiatives that you speak

 3   about.

 4            But we're falling short as a state.

 5   This is not -- this is not a knock on you or

 6   anybody who works in your office, because I

 7   believe in my heart that you're doing the

 8   very best you can with what resources you

 9   get.   But for me this comes down to wants

10   versus needs.

11            When I look at the Joseph P. Dwyer

12   program, the investment, $3.7 million, it's a

13   remarkable program, but that's a paltry

14   investment.    Last year there was a

15   million-dollar grant provided for schools to

16   compete against one another to address some

17   of their mental health issues.

18            You know, nobody knows the scope and

19   the difficulties of providing these services

20   better than you and the people that work for

21   you.   I would argue that we are really at a

22   crossroads in this state.    And when I see the

23   Executive make a suggestion that we would

24   invest $300 million in the restoration of the
                                                           84

 1   Erie Canal, but yet only invest $3.7 million

 2   in a program like Joseph P. Dwyer or have to

 3   fight over dollars to provide mental health

 4   services in schools, again, I think we're

 5   falling short and we need to do a much better

 6   job.

 7           Madam Chairwoman, thank you for the

 8   time.

 9           CHAIRWOMAN KRUEGER:     Thank you.

10           Assembly.

11           CHAIRWOMAN WEINSTEIN:    We've been

12   joined by Assemblywoman Buttenschon,

13   Assemblyman Weprin.

14           And we go to Assemblywoman Miller for

15   a question.

16           ASSEMBLYWOMAN MILLER:    Hi again.    For

17   the behavioral health ombudsman, where is the

18   funding coming from for that?     Is it coming

19   from the penalties that are deposited to the

20   fund?   And if that's the case -- I'm just

21   jumping the gun -- if that is the case, does

22   the ombudsman start or does it have to wait

23   for the program to get funded from that --

24           COMMISSIONER SULLIVAN:    Sorry.     It was
                                                     85

 1   actually started last year.   There was an

 2   allocation in the budget last year for 1.5

 3   million for the ombudsman program.    They've

 4   already seen about 1600 clients and I think

 5   have done 5,000 educational -- so they've

 6   done a lot of work.

 7         If fines are levied, that's additional

 8   dollars that would then go in addition, on

 9   top of the base funding, which is 1.5

10   million.

11         ASSEMBLYWOMAN MILLER:    Thank you.

12         CHAIRWOMAN WEINSTEIN:     Senate.

13         CHAIRWOMAN KRUEGER:     Senator Sue

14   Serino.

15         SENATOR SERINO:   Hello, Commissioner,

16   and thank you for being here today.

17         This is always a very sensitive

18   subject to me; I lost my brother by suicide

19   10 years ago, and I've been very open about

20   speaking about it from the time of his

21   obituary and trying to get rid of that

22   stigma.

23         And I know in 2018 we had passed a

24   bill that was -- not passed, I'm sorry, we
                                                      86

 1   introduced a bill that would establish the

 2   mental health services program coordinator

 3   that would reimburse the schools for hiring

 4   these professionals.   And I know Senator

 5   Akshar had spoken about that, and you

 6   mentioned that there are 800 schools that

 7   have some type of a pilot or a program.

 8         But I know in my district I'm hearing

 9   from kids -- and it doesn't matter if it's in

10   a wealthy school district, a poor school

11   district, middle class, they're all saying

12   that they're not getting enough help.   And I

13   know that we don't have the beds for our

14   children too.   Nobody wants to go into a

15   lockdown emergency services facility and then

16   -- you know, it's kind of scary, especially

17   for a kid, and then to think that they're

18   going to go back there again.

19         So I just wonder, you know, where

20   those 800 schools are, because I'm not seeing

21   it in my district.

22         COMMISSIONER SULLIVAN:    They're spread

23   across the state.    There are more of them

24   upstate, actually, than downstate.   But I can
                                                        87

 1   get you exactly how many might be in Staten

 2   Island.   I'm not sure off the top of my head

 3   which ones, but there are several -- not

 4   several, there's a number in the city,

 5   probably about 25 to 30 percent in the city

 6   and the rest are upstate.

 7         We've been working with the Department

 8   of Ed in the -- trying to work with the

 9   Department of Ed in the city to kind of

10   foster more ability to have mental health

11   clinics in the schools.    But I can -- I'll

12   definitely get to you on what's available in

13   your district.

14         SENATOR SERINO:     Thank you.   And I

15   liked hearing about the telepsychiatry too.

16   I think it's great, especially when you live

17   in a rural community.     As far as seniors, you

18   know, we have a lot of seniors that suffer

19   from social isolation.    And is there anything

20   that you're doing with the telepsychiatry for

21   our aging seniors?   I'm the ranker on the

22   Aging Committee and was wondering -- I'm just

23   joining the mental health committee now, so

24   I'm just wondering if there are any services
                                                     88

 1   for the seniors as well.

 2         COMMISSIONER SULLIVAN:    There's a

 3   mental health association in upstate New York

 4   that has done a little bit of a pilot with

 5   the elderly in terms of a telegroup where --

 6   dealing with the issue of social isolation,

 7   where people can get together, talk via --

 8   they're a combination of tablets and

 9   computers -- with a great deal of success.

10         So we're looking into that in terms of

11   some of the approaches that we have with the

12   elderly.   Social isolation is a huge issue,

13   by and large, and we're probably not using

14   technology the way we should be.   So that

15   whole -- telemedicine is something that we

16   have significantly expanded the ability to do

17   and to bill for.   Now I think we have to get

18   the word out there and get creative about how

19   we use it.

20         And I think that one of the creative

21   ways can be, you know, kind of group therapy

22   through -- which now could be reimbursed by

23   Medicaid, we're still working sometimes with

24   the commercial insurers.   But you could do
                                                     89

 1   that for the elderly across a group.

 2         So we'll definitely be expanding that.

 3   And I thinking that that really is a big

 4   piece of the future.   And it's also a way to

 5   increase access and to deal with the

 6   workforce limitations.   So there's a great

 7   deal that can be done with that.

 8         SENATOR SERINO:    That's very

 9   encouraging.

10         And then I just want to echo the

11   sentiments that my colleagues have mentioned

12   about the Dwyer, the Peer-to-Peer Program.

13   We first received it my first year in the

14   Senate, and it's been wonderful working

15   through Mental Health America, through the

16   county.   It's just great.   And I wouldn't

17   want to see any additional money that's put

18   in the budget for mental health -- you know,

19   like not robbing from Peter to pay Paul.

20         It's bad enough that our guys have to

21   come up here every single year and kind of --

22   you know, they schlep up here and they beg

23   for that money for the Dwyer program, where

24   we -- and I know that that's not you, but
                                                       90

 1   it's where -- you know, we keep fighting for

 2   it, and I don't want to see the extra money,

 3   the million dollars that are going to help

 4   our law enforcement, first responders,

 5   everybody for mental health, you know, be

 6   taken, you know, one for the other.   I think

 7   it's all vitally important.

 8         Thank you.

 9         CHAIRWOMAN KRUEGER:     Thank you.

10         CHAIRWOMAN WEINSTEIN:     I have a couple

11   of questions.   But before that, just wanted

12   to say that we've been joined by

13   Assemblywoman Carmen De La Rosa.

14         And I want to switch to a question

15   about jail-based restoration.    So the

16   Executive Budget includes 1.7 million in net

17   savings related to the development of

18   specialized beds in local jails to restore

19   felony-level defendants to competency.     And

20   I'm wondering if you might comment or if you

21   know the fiscal impact on jail based -- that

22   this jail-based restoration would have on

23   counties, since they'd now be required to pay

24   100 percent of the cost beginning on April 1.
                                                       91

 1         Are the counties both financially able

 2   to take on that responsibility, and do we

 3   have any concern about how the -- now that

 4   the counties would be doing this, how it

 5   would affect the quality of services provided

 6   within the local jails?

 7         COMMISSIONER SULLIVAN:   The counties

 8   are currently paying 50 percent of the cost

 9   of hospital-based restoration, which is about

10   $130,000 a year.   So it's quite high, because

11   it's hospital-based care and treatment.    When

12   it goes to 100 percent, that would be

13   $130,000 for -- pretty much the cost per

14   restoration to competency.

15         Jail-based restoration is about a

16   third of that cost.   So jail-based

17   restoration would leave probably a cost to

18   the counties of about 35,000 to 40,000 per

19   jail-based restoration.   So that's one of the

20   incentives perhaps to do jail-based

21   restoration.

22         The problem here is that

23   individuals are getting hospital-based care

24   for restoration when they really kind of only
                                                         92

 1   need outpatient level of care.        And so the

 2   counties are paying a very high cost even

 3   now, and it will get higher with the 100

 4   percent cost.

 5            CHAIRWOMAN WEINSTEIN:    Thank you for

 6   that response.

 7            Senate?

 8            CHAIRWOMAN KRUEGER:     Thank you.

 9   Second time, David Carlucci.

10            SENATOR CARLUCCI:   Great.    Thank you,

11   Chair.

12            Thank you, Commissioner, for your time

13   today.    I'll try to be as brief as possible.

14   I just had a few more points I wanted to go

15   through with you.

16            First, the streamlining preadmission

17   process for residential treatment facilities,

18   it looks like we're going from a 30-day wait

19   to 15 days, which looks good on paper.        I

20   just want to hear from you how we safeguard

21   this process and make sure that it's actually

22   working to the extent of what we have here on

23   paper.

24            COMMISSIONER SULLIVAN:    We're going to
                                                      93

 1   be monitoring it very closely.    The

 2   individuals who -- there will still be a

 3   review by a physician who will be designated

 4   by me to kind of take a look at those

 5   admissions and make sure.    But we should be

 6   able to reduce the time drastically because

 7   prior it required a number of committee

 8   steps, you had to have a group meet, which

 9   only met once a month.   I mean, that's now --

10   there will be timely meeting, there will not

11   be this once-a-month meeting, you can get a

12   review done in a day or two so that we can

13   get the information back.

14         So it should streamline the process,

15   but we're going to be monitoring it very

16   closely to make sure.    I think it will be

17   less than two weeks, but we're targeting, to

18   be sure, two weeks.

19         SENATOR CARLUCCI:     Yeah, I hope so.

20   Well, thank you.

21         And then back to the jail-based

22   restoration program, I know last year the

23   Governor had put this in the Executive

24   Budget.   But the difference is -- same
                                                        94

 1   proposal as this year, but the Governor was

 2   offering money to the localities that opted

 3   into this program.

 4            I'm concerned for a few reasons.

 5   First, that we're putting in a $1.7 million

 6   savings into the budget.   And it looks like

 7   the Governor is anticipating that

 8   municipalities will join onto this program.

 9   The concern I have is that -- and I'll let

10   you answer.    My concern is that

11   municipalities will not opt into this program

12   because there's no dollars coming forth to

13   make the upgrades necessary to meet these

14   needs.

15            Can you speak to the jail-based

16   restoration program and how you see it making

17   those savings?   And have any municipalities

18   expressed interest?    Are any municipalities

19   ready to go with no additional funding?

20            COMMISSIONER SULLIVAN:   There are some

21   municipalities who have expressed interest.

22   No one has said at this point this year that

23   they are ready to start, partly -- the one

24   municipality that had been, in the past,
                                                       95

 1   wanted to just wait and kind of think about

 2   it again because of some of the changes.

 3           But jail-based restoration would

 4   basically reduce the cost to the counties of

 5   what they were paying now and will pay in the

 6   future to have inpatient hospital

 7   restoration.

 8           Yes, there would be some start-up that

 9   might be needed in terms of getting this

10   started in the counties, but that should be

11   not that much.   And basically, even without

12   the additional dollars which were there in

13   the year before, which were really startup

14   dollars -- even without those dollars, it

15   should still be financially in the interest

16   of the counties to do this because the cost

17   of inpatient hospital-based restoration is so

18   high.

19           And this would only be for counties

20   that were big enough to have a large enough

21   population that would benefit from this.

22           SENATOR CARLUCCI:   So the $1.7 million

23   in savings -- that's savings to the State of

24   New York -- what now is the cost?    Do we bill
                                                      96

 1   the municipalities for that psychiatric care

 2   when an inmate is unable to -- when they are

 3   referred to the psychiatric facility?     What

 4   type of reimbursement are we talking about?

 5            COMMISSIONER SULLIVAN:   The average

 6   cost is a thousand dollars a day in a

 7   hospital.     And the average time -- that's

 8   average time, so for some it could be more or

 9   less -- is about three -- almost four months,

10   almost 140 days to restoration to competency.

11   So the actual dollars is close to -- on

12   average, is about $140,000 which counties

13   would now be paying, per restoration, to the

14   state.

15            SENATOR CARLUCCI:   What is currently

16   happening?    When they send someone to the

17   facility, is the state rebilling the county

18   for that?

19            COMMISSIONER SULLIVAN:   Currently,

20   yes.   The county gets billed currently

21   50 percent.    In New York City they have been

22   billed for the past year also at a hundred

23   percent.

24            Going forward, the counties would be
                                                        97

 1   billed -- all counties would be billed for a

 2   hundred percent.

 3         SENATOR CARLUCCI:   So, wait, what is

 4   it now?

 5         COMMISSIONER SULLIVAN:   Right now this

 6   year -- prior to this year, counties were

 7   paying 50 percent of the cost of the

 8   hospital-based restoration, which is about --

 9   which was about $70,000 per restoration.      If

10   you -- but New York City, as of last year,

11   was paying a hundred percent of the cost.

12         Going forward, all counties will pay a

13   hundred percent of the cost of the

14   hospital-based restoration.

15         SENATOR CARLUCCI:   And why is New York

16   City excluded from this proposal?

17         COMMISSIONER SULLIVAN:   They're --

18   they -- there wasn't any interest at the time

19   in New York City.   And partly it's the way

20   they are established, the way they have

21   pre-arraignment hospital -- the way they're

22   established doesn't really fit for the need

23   for jail-based restoration.   It really is a

24   program that is best-served upstate.
                                                      98

 1          SENATOR CARLUCCI:   Thank you,

 2   Commissioner.

 3          CHAIRWOMAN KRUEGER:   Thank you.

 4          The Assembly is done.   I'm just going

 5   to do one question in closing for you,

 6   Commissioner.

 7          So my last two colleagues asked you

 8   about the program in the local jails, mental

 9   illness.   In the General Welfare/ Human

10   Services hearing we had last week, one of the

11   discussions was that approximately 3200

12   people are released from the prisons directly

13   into the entry point for the New York City

14   Men's Shelter.   A disproportionately large

15   number of them suffer from mental illness.

16   That surely can't be a smart discharge plan

17   for someone with mental illness:   Okay, we're

18   letting you out of jail, and welcome to the

19   streets of New York.

20          I'm going to ask this in the Public

21   Protection hearing of DOCCS, but can you

22   please tell me what the right answer should

23   be?   Because I know that this can't be the

24   right answer.
                                                     99

 1         COMMISSIONER SULLIVAN:    Well, we know

 2   that basically if individuals with serious

 3   mental illness leave prison, that they do

 4   best when they are in housing which is

 5   supported by a series of services that

 6   enhance their ability to reenter into the

 7   community.

 8         We do a lot of work in the prisons

 9   before they are discharged to help the

10   seriously mentally ill get ready to go into

11   the community.   And just last year -- and

12   we're in the process of putting forward these

13   units, 250 additional apartment units were

14   authorized for individuals leaving the prison

15   system at the highest need, to be able to

16   move to housing which would be run by the

17   particular agencies that do very good work

18   with the forensic population.

19         We try as best as we can for most of

20   the seriously mentally ill leaving to get

21   into some degree of housing, whether it's

22   apartments or other kinds of family housing,

23   whatever is possible.   Some of the seriously

24   mentally ill do unfortunately end up going to
                                                      100

 1   the shelters, sometimes for -- hopefully, as

 2   often as possible -- for a briefer period of

 3   time waiting to get into the other housing.

 4   But we do the best we can to try not to have

 5   them go to shelters, because you're right,

 6   it's not the best disposition.

 7         CHAIRWOMAN KRUEGER:     But you are

 8   working with or IDing people in prison as

 9   suffering from mental illness.

10         COMMISSIONER SULLIVAN:     Oh, yes.

11   Before discharge we know all the individuals

12   who are seriously mentally ill.   We also know

13   their risk levels.   So we prioritize for the

14   high-risk clients to be able to go out into

15   housing.   Some of the lower-risk clients,

16   unfortunately sometimes we don't have enough

17   housing so they go to the shelters.

18         But every client who leaves is

19   assessed for their ability to go.   And if

20   they are assessed before they leave prison to

21   need additional help before going, they go to

22   one of the pre-discharge units in the prison

23   system.    We have two of those, and we're

24   going to be expanding to another one, where
                                                         101

 1   they spend anywhere from several months

 2   getting ready to leave the prison system to

 3   reintegrate into the community.

 4         CHAIRWOMAN KRUEGER:     And at that time

 5   you're attempting to find them someplace

 6   where they would move to as opposed to the

 7   shelters or the streets.

 8         COMMISSIONER SULLIVAN:    Yes.   Yup,

 9   absolutely.     Yes.

10         CHAIRWOMAN KRUEGER:     And is there some

11   kind of data report you can get for me and my

12   colleagues --

13         COMMISSIONER SULLIVAN:    Yes.

14         CHAIRWOMAN KRUEGER:     -- showing --

15   that would be very helpful.

16         COMMISSIONER SULLIVAN:    I can show you

17   -- we have the numbers and we have where the

18   individuals go, how many go into them.    We

19   can definitely get that to you.    Be glad to.

20         CHAIRWOMAN KRUEGER:     Thank you very

21   much for your time with us this morning.      You

22   are now free.

23         (Laughter.)

24         CHAIRWOMAN KRUEGER:     Well, you might
                                                       102

 1   not be free, but you're allowed to leave this

 2   room.   Let's not go too far.   Sorry.

 3           Our next witness is the commissioner

 4   of the Office for People With Developmental

 5   Disabilities, Dr. Theodore Kastner.

 6           Good afternoon.

 7           COMMISSIONER KASTNER:   Good afternoon,

 8   Senator.

 9           Good morning, Chairs Krueger,

10   Weinstein, Carlucci and Gunther and other

11   distinguished members of the Legislature.   My

12   name is Ted Kastner, commissioner of the New

13   York State Office for People With

14   Developmental Disabilities, or OPWDD.

15           Thank you for the opportunity to

16   provide testimony about Governor Cuomo's

17   fiscal year '20-'21 Executive Budget and how

18   it will benefit the more than 140,000 New

19   Yorkers with developmental disabilities

20   served by OPWDD.

21           It has been just over a year since I

22   assumed leadership of OPWDD, and I'd like to

23   begin my testimony by highlighting some

24   accomplishments of the past year.   In regard
                                                     103

 1   to our work with our partners, in 2019 we

 2   received federal approval to provide crisis

 3   services for individuals with intellectual

 4   and developmental disabilities, or CSIDD.

 5   This Medicaid State Plan amendment allows us

 6   to double our service capacity with the same

 7   investment of state dollars.   We will use

 8   these funds to complete our statewide network

 9   of crisis response services.

10         We're collaborating with the Office of

11   Mental Health to create new programs to

12   support individuals with severe, challenging

13   behaviors.   These include a new inpatient

14   unit in Brooklyn and a new extended treatment

15   unit in Queens.   We're exploring avenues to

16   enhance the skills of primary care and

17   behavioral health providers.

18         Complementing these efforts, we're

19   working diligently to improve collaboration

20   with our partners in county government.   We

21   have regular meetings with the counties and

22   are exploring opportunities to coordinate

23   state and county resources to improve crisis

24   response outcomes.
                                                       104

 1         We've achieved our goal of ensuring

 2   that all OPWDD-eligible individuals have a

 3   life plan developed by our care coordination

 4   organizations, or CCOs.    We're now working to

 5   ensure that these life plans meet the

 6   standards of being conflict-free and

 7   person-centered.

 8         In August of 2018, OPWDD published the

 9   draft Specialized IDD Plans-Provider Led, or

10   SIPs-PL, qualification document for public

11   comment.   We anticipate releasing a revised

12   draft for public comment soon.

13         Internal activities in 2019 have

14   helped lay a foundation for a more effective

15   system of support in the future.    We have

16   restructured our leadership team and are

17   working to improve public engagement through

18   our advisory committees.   OPWDD conducted a

19   thorough review of the organizational

20   structure and functions of approximately

21   20,000 employees to ensure that resources are

22   deployed to best meet the needs of people we

23   support.

24         We created a new Division of Data
                                                      105

 1   Management and Strategy to enable

 2   better-informed decision-making and to

 3   promote data transparency.   This will support

 4   IT development and data analytics.

 5         We're midway through the

 6   implementation of an electronic health

 7   records system for all state-operated

 8   services.   We've secured a five-year renewal

 9   of our federal Medicaid waiver, allowing us

10   to support more than 90,000 people in their

11   own home or community.

12         And finally, OPWDD strengthened

13   central office oversight of policy, budgeting

14   and program operations and has now begun to

15   reorganize the regional office structure to

16   streamline operations.

17         As a result of all these improvements,

18   all individuals and families have the same

19   access to supports and services no matter

20   where they live, what language they speak,

21   their race, religion or when they became New

22   Yorkers.

23         The Governor's Executive Budget

24   continues to build upon these successes,
                                                       106

 1   including significant new investments now

 2   leveraging approximately $9 billion in state

 3   and federal funding for OPWDD services and

 4   programs.     These include $120 million in

 5   annual all-shares funding to provide new and

 6   expanded services for people entering the

 7   OPWDD system for the first time; $15 million

 8   in capital funding to expand housing

 9   opportunities; and $170 million in new state

10   and federal resources to comply with the

11   state's minimum wage, to increase wages for

12   direct support professionals, and to support

13   our clinical staff employed by OPWDD's

14   network of nonprofit providers.

15         These additional human capital

16   investments bring the total commitment to

17   increased wages and compensation to our

18   nonprofit provider workforce to $650 million

19   since 2015.

20         New York leads the nation in the

21   amount of funding to support people with

22   developmental disabilities, providing twice

23   the national per-capita average.     As we move

24   into 2020 and beyond, OPWDD will continue to
                                                      107

 1   transform the delivery system to one that is

 2   more accessible, equitable and sustainable.

 3   New York's evolution to be a more responsive

 4   and flexible service system would not be

 5   possible without our collaborations with the

 6   Legislature, the input of the people we

 7   support and their family members, and our

 8   dedicated partners in the provider community.

 9           Thank you for your partnership, and I

10   look forward to answer any questions you may

11   have.

12           CHAIRWOMAN KRUEGER:   Thank you.

13           Our first questioner will be Chair

14   David Carlucci.

15           SENATOR CARLUCCI:   Thank you, Chair.

16           Thank you, Commissioner, for your

17   testimony today, and for your commitment to

18   our most vulnerable populations.    And I know

19   we've spoken at length about the need to

20   support our workforce.   It's the backbone of

21   the developmental disability system.    And

22   it's a struggle that we still have.    Every

23   day I hear about the concerns and the

24   complaints about the transition of the
                                                       108

 1   workforce.   And you can't blame them when

 2   they're paid minimum wage or just above, in

 3   some cases, to do the hardest work.    And that

 4   transition is just -- it really eats at the

 5   quality of care.

 6         So my hat goes off to the

 7   professionals, the people that -- the DSPs

 8   that have been there, that have done it as a

 9   career.    They pull together because of their

10   love and commitment to the people they serve,

11   so I thank them for that.

12         I first wanted to get into -- because

13   we'll get into the workforce, but the big

14   pressing issue is about the transition to

15   managed care.   And we've heard about this,

16   but yet it's something -- little details have

17   been provided, at least that I'm aware of.

18   Is New York still moving to -- are we still

19   transitioning to managed care?    And if so,

20   what is the time frame?

21         COMMISSIONER KASTNER:      Thank you,

22   Senator.   We have a process for the

23   transition to managed care.   At the present

24   time there are two primary components to
                                                       109

 1   that.   The first was in July of 2018, we

 2   launched our care coordination organizations.

 3   The effort was designed to expand the scope

 4   of our case management program and to

 5   incorporate healthcare services in addition

 6   to habilitative services, into what we now

 7   call a life plan.   So our care management

 8   system is now building the competency to be

 9   able to incorporate both health and

10   long-term-care services.

11           In August of 2018, we published the

12   draft SIPs-PL qualifications document.       We

13   received about 80 public comments on how that

14   document could be enhanced.     We've been

15   working on revisions to that document while

16   we're simultaneously working to ensure that

17   our CCO launch has been effective.    We are

18   near the end of completing a revision to that

19   draft SIPs-PL qualification document, and we

20   expect that draft to be made available to the

21   public soon.

22           SENATOR CARLUCCI:   What do you think,

23   how soon?

24           COMMISSIONER KASTNER:    I think soon.
                                                      110

 1          (Laughter.)

 2          COMMISSIONER KASTNER:    I have to say

 3   I --

 4          SENATOR CARLUCCI:   Because we've kind

 5   of heard that before.

 6          COMMISSIONER KASTNER:    I've said this

 7   before.   Actually, I went on record in saying

 8   in September it would be out in October or

 9   November, in November it would be out in

10   December, and obviously I've been wrong on

11   both counts.

12          So I'm a little uncomfortable saying

13   that it will be a specific date, although we

14   do expect it to be out shortly.

15          SENATOR CARLUCCI:   Okay.   And one of

16   the big concerns that we have is obviously

17   that -- the difference between state-operated

18   and voluntary services.    Do you have an idea

19   or a breakdown of what percentage of the

20   covered population is covered under

21   state-operated work and the nonprofit work?

22   Do you have any idea what the breakdown is?

23          COMMISSIONER KASTNER:    Yeah, a rough

24   ballpark is approximately 20 percent of the
                                                       111

 1   service delivery system is provided through

 2   OPWDD state employees and 80 percent through

 3   the voluntaries.    For residential, it's

 4   pretty easy to look at:     About 30,000

 5   certified residential opportunities through

 6   the voluntaries, about 7,000 certified

 7   residential opportunities through OPWDD.

 8         SENATOR CARLUCCI:     One of the concerns

 9   that we keep hearing about the transition to

10   managed care is that there would be start-up

11   costs that possibly have to be put out.     Can

12   you tell us, is that -- would that be true?

13   Can we give a guarantee?    Can we put people

14   at ease to say that no money from services

15   would be taken out in order to meet those

16   start-up costs?

17         COMMISSIONER KASTNER:      We have said

18   that in the past.    We do not have start-up

19   costs in our operating budget, and we believe

20   that that is still the case.     The operating

21   costs for administration and start-up would

22   come from another source.

23         SENATOR CARLUCCI:     Okay.   And does

24   there seem -- when we talk about we have the
                                                        112

 1   80 percent that's run outside of the OPWDD

 2   state-run system, does OPWDD track the fiscal

 3   health of the nonprofit providers?

 4           COMMISSIONER KASTNER:   Yes, we do.

 5   Our providers are compensated through a

 6   cost-based reimbursement mechanism.     So for a

 7   base year they submit to us the list of the

 8   costs that they incur in providing services

 9   to our individuals.   We incorporate that

10   information into the rates that are paid to

11   them.   It's probably the most favorable

12   reimbursement methodology that could be used

13   to provide payment to providers, because it's

14   based on their historical costs.

15           SENATOR CARLUCCI:   I'm sorry, what was

16   that last part you said?

17           COMMISSIONER KASTNER:   It's a very

18   favorable reimbursement methodology.    As

19   opposed to a fee or a capitation arrangement,

20   payment based on costs actually makes

21   providers whole as a result of, you know,

22   being fully compensated for the services

23   they're providing.

24           SENATOR CARLUCCI:   Okay.   And we have
                                                        113

 1   been pushing, we've got the

 2   BFair2toDirectCare campaign.   We were

 3   successful in putting some money into the

 4   budget last year.   I had asked the

 5   commissioner of OMH the same question about

 6   we're hearing about that the 2 percent

 7   increase has not been put out the door yet,

 8   and that's putting many of the providers at a

 9   very challenging cash-flow situation.

10         Can you explain to us what's going on

11   with that?   Is money getting out the door to

12   the providers?   Is there a holdup?   Am I

13   mistaken, has that money gone out?     Where are

14   we?

15         COMMISSIONER KASTNER:    We are very

16   grateful for the Legislature, in the

17   Executive Budget of last year, incorporating

18   a 2 percent increase for direct support

19   professionals on January 1st and also

20   April 1st for this coming budget.

21         My understanding is that OPWDD has

22   approved the new rate that would incorporate

23   the increase for DSPs, but we're waiting to

24   see that that is processed and then delivered
                                                      114

 1   to the providers.

 2           I don't know specifically where the

 3   holdup is, but I do know that we have

 4   approved those rates for providers for the

 5   January 1st increase.

 6           SENATOR CARLUCCI:   So but is it your

 7   understanding that that money has not been

 8   sent out the door yet?

 9           COMMISSIONER KASTNER:   From what the

10   providers have told me, it has not yet

11   arrived.

12           SENATOR CARLUCCI:   Okay.   So we need

13   to --

14           COMMISSIONER KASTNER:   We can look at

15   where that is.   It's somewhere between,

16   obviously, OPWDD and our providers.

17           SENATOR CARLUCCI:   Okay.   Okay.

18           We've talked about it before, about

19   what do we do to increase the longevity of

20   our employees.   And I've talked to you about

21   the idea of a credentialing program, that we

22   pay people for their experience.

23           Is there anything in the works through

24   OPWDD to have a program where we are actually
                                                       115

 1   paying people for their experience to make

 2   sure that that longevity continues?   We have

 3   agreed in meetings that that longevity is

 4   paramount to the quality of care.   It drives

 5   down the cases of neglect, of abuse, and just

 6   improves the continuum of care.

 7         Can you tell us, is there anything in

 8   the budget that you can point to here, plans

 9   that OPWDD has to strengthen the workforce

10   and to make sure that there's more of an

11   incentive, that this is an actual career, a

12   long-term career for people?

13         COMMISSIONER KASTNER:     Well, Senator,

14   as you know, when we met I told you that my

15   first job in this field was in 1976 as a DSP.

16         SENATOR CARLUCCI:   Yes.

17         COMMISSIONER KASTNER:     So I understand

18   the challenge of the work and the importance

19   of the work.   DSPs are the line staff, the

20   individuals who have the most day-to-day

21   contact with our individuals.    So we value

22   the DSPs.   We have to find ways to create

23   stability in that workforce and opportunities

24   for professional development.
                                                       116

 1         As far as salary, the last I was able

 2   to determine, looking at data from probably

 3   2015, the average salary for DSPs in New York

 4   was about $13.65, which put us in the top

 5   five nationally.   I think with the subsequent

 6   increases that have occurred, we're near $15

 7   an hour, we're near the very top in terms of

 8   the rest of the country.   And certainly we're

 9   favorably positioned relative to the states

10   that we compete against -- Pennsylvania,

11   New Jersey, New Jersey, Connecticut,

12   Massachusetts, Vermont.    We're certainly not

13   losing workforce to those states.

14         We have tried to identify

15   opportunities to leverage resources.     We

16   can -- we're conducting public service

17   announcements in the North Country

18   specifically reaching out to veterans at the

19   time of separation from service, identifying

20   a DSP role as a potential career path.    We've

21   been able to identify benefits that are

22   available from the Department of Veterans

23   Affairs that enhance salary and compensation.

24   We've also identified that veterans are --
                                                         117

 1   can benefit from enhanced entitlements like

 2   the SNAP Plus program.

 3         We are working with academic

 4   institutions.    We have two different groups

 5   working with the BOCES programs, one in

 6   Nassau and Suffolk Counties and the other

 7   upstate, to develop a curriculum and a

 8   certificate.    I went to the graduation for

 9   DSPs on Long Island, it must have been in the

10   fall, because that's an extremely important

11   area for us.

12         We're also looking at credentialing,

13   any number of activities that we can to

14   elevate the quality of the work and the

15   prestige associated with the role.    It turns

16   out it's not simply an issue of economics.      I

17   think people in the role value recognition

18   and the credit for the work that they do.      So

19   working within both the state operations and

20   our voluntaries to have a DSP Recognition

21   Week and recognition events has been very

22   important.

23         I've been to every part of this state

24   celebrating DSPs and attending the
                                                         118

 1   recognition events, which again we think is

 2   very important for setting a tone in how we

 3   value DSPs.

 4            SENATOR CARLUCCI:   Thank you.

 5            CHAIRWOMAN KRUEGER:     Thank you.

 6            Assembly.

 7            CHAIRWOMAN WEINSTEIN:    We've been

 8   joined by Assemblywoman Kimberly Jean-Pierre

 9   and Assemblywoman Rosenthal, and go to

10   Assemblywoman Gunther, chair of our Mental

11   Health Committee, for questions.

12            ASSEMBLYWOMAN GUNTHER:    Good morning.

13   So I'm not going to ask you about the DSPs.

14   We all know that we're looking for more money

15   for retention for our DSPs, it's a group of

16   women.    So I know that you're working on

17   that, and we're happy about that.

18            Thirteen dollars -- you know,

19   McDonald's in the city just raised to $15.

20   So, you know, there's a little competition

21   here.    And this is people's lives.    So -- but

22   I know that you're working on it, and I do

23   appreciate it.

24            So my next issue is bed blockers --
                                                          119

 1   that is, children who have aged out and

 2   should be in adult beds but continue to be an

 3   issue, they stay in children's beds.       And you

 4   know that we have a place that I represent in

 5   Sullivan County that we have quite a few bed

 6   blockers, and there really is not very many

 7   places to move these folks to, and it is an

 8   issue.

 9            So are we doing anything to create

10   more adult beds in the DD community?

11            COMMISSIONER KASTNER:   Well, as you

12   will recall, in 2017 we received the support

13   to build 459 new certified residential

14   opportunities.    We're about midway through

15   that process in building new residential

16   capacity.    We also have $15 million in

17   affordable housing capital available in this

18   year's budget which will help us address that

19   concern.    And we also have the capacity to

20   offer between 1200 and 1300 new residential

21   opportunities each year.

22            So we recognize that is a problem.

23   We're looking at how we can address that both

24   in terms of the individuals who occupy those
                                                    120

 1   beds, but also in making strategic

 2   investments in a continuum of care in order

 3   to reduce the pressure on those programs in

 4   terms of the numbers of children that are

 5   requesting residential services.

 6         I'm sure I'll have an opportunity to

 7   touch on that in a bit.

 8         ASSEMBLYWOMAN GUNTHER:   Thank you.

 9   Now, managed care and the CCO issue is next.

10   How can the Executive believe that moving to

11   managed care will save the system money.

12   It's just going to be another mouth to feed.

13   When you theoretically take the same pot of

14   money and add it to an entire another

15   administration apparatus, what other

16   conclusion can I and everybody else come to?

17         COMMISSIONER KASTNER:    Well, as I

18   think everyone within OPWDD has said, the

19   move to managed care is not for the purposes

20   of saving money.   And as I described it

21   earlier, we have a process in place where we

22   don't have specific timing.   The process

23   begins --

24         ASSEMBLYWOMAN GUNTHER:   Can you pull
                                                       121

 1   the mic a little closer?   Because I can't

 2   really hear you as clear as I should.

 3         COMMISSIONER KASTNER:    Sure.   I have a

 4   problem with mumbling, and I have an FM radio

 5   voice --

 6         ASSEMBLYWOMAN GUNTHER:    So do I.

 7         COMMISSIONER KASTNER:    -- so I can put

 8   anybody to sleep.

 9         (Laughter.)

10         COMMISSIONER KASTNER:    But, you know,

11   we're making investments to address the

12   transition to managed care.   The process

13   right now is focusing on the CCOs and

14   ensuring that all of our individuals have an

15   appropriate care plan and also the policy

16   framework being the SIPs-PL qualifications

17   document, which is currently under revision.

18   Those are the two steps that we're currently

19   engaged in.   We don't have time frames

20   specifically for going forward.

21         ASSEMBLYWOMAN GUNTHER:    Do you think

22   managed care works in the DD system or will

23   work in the DD system, it will save money or

24   create better care?   We should be -- the
                                                        122

 1   focus should be on the quality of care, but

 2   it's all soft core so a lot of it has to do

 3   with money rather than quality.

 4            And, you know, so far I don't think

 5   that there are many people that are bragging

 6   about managed care.

 7            COMMISSIONER KASTNER:   Well, as I said

 8   before, the focus on implementing managed

 9   care for people with developmental

10   disabilities is not focused on saving money.

11            One of the facts I think that's not

12   readily appreciated is that more than 28,000

13   people with intellectual and developmental

14   disabilities have volunteered to enroll in

15   mainstream managed care, and we believe

16   that's largely because it provides better

17   access to healthcare services for individuals

18   -- services that in the fee-for-service

19   Medicaid program might not be as accessible.

20            Generally that experience has been

21   favorable.    Individuals enroll on a voluntary

22   basis; they can also disenroll on a voluntary

23   basis.    So we think managed care as a safety

24   net for Medicaid State Plan services has been
                                                         123

 1   very helpful.

 2            As I said in regard to provider-led

 3   plans, we're still in the process of

 4   preparing the revised draft for public

 5   comment.    We hope that that will be out

 6   shortly, and that will give us more insight

 7   into the feelings of our individuals and

 8   families as to whether or not we should

 9   pursue it and the timing and scope as we go

10   forward.

11            ASSEMBLYWOMAN GUNTHER:   So will

12   services have to be cut for managed care and,

13   you know, the uniqueness of the service that

14   -- the services that you provide to those

15   individuals?

16            You know, when I think about managed

17   care, like, you know, you take in their age,

18   there are different factors you take in.      But

19   in the DD community it seems like there's so

20   many different things that could cost

21   additional money because of the child or the

22   adult themselves.

23            So managed care is we did it to save

24   money.    And I'm just wondering, you know,
                                                       124

 1   what else will be cut.   Right now we know

 2   that we're not paying DSPs, to me, enough

 3   money because we can see the turnover.     And

 4   now we're on managed care, you know.    And the

 5   hospital systems, I don't know that they got

 6   their big bang for the buck that they thought

 7   they were going to get, nor did they get the

 8   streamlined care that no infection or nothing

 9   unheard-of would happen, or something

10   unexpected.

11           And I just sometimes wonder, with this

12   unique community, how that's going to fit

13   into it.

14           COMMISSIONER KASTNER:    So the value

15   proposition, if you will, in managed care is

16   that managed-care organizations can avoid the

17   need for unnecessary services.    So by keeping

18   people healthy, for example, they can reduce

19   the amount of emergency room care or hospital

20   care.   And that premise is generally proven,

21   I think, for all people who are Medicaid

22   beneficiaries in virtually every state at

23   this point.

24           ASSEMBLYWOMAN GUNTHER:   I like the
                                                     125

 1   fact that, you know, we do that in acute-care

 2   hospitals.   And so on one side we're saying,

 3   yeah, better care, but on the other side

 4   we're saying we've got this turnover of DSPs.

 5   So one has to be worked out with the other in

 6   order to have any efficacy of these kind of

 7   changes.

 8         And you know what, the investment over

 9   the years is getting better, but the

10   investment in our most vulnerable

11   populations, whether it's Mental Health or

12   OPWDD -- you and I have been in those

13   facilities, we've seen the people that work

14   there, that are working at one facility on

15   one end of the town and the other facility.

16         So I think that these ideas that, you

17   know, that are thrown out -- thrown at us

18   every X amount of years, they sound great.

19   But, you know, have we seen a great deal of

20   change in the acute-care facilities?    A lot

21   of readmissions, sometimes, but other than

22   that I'm not really sure that it's been as

23   effective as we think.

24         That's my last question.
                                                           126

 1            COMMISSIONER KASTNER:    Thank you.

 2            ASSEMBLYWOMAN GUNTHER:    I don't know

 3   if you have a comment on it.

 4            COMMISSIONER KASTNER:    Thanks.

 5            CHAIRWOMAN KRUEGER:     Okay.   Senator

 6   Pete Harckham.

 7            SENATOR HARCKHAM:   Thank you, Madam

 8   Chair.

 9            Thank you, Commissioner.    Thank you

10   and your staff for all you do.      I want to

11   thank the treatment providers and the family

12   caregivers.    You know, this population that

13   doesn't have high-priced lobbyists, you know,

14   doesn't have star-studded, you know,

15   walkathons -- and so the people who are

16   committed to this, you know, you're doing

17   God's work and you deserve to be commended.

18            The question I have -- going back to

19   your testimony, you talk about 15 million

20   capital for housing.   Many of us in our

21   districts have existing housing, group homes

22   or whatever, through various agencies that

23   have been there a while.     And what they need

24   is new capital.    They need reinvestment.      You
                                                       127

 1   know, they're at a point where they need new

 2   roofs, maybe new boilers, maybe new siding,

 3   whatever it is.   And that's expensive.

 4          Is reinvestment in existing properties

 5   part of this capital expenditure?    Or is

 6   there money for that in other parts of your

 7   budget?

 8          COMMISSIONER KASTNER:   The

 9   reinvestment in capital for existing

10   residential capacity is within the providers'

11   budgets.   These funds are for the expansion

12   of new affordable housing.

13          SENATOR HARCKHAM:   All right, so

14   there -- you're -- I'm sorry, I didn't hear

15   you.   So you're saying that you're assuming

16   there's capacity in providers' existing

17   budgets to do capital?

18          COMMISSIONER KASTNER:   I'd have to

19   look specifically at how that is funded, but

20   I believe that that is not within the scope

21   of the $15 million that's within this year's

22   budget.

23          SENATOR HARCKHAM:   Okay.   Is there any

24   other funding, to your knowledge, anywhere in
                                                          128

 1   your budget that will assist with capital for

 2   existing facilities to repair

 3   infrastructure -- new roofs, new boilers,

 4   those kind of things?

 5            COMMISSIONER KASTNER:     Yeah, I need to

 6   go back and ask our budget people that

 7   question.    I apologize, I don't have the

 8   specific answer.

 9            SENATOR HARCKHAM:   Okay.   No, that's

10   fine.    We can touch base afterwards.

11            COMMISSIONER KASTNER:    Okay.

12            SENATOR HARCKHAM:   All right, thank

13   you.

14            COMMISSIONER KASTNER:    Thank you.

15            (Pause.)

16            CHAIRWOMAN KRUEGER:     Sorry.    I'm so

17   sorry.    Thank you.

18            Next is Assemblymember Miller.

19            ASSEMBLYWOMAN MILLER:    Hello.

20            COMMISSIONER KASTNER:    Hi.

21            ASSEMBLYWOMAN MILLER:    So as I'm sure

22   you're familiar, I have way more questions

23   than we are given time for.      So I will focus

24   on the issues, as usual, that I'm hearing
                                                      129

 1   most concern about from the families that

 2   reach out to me from all over the state.

 3           The first has already been spoken

 4   about a little bit:   Our transition into full

 5   managed care.   I know you've heard this

 6   before, even from me, but this model has not

 7   been successful in other states in this

 8   population.   Why are we so insistent that it

 9   will be here?

10           I can tell you that currently there is

11   little confidence on the part of the

12   consumers who are stuck in this constant

13   transition.   Families and agencies were sold

14   an amazing program -- care coordinators with

15   graduate degrees who understood the needs of

16   this community; they would be able to take so

17   much off of our shoulders.   We're certainly

18   not seeing that.   There is a tremendous

19   turnover rate, much more so than before, I

20   feel.

21           I myself, with Oliver, we're on our

22   third care coordinator in a year.   They're

23   inexperienced in the actual coordinating

24   that's required for this good care that we
                                                       130

 1   were told was going to follow this.    Many of

 2   them have been taken out of classrooms

 3   because at least they've dealt with this

 4   population, but unfortunately it doesn't mean

 5   that they know how to do what's required.

 6   This is not what we were told would be

 7   happening.

 8            As I often say, you don't know what

 9   you don't know.    And if the care coordinators

10   don't know and the family doesn't know, guess

11   what?    The individual is not getting what

12   they should be.

13            I'm sure you've heard all about the

14   CDPAP program and that it's been a target,

15   and now it's being looked at as one of the

16   reasons that the Medicaid deficit is so

17   great.    And I realize that has nothing to do

18   with OPWDD.    But the bottom line, from your

19   perspective, is that if these drastic

20   cuts are made to CDPAP, there will be a much

21   greater need for OPWDD services like

22   residential placement in group homes, since

23   these individuals will not be able to stay in

24   their home care environments.
                                                      131

 1          Currently it's allowing people to keep

 2   their loved ones at home.   We know there

 3   aren't enough slots for residential placement

 4   right now, and I've heard you testify that

 5   you're increasing that.   But what -- we

 6   really need to address this need for more

 7   housing, whether it be group home, supportive

 8   living, et cetera.   This is coming.

 9          There's also a rumor of cuts to the

10   comm-hab staffing.   This combination of CDPAP

11   and comm-hab are what enable individuals to

12   live successfully in supportive living or

13   apartments.   Removing these supports will be

14   devastating -- and then what do you do with

15   us?   This is the most frequent question that

16   I get from families:   What are we going to

17   do?

18          COMMISSIONER KASTNER:   Well, as I

19   described our planning for managed care, we

20   have to be assured that the care coordination

21   organizations are effective at delivering

22   person-centered, conflict-free case

23   management.

24          The CCOs launched July 1st of 2018.
                                                       132

 1   When I arrived in January of last year, I

 2   believe it's fair to say they were well

 3   behind in their development of life plans for

 4   individuals.   We specifically focused on that

 5   issue over the next year.    I am pleased that

 6   as of the end of January, all individuals

 7   served through CCOs do have a life plan.

 8         That only means they have a life plan.

 9   It doesn't mean that it is an adequate life

10   plan, that it is person-centered or

11   conflict-free.

12         ASSEMBLYWOMAN MILLER:     Or that they

13   have the services that they needed.

14         COMMISSIONER KASTNER:     I certainly can

15   give that to you.

16         But I will say that since July, when

17   it became apparent that we would then be

18   on-target for each individual having a life

19   plan, we began weekly meetings with CCOs to

20   focus on the more qualitative aspects of the

21   plan -- you know, were they person-centered,

22   did they provide services?    We began looking

23   at things like agency turnover and agency

24   staffing.
                                                      133

 1           We've had weekly meetings with CCOs.

 2   We're in the process of developing a

 3   performance report card based on metrics.

 4   We've told the CCOs that we plan to put

 5   information on our website to make it

 6   available for the public to see what percent

 7   of individuals who are enrolled have life

 8   plans and to look at their performance

 9   relative to each other --

10           ASSEMBLYWOMAN MILLER:   Are you asking

11   the families or the individuals or just the

12   CCOs?   Having a life plan is having a life

13   plan.   But are you asking the families are

14   they getting what they need?

15           COMMISSIONER KASTNER:   We're not

16   serving the families specifically, we're

17   talking with the CCOs at this point.

18           There is an opportunity to pull data

19   off the life plans because they're now

20   aggregated in an IT platform.   But we

21   certainly are open to looking at metrics that

22   families may recommend as being important to

23   them.

24           It's a process of evolution.   But I
                                                        134

 1   want to tell you, it's already underway and

 2   we plan on making that information available

 3   to people so that they can make an informed

 4   decision about the quality of care --

 5         ASSEMBLYWOMAN MILLER:     I think as

 6   usual the families are the last to be

 7   contacted, to be reached out to to see how is

 8   this working.

 9         COMMISSIONER KASTNER:     But we have

10   revitalized, I think, the input from

11   consumers both through our mandatory advisory

12   committees and through other committees.      We

13   have numerous meetings with different parent

14   advisory groups from around the state and

15   also much more locally.    We've really strived

16   to improve our ability to work with families

17   and communicate with them.

18         CHAIRWOMAN WEINSTEIN:     Thank you.

19         We go to the Senate now.

20         CHAIRWOMAN KRUEGER:     Senator Jim

21   Seward.

22         SENATOR SEWARD:     Thank you,

23   Madam Chair.

24         And Dr. Kastner, thank you for being
                                                      135

 1   here this morning -- or afternoon, I should

 2   say.

 3           I wanted to continue the discussion a

 4   bit longer on the CCOs.   And I just wanted to

 5   ask you directly, are there concerns that

 6   you're hearing from providers, families or

 7   other interested parties that are being

 8   brought to your attention through the -- you

 9   mentioned advisory groups and so on.   But are

10   you hearing concerns that you could share

11   with us?

12           And also I would note that in last

13   year's budget for fiscal year 2020, the

14   enacted budget included $5 million to help

15   providers with the transition to managed

16   care.   I note that that sum of money is not

17   included in this year's Executive proposal.

18   Is it no longer needed?   Or is this something

19   that should be continued?   Why weren't these

20   additional funds included in this year's

21   Executive Budget?

22           COMMISSIONER KASTNER:   To the second

23   question, there was last year an

24   appropriation of $5 million for provider
                                                         136

 1   organizations to provide technical assistance

 2   to our community providers for the purposes

 3   of managed-care readiness.      They've created a

 4   managed-care community of practice, are

 5   working with provider agencies on the

 6   potential transition to managed care.

 7           I don't believe that there are funds

 8   in this year's budget.    I can go back and

 9   look.

10           And if you can just repeat the first

11   part of the question, I'd be happy to address

12   that again.

13           SENATOR SEWARD:   Well, I was just

14   curious to hear whether or not you are

15   getting any concerns from providers,

16   families, and other interested parties in

17   terms of how this rollout of the CCOs, how

18   that's working.    Do you have concerns

19   directed to you?

20           COMMISSIONER KASTNER:    Absolutely.

21           The CCO rollout was one of the most

22   important issues that was presented to me in

23   early February when I arrived.     At that point

24   the number of individuals receiving life
                                                       137

 1   plans was far below what we expected, and we

 2   pushed the providers to meet time targets

 3   over the course of this year.     So at this

 4   point every individual has a life plan.

 5            Again, we're focusing on the quality

 6   of those life plans because we're still

 7   continuing to hear concerns from families and

 8   individuals as to whether or not those life

 9   plans are adequate.

10            SENATOR SEWARD:   And how are you

11   reacting to those concerns?

12            COMMISSIONER KASTNER:   Well, as I

13   said, there are carrots and sticks that we

14   can use.    And we meet with the providers and

15   provide them technical assistance, looking at

16   their benchmarks.    But we've also told them

17   we think this is important information to

18   share with the public.     Once we redesign our

19   website, we will be creating a place on the

20   website for people to look at CCO performance

21   and judge for themselves how well they're

22   doing.    We think that that type of public

23   disclosure is really to the benefit of our

24   individuals and families and should drive
                                                      138

 1   performance.

 2         SENATOR SEWARD:   Okay, thank you.

 3         Just one final question.    I wanted to

 4   shift gears to the issue of can you share

 5   with us some of the latest developments on

 6   the sheltered workshop transitions to

 7   integrated work settings as well as

 8   intermediate care facilities' conversions and

 9   the other Home and Community Based

10   Waiver-related compliance actions?

11         Specifically on the -- transitioning

12   our sheltered workshops, one concern that I

13   have when I tour the workshops in my

14   district, many of these folks would like to

15   continue to be working there.   That's what

16   they know, that's what they want.    And is

17   this going to continue to be possible?     If

18   you could just give us an update on how

19   that's going.

20         COMMISSIONER KASTNER:     Sure.   As you

21   know, we are transitioning from sheltered

22   workshops to employment, competitive

23   employment and supported employment.     As of

24   last year, I believe, there were about
                                                      139

 1   30 agencies that were operating sheltered

 2   workshops.   More than half of them had

 3   successfully completed a transition to some

 4   form of employment or supported employment.

 5   I don't have more specific data than that,

 6   but I can obtain that.   I can provide it to

 7   you at a later time, if that would be okay.

 8         SENATOR SEWARD:    Thank you.

 9         CHAIRWOMAN WEINSTEIN:    We go now to

10   Assemblywoman Rosenthal.

11         ASSEMBLYWOMAN ROSENTHAL:     Thank you.

12         OPWDD transitioned from about 350

13   Medicaid service coordinating organizations

14   to seven care coordination organizations to

15   try to eliminate conflicts in the case

16   management system.   Do you know if providers

17   are able to open their own CCOs and recommend

18   the individual receive services through that

19   provider?

20         COMMISSIONER KASTNER:    You are correct

21   that one of the goals of the CCO

22   implementation was to create a system that

23   was conflict-free.   We collaborated with the

24   Department of Health to implement CCOs using
                                                       140

 1   the health home model.    The Department of

 2   Health is the primary regulator of CCOs.

 3         We also coordinated with CMS about the

 4   design of CCOs and the role of providers in

 5   helping to create CCOs.    We believe that that

 6   satisfied CMS in terms of the requirement to

 7   be conflict-free.

 8         ASSEMBLYWOMAN ROSENTHAL:    I mean it's

 9   just about a year old, right, or less than a

10   year old?

11         COMMISSIONER KASTNER:     I'm sorry, I

12   didn't hear the question.

13         ASSEMBLYWOMAN ROSENTHAL:    This has

14   just been in place for a short time.    But

15   have you heard back from individuals or their

16   families in terms of how satisfied they are

17   with the services?

18         COMMISSIONER KASTNER:     I believe that

19   generally satisfaction is one of the metrics

20   that we're looking at.    I don't have that

21   data offhand.   But we are talking with

22   families and individuals about their

23   satisfaction.   And obviously there are

24   opportunities for improvement in that regard.
                                                        141

 1            ASSEMBLYWOMAN ROSENTHAL:   Do you

 2   believe a managed care company paying a

 3   capitated rate will lead to higher-needs

 4   individuals receiving less care?

 5            COMMISSIONER KASTNER:   Well, as I

 6   described it, we have a process for the

 7   implementation of managed care.     We're at the

 8   beginning of that process.    We're just now

 9   revising the draft SIP-PL document.

10            Managed care implementation will

11   depend upon, I think, the feedback that we

12   get on that document.    There are many ways in

13   which managed-care implementation could

14   occur.    It could be focused on state plan

15   services versus waiver services, it could be

16   focused on certain types of beneficiaries --

17   for example, people with Medicaid, people who

18   are dually eligible through Medicaid and

19   Medicare, people with medical insurance.      It

20   could be phased in in different geographies.

21            There are many inputs to an answer

22   that we're really not prepared to offer at

23   this point.

24            ASSEMBLYWOMAN ROSENTHAL:   And when do
                                                        142

 1   you think you will be?

 2          COMMISSIONER KASTNER:    Well, again,

 3   the process is to publish the revised draft

 4   SIP-PL qualifications document, ask for the

 5   public input, and see what they think of the

 6   revisions that we will be making.

 7          ASSEMBLYWOMAN ROSENTHAL:    Okay, thank

 8   you.

 9          CHAIRWOMAN WEINSTEIN:    We go to

10   Senator Savino for questions.

11          SENATOR SAVINO:   Thank you,

12   Assemblywoman.

13          Commissioner, this question may have

14   been asked previously when I was out of the

15   room, I apologize.   But I did say that I

16   would ask on behalf of the affected

17   individuals.   I do want to, though, echo the

18   comments of many of my colleagues with

19   respect to housing issues.     This week it's --

20   I think we're going to be having the

21   Developmental Disabilities Breakfast in

22   Staten Island, and there will be another one

23   in Brooklyn, and it is the number-one issue

24   that comes up over and over as aging parents
                                                       143

 1   are more and more concerned about what will

 2   happen to their sons and daughters if they're

 3   not around.   So we've got to solve this

 4   housing crisis.

 5          Again, I believe it's the shame of

 6   this state the way we treat human service

 7   workers, particularly direct support

 8   professionals.    That they're equated with

 9   minimum wage work, it's just -- it's

10   outrageous.   But it is what it is.

11          Last year, in an effort to satisfy the

12   #bFair2DirectCare campaign, where the

13   Governor proposed -- and it was adopted --

14   another deferral of the COLA, the human

15   service COLA, we did commit to an additional

16   2 percent to the agencies.    I'm being told by

17   several of the agencies in my district that

18   they're not collecting that money yet.     In

19   fact, they won't -- they anticipate they

20   won't get it till after this budget is put to

21   bed.

22          Can you tell me what's happening with

23   the #bFair2DirectCare money and why it hasn't

24   been disbursed?
                                                       144

 1         COMMISSIONER KASTNER:    Certainly.

 2   We've been discussing -- the January 1st

 3   increase of 2 percent for DSPs was

 4   recommended by OPWDD.   It was incorporated

 5   into our rates, and then the rates are sent

 6   up for approval and loading.

 7         So you are correct, they have not yet

 8   been received by our providers, but we do

 9   expect they should be received in the near

10   future.   I can't speak as to whether or not

11   that might occur after April 1st or not.    But

12   we're committed to ensuring that those rates

13   go into force and that they are retroactively

14   paid back to January 1st.

15         SENATOR SAVINO:   I'm not understanding

16   why, if it was supposed to go into effect

17   January 1st, why didn't it?

18         COMMISSIONER KASTNER:    As I said,

19   they've been approved by OPWDD --

20         SENATOR SAVINO:   They've been

21   approved, but they haven't been disbursed.

22         COMMISSIONER KASTNER:    Correct.

23   Because we're not the sole entity responsible

24   for payment to providers.
                                                        145

 1         SENATOR SAVINO:   Would the other

 2   entity be Medicaid?

 3         COMMISSIONER KASTNER:      Well, these are

 4   Medicaid funds; it involves the Department of

 5   Health, the Division of the Budget.

 6         But I can tell you at our end we have

 7   approved those rates and recommended that

 8   they be paid.   They will be paid retroactive

 9   to January 1st.

10         SENATOR SAVINO:   Will they receive

11   interest?

12         COMMISSIONER KASTNER:    I can't speak

13   to whether or not that occurs.    I --

14         SENATOR SAVINO:   It's almost as if

15   we're -- you know, they're giving you guys an

16   interest-free loan.   And I'm not putting you

17   on the spot, it's just -- you know, people

18   worked very hard to get that increase, and

19   it's just a little disconcerting to see that

20   while it's in statute, it's not actually in

21   operation.   And these agencies operate on the

22   margins so often, as you know.    And so it

23   just presents even more complications for

24   them as they deal with, you know, their own
                                                         146

 1   issues.

 2           So I would hope we would find a way to

 3   do it faster.   And I really do think we might

 4   want to consider giving them the interest on

 5   the money that they're owed.

 6           COMMISSIONER KASTNER:     We can

 7   certainly go back and try to nudge that

 8   process forward as quickly as we can.        I

 9   understand it's a cash-flow concern for

10   providers.   I ran provider agencies --

11           SENATOR SAVINO:   Yeah.

12           COMMISSIONER KASTNER:     -- myself, and

13   I understand the margins are tight, that cash

14   flow is a problem.

15           SENATOR SAVINO:   And again, not to put

16   you on the spot, but on January 1st the

17   minimum wage went up in this state.        And so

18   part of this money was to help them meet

19   that.   And so they're saddled with paying the

20   higher wage to their workforce, God bless

21   them -- in fact we want people to earn a

22   better living -- but they didn't get the

23   money to help them do that.

24           So I just think we should be a little
                                                        147

 1   bit more aggressive about making sure they

 2   get their money.

 3           COMMISSIONER KASTNER:    Well, thank

 4   you.    As I said, I'll go look at that.

 5           SENATOR SAVINO:   Thank you.

 6           CHAIRWOMAN WEINSTEIN:    Thank you.

 7           We go to Assemblywoman Miller.

 8           ASSEMBLYWOMAN MILLER:    I have just two

 9   other things that I wanted to ask.      I'm

10   hearing a lot about individuals on

11   self-direction not having -- or the rumor

12   that they will not have full budget

13   authority.   And it's frightening to hear

14   that.

15           Consumers have rights.   Self-direction

16   allows individuals to integrate into the

17   community.   They're gaining skills, making

18   progress to be more independent, with the

19   assistance of the comm-hab staff that I was

20   telling you before.

21           Isn't this the vision and mission

22   statement of OPWDD?    And I quote:    "Vision

23   Statement.   People with developmental

24   disabilities enjoy meaningful relationships
                                                        148

 1   with friends, family and others in their

 2   lives, experience personal health and growth,

 3   and live in the home of their choice and

 4   fully participate in their communities."

 5            The mission statement.   We help people

 6   with developmental disabilities live richer

 7   lives.     Isn't that the promise that we're

 8   making to these constituents?     I know it's

 9   what I promised.

10            They want to know what happened to

11   choices.     Taking away the full budget

12   authority within the regulations and

13   guidelines from the families and the brokers

14   will be devastating for them.

15            The other -- wait, before -- I'll just

16   ask them both at once and then you can just

17   answer.

18            Two years ago we enacted legislation

19   that created a new training program for first

20   responders to recognize and use appropriate

21   techniques to handle emergency situations

22   involving individuals on the autism spectrum

23   disorder.     What's the status of that?   And

24   has anything been developed, has anything
                                                       149

 1   been implemented as of yet?

 2           COMMISSIONER KASTNER:   Sure.

 3   Self-direction is an important tool for us in

 4   helping families and individuals access the

 5   services that they need.   Last year alone, we

 6   expanded the Self-Direction Program, added

 7   3500 more individuals and their families to

 8   the program, at a cost of approximately $100

 9   million.

10           So we are committed to self-direction.

11   We currently spend about $400 million a year

12   and support 17,000, 18,000 individuals.

13   We're -- we're not talking about cutting it.

14   We're not talking about the loss of budget

15   authority.

16           ASSEMBLYWOMAN MILLER:   You're just

17   giving the control to the CCMs {sic}, to the

18   care coordination agencies, rather than the

19   families and their brokers?

20           COMMISSIONER KASTNER:   I -- I don't --

21           ASSEMBLYWOMAN MILLER:   The CCOs are

22   already overwhelmed with the tasks that they

23   have.

24           COMMISSIONER KASTNER:   Well, CCOs are
                                                         150

 1   responsible for developing a life plan.      That

 2   is separate from a family working with a

 3   fiscal intermediary or a support broker to

 4   develop a plan of services to be delivered

 5   through self-direction.

 6         ASSEMBLYWOMAN MILLER:     But the actual

 7   control over the self-direction budget --

 8   things change.   It's fluid.   It changes back

 9   and forth.    Where you don't use one thing, we

10   put it into another -- like we have the

11   ability to make it meet the needs of the

12   individual.

13         COMMISSIONER KASTNER:     So families

14   have full budget authority, and they execute

15   that with --

16         ASSEMBLYWOMAN MILLER:     And they're not

17   losing that.

18         COMMISSIONER KASTNER:     We have no

19   plans at the current -- at this current time

20   to eliminate self-direction or full budget

21   authority.

22         ASSEMBLYWOMAN MILLER:     Okay.   Because

23   that was one thing that I keep hearing, that

24   they're taking the control and removing it
                                                        151

 1   from the families.

 2           Okay, thank you.    And then the --

 3           CHAIRWOMAN WEINSTEIN:    Thank you.

 4           ASSEMBLYWOMAN MILLER:    Thank you.

 5           CHAIRWOMAN KRUEGER:     Senator Carlucci

 6   for a second round.

 7           SENATOR CARLUCCI:   Thank you.

 8           Commissioner, I know we've been asked

 9   about the funding not coming through the door

10   yet.    We've also heard that the July 2019

11   rates have not been approved either.     Is that

12   true?

13           COMMISSIONER KASTNER:    To your point,

14   the July 2019 rates were approved by OPWDD.

15   And similar to the January 1, 2020, rates,

16   they were presented, they need to be approved

17   and loaded and then paid.     We recognize that

18   that's a hardship for our providers, and that

19   does affect their cash flow.     And we're

20   working as effectively as we can to try to

21   get those funds made available to our

22   providers.

23           SENATOR CARLUCCI:   Okay.   And we're

24   also hearing that there will be a cut across
                                                       152

 1   the board in July of this year.   Can you tell

 2   us about that?   Do you know how much that cut

 3   will be?   And is that -- is that true?

 4         COMMISSIONER KASTNER:     The budget did

 5   include a 2 percent across-the-board cut for

 6   providers, that is true.

 7         SENATOR CARLUCCI:    Okay, so 2 percent

 8   across the board.

 9         And before, in the previous

10   conversation we had or testimony we had, we

11   talked about how 80 percent of the services

12   being provided by nonprofits, 20 percent by

13   state-run facilities.    Can you tell us about

14   the cost of living adjustment or the trend

15   that we've seen?    Is that provided equally to

16   state-run facilities as well as

17   non-for-profit facilities or operations?

18         COMMISSIONER KASTNER:     Well, we've

19   talked a lot about the rates paid to

20   voluntaries for the services provided on

21   behalf of people with developmental

22   disabilities.

23         The state side of the operation is

24   funded based upon the collective bargaining
                                                       153

 1   agreement.    So I would defer to that document

 2   and those negotiations for specific

 3   information about the size of any increases

 4   of salary or benefits.

 5          SENATOR CARLUCCI:   So are we saying

 6   there's a difference between the COLA for

 7   state and the COLA for nonprofit

 8   organizations?

 9          COMMISSIONER KASTNER:    There probably

10   is.   I don't know the specific nature of

11   that, but that would be a reasonable

12   assumption.

13          SENATOR CARLUCCI:   Well, it seems that

14   there's been a deferred COLA on the

15   nonprofits but not for the state.

16          COMMISSIONER KASTNER:    I'm sorry?

17          SENATOR CARLUCCI:   The COLA has been

18   deferred for the nonprofits but not for the

19   state-run operations.

20          COMMISSIONER KASTNER:    Well, as I

21   said, there is a deferral of the COLA for the

22   voluntaries.   I don't know what the specific

23   parameters are of increases for state

24   employees under the collective bargaining
                                                       154

 1   agreement.

 2         SENATOR CARLUCCI:   Okay.    I wanted to

 3   ask just -- this has come up.    We see in the

 4   Executive proposal that the -- there will be

 5   the removal of the background checks for

 6   health homes in the Executive Budget.     And

 7   you're talking about it's a duplication of a

 8   background check.

 9         Could you tell us more about that and

10   maybe tell us why that's necessary and what

11   that will do?

12         COMMISSIONER KASTNER:     That is

13   applicable to health homes in general.     The

14   health homes are operated by the Department

15   of Health.   That falls outside of OPWDD's

16   scope, so I really can't comment on that.

17         SENATOR CARLUCCI:    Okay.   Since I have

18   just a minute left, I wanted to ask about

19   when we talk about children with autism, we

20   see a large spectrum.   And I've been working

21   with parents particularly that are concerned

22   about high-functioning children with autism

23   and making sure that they have the

24   appropriate services.
                                                        155

 1           Can you tell me what OPWDD is doing to

 2   make sure that children with high-functioning

 3   autism are getting the services that they

 4   need?

 5           COMMISSIONER KASTNER:    Sure.   One of

 6   the strengths of OPWDD is that it's focused

 7   on individuals and the planning is

 8   individualized.     And if you qualify for OPWDD

 9   services, you actually access a wide range of

10   support and services.     There are many

11   children, particularly individuals with

12   high-functioning autism, who can benefit from

13   services but may not qualify.

14           And in addition, we historically have

15   not been particularly strong at building

16   systems of care.    So we're taking a lesson, I

17   think, from OMH and focusing on building a

18   continuum of services.    We're looking at how

19   to engage pediatric providers, primary care

20   providers, and other healthcare professionals

21   to provide appropriate supports.    We're

22   looking at building capacity among behavioral

23   health providers.    We're also trying to

24   expand our access to intensive behavioral
                                                        156

 1   services and, as I described in my testimony,

 2   building out our network of crisis response

 3   services.

 4         We think there's a significant

 5   opportunity to help children and their

 6   families in particular access services which

 7   might be more preventive in nature, as

 8   opposed to reactive.   I've heard the comments

 9   about individuals in ERs and hospitals.     We

10   want to try to avoid those when we can.     So

11   being proactive, building systems that

12   support individuals would be very helpful in

13   that regard.

14         SENATOR CARLUCCI:   Thank you,

15   Commissioner.

16         CHAIRWOMAN WEINSTEIN:    Thank you.

17         We go to Assemblywoman Griffin.

18         ASSEMBLYWOMAN GRIFFIN:    Thank you.

19         Good afternoon.   I don't know if this

20   has been asked before, so forgive me if I'm

21   repeating.   I know that the direct care

22   worker wages have increased by 4 percent, and

23   a 2 percent increase for clinical staff.     But

24   I often meet with groups that work within
                                                      157

 1   these groups, but they're not considered

 2   direct care workers so they might not be

 3   getting this wage increase.

 4          And I wondered, are there known groups

 5   that are excluded from being categorized as

 6   direct care workers?

 7          COMMISSIONER KASTNER:    My

 8   understanding of how the salary increases for

 9   DSPs occurs is that there are certain types

10   of positions that are eligible for that

11   increase and others that are not.    I mean,

12   clearly the focus is on supporting

13   individuals that have a direct care

14   relationship to individuals as opposed to

15   management in the nonprofits.

16          So we use certain position categories

17   to identify individuals that would be

18   eligible for that salary increase.

19          ASSEMBLYWOMAN GRIFFIN:   Okay, thank

20   you.   Yeah, it seems like there are -- you

21   know, I've met with -- I represent

22   southwestern Nassau County and I've been at a

23   couple of, you know, information meetings,

24   legislative breakfasts.   And obviously it's a
                                                           158

 1   very underfunded area.   And there's so many

 2   workers that -- you know, so many families

 3   can't find people to work with their loved

 4   ones because it's not well funded, like to

 5   give them the adequate salaries.      So it does

 6   seem to, you know, to be an issue.        So that

 7   is something that I do question.

 8            The other thing is I notice that we

 9   have a cost-of-living adjustment that has

10   been deferred.    So if the direct care workers

11   are getting an increase, who are the ones

12   that getting deferred from a cost of living

13   adjustment?

14            COMMISSIONER KASTNER:    The salary

15   increases that were described earlier, the

16   January 1st and April 1st, are for DSPs.        The

17   second increase is for DSPs plus clinical

18   staff.    So the intent is to support the

19   capacity of organizations to provide services

20   directly to the individual, but the salary

21   increases are not focused on management.

22            ASSEMBLYWOMAN GRIFFIN:   Okay.     Okay,

23   thank you very much.

24            CHAIRWOMAN WEINSTEIN:    Senate?
                                                           159

 1            CHAIRWOMAN KRUEGER:     Thank you.     I'm

 2   almost going to let you go.      So someone asked

 3   you before, but either I didn't understand

 4   the answer or you didn't give the answer.

 5            You have 150 agencies on a financial

 6   watch list.    Tell me what that means, give us

 7   a list of the agencies -- send it to us --

 8   and tell me what it means when you add a 2

 9   percent cut in July.

10            COMMISSIONER KASTNER:    As we

11   discussed, we are looking at our provider

12   capacity to ensure that it is adequate to

13   meet the needs of our individuals.        The

14   current payment methodology to providers is

15   based on cost-based -- is cost-based, meaning

16   that the agencies send us a consolidated

17   fiscal report which identifies all of their

18   costs.    All of those costs go into the rate

19   setting for that specific organization.

20            So there's a high degree of

21   variability for each agency in terms of the

22   rate that they're paid.    We look at agencies

23   that may be fiscally stressed.      We do not

24   want agencies to fail.    We're particularly
                                                       160

 1   concerned about agencies that have lower

 2   costs, because they receive lower

 3   compensation.   Those are agencies that we do

 4   want to support.   There's no incentive for us

 5   to allow them to fail, because if they fail

 6   generally a higher-cost agency would assume

 7   responsibility for providing those services.

 8         So we're looking at opportunities to

 9   try to enhance their operations and make them

10   viable.

11         CHAIRWOMAN KRUEGER:      So you will be

12   able to provide us with a list of the 150

13   that are now on the watch list?

14         COMMISSIONER KASTNER:     Of course.

15         CHAIRWOMAN KRUEGER:      How many of them

16   went under last year?

17         COMMISSIONER KASTNER:     I do not know.

18         CHAIRWOMAN KRUEGER:      You don't know?

19         COMMISSIONER KASTNER:     No, I don't

20   have that personal information.    We can find

21   that for you.

22         CHAIRWOMAN KRUEGER:      So if you could

23   follow up and also let us know how many went

24   under in the past 12 months.
                                                          161

 1            COMMISSIONER KASTNER:    Yes.   Yes.

 2            CHAIRWOMAN KRUEGER:     I think that's

 3   your time with us today.   Thank you very much

 4   for testifying.

 5            COMMISSIONER KASTNER:    Thank you,

 6   Senator.

 7            CHAIRWOMAN KRUEGER:     Thank you.   And

 8   our next government witness, New York State

 9   Office of Alcoholism and Substance Abuse

10   Services, Arlene Gonzalez-Sanchez,

11   commissioner.

12            Good afternoon.

13            COMMISSIONER GONZALEZ-SANCHEZ:       Good

14   afternoon, Senator Krueger, Assemblymember

15   Weinstein, Senator Harckham, Assemblymember

16   Rosenthal, and distinguished members of the

17   Senate and Assembly.   My name is Arlene

18   Gonzalez-Sanchez, and I'm the commissioner of

19   the New York State Office of Addiction

20   Services and Supports, or better known as

21   OASAS.

22            Thank you for providing me with the

23   opportunity to present Governor Cuomo's

24   fiscal year 2021 Executive Budget as it
                                                     162

 1   pertains to OASAS.   The Governor's Executive

 2   Budget proposes that OASAS receive over $821

 3   million, including $140 million for state

 4   operations, $90 million for capital projects,

 5   and $591 million for aids to localities.

 6         The proposed Executive Budget will

 7   enable us to continue funding our prevention,

 8   treatment and recovery programs, including

 9   the increase in minimum wage for OASAS-funded

10   providers as well as targeted salary

11   increases for support, direct care and

12   clinical staff.

13         The budget also supports increased

14   spending for capital projects consistent with

15   the agency's five-year capital plan,

16   including over 200 residential treatment beds

17   expected to open throughout the state over

18   the next three years.

19         The Executive Budget establishes a new

20   fund for the collection of fines levied for

21   violations of existing state and federal

22   behavioral health parity laws.   Monies from

23   this fund would be used for initiatives

24   supporting further parity implementation,
                                                        163

 1   including the ombudsman program.

 2         The Governor has proposed legislation

 3   to add 26 additional fentanyl analogs to the

 4   state's schedules of controlled substances.

 5   This is especially crucial in the fight

 6   against the opioid epidemic, since the

 7   majority of all overdose deaths in New York

 8   State involve the use of substances

 9   containing fentanyl.

10         We will continue to enhance access to

11   medicine-assisted treatment, increase

12   prescriber education and resources, and train

13   individuals in the use of naloxone as part of

14   our continued effort to combat the opioid

15   crisis.

16         Through our ongoing work, we are

17   making measurable progress.   For the first

18   time in years we are starting to see a

19   reduction in opioid overdose deaths.     We have

20   accomplished much of this progress through

21   our Centers of Treatment Innovation, or

22   COTIs, which offer expanded access to

23   substance use disorder services through

24   mobile treatment, telepractice and peer
                                                     164

 1   services.

 2          Counties served by COTIs have seen a

 3   25 percent decline in opioid-related overdose

 4   deaths and a 48 percent decline in opioid

 5   overdose emergency department visits.    So

 6   this year we're expanding COTIs statewide.

 7   Today we announced the availability of

 8   funding to establish one mobile treatment

 9   vehicle in each of the 10 Economic

10   Development Regions in New York, and to

11   develop telepractice capacity in every county

12   in the state.

13          We have also facilitated

14   collaborations between emergency departments

15   and OASAS-certified treatment programs to

16   enhance medical providers' ability to offer

17   MAT.   EDs can begin induction on medication

18   to treat opioid use disorder, and with the

19   help of peers, provide a supportive

20   transition to ongoing treatment.

21          Another area that I would like to

22   highlight is our efforts to establish and

23   support MAT in state and local correctional

24   facilities.   Currently MAT is offered in
                                                      165

 1   11 state facilities and 52 county

 2   correctional systems, including New York

 3   City.

 4           We are currently working with the

 5   New York State Department of Corrections and

 6   Community Supervision and the Department of

 7   Health to implement a buprenorphine program.

 8   Medical staff at the seven facilities have

 9   received training on buprenorphine already.

10   This will permit individuals who are

11   maintained on buprenorphine while

12   incarcerated in county jails to continue

13   their treatment when transferred to state

14   custody.

15           OASAS also working closely with DOCCS

16   to initiate an OTP inside a correctional

17   facility.    This would be the first

18   state-operated OTP in a correctional facility

19   in the country.

20           As we all know, recovery supports are

21   crucial.    Over the past year, we have opened

22   18 new recovery centers, for a total of

23   32 recovery centers serving more than

24   50,000 individuals across the state.    The
                                                        166

 1   agency has also implemented a multifaceted

 2   approach to prevention, reaching youth,

 3   families and communities across the state

 4   through classroom-based curriculums,

 5   schoolwide environmental activities, and

 6   individualized prevention support for at-risk

 7   students.

 8         All of these services would not be

 9   possible without a dedicated SUD workforce.

10   At OASAS we are proactively finding ways to

11   support employees and staff.   Last week we

12   announced the award of over $300,000 in

13   scholarship funding to support the

14   professional development of employees at

15   OASAS-certified organizations.

16         Finally, we continue developing public

17   education campaigns to address stigma, raise

18   community awareness about addiction, and

19   provide information on where to get help.     In

20   2020 plans are underway to launch new

21   campaigns to address many common

22   misconceptions about addiction prevention,

23   treatment and recovery.

24         So as you can see, we have been
                                                           167

 1   working on expanding and enhancing our

 2   services across New York State.      And under

 3   Governor Cuomo's leadership, and with your

 4   support, we continue to make an aggressive

 5   push to confront the opioid crisis and save

 6   lives.    We look forward to your continued

 7   partnership as we advance these priorities.

 8            Thank you.

 9            CHAIRWOMAN KRUEGER:    Thank you.

10            Senator Pete Harckham.

11            SENATOR HARCKHAM:   Thank you, Madam

12   Chair.

13            Commissioner, it's great to see you.

14   Thank you and your team for the great work

15   that you do.

16            Before I ask you a couple of

17   questions, just a statement -- and you don't

18   have to respond to this -- that many of us

19   and many of the people in the field think

20   that you are drastically underfunded.        And so

21   I know that's not a question; you don't have

22   to respond to it.     Those decisions are made

23   at a different pay grade.      And I'm sure

24   you'll hear testimony from some of the
                                                       168

 1   experts later on in the afternoon saying the

 2   same thing.

 3         So I just wanted to put out on the

 4   record that for this Senator and for a number

 5   of the Senators who could not be here, we

 6   need to see your funding increased

 7   drastically, and that's our job to do.       So

 8   thank you for all you do.

 9         A couple of things.     We spoke about

10   workforce issues with the other agencies.

11   The Senate was happy to partner with you on

12   the loan forgiveness, $300,000.    Tell us how

13   that program is working, how it's been

14   received, and should we expand that.

15         COMMISSIONER GONZALEZ-SANCHEZ:     It's

16   going tremendously well.    As a matter of

17   fact, last week we announced -- I think it

18   was like 38 or 48 awards, which tells you

19   that it's really very much needed.    People

20   really jumped on it.   With this money, people

21   who are already or are thinking of becoming

22   licensed social workers or mental health

23   professionals will get additional help to pay

24   for the schooling as well as the certified
                                                        169

 1   prevention.

 2           So it's going tremendously well.    It

 3   was one of those initiatives that when we put

 4   it out, immediately the response was

 5   tremendous.   So it's going really, really

 6   well.   And it's going to do a lot for our

 7   workforce.

 8           SENATOR HARCKHAM:   Great.    Switching

 9   now briefly to the ombudsman program.     It was

10   mentioned during another agency's testimony;

11   $1.5 million is the budget.   If you would

12   explain to our constituents exactly what the

13   ombudsman program is and how many people it

14   serves.

15           COMMISSIONER GONZALEZ-SANCHEZ:     Well,

16   as Commissioner Sullivan indicated, they've

17   served over 1600 cases already.      It's boots

18   on the ground.   There are five community

19   agencies right now that are funded through

20   the 1.5 that are actually doing the boots on

21   the ground helping individuals.

22           Again, it's another program that has

23   shown the tremendous need for this kind of

24   work in the community.   And there are areas
                                                       170

 1   of the state that we don't have a

 2   community-based organization to assist

 3   families.

 4         SENATOR HARCKHAM:   Right.

 5         COMMISSIONER GONZALEZ-SANCHEZ:     And I

 6   see you have the map.

 7         SENATOR HARCKHAM:   Yeah.

 8         COMMISSIONER GONZALEZ-SANCHEZ:     And so

 9   if we were to acquire additional dollars, we

10   would want to ensure that those areas that

11   are blanked, we could have a community-based

12   organization there to help individuals work

13   with these entitlement issues.

14         SENATOR HARCKHAM:   All right.    So this

15   is the map of the areas where we have gaps.

16   So the gray areas are where we have gaps, the

17   colored are the regions where we have

18   service.

19         So how much would it cost us to get to

20   fill in the entire state and cover all the

21   regions?

22         COMMISSIONER GONZALEZ-SANCHEZ:     So

23   right now we're funding the existing ones at

24   $30,000, and there are five of them.    What we
                                                       171

 1   understand is that the funding is a little

 2   low, so what we'd like to do is bring it up

 3   to $50,000 and then fund additional CBOs at

 4   that rate.

 5         SENATOR HARCKHAM:   Okay.    And then the

 6   thought, as explained to me, is that the

 7   ombudsman program would go to $3 million,

 8   with approximately $1.5 million coming from

 9   the new ability of OFS to levy fines --

10   promulgate rules and levy fines against

11   insurance providers who are not guaranteeing

12   parity.

13         COMMISSIONER GONZALEZ-SANCHEZ:      Yes,

14   it would be up to 1.5 if the appropriation is

15   approved and goes through.

16         SENATOR HARCKHAM:   Okay.    All right.

17         And then in your estimation -- let's

18   just say things work in a perfect world, that

19   part of the budget goes through.    How long do

20   you think it takes for OFS to promulgate the

21   rules, people get up to speed, cases brought,

22   fines developed, and money starts flowing in?

23         COMMISSIONER GONZALEZ-SANCHEZ:     Well,

24   like anything, it will probably take a little
                                                         172

 1   time to get off the ground.    So in the

 2   interim, you know, we'll have to continue

 3   working in the areas that we are.     But it may

 4   take a little while before fines are

 5   promulgated and collected.

 6           SENATOR HARCKHAM:   So we're still

 7   going to be short -- unless there's

 8   legislative action, we're still going to be

 9   1.5 shy from the 3.0.

10           COMMISSIONER GONZALEZ-SANCHEZ:       Yes.

11           But, you know, I also want to make

12   clear just because we don't have a

13   community-based organization in those areas,

14   that we are not intervening when we're called

15   upon.   It's just that it makes it more

16   difficult when you don't have, you know, CBOs

17   in particular areas.    But we will continue --

18           SENATOR HARCKHAM:   Right.    And you've

19   got -- you've got the hotline, but that's

20   still not a 24/7.   So in either case, we have

21   gaps that we need to fill.

22           COMMISSIONER GONZALEZ-SANCHEZ:       Yes.

23           SENATOR HARCKHAM:   Okay.    Okay.

24           Moving on, a couple of other quick
                                                       173

 1   things.    We did a lot of traveling around the

 2   state, as you know, the Senate did, in the

 3   summer and in the fall, and we found out that

 4   there were a lot of gaps.    Gaps when people

 5   leave hospitals, when they leave a

 6   correctional facility, when they leave

 7   treatment.

 8            And one of the things that the federal

 9   government has offered is funding of

10   take-home doses, up to a month.    And that can

11   help sort of fill the gap in

12   medication-assisted treatment while we're

13   trying to get someone into their next.

14            New York's Medicaid reimbursement

15   model disincentives this.    So what are we

16   doing to try and make this a more proactive

17   means of protecting people in the short term?

18            COMMISSIONER GONZALEZ-SANCHEZ:   So as

19   you know, it is a complicated system, and

20   some of it is outside the jurisdiction of

21   OASAS.    Nevertheless, we continue to work

22   with correctional facilities, with our

23   community-based organizations, to see how we

24   could minimize those risks of people being
                                                        174

 1   released without medication, using our peers

 2   and primarily our community-based, you know,

 3   providers who assist us in being there and

 4   helping us with this situation.

 5            But it is a complicated system that

 6   really falls outside of, you know, OASAS when

 7   you're talking about Medicaid.

 8            SENATOR HARCKHAM:   Okay.   All right.

 9   I know we're going to run out of time soon.

10   I'm going to try and combine a bunch of

11   questions into one.

12            Criminal justice.   You had mentioned

13   medication-assisted treatment in our

14   correctional facilities.     A, want to know how

15   that is going.

16            B, we talk about criminal justice

17   reform.    A lot of the sheriffs are saying,

18   Well, we no longer have that population to

19   treat.    Obviously that's not where we want to

20   treat people, we want to get them first.

21            But what are the things that we can do

22   at the time of prearrest or arrest rather

23   than, you know, for that lower level

24   population?
                                                       175

 1         And the third question is, what are we

 2   doing to aid folks when they're getting out

 3   of correctional facilities as a bridge?

 4   Because we know that's -- those are among the

 5   highest population for overdose deaths.

 6         COMMISSIONER GONZALEZ-SANCHEZ:     Okay,

 7   so let's see how I figure this out.    So let's

 8   start off with we have 56 community-based

 9   correctional facilities.   And out of the 56,

10   45 are doing Vivitrol and 32 are doing

11   methadone and buprenorphine.

12         Now, on the state correctional side,

13   we have 52 prisons.   All 52 are doing some

14   addiction services.   Out of those 52, 11 are

15   doing medication-assisted treatment.     Out of

16   those, four are doing Vivitrol and seven are

17   doing methadone.   And soon, hopefully soon

18   they'll be doing buprenorphine as well.

19         So we have currently over 200

20   individuals behind the wall in state

21   facilities, including a handful of pregnant

22   women that are getting medication-assisted

23   treatment behind the wall.

24         On the community side, as I indicated,
                                                         176

 1   we have those programs already providing

 2   medication-assisted treatment.     For those, we

 3   continue to work with the sheriffs to look at

 4   realigning some of the dollars that they got

 5   to prescribe medication -- because the time

 6   frame is so short now, to do more quick

 7   assessment and referrals using peers.

 8          We're also working with the various

 9   DAs, you know, in Staten Island, here in

10   Albany, to do diversion programs at the point

11   in which police interact with the individual

12   prior to arraignment -- the HOPE program in

13   Staten Island, LEAD here.

14          So we are doing a lot of different

15   things on the community side to really

16   address this issue.

17          SENATOR HARCKHAM:    Thank you.

18          CHAIRWOMAN KRUEGER:     Thank you.

19          Assembly.

20          CHAIRWOMAN WEINSTEIN:    We go to

21   Assemblywoman Rosenthal, chair of our

22   Alcoholism Committee.

23          ASSEMBLYWOMAN ROSENTHAL:     Hi.     Thank

24   you.   Hello, Commissioner.    Good to see you.
                                                       177

 1            So we've heard how overdose deaths are

 2   going down.    But can you explain the

 3   disparity in data between the DOH opioid

 4   dashboard and the DOH county opioid quarterly

 5   reports?    And from the dashboard, it doesn't

 6   appear to be any improvements in

 7   opioid-related deaths in the state, yet it's

 8   been said often that the number of

 9   opioid-related deaths seems to be going down.

10            COMMISSIONER GONZALEZ-SANCHEZ:     I

11   don't know that I'm prepared to discuss DOH

12   dashboard data.    I don't know that I really

13   could do that.    So I couldn't respond to

14   that.

15            ASSEMBLYWOMAN ROSENTHAL:   Okay.   So

16   assuming, yes, there's a reduction in

17   overdose death rates between 2017 and 2018 --

18   and I think a lot of them were in the City of

19   New York -- the pace of recovery is lopsided.

20   And we've not moved the dial for low-income

21   communities and communities of color, it

22   seems.

23            I have legislation to require that

24   naloxone be made available in homeless
                                                        178

 1   shelters across the state, because every life

 2   matters.   Does OASAS have a program to

 3   provide shelters with naloxone?

 4           COMMISSIONER GONZALEZ-SANCHEZ:    Well,

 5   as you know, we do provide training, naloxone

 6   training, and we do our own training.     We

 7   also, in collaboration with DOH, do that.

 8   And when we do train folks, we have the

 9   ability to give kits.

10           ASSEMBLYWOMAN ROSENTHAL:   But I don't

11   believe that it's a requirement in all the

12   homeless shelters.   And certainly people with

13   opioid use disorder are present in shelters

14   the way they are throughout society.

15           COMMISSIONER GONZALEZ-SANCHEZ:    Right.

16   I don't believe it's required that they do

17   that.   But I do know in some of the shelters

18   that we have both mental health and addiction

19   teams doing some work with individuals in the

20   shelter.   I believe there's an offer and --

21   to give kits and also to train individuals,

22   to engage them in treatment.

23           But in terms specifically of Narcan

24   kits being given out, I really couldn't tell
                                                        179

 1   you that that was a mandate, no.

 2         ASSEMBLYWOMAN ROSENTHAL:     Okay.   So

 3   along those lines, I'm the sponsor of

 4   legislation requiring that

 5   medication-assisted treatment be provided in

 6   state and county correctional facilities as

 7   well as, yes, state prisons.

 8         The Governor announced in a State of

 9   the State proposal that New York would seek

10   to have DOCCS recognized as an OTP.    So while

11   it's good that the administration is

12   recognizing the importance of targeting the

13   vulnerable population with offers of MAT,

14   getting it recognized as an OTP will take a

15   long time.

16         It would be great if the

17   administration would consider expanding its

18   relationship with community-based OTPs so the

19   state correctional facilities can start

20   providing access to MAT now.

21         COMMISSIONER GONZALEZ-SANCHEZ:       Well,

22   in fact there are some guest dosing that was

23   being done by our community-based

24   organizations at these different facilities.
                                                         180

 1   And when DOCCS does get a program, then

 2   they'll be able to do it on their own.        But

 3   for now it's through relationships with our

 4   community-based organizations that they are

 5   providing the methadone.

 6         ASSEMBLYWOMAN ROSENTHAL:     I don't

 7   understand how anyone could justify not

 8   providing buprenorphine, Vivitrol and

 9   methadone -- all three -- in state prisons

10   where we know it's needed.     Every single

11   prison, so that -- and in every county

12   facility as well.   Because we know that

13   overdoses happen, we know that people

14   sometimes struggle to not be as dependent.

15         So if they had the buprenorphine, if

16   they had methadone, if they had Vivitrol for

17   those who want the one-month shot, that that

18   be given to them.   I mean, they don't have

19   fewer rights in terms of healthcare just

20   because they're behind bars.

21         COMMISSIONER GONZALEZ-SANCHEZ:      So

22   what I'd like to say -- first of all, you

23   know, I feel that I'm answering for the DOCCS

24   commissioner, and I want to make sure that I
                                                          181

 1   don't do that.    But from where I sit, I have

 2   to say that I've seen a tremendous

 3   partnership with DOCCS in the last couple of

 4   years.    I mean, the fact that we are in 11

 5   facilities I think speaks a lot.

 6            I think we need to also learn a little

 7   more about the needs behind the wall:       Do we

 8   need 52 prisons to have all three

 9   medications?    I don't know.   And I think this

10   is something we have to evaluate.

11            You have three reception centers that

12   they are opening that, you know, individuals,

13   once they are arrested and before they get

14   transferred to wherever they're going to do

15   their state time, will go.      We have three

16   that they could continue their medication,

17   and now we have seven facilities.

18            I think we need to look at who we're

19   talking about.    Are the numbers there to then

20   say we need to expand it to yet more prisons?

21   And I humbly say that's my opinion, and I

22   don't want to speak for the commissioner of

23   DOCCS.

24            ASSEMBLYWOMAN ROSENTHAL:   Okay.    Well,
                                                       182

 1   the Assembly last year added $1 million to

 2   the budget to expand MAT, but this funding

 3   was not carried over into the 2021 budget.

 4   So are there concerns that the funding, you

 5   know, not being continued will affect the

 6   pilot programs that are going on?

 7         COMMISSIONER GONZALEZ-SANCHEZ:     Well,

 8   I have to say that yes, it wasn't carried on.

 9   It was a one-time item, so the expectation

10   was not to carry it on.

11         However, I think that there are

12   efficiencies that we could look at.    Like I

13   said, that we are looking, we are working

14   with the local sheriffs and police to see how

15   we could realign some of the dollars that are

16   in the county jails.

17         And so at this point I think that

18   there are concerns.    I think that people are

19   working more closely together because of

20   other changes in laws.    And we're watching it

21   carefully to see if they are.

22         ASSEMBLYWOMAN ROSENTHAL:     I think this

23   is part of a game.    Like you put it in the

24   budget, and I'll take it out, and then you
                                                        183

 1   restore it.

 2         But in this area, and I'll echo

 3   Senator Harckham said, there's no room for

 4   games here.     I mean, it's a small budget and

 5   the need is so great.     We need to have Narcan

 6   in every emergency room.    We need

 7   buprenorphine in every emergency room.     We

 8   need MAT available with counseling to people

 9   behind bars.    We need so much more.   And this

10   petty -- you know, the Executive removes 2

11   million for SAPAS workers, the Assembly

12   restores it, now the Senate can join us in

13   restoring it.    It's like games that shouldn't

14   happen in a budget that is dealing with

15   life-and-death issues.

16         And I wish that there was much more

17   money devoted to dealing with the overdose

18   crisis than there is right now.

19         Can you tell me how much federal money

20   OASAS has received this year?

21         COMMISSIONER GONZALEZ-SANCHEZ:      Well,

22   we receive 111 million from -- for prevention

23   and treatment.    And as part of the SOR, we

24   are receiving 35, I believe -- 32, 35
                                                      184

 1   million.

 2         ASSEMBLYWOMAN ROSENTHAL:    And do we

 3   know what we expect in the future?

 4         COMMISSIONER GONZALEZ-SANCHEZ:      The

 5   SOR, the state -- well, the federal grant, we

 6   expect the same amount unless there are some

 7   cuts in Washington.   The SOR is time-limited,

 8   so this will be the last year that we get the

 9   30 to 35 million that we're getting.

10         ASSEMBLYWOMAN ROSENTHAL:    Okay.   And

11   then I see time is running out, but I have

12   legislation on sober homes, three-quarter

13   homes, recovery homes, where people who are

14   newly in recovery go to find a supportive

15   environment in which to live.

16         But many in recovery homes are in

17   treatment looking for a stable living

18   environment.   Sober homes are not typical

19   housing, and they are not treatment, so they

20   fall within a gray area.   Someone who doesn't

21   have a safe and stable home in which to live

22   will find it much more difficult to maintain

23   their sobriety.

24         What does OASAS think its role is, or
                                                         185

 1   should be, with respect to sober homes?

 2            CHAIRWOMAN WEINSTEIN:    And you'll have

 3   an opportunity to answer that in the second

 4   round.

 5            ASSEMBLYWOMAN ROSENTHAL:    Okay.

 6            CHAIRWOMAN KRUEGER:     Thank you.

 7            Senator James Seward.

 8            SENATOR SEWARD:   Thank you, Madam

 9   Chair.    And thank you, Commissioner.

10            Following up on the discussion in

11   terms of what goes on in the local jails, I

12   know that the last two to three years this

13   has been a Senate priority, to include

14   $3.75 million for jail-based substance use

15   disorder treatment.    Have these funds been

16   released from this year's budget?      Or what's

17   your plan to implement this $3.75 million?

18            COMMISSIONER GONZALEZ-SANCHEZ:       Oh,

19   no, the 3.75 is in the base.      And yes, it's

20   been released.    And that's what the local

21   jails and sheriffs are using to develop peer

22   programs and so on and so forth.      It's very

23   well used, yes.

24            SENATOR SEWARD:   Do you have a process
                                                            186

 1   in place to evaluate the effectiveness of

 2   these programs?

 3         COMMISSIONER GONZALEZ-SANCHEZ:          Of the

 4   jail-specific ones?

 5         SENATOR SEWARD:     Right.     Right.

 6         COMMISSIONER GONZALEZ-SANCHEZ:          We

 7   have a process and -- we have a report that

 8   we actually share with the Legislature on all

 9   the new initiatives, like the recovery

10   supports, the clubhouses.    And I believe the

11   report was sent either last week or today or

12   something -- I think last week.

13         With respect to the efficiencies or

14   the -- not efficiencies, but the outcomes of

15   the jail-based, we're continuing to work with

16   the sheriff associations to monitor the

17   outcomes.    So we work with them.    Do we get a

18   report?     We're working on trying to get a

19   report from them.

20         SENATOR SEWARD:     I would share the

21   concerns of my colleagues that the additional

22   $1 million for the MAT program in our local

23   jails is not included in the Executive's

24   proposal.    And it's certainly, I think, a
                                                      187

 1   much-needed program that hopefully we can

 2   figure out a way to continue that.

 3           You mention the reduction in heroin

 4   overdoses here, and I've experienced that in

 5   some of my counties as well.    Would you say

 6   that this is -- this phenomenon, and I think

 7   it is a good trend to see.     But is there a

 8   way to evaluate whether that is because of

 9   the expanded availability of Narcan?     Or is

10   there just less use of heroin through, you

11   know, the treatment opportunities and the

12   like?

13           I mean, how can we judge whether it's

14   the Narcan or less use through treatment and

15   other means?

16           COMMISSIONER GONZALEZ-SANCHEZ:    I

17   think it's a combination.    And what we saw

18   early last year is that those counties,

19   especially upstate, where we implemented the

20   COTIs, the Centers of Treatment Innovations,

21   where we brought telehealth, we brought

22   mobile capacity to very, you know, rural

23   areas where there was no treatment, we saw a

24   drastic decrease in overdose deaths and even,
                                                      188

 1   you know, emergency room visits.

 2           So I think having that, the treatment

 3   and the access to that -- remember, we've

 4   also, through legislation, really increased

 5   access by flexing some of our regulations.

 6   We're out there training, you know, on

 7   Narcan.   I think it's a combination of all

 8   that.

 9           But certainly I think that, you know,

10   the mobile treatment has been key.    And the

11   telehealth, it's been really, really

12   tremendous for our population.

13           SENATOR SEWARD:   And one final

14   question, Commissioner.    You know, as I read

15   the Governor's budget, the amount of funds of

16   approximately $240 million for

17   heroin/opioid-related funding of various

18   programs is flat.   And could you share with

19   us how these funds will be utilized --

20   generally, obviously.     You can't talk about

21   every single dollar -- but how these funds

22   will be utilized, and do you believe that

23   more funding would help combat even better

24   this heroin/opioid epidemic in New York
                                                           189

 1   State?

 2            COMMISSIONER GONZALEZ-SANCHEZ:       Well,

 3   what I could say is that there is a slight

 4   increase in our budget, at least the

 5   appropriated budget.   The budget -- this

 6   current budget does allow us to continue all

 7   the work that we're doing, and yet some that

 8   are in the pipeline, like I indicated, having

 9   telehealth in every county, having the mobile

10   treatment in each county.

11            So this budget does allow me to

12   continue those efforts.

13            SENATOR SEWARD:   Thank you.

14            CHAIRWOMAN KRUEGER:     Thank you.

15            Assembly.

16            CHAIRWOMAN WEINSTEIN:    Assemblyman Ra.

17            ASSEMBLYMAN RA:   Thank you,

18   Commissioner.

19            I just had a question with regard to

20   the cannabis proposal.     And I know there's

21   been obviously a lot of discussion about this

22   proposal publicly, it came up last year, and

23   there's an office that's going to deal with a

24   lot of the pieces of this.
                                                         190

 1            But do you foresee, you know, any new

 2   needs within your department as a result of

 3   this adult use of marijuana potentially

 4   becoming legal in New York State?

 5            COMMISSIONER GONZALEZ-SANCHEZ:   Well,

 6   we will continue to work with DOH and the new

 7   office.    We treat cannabis abuse right now in

 8   our system, and we will continue to do so.

 9            It's premature to really say whether

10   we're going to see a spike or not, you know.

11   I can't really comment on that at this point.

12            ASSEMBLYMAN RA:   Okay.   And just -- so

13   with regard to that, so whether there should

14   be some piece of this, that some level of the

15   revenue goes toward treatment or anything

16   like that, you think it's premature until we

17   see, you know, what potential increase in use

18   we might see in New York State.

19            COMMISSIONER GONZALEZ-SANCHEZ:   I

20   really can't comment on that because I think

21   those are negotiations that are happening

22   right now.    So I really can't comment on that

23   point.

24            ASSEMBLYMAN RA:   Thank you,
                                                      191

 1   Commissioner.

 2          CHAIRWOMAN WEINSTEIN:    Senate.

 3          CHAIRWOMAN KRUEGER:     Thank you.

 4          Senator David Carlucci.

 5          SENATOR CARLUCCI:   Thank you, Chair.

 6          Thank you, Commissioner.    It's great

 7   to see you.   And thank you for your

 8   commitment to fighting addiction wherever it

 9   is.   And it's great to always see you in the

10   district, at openings.   And my office has had

11   a great partnership with your office in doing

12   as many naloxone trainings as we can, and

13   we've trained hundreds of people, and they've

14   left with a kit.   And every now and then I'll

15   be in the community, someone will come up to

16   me and say, Hey, I was at one of those

17   trainings, I had the kit, I used it, and I

18   saved someone's life.    And you know, that

19   hits you.   And it says, Okay, we've got to

20   keep doing this.

21          So one of the things I want to ask is,

22   is there something in the budget we can point

23   to that will be funding these naloxone kits

24   to make sure that the programs that you're
                                                     192

 1   doing to distribute the kits free of charge

 2   is continuing?

 3          COMMISSIONER GONZALEZ-SANCHEZ:    I

 4   believe it is in our budget.   I couldn't

 5   really point it to you right now, but I'll be

 6   more than glad to give you that information.

 7          SENATOR CARLUCCI:   But you're

 8   satisfied that you're going to be able to

 9   continue that program and provide free kits?

10          COMMISSIONER GONZALEZ-SANCHEZ:    Yes.

11   Yes.

12          SENATOR CARLUCCI:   Okay.   Then I

13   wanted to ask about -- one of the things that

14   just drives me crazy is hearing about the

15   access to -- we've heard about

16   medical-assisted treatment and methadone.

17   And we know that the federal government has

18   allowed for take-home doses to exist.

19          But it seems that in New York State

20   that hasn't been as thorough or as accessible

21   as we'd like.    I mean, I have people that I

22   know travel hours every day to get access to

23   methadone just to live an independent,

24   productive life.   And we know -- we see our
                                                      193

 1   corrections units going down the Thruway all

 2   day long, or through our local roads, because

 3   they don't have access to methadone locally.

 4         What we've heard, though, on some of

 5   the programs is that because of New York's

 6   Medicaid reimbursement system, the way that

 7   it's set up is that it disincentivizes the

 8   take-home-dose program.    As you know, it can

 9   be 30 days that someone can have a take-home

10   dose, under the guidelines of the federal

11   government.

12         Can you speak to that?     What are we

13   doing to make it easier?    Is there something

14   that I'm missing?    Is there a problem with

15   moving it in a way that would incentivize to

16   have more of these take-home dose options?

17         COMMISSIONER GONZALEZ-SANCHEZ:     I

18   really feel uncomfortable speaking about the

19   whole Medicaid situation because that's

20   outside of our purview.    That's more of a

21   Department of Health question.    We continue,

22   as always, working with localities where

23   there is a need for medication-assisted

24   treatment.    We're doing it via the vans, the
                                                      194

 1   mobile vans.   We're doing the best that we

 2   can with what we can under our jurisdiction.

 3         But when it comes to the whole, you

 4   know, Medicaid billing and so on, I really --

 5   I can't speak to that.

 6         SENATOR CARLUCCI:     Okay, I could

 7   appreciate that.

 8         With that said, we can't dive into

 9   Medicaid, we don't have them here at the

10   table with us today.   But are there other

11   roadblocks that you can see that we could be

12   proactive with under this agency to make

13   methadone more accessible in New York State?

14         COMMISSIONER GONZALEZ-SANCHEZ:     Well,

15   we continue to move forward, you know, making

16   sure that our regulations speak to access,

17   individuals having access.    I think that we

18   have really done a tremendous job in that.

19         We're continuing to work with

20   individuals and, you know, educating them

21   around medication-assisted treatment, and we

22   will continue to do that.    I think that

23   there's still some gaps, some communities

24   that still don't understand that, you know,
                                                        195

 1   buprenorphine is a medication.    And that's

 2   something that, you know, we need any help we

 3   can in getting people to understand that it

 4   is.

 5          But like I said, you know, we continue

 6   to work with the criminal justice system, the

 7   judicial system, to get that across.

 8          SENATOR CARLUCCI:   So what would you

 9   say, what is the biggest roadblock right now

10   for access to methadone in New York State?

11          COMMISSIONER GONZALEZ-SANCHEZ:      I

12   don't know that I would say there's a

13   roadblock.   I think we need to look at some

14   of our insurance payers.   I think that's an

15   area we really need to look at.    Because, you

16   know, people say it's a block, but it's

17   really the payers.   So we need to do a better

18   job of talking to our private insurers as

19   well as Medicaid managed care plans.

20          SENATOR CARLUCCI:   Thank you.

21          COMMISSIONER GONZALEZ-SANCHEZ:      Thank

22   you.

23          CHAIRWOMAN KRUEGER:     Assembly.

24          CHAIRWOMAN WEINSTEIN:    Assemblywoman
                                                       196

 1   Rosenthal.

 2          ASSEMBLYWOMAN ROSENTHAL:    Okay, thank

 3   you.   So in terms of sober homes, where I

 4   ended last time -- and I've heard many

 5   stories where they set their own rules.    And

 6   if someone, you know, comes two minutes late

 7   then the management can say, Okay, you're out

 8   of here.   Or they say abstinence only, but

 9   for a person who's on buprenorphine, that's

10   abstinence for them, they're not using heroin

11   or other opioids.

12          So -- and I have a bill to address

13   this issue.   But what -- I think OASAS -- I'd

14   like to hear what you think the role should

15   be in terms of sober homes where people with

16   substance use disorder go.

17          COMMISSIONER GONZALEZ-SANCHEZ:    Okay.

18   So this comes up every year.    Sober homes, we

19   don't monitor -- our sober homes are not part

20   of our continuum of care.    That's probably

21   part of the reason why there's so many issues

22   with sober homes.

23          We do have our own system of housing

24   within our portfolio.   And I have in the past
                                                      197

 1   said and I continue to say if you have sober

 2   homes that want to be monitored and regulated

 3   by OASAS, then, you know, they're welcome to

 4   apply.

 5            The -- you know, I can't -- I can't

 6   tell a sober home that's not under our

 7   purview to follow our regulations.     I could

 8   only do that with individuals that are

 9   licensed under us.   And that's the issue with

10   sober homes.

11            ASSEMBLYWOMAN ROSENTHAL:   Okay.   I

12   mean you correctly point out, because there

13   really is no oversight, that it's a free

14   reign to do whatever they want.     And that

15   does need to change.

16            COMMISSIONER GONZALEZ-SANCHEZ:     I

17   think that -- you know, to a certain extent I

18   also think that's a local issue that needs to

19   be addressed as well.    Because some of these

20   entities, you know, are they zoned properly?

21   I mean, I really don't want to get into that

22   right now.    But who monitors and who decides

23   I'm going to become a sober home, and how

24   does that happen?
                                                      198

 1         ASSEMBLYWOMAN ROSENTHAL:     Exactly.

 2   Exactly.   And the sober home creators do say,

 3   Ooh, let me get your Medicaid money.   And so

 4   they have a certain responsibility back to

 5   the state to not have these kinds of

 6   frivolous power, you know, moves when a

 7   person is in treatment or other

 8   circumstances.

 9         So the Governor vetoed a bill that I

10   cosponsored with Senator Harckham about prior

11   authorization.   He did sign a bill that

12   commercial insurance would no longer have to

13   comply with -- would no longer have a prior

14   authorization issue, yet people on Medicaid

15   would still have to undergo prior

16   authorization.   And at times that is going to

17   bollix up their whole treatment.    Because

18   when a person needs their buprenorphine, for

19   example, there's no time to waste to wait

20   some days or even a week for prior

21   authorization.

22         How do you think that your agency or

23   others can attempt to make things right for

24   Medicaid patients?
                                                      199

 1         COMMISSIONER GONZALEZ-SANCHEZ:      So a

 2   couple of things, a couple of comments.

 3         Again, that's a DOH jurisdiction,

 4   Medicaid.

 5         But I just want to clarify that no one

 6   will go without medication.    I think that

 7   what the Governor is proposing, this

 8   standardized formulary would address a lot of

 9   other issues that we're not talking about

10   when it comes to the formulary.

11         There are different forms of

12   buprenorphine.   We have approximately 17 or

13   18, something like that, managed care

14   programs, right?   Entities.   They all cover

15   different forms of buprenorphine.   It's

16   really chaotic .   It's chaotic for the

17   person, the prescriber; it's chaotic for the

18   individual receiving the prescription.

19   Sometimes they go to their local pharmacy,

20   the pharmacy is not even stocked up.

21         So having a standardized formulary

22   where you have access, everyone's clear on

23   what forms of buprenorphine are covered by

24   the managed care entities, I think goes a
                                                         200

 1   long way.

 2           But I need to clarify:    No one will go

 3   without their buprenorphine.     And if there is

 4   -- I've got to finish.   If there is an

 5   individual that's on a particular form that

 6   their managed care company does not cover it,

 7   they have a -- we have in statute a five --

 8   they could get five days of the medication,

 9   and they also have a quick turnaround time

10   for prior approval.   That's in statute as

11   well.

12           ASSEMBLYWOMAN ROSENTHAL:    Thank you.

13           CHAIRWOMAN WEINSTEIN:    Thank you.

14           Senate?

15           CHAIRWOMAN KRUEGER:     Thank you.    I'm

16   going to offer a few questions.

17           So I was very disturbed that you were

18   hypothesizing whether the number of people

19   having opioid overdoses was going up or down

20   statewide and whether it was the same people

21   having multiple -- and then Narcan or

22   something else saving them, or whether they

23   were unique independent overdoses.

24           So I'm going to ask you to submit a
                                                       201

 1   document, a chart to the committees that

 2   shows how many people had overdoses, how many

 3   died, and whether -- if you know -- how many

 4   multiples there were of the same people, that

 5   the success of having access to Narcan

 6   treated them.

 7         Because in your testimony you talk

 8   about in the counties where you have X

 9   operating -- and then Pete Harckham had a map

10   that showed holes in the counties.   But I

11   think we really want to know county by county

12   what the story is and whether we're going up

13   or down.

14         COMMISSIONER GONZALEZ-SANCHEZ:     So can

15   I clarify?

16         CHAIRWOMAN KRUEGER:   Yup.

17         COMMISSIONER GONZALEZ-SANCHEZ:     The

18   map that Senator Harckham had had nothing to

19   do with overdose deaths.

20         CHAIRWOMAN KRUEGER:   Okay.

21         COMMISSIONER GONZALEZ-SANCHEZ:     It had

22   to do with the ombudsman program.

23         And I did not hypothesize of whether

24   the deaths are going up or down.    As a matter
                                                       202

 1   of fact, I didn't want to comment on a

 2   Department of Health database because I don't

 3   have that data to comment on.    I don't -- I

 4   didn't hypothesize that the numbers are going

 5   up or down.    In fact, in some areas they are

 6   going down and in some areas they're

 7   plateauing and in other areas they're just

 8   going up slightly.

 9         CHAIRWOMAN KRUEGER:     So you do have

10   that data available.

11         COMMISSIONER GONZALEZ-SANCHEZ:      Yes.

12   And the data that I have -- let me be

13   clear -- I also work with the Department of

14   Health to get.    Because they're the ones that

15   have that data.    They get it from the

16   hospitals.    That's the only way I would be

17   able to get that data.

18         CHAIRWOMAN KRUEGER:     Well, if you

19   died, they would get it from the hospitals,

20   perhaps.   But if you were saved and never

21   even got to a hospital, it wouldn't be

22   hospital data.

23         But I think you're right, that the

24   Department of Health should still have that
                                                       203

 1   data in their data collection.   But you

 2   should also have easy access to that kind of

 3   data.

 4           COMMISSIONER GONZALEZ-SANCHEZ:   Yeah.

 5           CHAIRWOMAN KRUEGER:   And then you were

 6   asked several times -- and I'm just totally

 7   confused.   Federal law says that they can

 8   give you Medicaid if you are moving,

 9   transitioning from one program or jail to

10   somewhere else so that you don't have an

11   interruption in medications that are helping

12   ensure you don't go back to the kinds of

13   drugs we don't want you on.   And you've said

14   several times you can't comment about how DOH

15   handles this.

16           You have many sort of arrangements

17   with the Department of Health where you do

18   things together.   I remember when you were

19   going through and moving methadone clinics to

20   being full health clinics so that people who

21   were going for methadone were getting full

22   healthcare at the same sites, because that

23   was very rational.

24           What is it that prevents the State of
                                                       204

 1   New York from making sure that people can

 2   continue medication uninterrupted so that

 3   they don't find themselves perhaps up to 30

 4   days with no access to medications that we

 5   know they were on and are working?

 6           COMMISSIONER GONZALEZ-SANCHEZ:     So I

 7   guess I would rephrase my answer by saying

 8   that I would need to discuss with the

 9   Department of Health to see what are the

10   issues, if any, preventing us from doing

11   that.

12           But right now I'm not -- I'm not

13   prepared to respond to the specifics of that.

14           CHAIRWOMAN KRUEGER:   But these are

15   people coming out of where?

16           COMMISSIONER GONZALEZ-SANCHEZ:

17   Prison.

18           CHAIRWOMAN KRUEGER:   Prison?   So when

19   they're in prison, we know everything about

20   them.   We've got all the I.D., we've got

21   every piece of information.    And there

22   certainly are models where people are signed

23   up for Medicaid while they're still pending

24   release from prison.   We've had that model in
                                                        205

 1   a variety of places throughout the state.

 2         So pretty much it's exclusively when

 3   you're leaving prison and we know you have

 4   been in a drug program where you're getting

 5   medicine, and we wanted to make sure you

 6   continue that medicine.    Right?

 7         COMMISSIONER GONZALEZ-SANCHEZ:      Right.

 8         CHAIRWOMAN KRUEGER:     Okay.   It may

 9   take DOH cooperation, it may take DOCCS

10   cooperation.   But this seems to me to be a no

11   brainer and that we want to make sure we're

12   not leaving people hanging out there for 30

13   days without the treatment that they have

14   been responding well to.   Because you're

15   setting them up for a couple of things.

16         One, you're of course setting them up

17   to go back to their addiction problem.    And

18   two, you're likely setting them up to just

19   get sent right back to the state jails

20   because they've flunked the test of sobriety.

21         So it just seems, again, this is a

22   win/win or a lose/lose, and we're currently

23   in the lose/lose column.   So I hope that we

24   can move to the win/win column quickly.
                                                     206

 1         Another follow-up question -- and Pete

 2   Harckham raised it, and I think Linda

 3   Rosenthal raised it -- just the inadequacy of

 4   enough money for drug treatment.    You and I

 5   have talked about in the past the problem we

 6   see in New York City where you're on the

 7   streets, you haven't been open to going into

 8   shelter, you are very often a dual mental

 9   illness and substance-abusing person, and

10   suddenly because of the work of the outreach

11   teams, usually, the person says, "You know

12   what, yeah, it's time, I need help, I need

13   treatment."   And they need to get them

14   residential treatment right away.

15         And we even had a meeting maybe two

16   years ago now with your team and the city's

17   HRA and homeless services team and I think

18   Department of Mental Health, and you had a

19   number of programs that were just about to

20   open and were going to help address this.

21         Did they open?

22         COMMISSIONER GONZALEZ-SANCHEZ:      Are

23   you talking specifically for the teams in the

24   shelters?
                                                           207

 1            CHAIRWOMAN KRUEGER:     You had a number

 2   of different programs.   But you also were

 3   committing to more residential on-demand for

 4   people who were on the streets with a

 5   combination of substance abuse and mental

 6   illness.

 7            COMMISSIONER GONZALEZ-SANCHEZ:      Well,

 8   we do have a couple of programs that have

 9   opened up throughout the state to do exactly

10   that.    I don't have the list -- I don't

11   remember the list.   But I'll be more than

12   glad to submit it to you and tell you when

13   they started, how they're doing, how many

14   people they're serving, and so on and so

15   forth.

16            CHAIRWOMAN KRUEGER:     Okay.   That would

17   be appreciated, thank you.

18            Assembly?

19            CHAIRWOMAN WEINSTEIN:    Assemblywoman

20   Gunther.

21            ASSEMBLYWOMAN GUNTHER:    So I have a

22   question regarding -- I was in a clinic in

23   Newburgh.    And, you know, there's -- people

24   fail on the other meds and often they stay on
                                                      208

 1   methadone, you know.   And you have to go to a

 2   clinic in order to get methadone.

 3         And yet what my understanding is is

 4   that, you know, people travel from all over

 5   the Orange County area to get to this clinic.

 6   And they also, you know, usually in those

 7   facilities they have ID doctors, just general

 8   practitioners.   And there's an issue with

 9   one-stop shopping for those folks.

10         Like, in other words, it has bathroom

11   issues -- it's like some ridiculous thing

12   that is stopping somebody to do their deal

13   and get what they need to remain sober, but

14   also going then on the -- maybe to the other

15   side and getting medical care, like if

16   there's an ID doctor and you have a

17   co-infection with HIV or something like that,

18   that you can't go from one side to the other.

19   Whether it's one bathroom missing -- it's

20   like ridiculous rules that the DOH has in

21   place that are preventing people from

22   one-stop shopping.

23         We're spending a boatload of money on

24   Medicaid cabs and -- because you come for one
                                                     209

 1   reason and then you go to someplace else for

 2   another reason.

 3         So it's a cost saving and it's also

 4   something that when you have a captive

 5   audience, you really get to be able to do a

 6   thorough, you know, full-person evaluation.

 7   And there's a remarkable thing called like

 8   talking to one another between like an ID

 9   doctor, someone that's running the program,

10   et cetera, et cetera.

11         And there's something that's stopping

12   it, and I don't know what exactly the law on

13   the books is.    But I know that it would be

14   much more cost-efficient, it would be better

15   for the patient, it's more of a holistic

16   approach in 2020.

17         And if you could look and see what we

18   can do to maybe change that system.   Because

19   I think it's important -- I know that

20   anonymity for many is very important.    But

21   again, you walk in with a tribunal of people

22   from all different walks of life -- there can

23   be, you know, the president and CEO and

24   somebody else.
                                                          210

 1            So I just thought I'd bring it to your

 2   attention because New York could save money

 3   on Medicaid cabs and it's also a convenience

 4   for many that are, you know, getting

 5   treatment.    And also because of, you know,

 6   brutalizing their body for some time, they

 7   have to make sure that their health is in

 8   good order.

 9            That's all I have to say.

10            COMMISSIONER GONZALEZ-SANCHEZ:     Thank

11   you.

12            ASSEMBLYWOMAN GUNTHER:   I just went

13   there.    That's why I brought it up.

14            CHAIRWOMAN KRUEGER:   Senator Pete

15   Harckham, second round, to close.

16            SENATOR HARCKHAM:   Thank you,

17   Madam Chair.

18            So many questions, so little time.

19   I'm glad Chair Rosenthal asked about housing,

20   we'll check that off the list.

21            Let's talk about harm reduction.     Over

22   the last couple of months as we traveled

23   around the state, we heard so much about, you

24   know, before you get people in treatment,
                                                       211

 1   we've just got to keep people alive and reach

 2   them where they are, wherever that may mean.

 3   Anything from needle exchange all the way to

 4   supervised consumption.

 5         So what is the state doing, what are

 6   we doing now in terms of harm reduction, and

 7   what opportunities do we have to do more?

 8         COMMISSIONER GONZALEZ-SANCHEZ:      So as

 9   you know, we have, you know, flexed our

10   regulations.   There's no wording in our regs

11   that says "abstinence only."    We're very

12   patient-centered in everything we do.     We

13   work with the individual where they're at.

14   We don't force treatment on anyone.     We work

15   with them.    And we will continue to do that.

16         SENATOR HARCKHAM:    Any specific

17   programs?    That's kind of a generic

18   philosophy.    I guess what I'm looking for,

19   what more can we do, particularly in our

20   hard-to-reach communities, in terms of

21   keeping people alive and harm reduction?

22         COMMISSIONER GONZALEZ-SANCHEZ:      Well,

23   you know, we're out, we have peers out in the

24   street doing one-on-one work with
                                                            212

 1   individuals, with Narcan, trying to get them

 2   into treatment if that's what they want.         And

 3   we're going to continue to do those efforts.

 4            SENATOR HARCKHAM:   All right.     Thanks.

 5            One of the other things that we hear

 6   and see is the shortage of doctors who have

 7   the waiver for -- to prescribe certain types

 8   of medication-assisted treatment.     What are

 9   we doing to try and incentivize more

10   physicians, physician assistants and nurse

11   practitioners into the program?

12            COMMISSIONER GONZALEZ-SANCHEZ:      Well,

13   I hear that often.   Last year it was the same

14   issue.    I'm not sure that's accurate.      I

15   think we have quite a few ex-waivered

16   physicians.    I think the issue is whether

17   they want to prescribe or not.     That's

18   another issue.

19            We now, of course, are working with

20   DOH to ensure that the EDs start induction of

21   medication-assisted treatment and then

22   communicate with the community-based

23   organizations to hook up the individuals if

24   they at the emergency rooms cannot or do not
                                                      213

 1   want to prescribe.

 2         So we should have a better sense this

 3   year, once these things are fully implemented

 4   and we have the appropriate oversight to know

 5   how that's working.   But we continue to work

 6   with physicians who want to be waivered.     I

 7   believe we do a -- we have even assistance in

 8   doing the actual waiving, the teaching and so

 9   on and so forth, and we will continue that.

10         SENATOR HARCKHAM:    All right.

11   Speaking of the emergency rooms, we had heard

12   from patient advocacy groups and treatment

13   providers there are still emergency rooms in

14   the state that don't have MAT-qualified

15   physicians in the emergency room.

16         I know you're rolling that out, you've

17   got a program for that.    How soon before we

18   close that gap and literally every emergency

19   room in New York State has at least one

20   MAT-certified physician?

21         COMMISSIONER GONZALEZ-SANCHEZ:     So as

22   I indicated, we will continue to work with

23   the Department of Health, because they're the

24   ones that have jurisdiction over hospitals,
                                                         214

 1   to ensure that that happens.

 2          But that is part of regulations right

 3   now, and they have to do discharge planning,

 4   that's appropriate, and they must start

 5   induction in the EDs.   We need that

 6   oversight.   So I will continue to work with

 7   the Department of Health to ensure that that

 8   happens.

 9          But there are several EDs that are

10   doing it already.

11          SENATOR HARCKHAM:   Terrific.   Thank

12   you.

13          Thank you, Madam Chair.

14          CHAIRWOMAN KRUEGER:     Thank you.     I

15   think we're done.   Thank you very much.

16          COMMISSIONER GONZALEZ-SANCHEZ:       Thank

17   you.

18          CHAIRWOMAN KRUEGER:     And our next

19   testifier is Denise Miranda, executive

20   director of New York State Justice Center for

21   the Protection of People with Special Needs.

22          EXECUTIVE DIRECTOR MIRANDA:     Good

23   afternoon, Chairs Krueger, Weinstein,

24   Carlucci, and Gunther, as well as other
                                                     215

 1   distinguished members of the Senate and

 2   Assembly.

 3         My name is Denise Miranda, and I am

 4   the executive director of the New York State

 5   Justice Center for the Protection of People

 6   with Special Needs.   I would like to thank

 7   you for the opportunity to testify regarding

 8   Governor Cuomo's Executive Budget proposal.

 9         Today I come before you on behalf of

10   the more than 1 million New Yorkers in care

11   with special needs.   The Justice Center's

12   work is directed by our steadfast commitment

13   to protecting vulnerable people from abuse

14   and neglect.   It is our commitment to that

15   focus that drives every aspect of what we do

16   and every decision that we make.

17         We refuse to deviate from our mission

18   because history has proven that this opens

19   the door to bad actors who for years worked

20   the system while hurting people.

21         CHAIRWOMAN KRUEGER:    Denise, pull the

22   mic a little closer to your mouth, sorry.

23   Thank you.

24         EXECUTIVE DIRECTOR MIRANDA:    Sure.
                                                      216

 1         Thanks to the leadership of the

 2   Governor, and with your partnership, cases

 3   that previously had fallen through the cracks

 4   are now fully investigated and those

 5   responsible for abuse and neglect are held

 6   accountable.

 7         Nearly seven years ago, the Justice

 8   Center was tasked with the important mission

 9   of protecting vulnerable populations, and we

10   have learned a lot in that time.     Some look

11   at the young age of this agency as a

12   detriment.    I see it as an advantage.

13   Because we are young, we are not entrenched

14   in how we operate.    Our processes are still

15   evolving.

16         Every day we work at evaluating where

17   we can be more efficient and build

18   collaboration both inside and outside of the

19   agency.     Time and time again, we search for

20   better ways to serve individuals, families

21   and stakeholders.

22         In our continual pursuit to build and

23   improve the Justice Center, we recognized a

24   need to renew our focus on one of our largest
                                                       217

 1   and most critical units -- investigations.

 2   We're getting back to the basics.    The agency

 3   has implemented a new, intensive on-boarding

 4   and mentorship program for all new

 5   investigators.   The program provides the

 6   resources they need as they learn to navigate

 7   these very complex cases.

 8         In the past 12 months, we have

 9   continued to explore new and better ways to

10   serve those we protect.   The Justice Center's

11   sexual abuse response team is now fully

12   operational.   This cross-disciplinary group

13   is highly trained in the latest investigatory

14   techniques and strategies. Our team takes a

15   trauma-informed approach so that individuals

16   will not be revictimized.   Creating a cohort

17   that has been trained by nationally

18   recognized experts ensures our ability to

19   bring justice to the victims and hold bad

20   actors accountable.

21         But investigating allegations is only

22   one part of what we do.   Our prevention work

23   continues to expand.   More than 350

24   corrective action plan audits, 40 site
                                                    218

 1   visits, and a dozen systemic reviews were

 2   conducted in 2019 to ensure providers are

 3   taking appropriate steps to stop abuse and

 4   neglect before it happens.

 5         We continue to collaborate with our

 6   state oversight agency partners on the

 7   Interagency Abuse Prevention Workgroup, but

 8   this year we're going even further. Recently

 9   the Justice Center established its own

10   internal workgroup solely focused on

11   developing new prevention initiatives.    We

12   also introduced an in-person training for

13   providers and staff on establishing

14   professional boundaries.

15         This past year we added a new toolkit

16   to our growing library of prevention

17   resources:   "The Dangers of Intestinal

18   Obstructions."   Justice Center data

19   highlighted this as a serious, sometimes

20   life-threatening issue for individuals

21   receiving services.   In addition, a toolkit

22   featuring guidance on wheelchair securement

23   will be coming out this year.

24         Engagement with stakeholders remains
                                                       219

 1   an ongoing need for the agency.    This has

 2   been a priority since my arrival three years

 3   ago.     In 2019, we focused on helping

 4   organized labor understand our role in the

 5   workplace.    We engaged in several sessions

 6   around the state with members of unions to

 7   share information about the Justice Center.

 8            Outreach to providers and families has

 9   also been a top priority.    The Justice Center

10   held five regional conferences throughout the

11   state in 2019.     These free, day-long events

12   gave attendees the opportunity to gain

13   in-depth knowledge of the agency.     The

14   conferences continue to open the dialogue

15   between the Justice Center and those we

16   serve.

17            Another way the Justice Center

18   supports individuals and families is through

19   our advocates.    Our team assisted more than

20   4,000 people last year and provided

21   accompaniment services to more than

22   400 people during interviews.    We also helped

23   hundreds of families access investigatory

24   records.     As a result of their hard work, we
                                                      220

 1   received additional grant funding and we were

 2   able to grow our staff of advocates in our

 3   high-volume areas.

 4         Last but not least, we continue to

 5   build on our established foundation of

 6   collaboration with our state oversight agency

 7   partners.   The Justice Center now holds

 8   monthly meetings with each state oversight

 9   agency.

10         We believe the work we have planned in

11   the coming year will continue to improve the

12   Justice Center.   The safety and well-being of

13   the individuals under our jurisdiction

14   remains the foundation of everything we do.

15   We do not deviate from this mandate, but we

16   seek opportunities to enhance it in any way

17   we can.

18         Thank you.

19         CHAIRWOMAN KRUEGER:    Thank you.

20         Our chair, David Carlucci.

21         SENATOR CARLUCCI:   Thank you.

22         Thank you, Commissioner, Director.

23   Appreciate your testimony here today and the

24   work that you've done.
                                                     221

 1         So just quickly, one of the things I

 2   wanted to make sure I asked you about was the

 3   change in the budget about the optional

 4   statewide central registry.   And this is

 5   something that, after reading, is just

 6   difficult to explain to my colleagues and to

 7   advocates about what is being done here.

 8         Can you tell us why this change is

 9   necessary and how the concern is that it will

10   -- that it won't lead to adverse outcomes?

11         EXECUTIVE DIRECTOR MIRANDA:    Sure,

12   absolutely.   And I appreciate the question

13   because I know this issue has been a source

14   of some confusion.

15         The SCR checks are part of our

16   criminal background check for pre-employment

17   purposes.   Those checks are going to remain

18   in place as they are.   The proposal that's

19   before us contemplates eliminating the need

20   for the SCR checks to be mandatory when

21   they're part of an investigation.

22         So this is not going to have any

23   impact in terms of qualifications, background

24   checks, et cetera, but it's really an
                                                        222

 1   investigatory stage of our cases where

 2   currently we are mandated to do an SCR check.

 3         The changes in the proposal still

 4   allow for that check to be discretionary if

 5   we choose to do so, but what we've found is

 6   that the SCR does not provide any value

 7   evidentiary-wise from the perspective of

 8   assisting us in our investigation.    Our

 9   investigation is limited to the four corners

10   of the allegations that are before us, and

11   the SCR is, frankly, drains on resources that

12   we have and we believe that it should be

13   discretionary, not a mandatory requirement.

14         SENATOR CARLUCCI:   And can you

15   elaborate why it is a drain on resources?

16   What's entailed here?

17         EXECUTIVE DIRECTOR MIRANDA:     Sure.   So

18   we're talking about two to three hours for

19   every single SCR check, which is a

20   considerable amount of time, again,

21   considering the weight that it will have and

22   the bearing it will have on an investigation.

23         The SCR check, as many of us know,

24   there have been a lot of concerns regarding
                                                         223

 1   the SCR check.    There are allegations that

 2   date back 20 years.    And so from the

 3   perspective of deciding whether an allegation

 4   of abuse and neglect has occurred, whether we

 5   can substantiate or unsubstantiate, the SCR

 6   does not help us build evidence in a case.

 7            SENATOR CARLUCCI:   Okay.   And so how

 8   often are you accessing that in a given year?

 9            EXECUTIVE DIRECTOR MIRANDA:    So for

10   every single investigation that we do, we're

11   currently required to run an SCR check for

12   the subject involved in that investigation.

13   So currently right now we're talking about,

14   last year, 12 to 13,000 investigations.        So

15   it is a real impact on the agency and our

16   ability to function.

17            SENATOR CARLUCCI:   And what do you

18   think that will -- so if we're going from 12

19   to 13,000 a year, what will that bring it

20   down to, you think?

21            EXECUTIVE DIRECTOR MIRANDA:    Well, as

22   I mentioned before, it's discretionary.

23   Right?    And so if in the rare instance we

24   find that this would be particularly helpful,
                                                       224

 1   we still have the ability to make that check.

 2         You know, again, I think a lot of the

 3   concern regarding the SCR check has been

 4   conflated with our background check process.

 5   That will remain in place.    The SCR will

 6   still be part of the employment clearance

 7   process.

 8         SENATOR CARLUCCI:     And so what do you

 9   think -- what's your estimate in terms of if

10   it's not mandatory, it's discretionary, how

11   often -- will it be 50 percent of the time, 1

12   percent of the time?

13         EXECUTIVE DIRECTOR MIRANDA:     That's

14   going to depend on the investigations.    Every

15   single investigation is unique.    We look at

16   those cases individually.    So I cannot at

17   this particular point hazard a guess with

18   respect to how often we would use the SCR.

19         What we have found thus far, with

20   close to 70,000 investigations done since the

21   opening of our agency in 2013, it has not

22   proven to be helpful in terms of building a

23   case of abuse or neglect or coming to a

24   determination that a case should be
                                                       225

 1   unsubstantiated.

 2         SENATOR CARLUCCI:     So from this it

 3   sounds like you would maybe never use it?

 4   Like when -- I'm just trying to understand

 5   when you would use this check.

 6         EXECUTIVE DIRECTOR MIRANDA:      It will

 7   remain discretionary.     And we will evaluate

 8   every single case to determine if it's

 9   necessary.   And if it's there, that resource

10   will be available.

11         SENATOR CARLUCCI:     Okay.   Now, you

12   mentioned that you've taken on 70,000

13   investigations since the start of the Justice

14   Center seven years ago.

15         EXECUTIVE DIRECTOR MIRANDA:      Correct.

16         SENATOR CARLUCCI:     And what -- can you

17   tell us, is there an agency that you have

18   more cases out of than any other?    Can you

19   tell us that?   And then have you seen a trend

20   in terms of newer types of cases that you're

21   getting?   Could you speak to both of those

22   issues?

23         EXECUTIVE DIRECTOR MIRANDA:      Sure.

24         So currently our cases, approximately
                                                       226

 1   50 percent of those cases are related to the

 2   state oversight agency of OPWDD.     That does

 3   represent the bulk of the investigations that

 4   we do.

 5            We're constantly analyzing our data to

 6   identify trends.    These trends help inform

 7   our prevention tools that we create every

 8   single year.    As I mentioned in my testimony,

 9   we do a "Spotlight on Prevention."    We've

10   done six of these.    A lot of the

11   determination of what the topic will be.

12   It's based on the trends of what we're seeing

13   in terms of investigations and allegations

14   that are coming in.

15            So we've created spotlight kits on

16   intestinal obstruction, we have another one

17   that will be forthcoming on wheelchair

18   securement, we've done one on caregiver

19   fatigue, safety for individuals left in

20   vehicles, and another one on restraints, on

21   how to eliminate or diminish the occurrence

22   of restraints.

23            So all of those topics are based on

24   the data that we're seeing in terms of the
                                                          227

 1   number of cases that are coming in, and we

 2   continue to review that data every year to

 3   help inform our choices.

 4         SENATOR CARLUCCI:     Okay.   So you

 5   mentioned those six categories.     I'm just

 6   trying to follow you here.     So you had the

 7   wheelchair constraints -- that is a report

 8   that you're putting out or --

 9         EXECUTIVE DIRECTOR MIRANDA:      So

10   wheelchair securement.    What we've seen is a

11   trend in individuals being injured because

12   they have been improperly fastened within a

13   vehicle.   Right?   And so this is a real

14   concern, because those injuries can be quite

15   serious if a person is not appropriately

16   secured, especially in a moving vehicle.       And

17   so that has informed our decision to make

18   sure that we're creating a toolkit which will

19   be released this year.

20         All of this information is available

21   on our website.     Our toolkits, besides

22   education and resource materials, there's

23   also a lot of material there for providers in

24   terms of self-assessments as well.
                                                        228

 1         SENATOR CARLUCCI:    So you would say

 2   that -- the question was about trends that

 3   you see, and the response is that there's

 4   these toolkits that are put in place when you

 5   do see a trend.    Is that what I can gather?

 6         EXECUTIVE DIRECTOR MIRANDA:     That's

 7   correct.

 8         SENATOR CARLUCCI:    Okay.   And so what

 9   were some of the other ones that you were

10   talking about?    I got confused with the

11   regional meetings that you're doing to do

12   outreach and educate the workforce, and then

13   the trends that you're seeing.     So you've got

14   the wheelchair restraints --

15         EXECUTIVE DIRECTOR MIRANDA:     So the

16   topics of the Spotlight?

17         SENATOR CARLUCCI:    Yeah, like --

18         EXECUTIVE DIRECTOR MIRANDA:     Reduction

19   of restraints --

20         SENATOR CARLUCCI:     -- what I'm trying

21   to understand is what you're seeing, because

22   you're seeing 10, 12 to 13,000 cases a year,

23   and what -- are there any types of things

24   that we should be concerned about or know
                                                      229

 1   that have been changes in the past seven

 2   years?    Things that you see that are

 3   increasing in more frequency.

 4            EXECUTIVE DIRECTOR MIRANDA:   So with

 5   respect -- besides the Spotlight on

 6   Prevention, right?   Which as I discussed,

 7   those topics are based on the data and the

 8   trends that we're seeing of abuse and

 9   neglect.

10            We also have a very consistent data

11   point with respect to the cases that are

12   substantiated.    Approximately 75 percent of

13   our cases are substantiated at Category 3.

14   Category 3 is our lowest category for abuse

15   and neglect.    That statistic has held

16   consistent for the past six years.

17            So what we see there is thankfully a

18   couple of things.    Number one, there's a low

19   rate of criminality within the service

20   settings, which is a good thing.    The

21   majority of the cases that we do investigate

22   are Category 3 and, thankfully, not the most

23   egregious cases, although those certainly do

24   occur and we have those cases within our
                                                          230

 1   jurisdiction.

 2            But in terms of category level

 3   seriousness, you know, those are the trends

 4   that have been quite consistent now for six

 5   years.

 6            SENATOR CARLUCCI:   Okay, thank you.

 7            Thank you, Chair.

 8            CHAIRWOMAN KRUEGER:     Thank you.

 9            Assembly.

10            CHAIRWOMAN WEINSTEIN:    Assemblywoman

11   Gunther.

12            ASSEMBLYWOMAN GUNTHER:    Can you give

13   us a little bit of an update where you are

14   with the lawsuit relating to the independent

15   prosecutor?

16            EXECUTIVE DIRECTOR MIRANDA:    Yes.    So

17   currently that issue will be before the Court

18   of Appeals.    As many of you may recall, the

19   issue here is the independent authority of

20   the agency to have a prosecutor.      There's

21   nothing in the State Constitution that

22   precludes the Legislature and the Governor

23   from appointing a prosecutor, so we're

24   expecting that that issue will be resolved
                                                         231

 1   this particular year.

 2            I think the question that usually

 3   follows that particular question is, so what

 4   are we doing right now?     How are we handling

 5   cases?    What about the criminal cases that

 6   we're actively involved in?

 7            So as I mentioned, the issue here is

 8   independent authority, right?      And the crux

 9   of the issue is really do we need the consent

10   of the county DAs.    Our position is that we

11   don't.    However, as a safeguard and a

12   preventative measure, we have sought the

13   consent of the county DAs on all the criminal

14   cases where we are involved.

15            I think it's important to note we have

16   never prosecuted a case over the objection of

17   any single county DA.    We work

18   collaboratively with them.     We enjoy a very

19   cooperative relationship.    And irrespective

20   of the outcome of this case, we will continue

21   to make sure that we're removing bad actors

22   from the workforce.

23            ASSEMBLYWOMAN GUNTHER:    And what about

24   like -- if the communication with parents is
                                                          232

 1   unchanged, as far as the Justice Center goes,

 2   on changes in any policy or procedure?

 3   There's a good line of communication?

 4         EXECUTIVE DIRECTOR MIRANDA:       Sure.   So

 5   communication, engagement, quite frankly,

 6   transparency, has been a priority since I

 7   arrived here three years ago.    I'm very happy

 8   to share that last year we launched a series

 9   of regional conferences.   We did one

10   conference in every single region, so there

11   were five last year.

12         This was a perfect opportunity for

13   family members, provider associations, and

14   smaller nonprofits to come and speak with

15   executive staff of the agency, to receive

16   updates, to get more information, to answer

17   questions.   And then in the afternoon we had

18   sessions that were specifically focused on

19   some very unique parts of the agency.     So

20   there was a topic of investigations, there

21   was also another panel discussion regarding

22   our criminal background check.

23         These were very well attended.      We

24   plan on renewing that effort and launching
                                                          233

 1   another series this year.

 2            ASSEMBLYWOMAN GUNTHER:   Well, I for

 3   one have received less complaints about the

 4   Justice Center, which is great.    And, you

 5   know, one of the largest employers in my

 6   district are people that care for people with

 7   disabilities.    So thank you for what you've

 8   done.

 9            EXECUTIVE DIRECTOR MIRANDA:     Thank

10   you.

11            CHAIRWOMAN KRUEGER:   Thank you.

12            Senator Jim Seward.

13            SENATOR SEWARD:   Thank you,

14   Madam Chair.

15            And Director Miranda, good to see you

16   again.

17            I know in the past -- I'm talking

18   about in the past -- a chronic complaint that

19   we had heard about the Justice Center was the

20   length of time of investigations.       And I know

21   -- I think last year when you were before us

22   we had a discussion about that and you were

23   looking to shorten those times.

24            Can you give us an update in terms of
                                                       234

 1   the length of time of investigations?

 2         EXECUTIVE DIRECTOR MIRANDA:     Sure.

 3         So currently our average cycle time

 4   for investigations is 69 days.    Since we last

 5   met here and spoke last year, we've taken on

 6   several initiatives.   We had the expansion of

 7   one of our regions, we opened up an office in

 8   White Plains in Westchester County.   We do

 9   that because we are constantly looking at the

10   data, trying to identify places in the state

11   where we need to deploy more resources.    You

12   know, resources impact cycle times.

13         We work with the providers as well to

14   ensure that they are familiar with our

15   internal processes.    You know, cycle time is

16   a priority, but it's also very nuanced and

17   complex.   Cycle time is going to be impacted

18   by the type of case, the complexity of the

19   case -- sometimes we have multiple subjects,

20   sometimes we have multiple witnesses,

21   sometimes these investigations need to be

22   coordinated with labor unions or perhaps

23   counsel.   We also rely on the provider or the

24   employer to supply us with the necessary
                                                       235

 1   documents to review.

 2         That said, cycle time is always a

 3   priority for us.    Recently we actually

 4   expanded a program where we're now allocating

 5   three business days to get additional

 6   information for a provider.    So in this pilot

 7   program -- we've put about 2500 cases through

 8   this pilot program, and what we've found is

 9   that 65 percent of those cases have been

10   reclassified.

11         This is particularly important because

12   we do not have discretion as an agency when

13   it comes to a call that's coming in.     If an

14   allegation of abuse and neglect comes in, we

15   are mandated to do an investigation, to reach

16   a conclusion, a substantiation or

17   unsubstantiation.    We have to make a

18   classification based on that call.

19         There are instances where perhaps

20   there are gaps in the information, and so the

21   three business-day extension, for lack of a

22   better word, allows us to seek additional

23   information oftentimes from the provider, so

24   that we can make a much more accurate
                                                     236

 1   classification.   This has had a tremendous

 2   impact on cycle time because it allows us to

 3   make sure that we're deploying resources for

 4   the cases that need it most.

 5         SENATOR SEWARD:   Thank you for that

 6   update.

 7         There -- there continues to be some

 8   concerns that the Justice Center has, shall

 9   we say, a law enforcement approach to all

10   investigations regardless of the nature of

11   those investigations in the original

12   complaint.   This can lead to fear and anger

13   among the provider staffs that are out there.

14         How do you respond to those

15   allegations, and what actions have been taken

16   to take care of that?

17         EXECUTIVE DIRECTOR MIRANDA:    So that

18   was a concern that was articulated when I

19   arrived here at the agency, and I think we've

20   gone to great lengths to make sure that we're

21   dispelling that myth.

22         You know, first and foremost we have

23   199 members of our investigatory unit; only

24   25 of those are sworn police officers.   But
                                                     237

 1   we do understand that sometimes, you know,

 2   the actions of one or two can color an

 3   agency, and so we've been extremely committed

 4   to making sure that we're providing training

 5   for all of our investigators on forensic

 6   interviewing, best practices, working with

 7   disabled populations.   And quite frankly,

 8   also reminding our entire agency -- in

 9   particular our investigators -- that an

10   investigation is a traumatic event, whether

11   you are a witness, whether you are a subject,

12   whether you are a victim on a particular

13   case, and making sure that we're using a

14   trauma-informed approach when speaking with

15   people.   Very important.

16         Additionally, we record all of our

17   interviews at the agency so when there is a

18   concern with respect to the tone or the

19   conduct of an investigator, this provides us

20   with an opportunity to actually review the

21   recordings and make sure that the conduct is

22   on par with our expectations.

23         SENATOR SEWARD:   I do like your

24   emphasis on -- in your testimony and your
                                                       238

 1   answers, on prevention and working with

 2   providers to avoid problems before they come

 3   up.

 4         EXECUTIVE DIRECTOR MIRANDA:

 5   Absolutely.

 6         SENATOR SEWARD:     One quick final

 7   question in terms of the applicants for

 8   background checks that you do for the various

 9   agencies.     You're looking at 13,000

10   applicants, but only a very small number,

11   380, were disapproved.

12         How do you account for that, such a

13   small percentage, being disapproved?

14         EXECUTIVE DIRECTOR MIRANDA:        So

15   actually our statistics for last year, we did

16   100,000 criminal background checks.      And so

17   there was a small number that were not

18   approved for employment due to

19   criminal-history backgrounds.    So our volume

20   is actually significantly higher.

21         The number -- the amount of people who

22   were not approved, you know, this is based on

23   the criminal history and an assessment that's

24   done during the criminal background check
                                                          239

 1   process.

 2          SENATOR SEWARD:    Do you have a -- any

 3   speculation why there's such a small number?

 4   Were those -- those maybe don't apply if they

 5   have a --

 6          EXECUTIVE DIRECTOR MIRANDA:

 7   Thankfully, mm-hmm.

 8          SENATOR SEWARD:   Yeah.   Thank you.

 9          EXECUTIVE DIRECTOR MIRANDA:     Sure.

10          CHAIRWOMAN KRUEGER:     Thank you.

11          Assembly?   No?

12          We're done.    Thank you very much.

13   Appreciate it.

14          EXECUTIVE DIRECTOR MIRANDA:     Thank

15   you.

16          CHAIRWOMAN KRUEGER:     {Mic off.}   I

17   have to leave for a meeting, but my very

18   capable cochair will be here in the interim.

19          CHAIRWOMAN WEINSTEIN:     Thank you.

20          So now we begin the portion of the

21   hearing for the nongovernmental witnesses.

22   And just a reminder, the witnesses have up to

23   five minutes to present their testimony.        As

24   you were forewarned in the beginning, it
                                                          240

 1   would be best, especially since we've

 2   received your testimony in advance, and it

 3   has been circulated to all the members, to

 4   try and summarize and not read word for word;

 5   you end up not getting through it.

 6           And just a reminder to members, any

 7   members with a question are limited to three

 8   minutes for question and answer.

 9           So now we have New York Association of

10   Psychiatric Rehabilitation Services, Harvey

11   Rosenthal, executive director.

12           MR. ROSENTHAL:   Good afternoon.     Thank

13   you to the chairs and members of the

14   committee for your long-time partnership,

15   thoughtful oversight, and support of the

16   thousands of people with serious mental

17   illnesses and the providers that we support

18   at NYAPRS.

19           This is my 25th annual budget

20   testimony, having begun in 1995.     And I

21   actually began my work in the field working

22   at the State Psych Center here in Albany in

23   1977.   And at that time, a diagnosis of

24   mental illness was a life sentence; severe
                                                      241

 1   functional limitations and frequent illness

 2   and relapses were considered the norm.

 3   Medication, hospitalization and community

 4   institutions were the only major treatment

 5   options, and people were rarely, were rarely

 6   considered capable of good judgment.

 7         Since the '80s we've all worked

 8   together -- the providers, the consumers, and

 9   government officials -- to raise the bar for

10   what's possible for people with mental

11   illnesses and what should be required from

12   our provider system.   State mental health

13   policy is a very personal issue for me, my

14   community.   I have a mental illness, and many

15   of the people who work in my office do, and

16   agency.

17         The lens through which we view the

18   budget has been based on the view that

19   everyone can recover, everyone can take on

20   responsibility, everyone can deserve the

21   dignity of an independent life in the

22   community and stable housing, employment, and

23   culturally good supports.   That's the lens

24   that I'm going to offer this testimony.
                                                       242

 1         The first issue I'm going to talk

 2   about is the community -- funding for the

 3   community services and the workforce.      It's

 4   important to distinguish that the money

 5   that's been made available that you've heard

 6   about, which is the 2 percent, is only for

 7   the workforce and only for the workforce that

 8   works for agencies that are funded by OASAS,

 9   OMH, and OPWDD.     So we're not talking about

10   the thing we've looked at, the COLA that's

11   been denied for over a decade.    We are

12   talking now about across-the-board increases

13   for the agencies as well as the workforce.

14   Because those agencies are in a state of

15   crisis that you'll hear a lot more about.

16         Our group, which is the statewide

17   #3for#5 campaign, is calling for a 3 percent

18   increase across the board for each of the

19   next five years.    And you'll hear that this

20   coalition is made up of an unprecedented

21   coalition of nonprofits across the human

22   service spectrum.

23         When it comes to Medicaid, we're quite

24   anxious about what we're going to hear in
                                                       243

 1   Medicaid.   We're worried about cuts.    We're

 2   grateful that we haven't been cut, as other

 3   sectors were, by the 1 percent, and we're

 4   looking for those kind of protections in the

 5   coming budget.   Since so much of the work

 6   relies on the MRT, we want the state to

 7   ensure there is significant representation

 8   from the mental health community, consumers

 9   and providers, and to allow for the active

10   level of participation I had in the past as a

11   member of the MRT.

12         Stable housing with individual

13   supports is fundamental to promote the

14   health, safety and dignity of people in

15   recovery.   We're grateful that there's a

16   20 million add in this budget, and 60 million

17   for capital funds.   More is needed.    You'll

18   hear more about that.

19               There's a line in the budget, in

20   the OMH budget, that talks about increasing

21   the capacity in emergency departments.     But

22   all it does is increase one more day of

23   reimbursement.   It misses the point.    People

24   are waiting in emergency rooms -- I visit
                                                        244

 1   them, I see that -- for days, waiting for an

 2   assessment.     There is simply not enough staff

 3   and facility, and we need to do more about

 4   that than increase reimbursement by one day.

 5           This budget increases -- permits, for

 6   the first time ever, the use of Medicaid in

 7   institutional settings.    The IMD exclusion

 8   that has set the tone for that has prevented

 9   states from using Medicaid to expand

10   institutions.    This budget takes a step that

11   we're very concerned about that will allow

12   Medicaid to provide services in an inpatient

13   setting.

14           You heard about the adult home

15   residents and the need for more services for

16   them.   Over the last I think it's seven

17   years, only one in five of adult home

18   residents with psych disabilities who were

19   supposed to leave have left.     The state needs

20   to do a lot more.    We want to work with them

21   on that.

22           In terms of criminal justice

23   reforms -- I'll end with that -- there are

24   three parts.    Crisis intervention teams --
                                                       245

 1   Senator Carlucci has been terrific on that.

 2   We've had several millions of dollars where

 3   police are trained and supported not to

 4   arrest or harm people and keep them out of

 5   the criminal justice system.

 6           We're very focused on diversion;

 7   Mrs. Gunther has been great in funding an

 8   alternative program in Westchester County

 9   that helps keep people out of prison and

10   jail.

11           We want the passage of the HALT Bill

12   that will ban solitary confinement of people

13   with mental illnesses and limit it for other

14   populations.   And I will stop there.

15           CHAIRWOMAN WEINSTEIN:    Thank you.

16           Questions?

17           ASSEMBLYWOMAN GUNTHER:   I think you

18   covered everything.    And I know I'll see you

19   in my office if --

20           MR. ROSENTHAL:   Okay, I'll be there.

21           CHAIRWOMAN WEINSTEIN:    Thank you.

22           Next, Mental Health Association in

23   New York State, Glenn Liebman, CEO.

24           MR. LIEBMAN:   Good afternoon.   I want
                                                       246

 1   to thank the Ways and Means Committee and the

 2   Senate Finance Committee as well as our

 3   chairs, our terrific chairs of -- you know,

 4   both Assemblywoman Gunther and

 5   Senator Carlucci have been outstanding

 6   supporters of the Mental Health Association

 7   and support for mental health services.

 8         So really today is about two budget

 9   narratives.   The first one -- and Harvey did

10   a great job of describing -- considering this

11   economic climate, this actually was a pretty

12   good budget, relatively.   Good credit goes to

13   Governor Cuomo and Commissioner Sullivan in

14   reflecting a budget with no major cuts to

15   mental health services.    We were protected

16   from the first round of Medicaid cuts and

17   actually added funding for housing as well as

18   keeping the commitment to the direct-care

19   workforce.

20         But there's also Narrative No. 2.     And

21   you all talked about it today with great

22   passion, and I heard this.    This is not only

23   about New York, this is the country.    We are

24   in a mental health crisis.    And it's great
                                                       247

 1   that the budget's been positive, but we are

 2   in a crisis.

 3            And I've been doing this for 17 years

 4   and I rarely have said the word "crisis," but

 5   this is what we are doing.     Individuals and

 6   families are suffering.    We heard the stories

 7   about six-month waiting lists for services,

 8   two-year waiting lists for housing,

 9   overworked and underpaid workforce, exploding

10   rates of anxiety, depression, and suicide

11   attempts among young people, shortage of

12   mental health professionals, suicidality

13   among veterans and discrete populations,

14   people not getting Medicaid for months as

15   they're released from jail and prison while

16   spending all this time -- so much of their

17   time, unfortunately -- in solitary

18   confinement as well.

19            So how do we respond to this crisis?

20   There are no simple answers.    And frankly,

21   New York is better that virtually any other

22   state.    But we're not here to blame or to

23   point fingers.    We're here for fixes.   And

24   yes, these fixes cost money.    And yes, we're
                                                       248

 1   in a budget of fiscal constraint.    But the

 2   reality for us in mental health is that it

 3   doesn't matter if it's a good budget or a bad

 4   budget, we always only get a small slice of

 5   the pie.

 6            The reality is we're not a small slice

 7   of the pie.    We actually comprise almost the

 8   entire pie.    One in five people in the

 9   United States has a serious mental health

10   issue.    Almost half of all Americans will

11   have a diagnosed mental health issue in their

12   lifetime.     I doubt there is anyone in this

13   room, or anywhere that we know of, that has

14   not been either directly or indirectly

15   impacted by mental health and mental illness,

16   whether as a family member, themselves, or as

17   a close friend.

18            In the context of our following

19   recommendations, we urge you to keep this in

20   mind, the importance of what we're advocating

21   for, and the significance of financial

22   support for our stated goals.

23            So I have here -- obviously I'm not

24   going to read it -- I have about 26 different
                                                       249

 1   recommendations.    And I'm going to focus

 2   really on two things in particular.   And

 3   that's not to minimize all the other 24 other

 4   things, because they're all equally as

 5   significant.   But what I'm going to focus on

 6   right now -- and Harvey talked about it as

 7   well -- is the #3for#5 campaign.

 8         So this is an unprecedented move

 9   whereby the entire human service sector

10   non-for-profit community is speaking with one

11   voice -- and you're going to hear from other

12   people today too.    Mental health,

13   developmental disabilities, addiction

14   disorders, aging, child welfare, domestic

15   violence, we're all speaking with one voice.

16   We're all advocating for a 3 percent increase

17   in funding for the next five years.   So

18   that's where the campaign is, the number 3,

19   "for" spelled out, f-o-r, 5.    Three for five.

20         We've lost over a billion dollars in

21   the last decade by COLAs not being part of

22   the human service sector.    We were supposed

23   to get a COLA every year for the last

24   11 years.   It's been carved out every year,
                                                      250

 1   unfortunately.    We've lost -- our entire

 2   sector has lost over a billion dollars.

 3   Think about how these nonprofits provide

 4   service and support for those in greatest

 5   need, and think of how different our lives

 6   would be if we had that funding.

 7         We are the safety net for these

 8   people.     And for those of us in mental

 9   health, what the safety net means is housing,

10   care management, respite, clinic services,

11   medication management, peer support,

12   employment, education and much more.

13         We get two questions a lot in this

14   campaign:    Why this year, when we know this

15   is a difficult budget year?    The bottom line

16   is, we don't pick a year.    This is a fiscal

17   crisis.     We're in a financial crisis.    We

18   can't say that, jeez, we should start the

19   #3for#5 campaign next year or the year after.

20   We are in a crisis.    Everybody here today is

21   going to talk about this, because this is the

22   reality.

23         And we do appreciate the 2 percent

24   across-the-board funding cut -- I mean,
                                                         251

 1   funding increase for the direct care

 2   workforce.    We do appreciate that very much.

 3   But the bottom line is we need more and our

 4   entire sector needs more.

 5            And the other thing is, we're the

 6   taxpayers' best friends.    We are economic

 7   drivers in the community, but we're also

 8   taxpayers' best friends.    When you're talking

 9   about things like -- what are we talking

10   about here?    With DSRIP and Medicaid managed

11   care and everything else, it's all dedicated

12   to keeping people out of expensive settings

13   and in the communities.     That's what we do in

14   the nonprofit sector every day.      We are doing

15   really great work in the community, and we're

16   saving people money as well.

17            So we hope that as we move forward,

18   that that $170 million we're asking for will

19   be added in the budget.

20            Do I have time for one more quick

21   thing?    Or I'm being --

22            CHAIRWOMAN WEINSTEIN:    Just finish up

23   that -- finish up your last thought.

24            MR. LIEBMAN:   Okay.    Mental health
                                                         252

 1   education in schools, really significant.      We

 2   really appreciate the support of our chairs

 3   in this area.    And we have a handout in the

 4   back of the report about the work we're doing

 5   in schools and communities around

 6   mental health and our resource center.

 7            And we appreciate Assemblywoman

 8   Gunther putting us -- initial support, as

 9   well as now the Governor in the last two

10   years.

11            And we also appreciate --

12   Senator Carlucci's just introduced a bill

13   last week around teacher training, and that's

14   the next step forward in terms of teacher

15   education -- I mean, around mental health

16   education in schools.

17            So thank you very much.

18            CHAIRWOMAN WEINSTEIN:   Thank you.

19            Senator Carlucci.

20            SENATOR CARLUCCI:   Thank you, Chair.

21            Thank you, Glenn.

22            I wanted to ask you about -- you

23   touched on mental health first aid and the

24   importance of that.    So I was going to ask
                                                        253

 1   you about that.   But I also wanted to ask,

 2   because you didn't get to it, about crisis

 3   intervention teams.

 4         MR. LIEBMAN:    Yes.

 5         SENATOR CARLUCCI:      I know the Mental

 6   Health Association in New York has been

 7   really pushing that initiative.     Could you

 8   tell us why that's important and why we need

 9   to put it in the budget?

10         MR. LIEBMAN:    Sure.    And again, we

11   appreciate your leadership in that area,

12   because it does mean a lot.     And you're going

13   to hear, you know, NYAPRS is talking about

14   it, and you're going to hear from NAMI as

15   well about how important it is to a lot of

16   us.

17         Basically, crisis intervention teams

18   are a best practice that brings together law

19   enforcement and individuals and their

20   families who are in crisis, in a mental

21   health crisis, to plan, be planful in the

22   process -- what should law enforcement look

23   for, what should they pay attention to when

24   somebody's in a current crisis, how do we
                                                      254

 1   minimize that crisis and make sure that, you

 2   know, we don't have those terrible outcomes

 3   that we so often have.

 4         And so we're very appreciative of this

 5   funding.   It is a best practice, and it's

 6   going on in counties around the state now.

 7   And this is relatively new, this is only in

 8   the last five years, because for years New

 9   York was behind the 8-ball on this, and now,

10   you know, with your leadership and the other

11   leadership, we've really been able to really

12   implement some really strong work around CIT,

13   which is really a positive for everybody in

14   our community.

15         SENATOR CARLUCCI:   Great.   And what do

16   you think we need in terms of funding in the

17   state to meet the needs to have more law

18   enforcement trained in crisis intervention?

19         MR. LIEBMAN:   Well, you know, I'd have

20   to do an environmental scan to find out how

21   many counties already have CIT and how many

22   counties need to have CIT.   Because everybody

23   wants it, and I think it would be appropriate

24   for everywhere.   So I don't know exact
                                                     255

 1   numbers, but I think that's appropriate.

 2         And the other thing is -- and you know

 3   this well -- is that Mental Health First Aid,

 4   specifically for counties that have CIT -- in

 5   a lot of counties, as we know, law

 6   enforcement, it's hard for them to take a

 7   35-hour training.    Mental Health First Aid

 8   has been the perfect backdrop for those

 9   individuals who are interested in finding out

10   more about law enforcement, how to work

11   mental health and law enforcement.    And

12   Mental Health First Aid has been that

13   ancillary piece that's been very helpful.

14         SENATOR CARLUCCI:    And with Mental

15   Health First Aid, you know, it's been great.

16   I talk to my children's preschool teachers,

17   they've taken the course, they've signed up

18   for the eight-hour course.

19         Can you tell us how many people have

20   been trained on Mental Health First Aid in

21   New York State?   Do you have that number?

22         MR. LIEBMAN:    I don't have it for

23   New York State specifically.    I do have it

24   for the country as a whole:    2.5 million
                                                       256

 1   people have been trained in Mental Health

 2   First Aid across the country.      And that's

 3   whether it's preschool teachers, you know,

 4   law enforcement, librarians -- every sector

 5   has been taught in Mental Health First Aid.

 6            And I know that we in New York State

 7   have done -- again, over the last several

 8   years we've gotten the funding to be able to

 9   go out there, and our members are certainly

10   doing it around the state, and I know there

11   have been hundreds of trainings that are

12   going on consistently around the state.

13            SENATOR CARLUCCI:    Thank you, Glenn.

14            Thank you, Chair.

15            MR. LIEBMAN:    Thank you.

16            CHAIRWOMAN WEINSTEIN:    Thank you.

17            Thank you for the work you do on this

18   issue.

19            MR. LIEBMAN:    Thank you.

20            CHAIRWOMAN WEINSTEIN:    Next we have

21   the National Alliance on Mental Illness-

22   New York State, Ariel Coffman, president.

23            MS. BURCH:     Good afternoon.   I'm

24   actually Wendy Burch.      I'm the executive
                                                       257

 1   director for NAMI-NYS.

 2         Our organization represents thousands

 3   of New Yorkers living with a mental health

 4   condition, as well as their family members.

 5   I appreciate the opportunity to present

 6   testimony today, and thank you for allowing

 7   me to do so.

 8         We have submitted our written

 9   testimony to you, so of course in the

10   interests of time, I'd just like to take a

11   moment to highlight some of the needs we see

12   in the course of our work at NAMI.

13         First we want to ensure that those who

14   need it have access to care and services.    We

15   recognize that people living with mental

16   health issues, when provided with appropriate

17   services in a timely manner, can live healthy

18   and productive lives.

19         Having the necessary supports in place

20   can prevent long-term hospitalization,

21   homelessness, incarceration, and the risk of

22   them taking their own lives.

23         This is the reason that NAMI-NYS has

24   joined the #3for#5 campaign.   Access to care
                                                     258

 1   begins by having human services agencies who

 2   have the ability to run their programs in a

 3   way that allows them to provide the

 4   continuity of care that is critical to

 5   recovery.   It is significant and speaks to

 6   the seriousness of the situation that so many

 7   providers and supporters across human

 8   services have come together to support and

 9   promote this campaign.

10         We urge you to lend your support as

11   well and institute the 3 percent increase in

12   funding for nonprofits in the human services

13   sector every year for the next five years.

14         NAMI-NYS was pleased to see that the

15   Governor's budget reflects the importance of

16   adequate community-based mental health

17   housing by including an additional

18   $20 million for existing residential

19   programs.   However, this investment still

20   falls short of what is needed to address the

21   quarter-century of flat funding to nonprofit

22   mental health housing programs.

23         We urge the Legislature to close the

24   gap in funding these vital programs.
                                                     259

 1   Recovery is only possible when a person first

 2   has a safe and stable place to live.

 3         Along with residential and treatment

 4   services, crisis services are also

 5   desperately needed.   NAMI-NYS believes that

 6   no one should have to travel more than an

 7   hour to access psychiatric emergency crisis

 8   services.   Unfortunately, this goal is

 9   unattainable for far too many New Yorkers.

10   We need investments to expand both mobile

11   crisis services such as assertive community

12   treatment teams and mobile intervention

13   teams, as well as stationary options such as

14   crisis stabilization centers and respite

15   centers.

16         We would like to commend the Governor

17   and the Legislature for their support in

18   several areas.   The first is in the area of

19   parity for mental health.   The establishment

20   of an ombudsman to oversee parity in the

21   CHAMP program, and now the Behavioral Health

22   Parity Compliance Fund, will help to ensure

23   that mental health issues are treated fairly

24   by insurance companies.
                                                       260

 1         We would also like to commend the

 2   Legislature for its commitment to improving

 3   the criminal justice-mental illness

 4   interface, particularly the investment in

 5   crisis intervention teams.    We hope to see an

 6   increasing emphasis on diversion initiatives,

 7   including the commitment to ensuring that

 8   psychiatric services exist, and are

 9   accessible, in which to divert individuals

10   from incarceration to recovery.

11         Finally, as a former member of the

12   armed services, I was pleased to see an

13   investment of the $1 million for services and

14   expenses related to suicide prevention

15   efforts for veterans, law enforcement and

16   first responders.    The defenders and

17   protectors of our nation deserve the support

18   of the community, especially in times of

19   personal struggle.

20         Thank you for the opportunity to

21   provide input to you today.   I know you will

22   continue to invest in initiatives that

23   support those working towards recovery so

24   that they can truly be a part of the
                                                         261

 1   community and lead healthy and productive

 2   lives.    Thank you.

 3            CHAIRWOMAN WEINSTEIN:      Thank you for

 4   your concise testimony.      As you noted, we do

 5   have the full testimony and it was circulated

 6   to all the members.

 7            I don't believe there are any

 8   questions.    Thank you for being here today.

 9            MS. BURCH:    Thank you.

10            CHAIRWOMAN WEINSTEIN:      Next we have

11   New York State Conference of Local Mental

12   Hygiene Directors, Kelly Hansen, executive

13   director.

14            MS. HANSEN:   Good afternoon.    My name

15   is Kelly Hansen.      I'm the executive director

16   of the New York State Conference of Local

17   Mental Hygiene Directors, and I appreciate

18   the opportunity to present testimony to you

19   today on the Governor's Executive Budget.

20            The conference represents the

21   directors of community services and county

22   mental health commissioners in each of the

23   57 counties and the Department of Mental

24   Hygiene for the City of New York.
                                                      262

 1         Given the five minutes -- you have my

 2   full testimony, but I want to spend my time

 3   on two specific pieces.   One is to be able to

 4   report to you how the funding was spent that

 5   the conference had advocated for and you

 6   provided for jail-based substance use

 7   disorder treatment and transition services.

 8   It's on page 4 of your testimony.

 9         And also I wanted to provide a

10   clarification around the discussions that

11   have occurred earlier around jail-based

12   competency restoration and also the shift to

13   the 100 percent county cost of state

14   psychiatric center treatment for competency

15   restoration.

16         So the conference, in partnership with

17   our partners in the New York State Sheriffs'

18   Association and also the New York State

19   Association of Counties, two years ago were

20   successful, with your help, in securing

21   $3.75 million to be able to provide

22   jail-based substance use disorder treatment.

23   And the reason that we were advocating for

24   this funding is because while the state had
                                                       263

 1   developed a number of community services, we

 2   know that our folks traditionally have

 3   significant interaction with the criminal

 4   justice system, and they would be brought

 5   into jail and we had no funding to be able to

 6   provide services to them.

 7         So last year's budget included the

 8   3.75, the Governor continued that, and as

 9   Chairwoman Rosenthal had indicated --

10         CHAIRWOMAN WEINSTEIN:    Why don't you

11   hold on for a minute.   Let's try and -- I'm

12   not sure if it's your mic or the -- maybe try

13   shifting --

14         MS. HANSEN:   Switch?   Okay.

15         CHAIRWOMAN WEINSTEIN:    Yeah.   I'm not

16   sure if it's the microphone or the speaker

17   feedback we're getting.

18         MS. HANSEN:   I have a one-out-of-three

19   chance to get this -- is this better?    So far

20   so good?   All right, thank you.   And thank

21   you for stopping the clock, I appreciate it.

22         So as I was mentioning, there was

23   3.75 million in the budget.   Our original ask

24   was for 12.8, to be able to provide funding
                                                        264

 1   for each of the counties outside of New York

 2   City.   New York City has a well-established

 3   program.

 4           We got 3.75.    So the result of that

 5   was roughly $60,000 to each county to be able

 6   to provide those services.     One of the pieces

 7   is that Herkimer County, with 58 people in

 8   their jail, got $60,000.    Nassau County, with

 9   over a thousand individuals in their jail,

10   got $60,000.

11           However, I'm pleased to report that we

12   had done a very in-depth survey of our county

13   mental health commissioners over the summer

14   and asked, what specifically did you use this

15   funding for, and did you create a new service

16   or did you enhance an existing service?

17           So a few of the numbers I just want to

18   point out to you is that 20 jails were able

19   to create individual and group counseling

20   services.   Fourteen jails created peer

21   services, which are so important.    And

22   15 jails were able to put in place transition

23   and reentry services.

24           So we have revised our budget ask
                                                     265

 1   based on what we anticipate may be the impact

 2   of bail reform.   We don't have a visual into

 3   what the numbers will change, but we do know

 4   that there will still be a need in county

 5   jails to be able to offer treatment.

 6         So in addition to the 3.75, we're

 7   asking for another 3.25 to bring our total to

 8   $7 million.    That's our ask.

 9         Also, as part of last year's budget,

10   there was another million added to pay for

11   the cost of medications only in the jail.

12   That, as you've heard, was not

13   reappropriated, and we're hoping that that

14   funding will be forthcoming.

15         The other piece I just want to quickly

16   talk about is the provision for authorizing

17   counties to do jail-based competency

18   restoration.   I can tell you that based on

19   what I hear from my members, who are all

20   clinicians, I don't know any who think that

21   doing restoration in a jail is a good place

22   to provide mental health treatment.

23         There's also significant issues with

24   being able to not provide medication over
                                                     266

 1   objection, training staff.    We just don't

 2   think that this is a good appropriate place

 3   to provide restoration, yet every year it

 4   turns up in the budget.   So we wanted to

 5   point that out.

 6         The other piece that we're very

 7   concerned about, and we will be coming to you

 8   to discuss further, is an assumption in the

 9   budget that shifts the cost of competency

10   restoration for someone who is in the care

11   and the custody of the state commissioner of

12   the Office of Mental Health, receiving

13   treatment in a state-operated psychiatric

14   center, to be returned to competency prior to

15   going back to face a criminal justice

16   procedure because they have been restored

17   such that they understand the charges against

18   them and can advocate on their own behalf.

19         In current years, the state has

20   charged the county 50 percent of a per-diem

21   rate for 730 competency restoration.    This

22   would do a shift so now the counties would

23   pay 100 percent of the daily cost per person

24   for competency restoration.   Outside of
                                                       267

 1   New York State, we're looking at 12 million.

 2         I can tell you that there's no

 3   planning that a county could do for the cost

 4   of restoration.    You could go four years

 5   without a 730, and then you've got six 730s

 6   in one year and it costs you hundreds of

 7   thousands of dollars -- or millions, in some

 8   counties.   So we -- and this money goes into

 9   the General Fund.    I think that's important

10   to point out.

11         So thank you very much for your time,

12   and we'll be visiting you later.

13         CHAIRWOMAN WEINSTEIN:     I'm going to

14   ask a question about what you just said.     So

15   you heard the commissioner respond to

16   questions about this topic of the local jail

17   restoration.    And I guess what I'm hearing

18   from you is you don't agree.

19         She was saying that people could be

20   treated in the local jail, which would be

21   reasonable to the county than having them

22   treated in a hospital setting.    But you seem

23   to say both that that's not an appropriate

24   setting and that the costs are greater than
                                                      268

 1   what she's saying.

 2         MS. HANSEN:    You are correct,

 3   Chairwoman.   I think there was a lot of

 4   confusion in the discussion between

 5   jail-based competency restoration and

 6   allowing counties to do jail-based -- keep in

 7   mind, this is an individual who's been

 8   charged with a crime, generally felony level,

 9   who's been evaluated and deemed incompetent

10   to go forward in the judicial proceedings

11   because they have a mental illness and have

12   been deemed to not understand the charges

13   against them and not able to aid in their own

14   defense.

15         So under law, that individual is then

16   transferred into the care and custody of the

17   commissioner of the Office of Mental Health,

18   and they are then treated at a state

19   psychiatric forensic center -- Kirby, some of

20   the others -- until they are restored to

21   competency, and then they would come back.

22         So the first piece is the jail-based

23   restoration, which is -- I don't agree that

24   it's a fiscal benefit to the counties.     And
                                                       269

 1   from the clinical standpoint, my members

 2   would tell you that they don't agree that the

 3   jail is a good place to provide mental health

 4   treatment.

 5         The other piece is on what has

 6   currently gone forward with the cost of the

 7   730 -- same thing, 730 Criminal Procedure

 8   Law -- for the competency restorations, where

 9   the counties have traditionally been charged

10   50 percent of the per-diem cost for a 730 --

11   all of which that money goes into the General

12   Fund -- and now that would be shifted to the

13   counties paying 100 percent of the cost.

14         New York City apparently started

15   paying 100 percent of the cost last year, and

16   it's millions of dollars.    And we're trying

17   to find the justification as to why this is a

18   county cost as well.

19         CHAIRWOMAN WEINSTEIN:     Thank you.

20         Senator Carlucci.

21         SENATOR CARLUCCI:     Thank you, Director

22   Hansen.   And thanks for coming to our

23   committee and giving us an overview, to the

24   Senate, of what some of the priorities are
                                                     270

 1   and what you're working on.

 2         And to follow up on the jail-based

 3   restoration program, the shift is something

 4   that we're all very concerned about in that

 5   cost, and what it just means to the locality.

 6   And do you have an idea from your estimate of

 7   what -- for the local mental hygiene

 8   directors, what that cost shift will be for

 9   the rest of the State of New York outside of

10   New York City?

11         MS. HANSEN:    We're told that, fully

12   annualized, about $12 million.

13         SENATOR CARLUCCI:    Okay, $12 million.

14   So it's right now -- just so I understand it

15   correctly, it's probably about $24 million

16   annually, and the county gets reimbursed half

17   of that?

18         MS. HANSEN:    No, it's -- we reimburse

19   6 million.    Rest of state, the cost is

20   12 million.    That would be the shift to

21   100 percent for the county.   And New York

22   City is separate.

23         SENATOR CARLUCCI:    Okay.   So right

24   now, under your calculation, it would be --
                                                       271

 1   if it stayed the same as last year, on

 2   average, it would be about a $6 million

 3   increase to the counties.

 4            MS. HANSEN:   Correct.

 5            SENATOR CARLUCCI:   Okay.   Thank you.

 6            MS. HANSEN:   That's my estimate, I

 7   guess.

 8            SENATOR CARLUCCI:   Okay.    And last

 9   year the Governor did put in $850,000 to

10   incentivize counties to take on this

11   challenge.    And could you just elaborate a

12   little bit more how -- you did make the

13   statement that you didn't think that that's

14   an appropriate place to get treatment.

15            Could you just tell us about your

16   reasoning?

17            MS. HANSEN:   Certainly.    Thank you.

18            And, you know, based on what I --

19   my -- our commissioners' discussions, you

20   know, I think -- if someone is deemed

21   incompetent, they have a severe mental

22   illness, a pretty high diagnosis.       And I

23   don't know how much time you've spent in

24   jails lately; I spent a lot with our SUD
                                                       272

 1   project.    And to put staffing in a jail --

 2   you need clinical staff, not COs.     Clinical

 3   staff.    And it's not a therapeutic place by

 4   any stretch of the imagination.

 5            The other piece is for a number of

 6   individuals, being started on a medication

 7   regimen is extremely important to starting to

 8   treat a serious mental illness.     The jails

 9   cannot medicate over objection without going

10   to court, and that takes away one of the very

11   significant tools that would need to be in

12   place in order to do jail-based restoration

13   if any county wanted to do that.

14            I know other states have done it.    I

15   don't see a lot of uptake from our members

16   that would think that this is a good

17   placement.    And I also don't think that, by

18   having the counties pay 100 percent of the

19   cost, that that provides any change in the

20   therapeutic discussion or that all of a

21   sudden people will want to do jail-based

22   restoration.

23            SENATOR CARLUCCI:   Okay, thank you.

24            MS. HANSEN:   Thank you.
                                                       273

 1         CHAIRWOMAN WEINSTEIN:    Thank you.

 2         Assemblywoman Rosenthal.

 3         ASSEMBLYWOMAN ROSENTHAL:     Thank you.

 4         Hi, good to see you.

 5         MS. HANSEN:    Great seeing you.

 6         ASSEMBLYWOMAN ROSENTHAL:     So last year

 7   we worked closely together, and left on the

 8   floor was my medication-assisted treatment

 9   bill, which I hope to get to pass this year.

10         How much money do you really think

11   would be necessary in order to accomplish

12   what we're trying to do?

13         MS. HANSEN:    There's a couple of

14   different factors.   Number one is, again, we

15   don't have a visual yet into what the jail

16   census will be.   And keep in mind that

17   someone's jail stay is generally anywhere

18   from 14 to maybe 20 to, outliers, 40 days.

19   So we're working with folks in a relatively

20   short timeline.

21         But the N, the number of individuals

22   in jail, is in part what drives what we put

23   together as a fiscal assumption.

24         For the medication-assisted treatment
                                                      274

 1   bill, we issued and shared with you and

 2   others a fiscal impact that took a very

 3   conservative approach and said that at any

 4   given time in the county jail system outside

 5   of New York City, individuals -- you'd have

 6   50 individuals on Vivitrol, 50 individuals on

 7   methadone, 50 individuals on Suboxone, and

 8   50 individuals on Sublocade.

 9         And as you know, the cost of these

10   medications is significant.    And in addition

11   to the cost is having the waiver prescribers,

12   the clinical piece around it.    And you

13   mentioned, Assemblywoman, that

14   medication-assisted treatment is the

15   medication and the clinical piece together,

16   it's all together.   I sometimes think that

17   gets lost in the discussion.

18         So our concern was the cost, with how

19   do you build these programs?    And what we're

20   saying is continue to fund our counties to be

21   able to develop the counseling, the

22   behavioral health services that are needed in

23   order to overlay a medication-assisted

24   treatment program.   because we're not there
                                                        275

 1   yet.     We've made great progress, with your

 2   support and funding, but we have more to go.

 3            So that was what our position was in

 4   terms of let's continue building services in

 5   the jails so we can help people in those 14

 6   to 22 days, and have transition services in

 7   place for a good, solid reentry into the

 8   community.

 9            ASSEMBLYWOMAN ROSENTHAL:   Are the --

10   the supply of Vivitrol, is that part of an

11   agreement with the company that makes

12   Vivitrol?

13            MS. HANSEN:   I don't know.   I mean, I

14   think that's more a sheriff discussion.      I

15   think it was the first one that was, you

16   know, available on the market.      It's

17   injectable, and certainly that's a

18   consideration as well.    I mean, Sublocade is

19   injectable now too, as things have changed.

20            ASSEMBLYWOMAN ROSENTHAL:   Right.

21   Right.    Right.

22            But would you call it a good

23   investment?     You know, we're going to try to

24   unearth that money.     You call it a good
                                                         276

 1   investment toward getting people back on the

 2   right path.

 3            MS. HANSEN:   I think any money to the

 4   county mental health commissioners that would

 5   allow us to expand treatment and transition

 6   services in the jails is a good idea for all

 7   individuals.

 8            ASSEMBLYWOMAN ROSENTHAL:    Thank you.

 9            CHAIRWOMAN WEINSTEIN:    Thank you.

10   Thank you for being here.

11            MS. HANSEN:    Thank you.

12            CHAIRWOMAN WEINSTEIN:    Next, Substance

13   Abuse Providers in Schools, Kevin Allen,

14   chair, Local 372.      And Donna Tilghman,

15   secretary.    Thank you.

16            MR. ALLEN:    Good afternoon.   To the

17   chairperson, to the distinguished members,

18   how's everyone?    My name is Kevin Allen.

19   Along with Donna Tilghman, we represent

20   275 substance abuse or prevention and

21   intervention specialists of the New York City

22   Department of Education, Local 372 with

23   DC 37.

24            You have the information in front of
                                                     277

 1   you, but I just want to make it personal so

 2   it would resonate.    The SAPIS is the only

 3   person in the school that works a 12-month

 4   year.   As opposed to guidance counselors, as

 5   opposed to various teachers that have grades

 6   K-12, SAPIS have all grades, kindergarten

 7   through 12th grade.    They also deal with

 8   students from A to Z.

 9           They also are the only people in the

10   building that deal with an evidence-based

11   curriculum that we teach.    And it's across

12   the board, all over New York City.    Life

13   skills, Second Step, Too Good For Violence,

14   Too Good For Drugs, are just examples of

15   evidence-based curriculum that OASAS has

16   okayed, along with the Department of

17   Education, for us to show fidelity throughout

18   no matter what borough, what school you go

19   into, SAPIS will be teaching out of this

20   curriculum.

21           We are here asking for a joint

22   legislative appropriation of 2 million

23   plus -- 2 million from the Assembly,

24   2 million from the Senate.
                                                       278

 1         As any successful corporation, any

 2   successful organization, there's two things

 3   that are always important to them.     One is

 4   scalability, and the other one is

 5   scalability.   To sustain and to build.    And

 6   so we're at the point where we are glad that

 7   we have dedicated SAPIS, but we want to be

 8   able to keep who we have and to be able to

 9   build on their reputation and build on their

10   success that they've already built.

11         They do classroom presentations, they

12   do positive alternatives, they meet with

13   parents, they meet with communities.    Because

14   of the new vaping, we are doing vaping demon

15   -- we're talking about vaping from another

16   perspective where we already have established

17   DVDs on that and we're bringing more parental

18   and more community awareness to that.

19         As our commissioner had just come to

20   speak about, there is more than ever before a

21   direct correlation between substance abuse

22   and mental health.   And we see that going

23   down from our high schools to our middle

24   schools and to our elementary students.     And
                                                     279

 1   what we want to do is give them as much

 2   information, give them as much of a

 3   foundation to be able to change the course of

 4   a child's achievement from kindergarten to

 5   the 12th grade.

 6         We are excited about that, and we're

 7   asking for the -- for both the Assembly and

 8   the Senate to each contribute $2 million

 9   towards SAPIS in this year's budget, for a

10   shared allocation of $4 million in funding.

11         All together, this would preserve and

12   create the equivalent to at least 48

13   full-time SAPIS positions, and the potential

14   to reach up to 24,000-plus students and their

15   families who would otherwise not have the

16   support that they need.

17         We just don't want to be driven on

18   data, but we want to be also driven on

19   results.   And as we go into each and every

20   school, each and every school has several

21   things that are in common.   They all have

22   their own culture, their own climate, and

23   their own community and language.   And

24   because of all of these things, we see that
                                                        280

 1   it's more necessary than ever before to bring

 2   home the message of this.

 3          One additional thing that a SAPIS does

 4   that no one else has, the way that we do it

 5   is that we have built our social-emotional

 6   needs in these lessons.    If there's

 7   15 lessons and life skills curriculum, and if

 8   there's 13 lessons and a Second Step,

 9   85 percent of those lessons are based on

10   social-emotional.     Which means that we want

11   to get to the root of the matter.

12          I thank you for listening, and if

13   there's any questions, please feel free to

14   ask.

15          CHAIRWOMAN WEINSTEIN:     Senator Liu for

16   a question.

17          SENATOR LIU:    Thank you, Madam Chair.

18          Not so much a question, I just wanted

19   to thank Mr. Allen and his colleague.    They

20   are leaders at Local 372 who really are

21   instrumental.   I mean, honestly, when we talk

22   about schools, we -- when we're thinking

23   about schools, we talk about teachers,

24   principals.   We often forget the other staff
                                                       281

 1   that rounds out the education and the care

 2   for our kids.

 3         So thank you and your members for all

 4   the work that you do.     And I certainly will

 5   support this.

 6         MR. ALLEN:   Thank you, Senator.

 7         CHAIRWOMAN WEINSTEIN:      Assemblywoman

 8   Rosenthal.

 9         ASSEMBLYWOMAN ROSENTHAL:      Hi.

10         I too would like to commend all the

11   good work that you do in schools.    And the

12   Assembly for years have provided $2 million

13   in extra funding for you, which I hope this

14   year we can -- each house can provide

15   $2 million, that's my goal.

16         I wonder if you could just expand on

17   how, if you got this increased funding --

18   right now you have 270 people working in the

19   schools, right?

20         MR. ALLEN:   Yes.

21         ASSEMBLYWOMAN ROSENTHAL:     And how many

22   more could you get if we increased the

23   funding?

24         MR. ALLEN:   We would go to at least 24
                                                        282

 1   to 50 more additional people, 48 full-time.

 2   Which means that if there's 1700 schools in

 3   the New York City Department of Education, it

 4   would be even that more that we'll be able to

 5   get at any point.

 6         And that means even with the point of

 7   having a SAPIS collocated in different

 8   schools, which we have in some situations, we

 9   can fill that need more prevalent than is

10   happening.

11         ASSEMBLYWOMAN ROSENTHAL:      I mean, one

12   of the key elements everyone talks about is

13   prevention, education and then, of course,

14   treatment and recovery.   But if we don't do

15   the first two points, we're not -- you know,

16   we're going to keep going down a bad road.

17         So I think your work is essential.

18   And I know you have included vaping now,

19   because that is also --

20         MR. ALLEN:    Yes, we have.

21         ASSEMBLYWOMAN ROSENTHAL:      -- something

22   all the kids are doing, unfortunately, in

23   schools.   But I think your model is great,

24   and continue to do the great work you do.
                                                         283

 1   Thank you.

 2          MR. ALLEN:    And I thank you for your

 3   support.

 4          And we've seen, more than ever

 5   before -- it seems that every other week

 6   there's another vaping fatality.      And we take

 7   that to heart.   And the information that

 8   we're able to give each and every student,

 9   which gives to each and every family, that

10   gives to each and every community, that gives

11   to each and every city, that's what we want

12   to circumvent, that type of thing.

13          Because we're talking about -- the new

14   word is the "C" word, contemporary issues.

15   These are issues that maybe 15 or 20 years

16   ago, we did not see as rampant as we see now

17   in our elementary, middle school and high

18   school students.    So we want to be right on

19   the cutting edge in regards to this.

20          ASSEMBLYWOMAN ROSENTHAL:     Okay.   Thank

21   you.

22          MR. ALLEN:    Thank you.

23          CHAIRWOMAN WEINSTEIN:      Thank you for

24   being here.   And again, thank you for the
                                                       284

 1   work your members do in the city schools.

 2         MR. ALLEN:   Thank you, Chairperson.

 3         CHAIRWOMAN WEINSTEIN:    Next, Friends

 4   of Recovery-New York:   Angelia Smith-Wilson,

 5   executive director; Allison Weingarten,

 6   director of policy.

 7         And if you're keeping score, after

 8   this will be research for a Safer New York,

 9   then Legal Action Center, then The Arc

10   New York.

11         MS. SMITH-WILSON:   Good afternoon.     I

12   am Angelia Smith-Wilson, the executive

13   director of Friends of Recovery-New York.

14   Friends of Recovery-New York is the only

15   statewide recovery organization in New York

16   State, and we represent the voice of

17   individuals and families living in recovery

18   from addiction, families who have lost a

19   family member, or people who have been

20   otherwise impacted from addiction.     I myself

21   am a family member in recovery.

22         In New York State there are over

23   260,000 admissions annually.   These

24   admissions make up crisis and noncrisis
                                                      285

 1   admissions to treatment facilities.   We know

 2   that those folks that enter a treatment

 3   facility will leave that treatment facility

 4   and reenter their community.   So it is

 5   important that we keep at the front of any

 6   discussions around addiction and addressing

 7   the opioid crisis.   When we talk about

 8   treatment, we cannot miss talking about

 9   recovery, because recovery wraps itself

10   around and supports people as they leave

11   treatment.   It supports the treatment itself.

12         So fortunately since 2017,

13   recovery-oriented systems of care, which

14   include the development of recovery community

15   organizations, recovery community outreach

16   centers, recovery youth clubhouses, peer

17   engagement specialists, family support

18   navigators -- these services, combined, have

19   touched over 250,000 individuals, saving

20   lives to no doubt mitigate the overdose

21   crisis that we are currently in.

22         We respectfully ask you to further

23   continually consider recovery in your

24   discussions when you discuss being effective
                                                     286

 1   at addressing the current opioid drug crisis,

 2   as without adequate funding, as we have heard

 3   today, as you have pointed out today,

 4   treatment services will not be fully

 5   supported if you are not supporting recovery

 6   services.   So more funding is needed.

 7         We would ask that any proceeds coming

 8   from the opioid settlement dollars -- which

 9   we estimate could be as high as $1 billion --

10   to be directed to evidence-based prevention,

11   treatment and recovery services, as these

12   dollars in particular, $40 million of them,

13   are needed to further ensure that one

14   recovery community organization, one recovery

15   community outreach center, one recovery youth

16   clubhouse, two peer engagement specialists,

17   two family support navigators, can and will

18   be in every county throughout New York State.

19         So in addition, we are very much in

20   tune -- in light of the sign of the times in

21   increasing access to substances, we are very

22   concerned about our youth.   So Allison will

23   talk about that point.

24         MS. WEINGARTEN:    Thanks, Angelia.
                                                      287

 1         And I would like to just say that I

 2   work very closely with a group called Youth

 3   Voices Matter in New York State, and they are

 4   under the Friends of Recovery organization.

 5   And there are currently three young people

 6   employed in Western New York, New York City,

 7   and the Capital Region, to go out and find

 8   young people and support recovery.

 9         And if we're talking about a continuum

10   of care, we like to say that prevention is

11   recovery, especially for young people.   So

12   that we are providing these services so that

13   young people don't feel like they're alone.

14         So that is federally funded, and we

15   are definitely looking for your support,

16   especially over the next year, to try and get

17   that embedded in the state budget.

18         And I want to say that that program is

19   being recognized federally.   Angelia attended

20   a conference last summer, a national

21   conference, and that New York State program

22   was getting that kind of credit.   So we want

23   to definitely see that continue.

24         Thank you so much.
                                                          288

 1            MS. SMITH-WILSON:   Thank you.

 2            CHAIRWOMAN WEINSTEIN:   Thank you for

 3   being here.

 4            Senator Carlucci.

 5            SENATOR CARLUCCI:   Thank you, Chair.

 6            And thank you both for being here

 7   today.    Director Smith-Wilson, Angelia, good

 8   to see you again.

 9            And I just want to thank you for your

10   commitment to our community.     I know we have

11   a very strong group in Rockland and

12   Westchester Counties with Friends of

13   Recovery, and it's been tremendous.       So thank

14   you for your commitment.     You've risen to the

15   occasion, and it's just been tremendous.

16            We've talked a lot today about so many

17   different issues which you are -- you're

18   involved in each of them, pretty much, when

19   it comes to addiction.   And I was questioning

20   the commissioner earlier today about some of

21   the barriers.    And you list out, and you do a

22   great job of that, about what is needed and,

23   with the right funding, the services you'll

24   be able to provide.
                                                     289

 1         I wanted to ask you about some of the

 2   direct obstacles that you see to access to

 3   medical-assisted treatment, but particularly

 4   to methadone.    When I was asking the

 5   commissioner, the commissioner didn't want to

 6   comment on anything related to Medicaid.

 7         Would you be able to tell us what

 8   you've seen in terms of access to methadone,

 9   any of the major roadblocks, or suggestions

10   that you see that we could be doing to make

11   it easier to access that type of treatment?

12         MS. SMITH-WILSON:    Well, I think as

13   the commissioner kind of touched on, it is a

14   very complicated issue with regards to having

15   individuals be able to bridge certain scrips

16   when they leave.    And because of all of the

17   issues that are tied with Medicaid, it

18   becomes a complicated issue.

19         And I think for our folks, we just

20   simply want, to be honest, for you guys to

21   figure it out.   Because our folks are the

22   ones that are leaving treatment facilities,

23   jails or outpatient or even at the ED, our

24   folks are the folks that are leaving and not
                                                        290

 1   having the medicines that they need.

 2            And so we have tried to support in any

 3   way that we can by providing testimony from

 4   individuals, by collecting data.     We do a lot

 5   of surveys, and anytime there's any issue

 6   that our community is facing, we will put

 7   together a survey to really collect that data

 8   and to really be able to drill down and apply

 9   recommendations that the community has kind

10   of validated and authenticated and that is

11   real, that is happening for them on a daily

12   basis.

13            And so I would say that it is a

14   complicated issue, one that we are hopeful

15   that in the coming years we can begin to

16   really kind of mitigate.     And folks will have

17   the necessary medications that they need as

18   they leave facilities.

19            SENATOR CARLUCCI:   Okay, thank you.

20            I was going to ask -- I know we're out

21   of time, but we'll talk further about it --

22   but the access to supportive housing and the

23   barriers that are there.

24            MS. SMITH-WILSON:   Oh, yes, that
                                                         291

 1   remains.    That was a -- we did a survey at

 2   our recovery conference in October.    Over 150

 3   people were surveyed, and that was at the top

 4   of our list.

 5         So Stand Up for Recovery Day, we will

 6   definitely be talking about housing.

 7         MS. WEINGARTEN:    Yup.    Tuesday,

 8   February 11th, I know many of you are going

 9   to be there.   So we're excited to have you

10   there to listen to the voices of the people

11   in recovery.

12         And thank you for all that you do.       We

13   want to work together, continue to work

14   together.

15         CHAIRWOMAN WEINSTEIN:     Thank you for

16   being here today.

17         Next we have Legal Action Center,

18   Christine Khaikin and -- Wendy Burch was

19   before, so I assume that's not accurate.

20         MR. ROBINSON:    What about Research for

21   a Safer New York?

22         CHAIRWOMAN WEINSTEIN:     Oh, I'm sorry.

23   Research for a Safer New York.    Please.   Ken

24   Robinson.
                                                       292

 1         MR. ROBINSON:     Thank you.   I didn't

 2   want to miss my turn.

 3         CHAIRWOMAN WEINSTEIN:     Not to worry.

 4         It's the bright lights.

 5         MR. ROBINSON:     Good afternoon.   As my

 6   written testimony indicates, my name is Ken

 7   Robinson, and I am the executive director of

 8   Research for a Safer New York.

 9         Research for a Safer New York is a

10   consortium of harm-reduction providers that

11   has been established to oversee a pilot

12   research study in the form of the operation

13   of five overdose prevention centers in New

14   York State, four in New York City and one in

15   Ithaca.   The 24-month pilot study will

16   evaluate the efficacy of OPCs as a crucial

17   strategy to prevent opioid overdose

18   fatalities, reduce public drug use and needle

19   sharing, create a pathway to substance use

20   disorder treatment and recovery, and combat

21   the HIV and hepatitis C epidemics.

22         Most of you probably know that

23   overdose prevention centers are a safe and

24   clean place where indigent IV drug users can
                                                      293

 1   consume their drugs under the supervision of

 2   staff that have been trained to intervene

 3   with naloxone in the case of overdose.

 4            OPCs started in Europe in the '70s,

 5   and they then spread to Australia and Canada.

 6   Multiple empirical studies have been done,

 7   and the data has been consistent and it has

 8   been clear:     OPCs increase access to drug

 9   treatment and services.

10            They decrease crime and disorder.

11   They reduce public injection and hazardous

12   litter.    They prevent HIV and hepatitis C

13   transmission.    And they are cost-effective.

14   Studies indicate that they save the

15   jurisdictions that they operate in millions

16   of dollars by reductions in medical, criminal

17   justice, incarceration, and public sanitation

18   costs.

19            So this is my second year in a row to

20   come before this body to ask you to authorize

21   the Overdose Prevention Center Act.    In the

22   meantime, I have met with many of you and/or

23   your staffs to essentially plead with you to

24   support this initiative.    Last year we tried
                                                      294

 1   to get the OPC Act included in the budget;

 2   that failed.   Then we tried to get a bill

 3   passed, but it never made it out of

 4   committee.

 5           I have to tell you, my heart has

 6   become heavy, because people are dying.

 7   We're talking life and death here.     I could

 8   have done an easy, quick calculation of the

 9   people who have died from the last time I

10   testified to this time, but I didn't, but we

11   all know it's a substantial number of people.

12           It really, truly, sincerely is beyond

13   my comprehension that we cannot pass this

14   simple piece of legislation, whose sole

15   purpose is to save lives and to get a very

16   vulnerable and hard-to-reach population into

17   care.   Saving human lives should not be

18   controversial.   Saving human lives should not

19   be a crime.

20           Esteemed Senators and Assemblymembers,

21   it is time for all of us to show moral and

22   political courage.   I know that this bill has

23   negative stigma associated with it, but that

24   is because people do not understand.    Most
                                                       295

 1   people are good and decent, and it is

 2   incumbent upon us to educate them.      Passing

 3   this bill is simply the right thing to do,

 4   and we must do it.

 5         A great example of the benefits of

 6   OPCs is the Insite program in Vancouver,

 7   Canada.   Insite was the first OPC in

 8   North America, and it's one of the most

 9   well-known OPCs in the world.   On their

10   website they say that in 2017 they engaged in

11   1,983 overdose interventions and in 2018 they

12   engaged in 1,466.

13         Last July I spoke with Insite's

14   director, Elizabeth Holliday.   I was curious,

15   and I asked Ms. Holliday if she would say

16   that each one of those interventions was a

17   life saved.   She emphatically replied that

18   she knew with a high level of certainty that

19   each of those of 3,449 interventions was a

20   human life saved.

21         Think about that.   That's 3,449

22   families that did not have to bury a son,

23   daughter, brother or sister; 3,449 mothers

24   that did not have to suffer the crushing
                                                      296

 1   grief of losing a child.

 2         Again, we must authorize the overdose

 3   prevention, we must authorize overdose

 4   prevention centers this session.    One of the

 5   lives saved may very well be one of your

 6   friends or family members.

 7         Thank you.

 8         CHAIRWOMAN KRUEGER:     Thank you.

 9         Senator David Carlucci.

10         SENATOR CARLUCCI:     Thank you, Chair.

11         Thank you, Director Robinson.

12         MR. ROBINSON:   You're welcome.

13         SENATOR CARLUCCI:     I wanted you to

14   elaborate on -- I'm going to ask you two

15   things.   First, what are some of the reasons

16   you believe that this legislation has not

17   been passed?

18         And we saw not too long ago, a few

19   months ago, a federal judge rule down the

20   Department of Justice's intervention in

21   trying to strike down a nonprofit provider

22   from doing safe -- overdose prevention in a

23   facility in Philadelphia.    And so they said,

24   okay, well -- they were fighting and saying
                                                        297

 1   that the Controlled Substance Act of 1986

 2   precluded them from doing this.      The federal

 3   judge said no, they can.    Where does put us

 4   now?

 5           And then also, because that roadblock,

 6   it seems to be pushed aside that, okay, we

 7   had -- it was against federal law, possibly,

 8   to do this.   We see that that's not the case.

 9   Could you elaborate on that?    And also, what

10   are some of the other issues holding up this

11   important legislation?

12           MR. ROBINSON:   If it's okay, I'll back

13   up even a little bit more and explain to

14   everybody -- I know some of you know this

15   story, but originally this was going to be

16   done by executive order through the Health

17   Department.   The Governor was all in, he

18   promised us that he was going to authorize

19   this.   We even saw a draft of the letter that

20   they wrote to authorize it.    And

21   Commissioner Zucker, I understand, was

22   holding that letter, just waiting for the

23   Governor to say go ahead.    The Governor said

24   "However, I need to wait until after the
                                                     298

 1   general election," which we understood, but

 2   then we never heard from him again.   He just

 3   went away.

 4         Interestingly, I had -- we had a

 5   meeting with his chief counsel, the first

 6   time we've talked to them at all since then,

 7   earlier today.   There may be a glimmer of

 8   hope that that could happen.    I'm not

 9   terribly optimistic about it.

10         So then we switched to the strategy of

11   getting a bill passed, under the leadership

12   of Assemblymember Rosenthal.    And I would

13   have to give credit to Senator Rivera too.

14   We all worked really hard, I think, to get it

15   passed last year.   The political will just

16   wasn't there, I guess, Senator Carlucci,

17   that's the best thing I could say about it.

18         SENATOR CARLUCCI:   Do you believe that

19   the federal court's decision --

20         MR. ROBINSON:   Oh, going back --

21         SENATOR CARLUCCI:   Yeah.

22         MR. ROBINSON:   Well, I have kept up

23   quite a bit with the Philadelphia situation.

24   Everybody knows that the judge ruled in favor
                                                      299

 1   of Safehouse, and then the Justice Department

 2   pretty quickly said, We are going to appeal.

 3   Well, of course they are, we knew that they

 4   would do that.

 5         Safehouse recently said:    We're going

 6   to open anyway.   We feel we have a stronger

 7   case in New York State, because they're doing

 8   that just on the authority of the City of

 9   Philadelphia.    We would be doing it on the

10   authority of the State of New York, who has

11   the authority for an emergency -- we're in an

12   opioid crisis, an epidemic.   The state could

13   recognize that as an official emergency, and

14   we would have a much stronger case in court.

15         Through our discussion this morning,

16   there were two or three lawyers in the room.

17   We don't think that they could probably even

18   get an injunction like they got in

19   Philadelphia.    That's what the people in the

20   room said this morning.

21         SENATOR CARLUCCI:    Okay, thank you.

22         MR. ROBINSON:    You're welcome.

23         CHAIRWOMAN KRUEGER:     Thank you.

24         Assembly.
                                                        300

 1            CHAIRWOMAN WEINSTEIN:    Assemblywoman

 2   Rosenthal.

 3            ASSEMBLYWOMAN ROSENTHAL:   Thank you.

 4            Good to see you again.

 5            Do you think the stigma around being a

 6   drug user is abating a bit?

 7            MR. ROBINSON:   I do.   I certainly do.

 8   I think that that stigma -- you know, this

 9   just crushes my heart.    You know,

10   unfortunately, it seems to me people don't

11   value their lives.    That stigma is so strong

12   that people just don't seem to care whether

13   they die or not.    You know, it breaks my

14   heart.

15            I -- you know, a couple of people

16   today have mentioned about making it

17   personal.    I'll make it a little bit personal

18   for me.     I'm in recovery, recently in

19   December celebrated 20 years.     I'm a former

20   IV drug user.    So I've got a passion, I've

21   got a passion to get this done.     And I know

22   that stigma firsthand.

23            You know, I'm also a gay man of a

24   certain age, and I saw the government turn
                                                        301

 1   their back on us.   And they didn't give a

 2   damn if we died or not either.     And a lot, a

 3   lot of people died.   Well, I'm seeing the

 4   same thing now, it seems like to me, with

 5   this group of people.    It seems that -- like

 6   many -- many, certainly not everybody, but

 7   many in government are more worried about

 8   political considerations than they are

 9   whether or not these people live or die.

10         ASSEMBLYWOMAN ROSENTHAL:     Well, I look

11   forward to continuing our work together.     I

12   mean, it is an epidemic and it is a matter of

13   life and death.

14         And it's hard for me to understand as

15   well when overdose prevention sites have been

16   legal around the world for years, and here in

17   the United States and in the progressive

18   State of New York, we can't take a step

19   forward when we know it works in saving lives

20   and providing treatment, housing, healthcare,

21   et cetera, for people who need it.

22         MR. ROBINSON:     Right.   It's become the

23   number-one entryway to treatment in

24   Vancouver, the number-one portal in
                                                         302

 1   Vancouver.   We would see the same thing here,

 2   I'm sure.

 3         ASSEMBLYWOMAN ROSENTHAL:       Thank you.

 4         CHAIRWOMAN KRUEGER:      Thank you very

 5   much for your testimony here.

 6         MR. ROBINSON:     Thank you.

 7         CHAIRWOMAN KRUEGER:      Next up,

 8   Christine Khaikin, from the Legal Action

 9   Center, and then followed by -- if people

10   want to get ready and come forward -- Mark

11   van Voorst of The Arc New York, and then he

12   will be followed by a panel of Lauri Cole and

13   Andrea Smyth.

14         Good evening -- is it -- wait,

15   afternoon, I take that back.

16         MS. KHAIKIN:    Good afternoon.     My name

17   is Christine Khaikin.    I'm a health policy

18   attorney at the Legal Action Center.      And we

19   have a long history of working to remove

20   barriers to health insurance coverage for

21   people with substance use disorders and

22   mental health needs, and so we thank you for

23   the opportunity to provide input today.

24         You have my written testimony, so I'll
                                                     303

 1   just focus on a couple of priorities.

 2         Last year's passage of the behavioral

 3   health insurance parity reforms, a

 4   groundbreaking set of policies, made several

 5   advances towards improving the ability to

 6   access life-saving substance use disorder and

 7   mental health treatment.   But New Yorkers

 8   still struggle to access life-saving

 9   addiction and mental health care.

10         For example, they have trouble finding

11   providers with available appointments in

12   their insurance networks, they face delays in

13   getting care because their insurer requires

14   prior authorization, or their care is denied

15   midway through treatment because their

16   insurer says their treatment is not medically

17   necessary.   People are paying hundreds or

18   even thousands of dollars out of pocket when

19   they have insurance, due to copays and

20   coinsurance charged higher or more often for

21   substance use disorder and mental health care

22   than for medical care.

23         High-quality providers throughout the

24   state are not accepting insurance or
                                                      304

 1   struggling because they receive subpar

 2   reimbursement rates for behavioral health

 3   services compared to physical healthcare.

 4          The state and federal parity laws have

 5   made things better, but insurers are still

 6   often not held accountable for violating the

 7   law.   Insurance should help people access

 8   care, not prevent someone from receiving

 9   treatment.

10          That is why we were thrilled to see

11   that the Executive Budget includes a proposal

12   to require the Department of Financial

13   Services and DOH to promulgate regulations to

14   clarify and strengthen parity compliance

15   requirements.    These could provide strong

16   compliance standards so that the regulators

17   can hold plans accountable to follow the law

18   and to not discriminate against people with

19   substance use disorders or mental health

20   service needs.

21          The Executive also proposes to

22   establish the Behavioral Health Parity

23   Compliance Fund, to collect penalties from

24   plans who violate the law.    And as we heard,
                                                     305

 1   $1.5 million of those funds will eventually

 2   go to support New York's mental health and

 3   substance use disorder ombudsman program,

 4   known as CHAMP.

 5         Thanks to the Legislature, in 2018

 6   CHAMP became a first-in-the-nation ombudsman

 7   program.   Operated by OASAS and OMH, CHAMP

 8   operates a helpline, run through the

 9   Community Service Society, as well as a

10   current network of five community-based

11   organizations that provide on-the-ground

12   outreach and localized support and expertise.

13   CHAMP has served over 1600 New Yorkers since

14   it launched, and it helps people overcome

15   many of the insurance barriers that I cited,

16   as well as connects people to care.

17         While this fund will hopefully

18   eventually provide support for CHAMP, there

19   is a great need now for the Legislature to

20   provide $1.5 million to supplement the

21   current $1.5 million budget for CHAMP.    The

22   additional funding will allow a localized

23   network of CBOs to expand to many more

24   counties across the state -- we saw Senator
                                                       306

 1   Harckham's map showing there are many bare

 2   counties -- and additional money will also

 3   help extend the helpline hours beyond a

 4   limited time during weekdays.

 5         We were also grateful for the

 6   Legislature's support for removing prior

 7   authorization requirements for all

 8   FDA-approved medications to treat substance

 9   use disorder.   And while we were thrilled to

10   see the Governor sign legislation to remove

11   prior authorization in commercial insurance,

12   Medicaid recipients must also receive this

13   benefit, because administrative barriers

14   should not be getting in the way of receiving

15   immediate life-saving care.    And we thank the

16   Legislature for your continued support to

17   make this happen.

18         And I just want to thank you for the

19   opportunity to provide input.

20         CHAIRWOMAN KRUEGER:     Thank you.

21         Senate?   Well, I have one quick one.

22         So you were here earlier when we were

23   asking the OASAS commissioner questions.

24   What's your opinion about what's preventing
                                                       307

 1   the State of New York from just making sure

 2   people have continuation of Medicaid coverage

 3   from when they're leaving prison to when they

 4   get to communities?    There seems to be such a

 5   disconnect in our inability to get this taken

 6   care of.

 7         MS. KHAIKIN:    Well, I think one of the

 8   issues there is the current inability to

 9   provide Medicaid inside the walls.    And so

10   DOH recently submitted a federal waiver to be

11   allowed to provide Medicaid for the last 30

12   days while people are inside.   And that would

13   really help with that transitional care,

14   because it would allow people to get enrolled

15   and begin receiving transitional services

16   even before they leave.

17         And so I think that waiver will be

18   really important.    Right now it's with the

19   federal government, so we'll see what

20   happens.   But I think that that -- being able

21   to start those transitional services and

22   provide Medicaid inside is a great path

23   forward for that.

24         CHAIRWOMAN KRUEGER:     So when they're
                                                           308

 1   inside they can get the drug, but you're

 2   suggesting that we need a federal waiver to

 3   start them a month in advance before they

 4   leave jail.    But we could still do the

 5   application while they're in jail and

 6   literally turn it on the day they get out,

 7   right?

 8            MS. KHAIKIN:      Yes, correct.    Yes.

 9            CHAIRWOMAN KRUEGER:      We wouldn't need

10   a waiver for that.

11            MS. KHAIKIN:   You would not need a

12   waiver for that, that's right.

13            I don't know if I can speak to all of

14   the reasons preventing that from happening

15   right now, but I do think that that --

16   starting services and Medicaid before people

17   leave would be great.       And we'll see what

18   happens with the waiver.

19            CHAIRWOMAN KRUEGER:      Thank you.

20            Assembly?   No.    Thank you very much.

21   Appreciate it.

22            MS. KHAIKIN:   Thank you.

23            CHAIRWOMAN KRUEGER:      Okay.    And as I

24   said, we now have Mark van Voorst, The Arc
                                                     309

 1   New York, followed by a panel of two.

 2         Good afternoon.

 3         MR. GEIZER:   Good afternoon.   Thank

 4   you for the opportunity to speak with you

 5   today and provide feedback on the proposed

 6   Executive Budget, its impact on our field,

 7   and the people that we serve.

 8         I am Erik Geizer.   I'm one of the

 9   deputy executive directors.   Mark van Voorst

10   unfortunately could not be with us today due

11   to illness.

12         The Arc New York represents 47

13   chapters across the state who deliver

14   essential supports and services to

15   New Yorkers with I/DD.   We are the largest

16   voluntary provider in our field.   We support

17   more than 60,000 individuals and families.

18   And we employ almost 30,000 people throughout

19   the state.

20         I've organized my talking points today

21   into five distinct areas which are reflected

22   also in our written testimony, but I'd like

23   to just touch briefly on each of them.

24         The first is #3for5, which you've
                                                     310

 1   heard several times today.   The Arc New York

 2   has joined forces with the New York State

 3   disability advocates and the larger human

 4   services sector to request a 3 percent annual

 5   program funding investment every year for the

 6   next five years.   This is the same #3for5

 7   campaign you've heard today, sector-wide

 8   support.

 9         Investment keeps pace with inflation,

10   it's aligned with the overall growth of

11   Medicaid funding that the Governor deemed

12   reasonable and expected in his State of the

13   State address.

14         New York has a legal and ethical

15   obligation to provide essential services,

16   quality care, and integration for its

17   citizens with I/DD.   Our shared

18   responsibility to the people we support is

19   non-negotiable.

20         The next area I'd like to just speak

21   about is mergers and consolidations.    While

22   we appreciate the investment in our DSP

23   workforce, a decade of deferred

24   cost-of-living increases has left our system
                                                       311

 1   in crisis.   We believe the state is

 2   intentionally and systemically underfunding

 3   the system to drive consolidation.

 4         In the first 65 years of our

 5   organization's existence, The Arc New York

 6   conducted a total of four mergers, one each

 7   decade.   Yet eight mergers were completed in

 8   the last five years alone, and another five

 9   are planned by the end of 2021.    A similar

10   trajectory can be seen throughout the field.

11         If the state's goal is increased

12   efficiency, consolidations should be planned,

13   proactive and initiated prior to providers

14   developing into a crisis where services are

15   jeopardized.   However, crisis consolidation

16   will continue to escalate in response to the

17   economic constraints our providers face, and

18   OPWDD simply does not have the funds or the

19   capacity at this time to handle the rapid

20   increase in consolidations.

21         COLA deferral has saved the state

22   $5 billion over the last decade.    We request,

23   respectfully, that $10 million in state share

24   funding be reinvested from that savings to
                                                       312

 1   support the cost of additional consolidations

 2   occurring in the upcoming year.

 3         In addition to the current financial

 4   pressure on providers, the release of the

 5   Executive Budget has raised further concerns

 6   about cuts to program funding the system

 7   simply could not sustain.

 8         Managed care.     The 2020 Budget

 9   Briefing Book included language which clearly

10   articulated that funds required to transition

11   to a managed care environment would be

12   covered by the global Medicaid budget.     This

13   year the briefing book is silent on the

14   matter.   This omission is deeply concerning

15   for our organization.

16         Funding for the implementation and

17   operation of managed care cannot come from

18   the operating budgets of providers delivering

19   supports and services to the people with

20   I/DD, or from existing resources of the OPWDD

21   system.   Any attempt to do so will result in

22   the creation of a financial crisis that will

23   rapidly and irreparably damage the service

24   system before any positive outcomes can be
                                                       313

 1   derived from managed care.

 2         Deferred rate action.     On their budget

 3   briefing call, OPWDD indicated there is

 4   insufficient funding in the budget to fully

 5   fund provider costs moving forward, based on

 6   the most recent rates.   We are grateful that

 7   OPWDD shifted funds to fully reimburse

 8   providers through July 2020.    However, we

 9   have been told to expect a budget neutrality

10   factor of less than 1 that will be applied in

11   July, in an effort to recoup $30 million in

12   state share funding.

13         In his testimony today,

14   Commissioner Kastner indicated that the

15   budget neutrality factor will cut all

16   rate-rationalized programs by 2 percent,

17   significantly more than we estimated.    This

18   cut would drive already strained providers to

19   the brink and would escalate crisis mergers

20   beyond the current unsustainable rate.    We

21   request that the $30 million be included in

22   the Executive Budget to fully cover actual

23   costs for the fiscal year.

24         Our organization wants to partner with
                                                      314

 1   state leaders.   But to do so, we must be

 2   informed, we must have clarity of direction

 3   necessary to plan thoughtfully and invest

 4   proactively in the future of our service

 5   system.   Today I urge not only your

 6   investment, but your transparency.     We have

 7   far more questions than clarity about the

 8   transition to managed care and the

 9   preparation and investment that will be

10   necessary to transform our field.

11         We believe the state is driving the

12   field towards consolidation, but we have no

13   definitive picture of New York's plan for our

14   service system or its expectations for

15   providers.   To be effective partners with the

16   state in serving people with I/DD, we need

17   the administration to be clear about its

18   vision for the future of our field.

19         And lastly, we will work to identify

20   solutions and be strong partners in achieving

21   our shared goals.   To do so effectively and

22   to fulfill our mission and our responsibility

23   to the people we serve, we need the state to

24   clearly define the path forward.
                                                        315

 1         CHAIRWOMAN KRUEGER:    Thank you.    Thank

 2   you very much for your testimony today.

 3         MR. GEIZER:   Thank you.

 4         CHAIRWOMAN KRUEGER:    Next up, Lauri

 5   Cole, executive director, New York State

 6   Council for Community Behavioral Healthcare,

 7   and Andrea Smyth, executive director,

 8   Coalition for Children's Behavioral Health.

 9         MS. COLE:   Good afternoon.

10         CHAIRWOMAN KRUEGER:    Good afternoon.

11         MS. COLE:   Good to see you all.     Thank

12   you for being here and staying in the game

13   this afternoon.

14         My name is Lauri Cole.     I'm the

15   executive director of the New York State

16   Council, as you've said.   And just to put it

17   on record, it's 20 years for me before this

18   entity.

19         And in addition to being a membership

20   association director representing mental

21   health and substance abuse providers around

22   the state, I'm also a family survivor, twice

23   over in the last two years, both losses to

24   the opioid epidemic.
                                                     316

 1         Everything that I say here today and

 2   that you've heard before me is largely

 3   related to the -- everything that I see is

 4   through the lens of access to care.   Without

 5   it, without adequate access and continuity to

 6   care for some of New York's most vulnerable

 7   people, we are nowhere.

 8         There are two public health crises

 9   facing us right now with the epidemic, the

10   opioid epidemic, and increasing rates of

11   completed suicides in certain populations.

12   Our workforce are like first responders at

13   this point.   They are essential staff and

14   should be treated, in that regard, similarly

15   to the way that emergency personnel are often

16   treated.

17         At this point the trauma associated

18   with working in a job as a direct care person

19   who is face-to-face with clients who may be

20   there one day and not there the next, is

21   collective and it's fierce.   And it's

22   resulted in all kinds of disadvantages for

23   our field and our sector as it relates to

24   being able to recruit and retain staff.
                                                        317

 1           Andrea and I are both part of the

 2   #3for5 coalition, and I'll tell you that it

 3   is an unprecedented group of individuals.

 4   And we are looking for something more than a

 5   COLA.   It is not that we're not appreciative,

 6   but instead it is that roofs need repair,

 7   health insurance bills go up, all kinds of

 8   expenses that we cannot control go up every

 9   year, in addition to recruitment and

10   retention issues, et cetera.

11           So while we appreciate the COLA, and

12   we needed it, we need something more.   We

13   need an investment, an infusion of resources

14   into our human services sector.

15           There is money to be had this year.    I

16   want to remind you of that.    I try and do

17   that every year.   There is a whole lot of

18   money potentially proposed through DSRIP, and

19   you'll hear about and see that a coalition of

20   advocates is looking for a set-aside of DSRIP

21   funds for community-based organizations,

22   where in the past in DSRIP 1.0, we got a

23   smidgen of those dollars for the

24   community-based care side.
                                                     318

 1         In addition to that, we continue to

 2   urge you to take a look at the Healthcare

 3   Transformation Fund account.   That is the

 4   fund where Centene-Fidelis and other formal

 5   business transaction monies go and where

 6   hospitals and nursing homes received a

 7   disbursement this past spring.   We do not

 8   begrudge our colleagues that money, but by no

 9   means do we think -- the legislation, the

10   statutory legislation does not stipulate that

11   it is only for a portion of the healthcare

12   sector.

13         Now, that account is controlled by the

14   Governor, and we just urge you to look at it

15   and perhaps to speak about it and perhaps

16   even to advance legislation that would put

17   you in the mix in terms of that discussion,

18   because we need you as champions.

19         In addition, I'd like to just also

20   point out to you that there's money related

21   to settlements to come -- the opioid

22   settlement being one, but not the only one.

23   The Governor's proposal on parity compliance

24   provides an opportunity for income where
                                                       319

 1   there has not been before.     I'm hoping some

 2   of you will ask me questions about the type

 3   of enforcement that's gone on to this point,

 4   both in the Medicaid and the commercial

 5   space, related to the implementation of

 6   Medicaid managed care in our sector.       It's

 7   been 3 1/2 years, and there have not been

 8   very many violations.

 9         So with that, I'll turn it over to

10   Andrea, my colleague from the Children's

11   Coalition.

12         MS. SMYTH:     Hi.   I'm executive

13   director of the New York State Coalition for

14   Children's Behavioral Health.    My name is

15   Andrea Smyth.   I'm also going to run through

16   five quick issues.

17         Thank you for asking questions about

18   the children's behavioral health expansion.

19   I think pursuant to the previous Arc

20   testifier, you can't start up a program

21   unless you invest in new services.     And what

22   you heard today was that on January 1st, our

23   startup got cut by 11.5 percent.    And yet

24   people are promising that that startup, that
                                                       320

 1   expansion, is what's going to address the

 2   lack of access to care.

 3            And I don't see how you start up and

 4   grow a program without the available startup

 5   funds.    And the startup funds were not on the

 6   streets long enough.   And they were paid

 7   through each individual child that got

 8   services as an add-on to the rate, and we

 9   think less than 700 kids got the services.

10            So the startup funds to expand the

11   children's behavioral health capacity were

12   not paid out.    They're being limited by the

13   Medicaid global cap.    We've got to figure out

14   the auspice between this committee and the

15   Medicaid committee and what we're going to do

16   about the Medicaid global cap.

17            The reason why there isn't an

18   expansion in children's and family treatment

19   and support services is because the Medicaid

20   global cap is suppressing what they said

21   they're going to invest in new services to a

22   very small number -- $15 million -- under the

23   global cap.    So even if they say we need $60

24   million to spend on children's behavioral
                                                      321

 1   health services, they're only going to commit

 2   to $15 million.    And they will commit to

 3   $15 million from now until we change the

 4   global cap, so.

 5           As Lauri indicated, we also are

 6   joining all of the human services field to

 7   talk with you about #3for5 funding to help

 8   communities thrive.    The COLA has not been

 9   consistently funding; you've all acknowledged

10   that.   But my organization doesn't believe

11   that the patchwork of alternatives is

12   long-term sustainable for the nonprofits.

13   And so by investing in the community-based

14   service system, this year, with the first

15   year of a five-year commitment of 3 percent,

16   we believe we'll get on the right foot.

17           I'm hoping that you will look to other

18   tables to help us with our workforce

19   problems.     The Governor proposed last year

20   $175 million in statewide workforce

21   development initiatives.    We hope that the

22   human services chairs will look towards

23   adding a new human services workforce

24   initiative.
                                                     322

 1         Specifically, one of the key reasons

 2   why people are dissatisfied with the

 3   low-paying human services jobs -- the second

 4   reason.   Low-paying is the first

 5   dissatisfaction.   The second reason is

 6   overwhelming paperwork.

 7         And we think if you had a legislative

 8   roundtable that talked about how the human

 9   services field could use the robotic process

10   automation to reduce paperwork, and you

11   invested in our ability to train people to do

12   that work and to come and work for us, that

13   we would start to have some productivity

14   improvements in the human services workforce.

15         So we really urge you to carefully

16   take a look at that.   We are going to apply

17   under the existing workforce funds.    We're

18   working with UIPath and Gigster, nationally

19   known social impact bond corporations, to put

20   together the proposal.    But if we do it,

21   there won't be a way for other human services

22   agencies to do it unless you do a human

23   services workforce initiative.

24         We heard with interest that the
                                                       323

 1   $350,000 from OASAS for loan forgiveness was

 2   announced today, and we think that's great.

 3   And I've spoken with Senator Harckham about

 4   the fact that doing loan forgiveness for

 5   addiction professionals joins the

 6   $3.9 million that's in the budget for

 7   Senator Pat McGee's loan forgiveness for

 8   nurses and $1.7 million, through

 9   Senator Savino, for the LCSW loan forgiveness

10   program, $50,000 for the child welfare worker

11   loan forgiveness program, zero for the

12   children's mental health, licensed community

13   mental health, licensed creative arts

14   therapists, licensed marriage and family

15   therapists.

16         It's okay if we want to do this all

17   piecemeal.    It's fine.   I'll ask you for

18   $250,000.    I'll go out and get a

19   philanthropic match to make it $500,000.      I

20   can't retain my clinicians who come out of

21   graduate school with a six-year degree with

22   $120,000 in loans at a $39,000 annual payment

23   rate if I can't offer them loan forgiveness.

24   It's vitally important that we address it for
                                                          324

 1   all fields.

 2         Last year Senator Carlucci and

 3   Assemblywoman Gunther put in a revision to a

 4   loan forgiveness program.       But we ask you one

 5   way or the other to make sure it hits the

 6   children's mental health field.

 7         CHAIRWOMAN WEINSTEIN:        Assemblywoman

 8   Rosenthal.

 9         ASSEMBLYWOMAN ROSENTHAL:       Hi.

10   Thank you.    Thank you both.

11         I have a question for Ms. Cole.        I'm

12   interested about the availability of MAT

13   prescribers across New York State.       I know

14   that there are not enough medical

15   professionals who have the waiver and are

16   allowed to prescribe.

17         So I wonder if you would talk about

18   that and ways that we could increase the

19   number so that more people would have

20   availability.

21         MS. COLE:    Thank you for asking that

22   question.

23         It's a big state, and certainly there

24   are qualified, ready physicians, medical
                                                      325

 1   staff who are prescribing MAT.     However,

 2   federal regulation combined with some turf

 3   issues in New York State around scope of

 4   practice create a volatile situation where we

 5   are not maximizing the workforce that is the

 6   most interested, the most ready, and the most

 7   motivated to provide MAT.   And those would be

 8   people who currently are operating under

 9   caps, arbitrary caps due to federal

10   requirements.

11         One of the ways we can solve this

12   problem, particularly in areas of the state

13   that are not in concentrated urban settings,

14   but also in rural areas of the state, et

15   cetera, would be to focus on what can we do

16   to incentivize those individuals -- nurse

17   practitioners, psychiatric nurse

18   practitioners -- in order to want to do this.

19         This is not easy work.     That's why

20   there are probably lots of slots available in

21   a doctor's practice that are not filled to

22   the limit with clients who need MAT because

23   perhaps some potential prescribers do not

24   want to do this work.   We need to identify,
                                                      326

 1   recruit, retain individuals who do want to do

 2   it.

 3         And in order to do that, we have to

 4   look at scope issues.   We have to look at

 5   what we can do to be flexible around federal

 6   regulations, and we've begun that discussion.

 7   But access to care begins with access to

 8   appropriate medications.

 9         ASSEMBLYWOMAN ROSENTHAL:   Is it

10   federal law that -- I mean, for example, are

11   we allowed to say every physician should be

12   able to prescribe bu?

13         MS. COLE:   There's an educational

14   component that they have to complete.    And

15   sometimes for a prescriber who -- or a

16   potential prescriber who has a busy practice,

17   that may not be desirable.

18         ASSEMBLYWOMAN ROSENTHAL:   But it's not

19   preempted by the federal government, is my

20   question.

21         MS. COLE:   There are preemptions

22   around the number of clients you can carry on

23   a caseload.

24         ASSEMBLYWOMAN ROSENTHAL:   Right.    But
                                                              327

 1   not how many people can write a prescription.

 2            MS. COLE:    I don't believe so.

 3            ASSEMBLYWOMAN ROSENTHAL:      Okay.     Well,

 4   I'd love to work with you on that.

 5            MS. COLE:    Thank you.

 6            ASSEMBLYWOMAN ROSENTHAL:      Thank you.

 7            CHAIRWOMAN KRUEGER:       Thank you both

 8   very much.    Appreciate it.

 9            MS. SMYTH:    Thank you.

10            ASSEMBLYWOMAN GUNTHER:      I think I have

11   one.

12            Could you shed some light on the

13   disparity in rates between commercial and

14   Medicaid and what they pay?

15            MS. COLE:    Yes.

16            ASSEMBLYWOMAN GUNTHER:      The other

17   thing I thought when you were just talking

18   about physicians, there's a lot of physicians

19   that -- you know, it's a tedious practice

20   when you do MAT, medication- assisted

21   treatment, and a lot of doctors still had in

22   their mind this picture of those that take

23   drugs.    They don't realize it's the

24   stockbroker with the suit on and those kinds
                                                       328

 1   of things.    So it's about -- it's a stigma

 2   issue a lot of times.

 3            MS. COLE:   That's right.   That's

 4   right.

 5            ASSEMBLYWOMAN GUNTHER:   And I think

 6   that -- you know, I know that in my -- kind

 7   of my own research, people travel miles and

 8   hours away to pick up their methadone in the

 9   morning because they don't want to be seen

10   walking in and out.

11            However, if it were some simple doctor

12   that -- or not a simple doctor, but a doctor

13   that had all kinds of things going on, you

14   wouldn't have to charge in error because no

15   one would know your business, for instance.

16            MS. COLE:   Yes.

17            I'll just tell you, as a partner in

18   the state's ombuds program, we spend an awful

19   lot of time watching people travel great

20   distances to access care.    And that's why the

21   proposal that Christine spoke about earlier

22   that would fund the ombuds program beyond the

23   initial 1.5 is so important, because in your

24   communities around the state, probably most
                                                       329

 1   of you do not have community-based

 2   organizations that are set up and that are

 3   working with the ombuds program to provide

 4   local coverage.

 5            ASSEMBLYWOMAN GUNTHER:   And they work

 6   in silos also.

 7            MS. COLE:   That's right.   That's

 8   right.

 9            But to your question about commercial

10   versus Medicaid rates, we've testified for

11   close to a decade, the council has, that

12   unlike other areas of the healthcare sector,

13   in the behavioral health sector it is the

14   Medicaid rate, the Medicaid managed care

15   rate, that is consistent, stable and

16   government actuarially set.    Okay?   That is

17   called an APG government rate.

18            On the commercial side, over the last

19   10 years the New York State Council has asked

20   the Department of Financial Services over and

21   over and over again to take responsibility

22   for the inadequate rates that commercial

23   payers -- that is, private health plans --

24   are permitted to pay that are not in any way
                                                          330

 1   near cost of care, let alone the Medicaid

 2   rates which the state has set.

 3         And so what is created is a disparate

 4   system in which, interestingly, people with

 5   private health insurance, with commercial

 6   health plans, people who are underinsured,

 7   working-class people every day struggle to

 8   find access to care in those same clinics,

 9   with the same staff, with the same provider

10   as a person who would show up at the clinic

11   with a Medicaid card in his hand.

12         It is incredible.    The state continues

13   to permit it.   What we've asked the

14   Department of Financial Services to do is to

15   take responsibility and seek statutory

16   purview to set actuarially sound commercial

17   rates so that we do not have this disparity

18   in rates between commercial clients and

19   Medicaid clients.

20         CHAIRWOMAN KRUEGER:        Thank you very

21   much, both of you.

22         MS. COLE:     Thank you.

23         CHAIRWOMAN KRUEGER:        Next up, New York

24   Disability Advocates, Susan Constantino, and
                                                       331

 1   I believe New York Alliance for Inclusion &

 2   Innovation, Michael Seereiter.    And there was

 3   a third, but they did not submit testimony,

 4   so I'm double-checking, Yvette Watts and the

 5   New York Association of Emerging &

 6   Multicultural Providers as well.     Did we get

 7   testimony from Yvette Watts?    Yes.

 8         MS. WATTS:    Good afternoon, Chairwomen

 9   Krueger and Weinstein, Senator Carlucci,

10   Assemblymember Gunther and other members of

11   the Senate and Assembly.   Thank you.

12         My name is Yvette Watts, and I'm the

13   executive director of the New York

14   Association of Emerging & Multicultural

15   Providers.   But the title that I'm most proud

16   of is I'm a parent of a 34-year-old woman

17   with autism, who still lives at home with me

18   because of the wonderful services and

19   supports that I received in the span of her

20   life from the volunteer agencies downstate.

21         And I'm able to be here today because

22   of the wonderful services that the DSP is

23   providing for me right now.    So thank you.

24         I'm here with my colleagues Susan
                                                       332

 1   Constantino from -- she's the CEO of UCP of

 2   New York State {sic} -- and Michael

 3   Seereiter.   He is the president and CEO of

 4   the New York Alliance.    We speak to you today

 5   not as executives of our individual agencies,

 6   but as representatives of the New York

 7   Disability Advocates -- that's NYDA -- a

 8   newly formed coalition of more than

 9   300 volunteer providers who are instrumental

10   in delivering services and support to over

11   140,000 New Yorkers with I/DD.

12         While we've come to you independently

13   for years to advocate for the field and for

14   people we serve, today we come as one.   Our

15   members hold various perspectives and

16   priorities on some matters, but our single

17   driving goal is shared:    The sustainability

18   of comprehensive quality supports and

19   services for New Yorkers with I/DD.

20         Across the state these organizations

21   and the more than 120,000 people they employ

22   provide lifelong, comprehensive,

23   individualized services to support people

24   with I/DD in all areas of their lives.   In
                                                      333

 1   addition to delivering physical and

 2   behavioral health services, they assist with

 3   transportation, housing, medication

 4   administration, cooking, feeding, developing

 5   personal care, community living, employment,

 6   and other crucial services.

 7           As part of the broad coalition of over

 8   40 associations across the human services

 9   sector, we are here today to ask the state to

10   facilitate the continuation of this care and

11   to stabilize the non-for-profit sector by

12   providing a 3 percent increase in investment

13   annually for the next five years.   We're

14   asking for #3for5.

15           We understand the state is facing

16   financial headwinds.   However, achieving

17   #3for5 is crucial for ensuring continual care

18   for New Yorkers throughout the state with

19   I/DD.   Right now crucial services are in

20   jeopardy.   Over the last decade, provider

21   organizations have received only one

22   cost-of-living funding increase -- that's

23   less than .02 percent -- and have experienced

24   $2.6 billion in cuts, pushing many provider
                                                      334

 1   agencies to the brink of insolvency.

 2         In a statewide survey that we

 3   conducted, nearly half of them have less than

 4   40 days of cash in hand.   A third of the

 5   providers reported having to reduce services

 6   or cut programs completely in the last three

 7   years due to funding constraints, impacting

 8   almost 50,000 New Yorkers with I/DD and more

 9   than 30,000 employees who support these

10   individuals.   And all over New York,

11   providers are operating with minimal or

12   outdated technology and deteriorating

13   infrastructure.   This is really dangerous.

14         Stagnant funding also affects

15   employment.    Provider organizations employ

16   more than 120,000 people across the state.

17   The majority of them are women and

18   minorities.    Many of these organizations are

19   the largest employers in their counties,

20   playing a vital role in the local economies.

21         Organizations are doing what they can

22   to operate within these constraints, and

23   they've taken a variety of steps to lower

24   their costs, with four out of five having to
                                                         335

 1   slash employee benefits to these already

 2   underfunded individuals.   Yet they are

 3   running out of options and simply cannot

 4   continue to do more with less.

 5         These communities deserve the same

 6   access to quality care as every other

 7   New Yorker.   They deserve opportunities to

 8   lead independent, fulfilling lives and

 9   participate in their communities.    We and I

10   implore you to champion the lives of people

11   with I/DD and to commit to support an annual

12   3 percent investment for the next five years.

13         CHAIRWOMAN KRUEGER:     Thank you.

14         MS. CONSTANTINO:     Thank you.   I'm

15   Susan Constantino, and I am here just to

16   represent the New York Disability Advocates.

17         What I really wanted to do was just to

18   give you a little more information about what

19   these providers are going through.      What we

20   had done is in December we did a survey.      And

21   currently right now, as Yvette has said,

22   there's 300 providers in the intellectual and

23   developmental disability area.   You heard

24   everyone today talking in the whole human
                                                      336

 1   service coalition, but I just have the

 2   information on the I/DD providers.

 3         The providers that we surveyed have

 4   really been in their communities for 30, 40,

 5   50 years or more.   These are agencies that

 6   are viable, have always been viable agencies

 7   providing support to individuals and their

 8   families.    But all of a sudden this is not

 9   what's going on any longer.

10         As Yvette stated, and we'll go just a

11   little bit deeper, 50 percent of the

12   providers statewide have less than 40 days of

13   cash on hand.   Your auditors will tell you

14   that's not a good thing.   However, 30 percent

15   of the providers have less than 30 days of

16   cash on hand, and we do know that there are

17   providers that may have 10 days of cash on

18   hand or less.

19         So because #bFair2DirectCare gave us

20   dollars to increase salaries, those dollars

21   came in and went right back out to those

22   employees every single time, but not to the

23   agencies so that we could help their

24   structure.
                                                      337

 1           Fifteen percent of our providers

 2   indicate that in the current years that they

 3   have used up to 75 percent of their lines of

 4   credit, the balance on their lines of credit.

 5   Some might have $2 million, some might have

 6   $15 million, depending on the size of the

 7   agency.   It doesn't matter -- bigger agency,

 8   bigger bills.    So they are using those

 9   dollars up.

10           And also, which I think is really one

11   of the real critical things that is such a

12   shame in all of this, is that in the last

13   three years the agencies tell us that they've

14   had to either reduce or eliminate programs.

15   They have vacancies in their programs,

16   vacancies that should be filled by people in

17   the community waiting to come in.   But they

18   can't bring them in because many of these

19   people who are referred to them have complex

20   needs, complex behavioral needs or complex

21   medical needs.   And they would have to put on

22   more staff in order to be able to accommodate

23   them, and they don't have the dollars to do

24   that.   So those folks are not getting the
                                                       338

 1   service that they need.

 2            Years ago, those of us who are old and

 3   have been in this field a long time remember

 4   what the nonprofits offered to individuals,

 5   to our staff, was good benefits.    We may not

 6   have always been the highest-paid in the

 7   community, but we offered good benefits.

 8            That's not the case any longer.   And

 9   over the last two years, what people have had

10   to do is restructure their benefits so that

11   people often -- your employees have to pay

12   more than what they've paid before.   They've

13   reduced and restructured their retirement

14   plans so that it's harder for individuals to

15   make it on retirement.    And many have had to

16   reduce and/or close programs because they

17   just can't afford what it costs to keep that

18   program running.    And, again, all critical

19   services to families that are now being lost

20   to us.

21            What individuals -- what they've told

22   us is that, you know, they have had to

23   really -- and I heard this question

24   earlier -- they've had to really look very
                                                       339

 1   carefully at what they do with their own

 2   facilities.    Can they make all of the repairs

 3   that their facilities need, can they afford

 4   to put on the roofs, can they afford to do

 5   many things.   The funding streams are not

 6   what they used to be, and those are also very

 7   significant issues to us in our communities.

 8           They've had to switch vendors, not

 9   worrying about quality but worrying about

10   cost, which is not always the best thing to

11   do.   And for many of them, they've had to

12   reduce program staffing needs.    Now, we all

13   know that one of our main directives is

14   always community inclusion, that's what we

15   need to do.    But if we don't have enough

16   staff, and the staff because we've not been

17   able to pay them, then we're not able to do

18   that.

19           So I think -- and within there, and

20   we've totally been appreciative of the -- all

21   of the money that came with

22   #bFair2DirectCare.   But there are other

23   people who work for us, vital people -- our

24   payroll people, our human resources people,
                                                       340

 1   any of our administrative people and

 2   secretaries that have been very difficult for

 3   us to be able to support any kinds of

 4   increases for them -- that's something that a

 5   COLA would be able to do.

 6            So I guess what I'm saying is that the

 7   #3for5 is critical to us right now.    This is

 8   the only way we're going to be able to keep

 9   on.   And we are a much better deal than the

10   state.    So we are asking you please to

11   consider this.

12            CHAIRWOMAN KRUEGER:   Thank you.

13            MR. SEEREITER:   Good afternoon.   I'm

14   Michael Seereiter of the New York Alliance

15   for Inclusion & Innovation.    Thank you.

16            I'd like to start with a thank you to

17   you for your ongoing support and the support

18   from the Governor for our workforce, which is

19   really the backbone of the I/DD industry and

20   the sector.    We're very pleased to see the

21   increase for the #bFair2DirectCare campaign

22   and the effort, reflected in the Governor's

23   budget, for a 2 percent increase this year

24   taking effect on April 1st.
                                                          341

 1            I would say that wages, I think, are

 2   only part of that equation, however.       I think

 3   that another piece of that puzzle to address

 4   what is a huge workforce challenge for our

 5   sector is also a credential.    And we would

 6   support -- we would urge resources to be

 7   supportive of the piece of legislation

 8   sponsored by Senator Carlucci and

 9   Assemblymember Gunther related to a DSP

10   pilot.

11            I would like to quickly address

12   something the commissioner addressed earlier,

13   speaking around DSP wages and the fact that

14   New York State enjoys DSP wages that are

15   typically higher than most other states.      I

16   think the question really needs to be asked

17   about what is the cost of living in New York

18   State as it relates to those wages.    And

19   furthermore, what is the value of the

20   supports and services the direct support

21   professionals provide?   I would argue it is

22   not minimum wage work.

23            So we are indeed pivoting our advocacy

24   efforts, and we're very pleased to be working
                                                     342

 1   with the New York State Disability Advocates

 2   and the larger #3for5 campaign for the

 3   3 percent increase each year for five years,

 4   as my colleagues here have more eloquently

 5   articulated today than I will.    I will say

 6   three quick things about this.

 7         Number one, the flexible resources we

 8   seek would do three things.    One, it would

 9   stabilize the sector.    Number two, it would

10   provide the opportunity for provider

11   organizations that operate in the sector to

12   be planful about their futures.   And lastly,

13   it would actually allow us to continue the

14   workforce investments that began under the

15   #bFair2DirectCare campaign.

16         One of the things that -- well,

17   another thing that Commissioner Kastner

18   articulated earlier was that the cost-based

19   methodology that currently is the methodology

20   by which provider organizations are funded in

21   this sector is probably the most favorable of

22   any of the structures.   I would say that

23   that's probably true.    However, that's not

24   necessarily true when you artificially
                                                      343

 1   suppress those rates with a budget neutrality

 2   factor or other across-the-board reductions

 3   like those that were articulated today.

 4           So the rates are indeed less than what

 5   it costs to provide services.   And just as a

 6   kind of -- in passing, those are rates that

 7   are reflected two years after the services

 8   are delivered.   And again, they have not been

 9   reflective of any of the cost-of-living

10   adjustments that this sector needs and has

11   not been privy to over a period of about a

12   decade now.

13           On the Medicaid Redesign Team No. 2,

14   we're watching this very carefully and

15   cautiously.   We would encourage you to do the

16   same.   There seems to be no reason that this

17   process can't improve on the previous process

18   of the MRT 1 in three particular areas:

19   Number one being improved representation for

20   the populations that are impacted; number two

21   being improved stakeholder input; and number

22   three being an improved opportunity for

23   reviewing the recommendations that are

24   ultimately put forward.
                                                      344

 1         Lastly, on managed care, we heard

 2   today and we've heard through the Governor's

 3   budget proposal that the SIP-PL plan

 4   qualification document is expected shortly.

 5   If indeed the I/DD sector is to continue to

 6   move toward managed care, it needs, I

 7   believe, four things:   Number one, a

 8   continued investment in readiness resources,

 9   including the managed care community of

10   practice that Senator Seward was asking about

11   earlier, which is a project of the New York

12   Alliance.

13         I will say two things about the

14   managed care community of practice.     One is

15   that we are beginning the work to

16   specifically try to address some of the itch

17   points, the concerns related to the CCO

18   implementation, and we are happily taking up

19   some of that work, which will be starting

20   with an inclusive conversation of everyone,

21   all stakeholders involved in the system.

22         Number two, I would say that very

23   shortly we will be delivering to your offices

24   a white paper that discusses the implications
                                                         345

 1   for New York State, based on a study of five

 2   other states that have already implemented

 3   managed care for the I/DD sector, and what

 4   can be learned from those experiences.

 5           The second on my list of things that

 6   are necessary for success in managed care are

 7   investments in health information technology

 8   to be able to operate in a managed care

 9   structure.

10           Number three would be an I/DD

11   ombudsperson program specifically geared for

12   the specific needs of this population.      It is

13   a very different population than all of the

14   other populations that have moved to managed

15   care.

16           And lastly, I will quote from the

17   Transformation Panel recommendations from now

18   five -- I believe it was five years ago --

19   to, quote, identify funding to meet the

20   administrative costs of managed care,

21   distinct from funding required to meet the

22   needs of individuals for services.

23           Under no means can the resources

24   necessary to stand up that system come out of
                                                     346

 1   the existing system provider sector or, by

 2   any means, out of those services and supports

 3   that individuals and families rely on on a

 4   day-to-day basis.

 5         Thank you.

 6         CHAIRWOMAN KRUEGER:    Thank you.

 7         Senator Carlucci.

 8         SENATOR CARLUCCI:   Well, thank you for

 9   your testimony and thank all of you for your

10   commitment to protecting our most vulnerable

11   populations.   I share the concerns that all

12   of you addressed today, and I think many of

13   our colleagues do as well.

14         I just wanted to ask you to elaborate

15   more upon -- because we didn't get time to

16   talk about it today -- about the

17   credentialing program, how you see that

18   working and how it will help to give a better

19   experience to the people that are being

20   served.

21         MR. SEEREITER:   Several years ago the

22   Legislature appropriated funds to study this

23   program -- study this idea in its totality.

24   And the recommendations that came out of that
                                                      347

 1   report really talk about how the credential

 2   needs to be accompanied by what is already in

 3   the existing system when we talk about core

 4   competencies.

 5         That's kind of the base, right?      And

 6   then on top of that you want to start to

 7   strive for excellence.   And between the two

 8   of those things, you start to actually move a

 9   system toward identifying those opportunities

10   for improving quality.

11         Quality is a definition that I

12   think -- the definition of quality in this

13   sector is something that is not yet fully

14   defined.   In fact, I think we're in the

15   process of that right now.

16         If we are to be playing a role in

17   helping to make that a -- helping to define

18   what that is and certainly improving the

19   lives of individuals with disabilities that

20   these services and supports are designed to

21   do, we need to be striving for that

22   excellence.

23         And in doing so, the credential starts

24   to push the system and it starts to create
                                                         348

 1   the opportunities for people who want to be a

 2   direct support professional to do this and to

 3   make it a career, which is really where I

 4   think the secret sauce is.   It's in the

 5   relationship between the individual served

 6   and the person providing those services.      The

 7   longevity of that relationship, the quality

 8   of that relationship drive so much of what we

 9   see in terms of the outcomes I think that are

10   possible in this system.

11         SENATOR CARLUCCI:    Thank you.

12         And I wanted to -- I just wanted to

13   also thank you for your advocacy for the

14   #3for5 campaign.   It's so important that we

15   get the funding into the system.

16         And also I want to thank you for

17   bringing it to the attention that it was

18   stated earlier that our DSPs are paid at a

19   level top in the country compared to other

20   states.   And I think it's important that we

21   remind everyone that we really can't be

22   looking to other states.   If we want to go

23   backwards, maybe we'll do that, but we want

24   to continue to go forward.
                                                         349

 1            And New York is consistently seen as a

 2   leader in providing services to our most

 3   vulnerable populations, and I think we have

 4   to isolate ourselves from that and not look

 5   to go backwards but look to go forward and

 6   continue to be an example for other states to

 7   follow.

 8            So I just want to thank you for

 9   bringing that point up and really correcting

10   that statement that was said earlier.      Thank

11   you.

12            Thank you, Chair.

13            CHAIRWOMAN KRUEGER:    Senator Jim

14   Seward.

15            SENATOR SEWARD:    Yes, one question for

16   the panel.    I know some of you have talked

17   about this in general terms, but I wanted to

18   get your assessment of the CCOs and the

19   impact on services to those that need the

20   services in the DD community.

21            MS. CONSTANTINO:    I'll take one crack

22   at it.

23            SENATOR SEWARD:    I mean, how's it

24   going, I guess is the --
                                                     350

 1         MS. CONSTANTINO:   You know, I think

 2   for it being a program that's not quite two

 3   years old, it's going well, considering what

 4   we did and how we totally did away with one

 5   whole piece of what we had come to rely on,

 6   which was our Medicaid service coordinators,

 7   and move to something different.   So I think

 8   in that regard it's doing well.

 9         I think -- and we did hear the

10   commissioner talk today, and I was really

11   glad to hear him say they are meeting weekly.

12   Because we as providers have sent our

13   concerns, because there still are concerns.

14         I think the hardest part is for the

15   families.   They were very used to a very

16   close relationship with their service

17   coordinators.   Because the CCOs have had

18   to -- they have larger geographic territories

19   and they've had to change how they really

20   have been able to assign people, people have

21   had to get to know new folks.   And they've

22   had so much pressure to do the life plans

23   that they probably haven't had as much time

24   to really begin to integrate into people's
                                                      351

 1   lives a little bit more.

 2         But I think for being a new program,

 3   it's really moved along quite remarkably.

 4         MR. SEEREITER:     I would echo that,

 5   actually.    I think, you know, when you look

 6   at the larger trajectory of implementing a

 7   system change of that magnitude -- you're now

 8   a year, 19 months into the process, roughly

 9   -- I think it has gone along quite well, all

10   things considered.

11         I think there's just also a -- I think

12   there are some fundamental issues that do

13   need to be addressed with the existing --

14   kind of the system that we now have.     We're

15   now, again, 19 months into implementation.

16   That's no longer part of the implementation

17   period.     But I think that there are

18   expectations that are either unrealistic or

19   don't match up with what the service system

20   is now looking like.

21         I think it is an oversimplification to

22   say that it is simply a shift of the Medicaid

23   service coordination capacity from the

24   previous process to the care coordination
                                                        352

 1   structure.   That is, it's different.    It is a

 2   health home model.   And the scope and

 3   magnitude of the responsibilities of the

 4   health home and the care managers who work

 5   for them are different than those that work

 6   for the Medicaid service coordinators.

 7         So setting reasonable expectations and

 8   helping everyone understand what the roles

 9   and responsibilities are, I think we kind of

10   need to go back and do a little bit of the

11   going back to basics.   And that's actually

12   where we're going to try to focus some of our

13   managed care efforts, managed care community

14   and practice efforts, to try to help

15   understand what is it that we can actually

16   expect out of this process and what are

17   reasonable expectations.

18         MS. WATTS:     But I can say, as a parent

19   and also as an association rep, that we as

20   parents, we've always worked with OPWDD and

21   the volunteer sector.   We've worked very

22   closely with them.

23         So yes, this -- as Susan did say --

24   was a tremendous leap for the families, but
                                                       353

 1   they are resilient.    And I will tell you that

 2   the OPWDD providers, they worked with us and

 3   the CCOs.     Because the CCOs, many of them

 4   were the providers.    So it was a tremendous

 5   transformation, which I think is starting to

 6   find its way.    Because as Michael was saying,

 7   now they're going back and saying, okay, what

 8   were the mistakes?    And we're going to work

 9   together.

10         And I think that's what is so

11   wonderful, is the collaboration.     And if we

12   can get this #3for5, we can continue that

13   collaboration, which parents need to continue

14   to be -- like myself, to continue to work and

15   have quality of life and still maintain your

16   individual at home longer because you're

17   getting the good services from these provider

18   agencies.   So it's all a collaboration that

19   needs to continue.

20         SENATOR SEWARD:     Thank you for your

21   assessment.

22         CHAIRWOMAN KRUEGER:      Thank you very

23   much, all three of you.    Appreciate it --

24         MS. CONSTANTINO:     Thank you.
                                                         354

 1           CHAIRWOMAN KRUEGER:     Our next

 2   panelists are Alcoholism and Substance Abuse

 3   Providers of New York State, John Coppola,

 4   and Coalition for Behavioral Health,

 5   Amy Dorin.

 6           You can start in whichever direction

 7   you prefer.

 8           MS. DORIN:     We're going to start with

 9   John.

10           MR. COPPOLA:    Good evening.   I'm happy

11   to be here.

12           And just want to begin by sort of

13   echoing a point that a number of -- that,

14   Senator Krueger, I heard you make, and

15   Senator Harckham a little bit earlier,

16   Assemblywoman Gunther, Assemblywoman

17   Rosenthal, in terms of talking about the

18   amount of resources that are committed to the

19   crisis.   And I think Senator Harckham's words

20   were "drastically underfunded."

21           The magnitude of our response to the

22   public health crisis that's been created by

23   the addiction related to opioids and opioid

24   overdose deaths -- the magnitude of our
                                                       355

 1   response has not approximated the magnitude

 2   of the crisis.    And that's a significant

 3   problem.

 4         It is not acceptable that -- you know,

 5   there's a chart that I included in my

 6   testimony that shows the funding for local

 7   assistance programs in communities across the

 8   state beginning in 2013 and ending with the

 9   current year's proposal.    And if you think

10   about the work that you did last year, after

11   the Senate and the Assembly were finished

12   adding to what the Governor proposed, the

13   result was a 1 percent increase over the

14   previous year.

15         And that was in a year when we were

16   talking about a record number of overdoses

17   and a record impact of addiction on the

18   system.     And when we were all done with the

19   budget, there was a 1 percent increase to

20   help folks address this crisis.    Which means,

21   you know, all of the things you've heard

22   people talk about relative to the cost of

23   doing business were somehow, you know, also

24   included.
                                                      356

 1          And one of the things that I want to

 2   do -- I want to call a little bit of

 3   attention to the testimony that Ken Robinson

 4   gave a little bit earlier.    And he talked

 5   about his experience working with AIDS and

 6   HIV.   And his -- you know, he must have said

 7   three or four times "My heart is broken," and

 8   he was thinking about the lack of attention

 9   that we pay to people who are currently

10   using, you know, drugs.    And, you know, our

11   lack of ability to see the fundamental

12   dignity in those people.   And so he was kind

13   of surmising that it was a stigma which was

14   the reason why we were so poorly funded.

15          And I want to call your attention to

16   what happened specifically with AIDS/HIV.

17   You all were responsible for a significant

18   change in the response that that illness and

19   that health challenge received, and that was

20   that you increased the rates, the Medicaid

21   rates for physicians who were supposed to be

22   paying attention to that crisis.   And as soon

23   as the rates were increased, physicians

24   started coming out of the woodwork to do that
                                                      357

 1   work.   Absolutely.

 2           And I would suggest to you that if you

 3   take a page or two out of the playbook that

 4   you used in addressing the crisis that was

 5   caused by the incidence of HIV and AIDS, that

 6   that would go a long way toward helping us

 7   address the needs of people suffering with

 8   addiction to opioids and other drugs.

 9           And I would just sort of suggest that

10   the conversation be much broader than just

11   the opioid crisis.    It was alarming to read

12   recently that the number of deaths

13   attributable to alcohol doubled -- doubled --

14   in the last 10 years.   And so when you think

15   about, you know, addiction related to

16   alcohol, addiction related to opioids, and

17   we're starting to hear about

18   methamphetamine and cocaine and fentanyl,

19   it's a sizable public health issue.

20           And I believe that if you approach it

21   the same way that you approached AIDS and

22   HIV, look at the Medicaid rates and, you

23   know -- and again, I think that is at the

24   point when Assemblywoman Rosenthal asked the
                                                    358

 1   question about why don't more doctors

 2   prescribe buprenorphine, why aren't more

 3   doctors getting involved.

 4         There are a lot of doctors that are

 5   certified that are not prescribing to

 6   anybody, and they've made a decision that

 7   it's not good business for them to do so

 8   because the rates don't pay for the cost of

 9   doing the service, it's a bad idea.   And so

10   there's an inherent discouragement of

11   offering the very service that people are

12   talking about so frequently which is also,

13   you know, medication-assisted treatment.

14         So it really is fundamentally a

15   question of do we have the will to really

16   address this problem and can we work looking

17   at the Medicaid rates.

18         So our first priority this year is

19   indeed the #3for5.   And you've heard from

20   everybody that if you don't have an

21   economically viable, fiscally solvent --

22   fiscally sound organization, you are not in

23   the best possible position to address the

24   needs of people in need.    And so we stand
                                                       359

 1   firmly with our partner organizations in the

 2   #3for5 campaign.

 3          The second one is really -- which I

 4   just identified, is to take a look at the

 5   Medicaid rates and to do something with

 6   Medicaid rates.

 7          And the final point is to look at the

 8   possible revenue that you have at your

 9   disposal, whether it's the settlements from

10   opioids, whether it's the tax on marijuana

11   for adult users -- if that's something that

12   you legalize -- if it's the Comrie-DenDekker

13   alcohol tax which would literally tax maybe

14   5 cents for a drink, or if there's additional

15   funds that go into the pharma fund.     There

16   are resources there if you want to do the

17   job.

18          Thank you.

19          CHAIRWOMAN WEINSTEIN:     Thank you.

20          Amy?

21          MS. DORIN:   Thank you.    Good evening.

22          We really appreciate your convening of

23   this joint legislative public hearing on the

24   2020-2021 Executive Budget.
                                                     360

 1         I'm Amy Dorin.   I'm the president and

 2   CEO for the Coalition of Behavioral Health.

 3   The coalition represents more than

 4   100 community-based behavioral health

 5   providers who collectively serve over

 6   600,000 New Yorkers every year.

 7         I'm testifying today with my colleague

 8   John Coppola.   The coalition and ASAP

 9   recently announced a strategic partnership to

10   build a unified voice for behavioral health

11   providers throughout the state, highlight

12   integration as the future of our field, and

13   improve care for individuals with mental

14   health and substance use disorders.   We're

15   very excited about this partnership, and

16   together the coalition and ASAP represent

17   about 250 community-based agencies throughout

18   New York State.

19         This is a critical time for behavioral

20   health in New York.   The opioid and suicide

21   epidemics are taking the lives of thousands

22   of New Yorkers every year.   New York State

23   has the opportunity at this moment to truly

24   invest in behavioral health, tackle these
                                                       361

 1   epidemics and emerging issues, and improve

 2   public health for the state.

 3         Unfortunately, the current funding and

 4   support for the sector means that providers

 5   lack the flexibility to fully address these

 6   issues.   Individuals throughout the state

 7   frequently encounter waitlists for services,

 8   which delays access to care and increases the

 9   likelihood of utilizing much costlier

10   services such as the emergency room and

11   inpatient hospitals.   Clients also experience

12   staff turnover that is detrimental to their

13   care, as funding does not allow for

14   sufficient salaries.

15         Our first and most important issue is

16   the #3for5 campaign, which I'm sure you've

17   heard all throughout the day.   It is

18   absolutely crucial.    If we do not invest in

19   our community providers, we're not going to

20   go anywhere or be able to do anything.    So we

21   stand with human services coalitions from

22   across New York State calling for the states

23   to invest in a 3 percent increase on

24   contracts and rates for the next five years.
                                                       362

 1            Human services funding has been

 2   slashed by 26 percent since 2008, resulting

 3   in rates that are lower than 1980.    The

 4   800,000 New Yorkers who make up the human

 5   services workforce bear the brunt of this,

 6   with stagnant low wages which leave the

 7   average human services worker living at or

 8   below the poverty line.

 9            One of our members today -- and it

10   represents several members -- talked about

11   their workforce that are homeless.    They live

12   in homeless shelters, come into work every

13   day to help other people who are also on the

14   brink of homelessness.    I think that is quite

15   a statement and very impactful.

16            This chronic underfunding threatens

17   the stability of New York's entire human

18   services sector.    Thirty-nine percent of

19   New York's human services organizations have

20   less than three months of cash on hand.      If

21   you run an organization, that's very, very

22   scary.

23            Organizations often have just a few

24   late payments -- are a few late payments away
                                                        363

 1   from being able to make payroll.

 2   Organizations struggle to pay for increasing

 3   requirements and demands necessary to conduct

 4   business, including widespread adoption of

 5   electronic health records, data analytics,

 6   cybersecurity -- all part of the cost of

 7   doing business.

 8         For behavioral health, chronic

 9   underfunding has also led to the severe

10   workforce crisis across the state.     There's a

11   34 percent turnover rate, an increasing

12   vacancy rate, with behavioral health

13   providers reporting lower-level staff leaving

14   for positions that pay better in retail and

15   food service.   And we do have staff leaving

16   to work at Home Depot or McDonald's because

17   the rate of pay is equal to what we're paying

18   or more.

19         This is not easy work to begin with.

20   While it can be immensely rewarding, hours

21   are often inflexible and include nights and

22   weekends, and common incentives like working

23   from home are simply not available to many of

24   the members of our workforce.
                                                        364

 1            It is critical that programs are able

 2   to staff appropriately to serve individuals

 3   with mental health and substance use

 4   disorders, but low salaries make it

 5   impossible for providers to do so.     There are

 6   less people coming into the field and less

 7   staying in the field -- and that is direct

 8   service as well as supervisors.

 9            The second issue in our request or

10   ask:   Maintaining existing behavioral health

11   funding.    We were happy in the first round of

12   cuts when the 1 percent did not affect

13   agencies operating under the Mental Hygiene

14   Law.   We need to at least maintain what's

15   happening now, and we must be represented on

16   MRT II since our providers serve the

17   highest-cost, highest-need individuals in the

18   state.

19            Next ask:   Ensuring that the opioid

20   settlement funding responds to our epidemic.

21   We will absolutely advocate for the

22   settlement funds to be infused back into the

23   system for substance use prevention and

24   treatment, and we hope that you join us in
                                                        365

 1   that.

 2           Restore funding for children.    This is

 3   a huge issue.    We can't cut kids -- it has a

 4   devastating impact on children, families, and

 5   our society.    We are requesting a restoration

 6   of cuts made to Children and Family Treatment

 7   and Support Services, CFTSS, and fulfillment

 8   of the state's promise to increase access to

 9   services through Medicaid redesign.     By

10   bringing children with mental illness, with

11   serious emotional disturbance into

12   Medicaid-managed care --

13           CHAIRWOMAN WEINSTEIN:   If you could

14   wrap up.

15           MS. DORIN:   I'll wrap up.

16           Children -- in this case, we cannot

17   cut.    We've lost so far 25 agencies around

18   the state that have de-designated.      That

19   means that they're not going to continue to

20   do CFTSS services for children.

21           CHAIRWOMAN WEINSTEIN:   That final --

22           MS. DORIN:   Just a concern about CFTSS

23   and the low rates that have caused a lot of

24   providers around the state from
                                                        366

 1   de-designating.    That means that they cannot

 2   do the business of serving children, and it's

 3   horrifying.

 4         And the last ask has to do with

 5   integrating care to improve quality and

 6   access.   And I'm looking at the model of the

 7   CCBHC, the Centers of Excellence for

 8   Behavioral Health -- there are 13 in the

 9   state, seven in New York City.     And really an

10   ask to replicate that model, which allows

11   community providers to have the funding they

12   need to do the services.

13         Thank you.

14         CHAIRWOMAN WEINSTEIN:     Thank you.

15         There are no questions.      Thank you for

16   being here.

17         MR. COPPOLA:    Thank you.

18         ASSEMBLYWOMAN GUNTHER:     Well, I

19   just --

20         CHAIRWOMAN WEINSTEIN:     I'm sorry.

21   Assemblywoman Gunther.

22         ASSEMBLYWOMAN GUNTHER:     So I read -- I

23   try to go along and read along -- you were

24   quick, so it was hard.   But, you know, when
                                                        367

 1   I'm looking at this, we realize that not all

 2   of these requests will be fulfilled.     So in

 3   my opinion, it's just like my kid's Christmas

 4   list -- you know, you've got to go for the

 5   ones that are most important to you.

 6         MS. DORIN:      Yeah.

 7         ASSEMBLYWOMAN GUNTHER:     And I think

 8   that's important.     And I think it's important

 9   also, can we incorporate into like

10   organizations that already are in

11   communities?

12         I think a lot of the times when I go

13   back to the HIV when that was going on, we

14   used to ID physicians that were already

15   existing in our community, you know, we did

16   it kind of secretly behind -- you know,

17   people would go in.

18         But what I'm saying is that there

19   won't be enough money to support every agency

20   that has come and testified today.    So it's

21   almost like we can't be redundant, because

22   there's only a limited amount of money.    So

23   how can we get the best bang for the buck

24   without redundancy?
                                                        368

 1          I know that you're working together,

 2   but I almost think we have to do it just --

 3   like it was different interagencies.    They're

 4   doing lots to communicate together.    They

 5   want DSPs to get a raise -- to get an

 6   increase, so they're working together on

 7   those things.

 8          Well, as far as we look at the areas

 9   of New York State, the agencies that we can't

10   have redundancy -- and the providers.     And

11   it's important.    And -- because there's only

12   that much money to go around.    And you hate

13   to keep saying no to people.     So how can we

14   make it more cost-effective with efficacy, is

15   what I'm saying.

16          And, I mean, I think that brilliant

17   minds, they do prevail, and there's got to be

18   some way, because we're not going to get it

19   all.   And I know that.   And I'm sure other

20   people agree with me.     I feel bad when people

21   sit here and are asking for money and I feel

22   like, you know, I'm going to be -- it's going

23   to be disappointing.

24          So how could you not disappoint people
                                                     369

 1   and utilize what you have and also

 2   collaborate together to provide the services

 3   that you really want for our communities?

 4           MR. COPPOLA:   I think there's two

 5   things specific to your point.    One of them

 6   is to take advantage of the additional

 7   resources that we mentioned, to have the

 8   conversation about how can we utilize funds

 9   from the settlement funds to, you know,

10   distribute in a way that will really make the

11   kinds of changes we're talking about.

12           When we have the conversation about

13   the marijuana tax, if that's something that

14   happens, how do we make sure that we make the

15   investment in prevention and treatment that

16   we --

17           ASSEMBLYWOMAN GUNTHER:   But we don't

18   know that it's going to happen.   So I'd

19   rather look at what is in front of us,

20   because that -- by the time the tax is, you

21   know, when they start -- if they do get --

22   the tax comes, it's still going to be a

23   length of time before that money will be able

24   to be utilized --
                                                       370

 1         MR. COPPOLA:     Right.

 2         ASSEMBLYWOMAN GUNTHER:      -- for

 3   anything.   So --

 4         MR. COPPOLA:     So what is in front of

 5   you, though, is the results of DSRIP No. 1.

 6   And DSRIP No. 1 -- if you say, okay, let's

 7   look only at the successful programs that

 8   drove savings.    And those savings were

 9   largely driven by behavioral health

10   organizations where there was a commitment of

11   resources from DSRIP to those programs which

12   drove savings.

13         So that is not only a question of

14   making the investment, that's where the

15   providers can say to you "We can help you

16   close the gap."     We can help you -- and I'll

17   give you one concrete example which was

18   incorporated into DSRIP.

19         There was a program in New York City

20   that did case management with 750 folks who

21   had frequent services paid for by Medicaid,

22   and they were given case management and

23   treatment for their addiction.     And it saved

24   those 750 individuals who received treatment,
                                                        371

 1   saved in the same fiscal year $10 million.

 2   When the program increased from 750 to 1500,

 3   it saved $20 million.

 4            So you have the ability to say, let's

 5   utilize what we know from DSRIP and let's

 6   project out how much savings will be

 7   generated if we make the investment in the

 8   community-based organizations that can drive

 9   it.

10            ASSEMBLYWOMAN GUNTHER:    I agree with

11   you.   I agree.

12            CHAIRWOMAN WEINSTEIN:     Thank you.

13            MS. DORIN:   Thank you.

14            CHAIRWOMAN WEINSTEIN:     Thank you for

15   the work you do and for being here today with

16   us.

17            MR. COPPOLA:   Thank you.

18            MS. DORIN:   Thank you.

19            CHAIRWOMAN WEINSTEIN:     Next we have

20   Northern Rivers Family of Services,

21   William Gettman, to be followed by the

22   Association for Community Living, to be

23   followed by Families Together in New York

24   State.
                                                        372

 1            MR. GETTMAN:   Good evening.    My name

 2   is Bill Gettman, from Northern Rivers Family

 3   of Services.    We're a mental health provider,

 4   a child welfare provider, and an educational

 5   provider in the Capital Region.    We serve

 6   18,000 children and adults in the 30-county

 7   area.

 8            Thank you for your time today, and

 9   thank you for your public service.

10            I want to address three critical

11   things related to the delivery of services

12   for children and adults across New York

13   State.    First, as my colleagues have

14   suggested, we need to invest in the #3for5

15   campaign.    The #3for5 campaign is an overdue

16   action by the Legislature and the

17   administration to support the viability of

18   our local not-for-profit sector.

19            Many people think of #3for5 as a

20   shorthand for the workforce, but it goes

21   beyond the workforce.    It pays for things

22   like physical security in our schools and in

23   our residences.    It pays for the IT costs

24   that allow us to negotiate with managed-care
                                                          373

 1   companies.    It pays for heaters.

 2            As I was sitting here today I received

 3   an email from my facilities director, who

 4   told me that one of the heaters in the

 5   residences had just blown up and we have an

 6   $18,000 expense tomorrow.     In the past years

 7   I could go back to the state, I could go back

 8   to our funders -- OMH, OPWDD, OCFS and

 9   others -- and look for dispensation.       That no

10   longer exists.    I have to go out and

11   privately raise that money.

12            So we ask for #3for5.   We need

13   predictable funding over the next five years.

14            Related to that is the recommendation

15   from Andrea Smyth and the Children's Mental

16   Health Coalition for an appropriation to

17   support the mental health workforce and a

18   loan forgiveness program.

19            At Northern Rivers this year we

20   piloted a loan forgiveness program for our

21   staff.    We privately raised $150,000 to go

22   out and provide monthly stipends to our staff

23   so they would stay and work for us, so they

24   wouldn't be hired away to go to work for the
                                                       374

 1   managed-care companies or for the state.

 2         In that regard, I have one additional

 3   workforce story to share with you.    We have a

 4   young man who is 18 years old.    He lives in

 5   one of our group homes, and I'm proud to say

 6   he just got a part-time job.     He is the

 7   assistant shift supervisor at a local coffee

 8   store here in the Capital District.    He makes

 9   $16.85 an hour, and he works as many hours as

10   he can schedule.

11         The staff person who takes him there

12   every day and picks him up makes $13 an hour.

13   And 25 percent of my staff have to work a

14   second job to meet their needs.

15         So again, I encourage you to support

16   the workforce in various ways through loan

17   forgiveness as well as #3for5.

18         Last, I need to touch on the

19   community-based services that are available

20   under the CBFT services, the new Medicaid

21   services.   There are large waiting lists,

22   there are turnover of staff, and they're not

23   financial viable.

24         We are a large provider, and we
                                                       375

 1   provide these services to several hundred

 2   families currently.   We will lose $1 million

 3   this year based on the current rates.    It's

 4   not a productivity issue, it's an

 5   insufficiency of the rate.     If we can't meet

 6   this need to break even on this program, we

 7   will have to close it.

 8         Which gets back to the question that

 9   Chair Gunther asked about how do we make sure

10   we're having an impact, because these kids

11   will end up in hospital rooms, in hospital

12   EDs, they'll end up in homeless shelters, and

13   their problems will escalate, therefore

14   costing more Medicaid.

15         So again, I encourage you to support

16   the human service sector through #3for5, the

17   loan forgiveness, and look hard at the new

18   state plan Medicaid services.

19         I appreciate your time and your

20   service and your dedication.    This is a tough

21   budget.   But I think we need to invest in

22   kids, because kids are our future.

23         Thank you.

24         CHAIRWOMAN WEINSTEIN:     Thank you for
                                                      376

 1   being here today.    Thank you.

 2           Next, we have the Association for

 3   Community Living, Antonia Lasicki, executive

 4   director, to be followed by Families Together

 5   in New York State.

 6           MS. LASICKI:   Hi, good afternoon.

 7   Thank you so much for staying and listening

 8   for so long.   Hi, how are you?

 9           I'm going to be as brief as possible.

10   I don't want to repeat a lot of what's

11   already been said here.    I do want to start

12   out just by saying that we so support the

13   $20 million that the Governor put in his

14   proposed budget for OMH residential programs.

15   These programs have been underfunded for many

16   years -- some of them did not get increases

17   for 20 years, literally.   So it's very much

18   appreciated, and we hope you will support

19   that.

20           Just to put that into context, though,

21   if you take -- we have about 40,000 units of

22   housing operated by not-for-profit providers

23   for people who are -- with serious and

24   persistent mental illnesses who are
                                                        377

 1   functionally impaired by those illnesses.     So

 2   the people with very challenging behavior and

 3   medical issues, often on six to 12

 4   medications each -- we have people with a

 5   high school diploma supervising all those

 6   medications, managing that care.   Very

 7   complicated jobs, as other people have said.

 8         And when you think about the

 9   $20 million over 40,000 units of housing, it

10   comes out to about $500 per person per bed

11   per year.   So it's really -- because the

12   housing system under the Office of Mental

13   Health is so big, it's approximately a

14   billion dollars of their budget.   And so

15   $20 million is a 2 percent increase.   And

16   when you've gotten nothing for years and

17   years and years, 2 percent is not very much.

18         So we really need that money.    It's

19   going to offset other losses.   So we -- but I

20   must say, I do appreciate it.   It's a very

21   tough budget year.   And I did want to just

22   put a couple of things into context.

23         There was a couple of questions to the

24   commissioner about the 2 percent workforce
                                                      378

 1   increase, as compared to the statutory COLA

 2   that's been deferred 12 out of the last

 3   14 years.    So the statutory COLA was put in

 4   in 2006; we only got it two out of the

 5   14 years since then.

 6         So what's the difference?      So the

 7   statutory COLA covers Office of Mental

 8   Health, OPWDD, OASAS, OCFS, OTDA, and Office

 9   for the Aging.    So that's -- the extra

10   COLA was for those six state agencies and all

11   the providers who contracted with those six

12   state agencies.

13         The 2 percent workforce COLA is only

14   for OMH, OPWDD, and OASAS.    So those other

15   three state agencies have gotten nothing from

16   the 2 percent workforce increases.    They've

17   got nothing for many years.

18         The other thing is, and I think

19   Mike Seereiter spoke about this

20   specifically -- or maybe it wasn't Michael,

21   but -- the 2 percent workforce increase is

22   only for the direct support professionals, as

23   we know.    But all those other workers in the

24   organizations are not in that 2 percent.
                                                      379

 1         So if you have a worker who is doing

 2   data entry for minimum wage -- and we have to

 3   enter every single gas receipt, every single

 4   expense, it's tedious work -- we have a lot

 5   of the workers like that, and they're not

 6   part of the 2 percent.   So they're left out,

 7   even in the OMH, OASAS, and OPWDD systems.

 8         So the 2 percent does not replace the

 9   COLA that we lost.    The COLA that we lost is

10   a completely different animal.    And that's

11   why everybody is asking for #3for5, because

12   the #3for5 would take the place of the

13   statutory COLA that we have lost.

14         The 3 percent for five years is a

15   3 percent COLA on the contracts, which is

16   what the statutory COLA would have been --

17   not just for certain workers in certain

18   categories.   So the #3for5 is critical,

19   because the longer we go with targeted

20   workforce increases -- yes, we can give a

21   2 percent workforce increase to certain

22   workers, but the agencies are still going to

23   go out of business.    They're still going to

24   go out of business.
                                                        380

 1           So it makes no -- it doesn't really

 2   make a lot of sense to just give a targeted

 3   workforce increase and let agencies sink.     So

 4   we -- I often think about this, the targeted

 5   workforce increase idea, as kind of like a --

 6   it's kind of a state idea where you're -- you

 7   know, you give CSEA workers a raise.   You

 8   know, there's an arm of the state -- the CSEA

 9   workers, they get a raise, but nobody is

10   concerned that the Office of Mental Health is

11   not going to be able to continue to operate

12   from an administrative/managerial point of

13   view.   They're still not going to be able to

14   cover their rents, their utilities, their --

15   you know, liability insurance.   All that gets

16   taken care of.

17           But for us, it doesn't get taken care

18   of.   We get a targeted workforce increase to

19   a direct care worker, and the rest is left

20   alone, and we are -- a lot of our agencies,

21   as you heard, you know, the cash on hand is

22   two weeks.

23           It's really not -- it's not a healthy

24   way to do business, particularly when you are
                                                      381

 1   taking care of some of the most vulnerable

 2   people in the state, and you don't want

 3   providers to go out of business and have an

 4   emergency situation on your hands where you

 5   have to scramble and figure out how you're

 6   going to take care of people.

 7         So the #3for5 really takes the place

 8   of the statutory COLA.   The 2 percent

 9   targeted workforce increases are very much

10   appreciated.   It's a very tough year, we get

11   that, and we appreciate it.    But something

12   else has to be done.   We have to move forward

13   in a different way.    And I think the #3for5

14   campaign is a campaign that has got everybody

15   on board under all six of those state

16   agencies, all the advocates.

17         And so in terms of Assemblywoman

18   Gunther's question, you know, where do you

19   get the best bang for your buck, I think the

20   #3for5 campaign is probably where you get the

21   best bang for your buck.   And -- but again,

22   thank you all for your support, and we'll

23   talk more over the coming months about all of

24   this, I'm sure.
                                                           382

 1            CHAIRWOMAN WEINSTEIN:       Yes.

 2            Assemblyman Santabarbara.

 3            MS. LASICKI:   Yes.   Hi.

 4            ASSEMBLYMAN SANTABARBARA:      I just want

 5   to thank you for being here, and I also want

 6   to thank you for visiting my district.

 7            MS. LASICKI:   I'm sorry?

 8            ASSEMBLYMAN SANTABARBARA:      I want to

 9   thank you for visiting my district and for

10   providing me the information back in

11   Schenectady, Mohawk Opportunities, we had a

12   meeting and it just kind of --

13            MS. LASICKI:   I'm sorry.     I'm having a

14   hard time understanding you.

15            ASSEMBLYMAN SANTABARBARA:      Oh, I'm

16   sorry.    I just wanted to thank you for being

17   here and thank you for visiting my district

18   over the summer.

19            MS. LASICKI:   Oh, yes, yes, yes, yes.

20            ASSEMBLYMAN SANTABARBARA:      Yeah, we

21   got --

22            MS. LASICKI:   I really liked that,

23   yes.

24            ASSEMBLYMAN SANTABARBARA:      And Mohawk
                                                         383

 1   Opportunities -- and executive director Joe

 2   was there --

 3         MS. LASICKI:    Yes.

 4         ASSEMBLYMAN SANTABARBARA:         -- and

 5   provided me information ahead of the hearing.

 6         MS. LASICKI:     Yes.    Yes.

 7         ASSEMBLYMAN SANTABARBARA:         That was

 8   very helpful, because there's a lot to take

 9   in at the hearing.

10         MS. LASICKI:    Yes.

11         ASSEMBLYMAN SANTABARBARA:         So I

12   appreciate you taking the time.       And, you

13   know, the homes that we're talking about, the

14   facilities, some of them are not far from

15   where I live --

16         MS. LASICKI:     Right.

17         ASSEMBLYMAN SANTABARBARA:         They're

18   certainly in my district.      And we talked

19   about the City of Amsterdam as well, a new

20   project that's going to be --

21         MS. LASICKI:     Yeah.    Yeah.

22         ASSEMBLYMAN SANTABARBARA:         -- coming

23   online very soon.    So I wanted to thank you

24   for -- I know it's a short period of time,
                                                        384

 1   but we did review that information and we

 2   will be fighting for you in the budget.

 3         MS. LASICKI:     Great.   Great.

 4         ASSEMBLYMAN SANTABARBARA:      Thank you.

 5         MS. LASICKI:     Thank you.

 6         CHAIRWOMAN WEINSTEIN:      Thank you for

 7   being here today.

 8         MS. LASICKI:     Thank you.

 9         CHAIRWOMAN WEINSTEIN:      Next we have

10   Families Together in New York State, Paige

11   Pierce, to be followed by Jim Karpe.

12         And is Amber Decker here?     No?

13         Yes, go ahead.

14         MS. PIERCE:    Good afternoon.      Thanks

15   for sticking it out.

16         I'm Paige Pierce, I'm the CEO of

17   Families Together in New York State.

18   Families Together is a family-run

19   organization that represents families of

20   children with social, emotional, and

21   behavioral health and cross-systems needs.

22   We represent thousands of families from

23   across the state whose children have been

24   involved in many systems, including mental
                                                      385

 1   health, addiction, special education,

 2   juvenile justice, and foster care.

 3         I am one of those parents.     I have a

 4   son who's 28 who's on the autism spectrum,

 5   and I've been advocating with him and for him

 6   over the last 25 years.    Our board and staff

 7   are made up primarily of family members and

 8   youth who have been involved in these

 9   systems, and our 2020 policy agenda, which

10   you have in my written testimony, is created

11   by our families.

12         In 2011, when the Medicaid Redesign

13   Team was launched, I was glad to serve as one

14   of the people on the Children's Behavioral

15   Health MRT Subcommittee.   The central premise

16   of redesign was that New York would rein in

17   costs by investing in better, more creative

18   preventive healthcare strategies.

19         Back then, we knew that the children's

20   behavioral health system was underresourced.

21   We knew that we had insufficient capacity to

22   meet the needs of our children.   The state

23   acknowledged this reality.    For children,

24   unlike every other aspect of Medicaid, we
                                                     386

 1   resolved that the state would spend funding

 2   most effectively by actually investing more.

 3         But now, in 2020, despite several

 4   delays, the new services are finally here and

 5   we must acknowledge a new reality.   After

 6   nine years, the promised expansion of

 7   200,000 newly eligible young people who would

 8   be able to access a suite of innovative and

 9   evidence-based services known as the Children

10   and Family Treatment and Support Services,

11   CFTSS, has not been realized.

12         These services are designed

13   specifically to be delivered in our homes,

14   schools, and communities instead of waiting

15   for families to reach crisis and rely on

16   emergency rooms, residential placements, and

17   police involvement.   Today, only 6400

18   children are utilizing these services -- not

19   because children no longer need them as they

20   did back in 2011.   In fact, depression and

21   anxiety are rising among children and

22   adolescents.   Seventeen percent of high

23   school students reported seriously

24   considering a suicide attempt.   Suicide is
                                                     387

 1   the second leading cause of death among

 2   15-to-19-year-olds.

 3         And we heard earlier about, you know,

 4   all of the statistics:   54 percent of

 5   children with behavioral health needs don't

 6   receive the treatment that they need.

 7   Almost a decade since the MRT acknowledged

 8   the children's capacity crisis, the expansion

 9   of the children's service system has been

10   delayed so long and supported so sparingly

11   that the nonprofit community-based

12   organizations and their workforce have been

13   left in disarray.

14         Rates were set drastically lower than

15   the actual cost of delivering these services.

16   Even the enhanced rate during the first year

17   wasn't sufficient to cover costs.

18         On December 31st of last year, despite

19   the outcry from the children's behavioral

20   health community, and with these services

21   barely off the ground, the enhanced rates

22   were rolled back as scheduled.   As you heard

23   from the commissioner earlier, that's the

24   explanation for why they were rolled back, is
                                                        388

 1   that it was -- that was the schedule.

 2           Staff turnover is high, waitlists are

 3   common, and in some parts of the state, it

 4   can take half a school year to get into a

 5   therapy program that serves kids, and they

 6   have to travel hours for just an assessment.

 7           The bottom line is that despite the

 8   fanfare and despite the years of preparation,

 9   we are not reaching nearly the number of

10   children the state promised to serve.

11   Cutting rates at this time has not only

12   crippled providers, it has harmed children

13   who will now not have the access to the

14   services that they need.

15           Today, Medicaid is overspent by the

16   standards set nearly 10 years ago.   And

17   before the original MRT plan has been

18   realized, a new MRT II will now envision how

19   they can further reduce costs locally.     In my

20   experience, I worry that children and

21   families will be caught in the crossfire.

22   They can't, again, be sent to the back of the

23   line.

24           Will children have to wait yet another
                                                        389

 1   decade for their needs to be a priority?       I

 2   hope not.     We must put children first. We

 3   must invest in services that strengthen

 4   families and help young people reach their

 5   potential.

 6         Evidence is clear that exposure to

 7   childhood traumas, known as adverse childhood

 8   experiences, ACEs, can lead to poor health,

 9   mental health and socioeconomic outcomes

10   later in life, health outcomes that are no

11   doubt driving the increasing costs of

12   Medicaid.    Our failure to make investments in

13   the mental health of young New Yorkers a

14   decade ago can't be the reason we don't

15   invest now.

16         What we do this year will impact

17   entire generations of New Yorkers moving

18   forward.    That's why we're proud to help lead

19   the Campaign for Healthy Minds, Healthy Kids

20   in calling for a moratorium on all cuts to

21   children's behavioral health services and to

22   restore recent cuts to the CFTSS services.

23   We also join the unprecedented coalition of

24   human service organizations for the
                                                     390

 1   #3for5 campaign that you've heard so much

 2   about today.

 3         Our human service programs are the

 4   thing that will drive down the enormous cost

 5   of ER visits and unnecessary

 6   hospitalizations.   You can see in my written

 7   testimony the other priorities that we have.

 8         We just want to say how much we

 9   strongly support the Behavioral Health

10   Priority Compliance Fund holding health plans

11   accountable and enforcing mental health

12   parity laws.   We worked for years on the

13   Timothy's Law campaign to ensure that parity

14   was the law of the land, and we need to

15   enforce it now.

16         If we fail to acknowledge the

17   underresourced system and don't invest in our

18   children today, we will most certainly

19   continue to scratch our heads for decades to

20   come, wondering how we can contain costs in

21   human services and address the growing health

22   and behavioral health needs in our state.

23   Please be the progressive leaders that we

24   need and that our children need.
                                                        391

 1           CHAIRWOMAN WEINSTEIN:      Thank you for

 2   being here.    And as you said, we have your

 3   testimony, it's been circulated to members.

 4   So I --

 5           MS. PIERCE:    Thanks.

 6           CHAIRWOMAN WEINSTEIN:      No questions.

 7   Thank you.

 8           Let me just ask again, is Amber Decker

 9   here?   No.   Okay.

10           So then Jim Karpe is going to be our

11   last testifier.

12           MR. KARPE:    Thank you.

13           CHAIRWOMAN WEINSTEIN:      Thank you for

14   being here.

15           MR. KARPE:    Okay.   Thank you to the

16   members for sticking it out.       It's been a

17   marathon.

18           And here we are to talk about

19   intellectual and developmental disabilities

20   and I'll alert you right away, don't bother

21   trying to follow along with the written

22   testimony, because I'm going to vary widely

23   from it.    A lot's been said today, and I'm

24   going to bounce off of some of that.
                                                       392

 1          SWAN, for those who don't know, is an

 2   independent grassroots coalition of unpaid

 3   parents from across New York State.    The only

 4   stake that we have in this system is the care

 5   of our children.   I'm one of those unpaid

 6   volunteers, and I'm a parent of two young

 7   adults with developmental disabilities.    So I

 8   often say I've got a caseload of two and also

 9   a caseload of 200,000.

10          I'm here today really to talk to you

11   about accountability, about holding the

12   system accountable and about holding

13   ourselves accountable for asking the right

14   questions, for looking into all the dark

15   corners.   We've done a pretty good job here

16   today, but I'm going to make suggestions

17   about some better work that we can do to

18   continue to probe and continue to hold

19   ourselves accountable and the system

20   accountable.

21          And the first question I have is, why

22   are we moving forward with managed care at

23   all?   The state now concedes that this will

24   lead to no savings.   So why do it?   Perhaps
                                                       393

 1   it leads to better quality, but I would read

 2   to you one quote from the top of page 4,

 3   "There is no definitive conclusion as to

 4   whether managed care improves or worsens

 5   access to or quality of care."    And that's

 6   the conclusion of the congressional committee

 7   charged with reviewing managed care for

 8   Medicaid.    So why move forward with it at

 9   all?

10            And if we can't save money through

11   managed care, where can we save money?     I've

12   got some ideas.    One place I can tell you

13   where we can't save money is in comm-hab.

14   Comm-hab right now, community habilitation,

15   serves about 7,000 individuals in New York

16   State at a total cost -- an average cost per

17   person of 23,000.    So even if we looked into

18   each of those cases and found some savings,

19   we wouldn't be able to save very much.

20            There is a place where we can save

21   money.    There's some big buckets of money,

22   and specifically it's residential services.

23   Residential services --

24            (Mic problems.)
                                                        394

 1         MR. KARPE:   Oh, I'm sorry.   Is this

 2   better?    Okay.

 3         Residential services consume well over

 4   half of the OPWDD budget.   And within that

 5   category, state services consume over

 6   $2 billion, at an average cost for state

 7   services' IRAs of $233,000 per person.     So if

 8   we were to find 10 percent savings for those

 9   7,000 people, we'd be able to have another

10   7,000 people in comm-hab.   And even after

11   finding that 10 percent savings in the state

12   services, they would still cost twice as much

13   as the nonprofit providers for the equivalent

14   service.

15         And that leads me to another question.

16   We have the MRT II busy looking at how to

17   save money.   And what makes us think that

18   hospitals and unions will look to themselves

19   for ways to save money?   I think it's a

20   tragedy if we allow that to move forward.

21         So I have a list of many other

22   questions, but I'll close with this.     What

23   are you, the Legislature, doing to help give

24   OPWDD the flexibility and the power that it
                                                         395

 1   needs to actually make change in the system?

 2           OPWDD's hands are tied.     They don't

 3   actually control the licenses of the CCOs,

 4   they are -- we've heard today about having to

 5   put stuff up to DOH.    We've heard about the

 6   collective bargaining agreement.      What can we

 7   do to actually free up OPWDD to change the

 8   system?

 9           That's the end of my time.    I invite

10   you to ask me some of the questions you've

11   asked others, such as how are the CCOs doing.

12           CHAIRWOMAN WEINSTEIN:   Senator

13   Jackson.

14           SENATOR JACKSON:   Good afternoon.

15           First let me thank you for coming in.

16   And I came in later, so I didn't hear all of

17   the testimony.   But you asked a question

18   about what can we do.    So I'm sure that you

19   have suggestions for the MRT --

20           MR. KARPE:   The MRT II.

21           SENATOR JACKSON:   -- II.    So are some

22   of those incorporated in here?      Or you're

23   going to be submitting those to the design

24   team?
                                                        396

 1         MR. KARPE:   We can submit them to the

 2   design team.

 3         It was breaking news about it, and

 4   we -- but I would echo Michael Seereiter in

 5   saying that it's vitally important that there

 6   be representation of all parties.

 7         SENATOR JACKSON:    On the redesign

 8   team, is that correct?

 9         MR. KARPE:   On the redesign team.     And

10   that there be an opportunity to review the

11   results, and that there be actual stakeholder

12   engagement.

13         SENATOR JACKSON:    Now, in my

14   understanding -- and you probably know more

15   that I do, because you're following this very

16   closely because of your advocacy on behalf of

17   not only your two adults but, you said, 2,000

18   other people involved.

19         So if we do not agree with the

20   redesign team and do not adopt their

21   recommendations, then we have to deal with a

22   $2.5 billion deficit.    One way or the other,

23   do you see the redesign team and them coming

24   forward, whatever they're going to come
                                                       397

 1   forward with -- do you think it's going to be

 2   positive overall for all of the constituents,

 3   your children and others, with regards to

 4   children with mental health or developmental

 5   disability issues?

 6         MR. KARPE:     I unfortunately don't have

 7   much faith.   It's being led by the head of a

 8   hospital system and the head of a union.

 9         SENATOR JACKSON:    And that's why you

10   say it's imperative -- and these are my

11   words -- imperative that you have activists

12   and parents that have been involved from a

13   leadership point of view, like yourself and

14   others that have testified, as part of the

15   redesign team.

16         MR. KARPE:     I would concur with your

17   use of the word "imperative."   Thank you.

18         SENATOR JACKSON:    Well, let me -- I

19   wanted to thank you and everyone else that

20   came in in order to give testimony, because

21   it's extremely important overall.

22         And the leaders here have been here

23   for days hearing testimony; I'm just spotting

24   here and there, being in other hearings.     So
                                                        398

 1   thank you for coming in and giving testimony.

 2            Thank you, Madam Chair.

 3            CHAIRWOMAN WEINSTEIN:   Thank you.

 4            Assemblyman Ra.

 5            ASSEMBLYMAN RA:   So thank you for your

 6   patience in waiting to testify today.

 7            So you closed with a potential

 8   question to ask you, so how are the CCOs

 9   doing?

10            MR. KARPE:   So Assemblywoman Missy

11   {Miller} said that she was on her third --

12   I'm on my eighth care manager in 19 months.

13   Before then, I had the same MSC for five

14   years.    So just on that metric, I'd say it

15   gets an F.

16            I have -- I have hope for the future

17   that with a lot of hard work, a lot of

18   actually developing the IET {ph} systems that

19   are necessary to gather information, that

20   it's possible to salvage this.     But right

21   now, it's -- from my viewpoint as a parent,

22   from the viewpoint of the parents that I

23   speak with, it's just not the rosy picture

24   that you've been presented with today.
                                                       399

 1         ASSEMBLYMAN RA:     What have you seen in

 2   terms of, you know, the reasons why you've

 3   had so many?   You know, are they just -- you

 4   start working with one and then they leave

 5   and go somewhere else, or --

 6         MR. KARPE:    They leave because the

 7   work is very frustrating, because there's so

 8   much emphasis on metrics versus helping

 9   people.   People get into this profession

10   because they want to help others, and a large

11   increase in salary doesn't make up for not

12   feeling a sense of purpose.

13         So people are motivated by money,

14   purpose, mastery.   You can give people a lot

15   of money -- if they don't feel a sense of

16   purpose, if they don't have a chance to

17   master their tasks, they're going to leave.

18   That's my belief and my experience.

19         ASSEMBLYMAN RA:     Thank you.

20         CHAIRWOMAN WEINSTEIN:     So thank you

21   for being here and waiting through the end of

22   the hearing to testify.

23         So this concludes the Mental Health

24   Joint Budget Hearing.   Committees will
                                                      400

 1   reconvene tomorrow morning at 9:30, where we

 2   will have joint fiscal committee hearings on

 3   the Higher Ed portion of the Executive's

 4   budget.

 5         Thank you all.

 6         (Whereupon, the budget hearing concluded

 7   at 5:45 p.m.)

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