Public Hearing - February 05, 2021

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 2  -----------------------------------------------------


 4             In the Matter of the
           2021-2022 EXECUTIVE BUDGET ON
 5                MENTAL HYGIENE
 6  -----------------------------------------------------

 8                           Virtual Hearing 
                             Conducted via Zoom
                             February 5, 2021
10                           9:36 a.m.
             Senator Liz Krueger
13           Chair, Senate Finance Committee
14           Assemblywoman Helene E. Weinstein
             Chair, Assembly Ways & Means Committee
             Senator Thomas F. O'Mara
17           Senate Finance Committee (RM)
18           Assemblyman Edward P. Ra 
             Assembly Ways & Means Committee (RM)
             Senator Samra G. Brouk
20           Chair, Senate Committee on Mental Health
21           Assemblywoman Aileen Gunther
             Chair, Assembly Committee on Mental Health 
             Senator John W. Mannion
23           Chair, Senate Committee on Disabilities


 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3  PRESENT:  (Continued)
 4           Assemblyman Thomas J. Abinanti
             Chair, Assembly Committee on People with
 5            Disabilities
 6           Senator Pete Harckham
             Chair, Senate Committee on Alcoholism 
 7            and Substance Abuse
 8           Assemblyman Phil Steck 
             Chair, Assembly Committee on Alcoholism
 9            and Drug Abuse
10           Assemblyman Michael Cusick
11           Senator Diane J. Savino
12           Assemblyman Angelo Santabarbara
13           Senator John Liu
14           Assemblywoman Melissa Miller
15           Senator Gustavo Rivera
16           Assemblywoman Mary Beth Walsh
17           Senator Sue Serino
18           Assemblywoman Chantel Jackson
19           Senator Anthony H. Palumbo
20           Assemblyman Khaleel M. Anderson
21           Assemblywoman Vivian E. Cook
22           Senator Roxanne J. Persaud
23           Assemblyman Harry B. Bronson


 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3  PRESENT:  (Continued)
 4           Assemblyman Jeffrion L. Aubry
 5           Senator Robert G. Ortt
 6           Assemblyman Harvey Epstein
 7           Assemblywoman Carmen N. De La Rosa
 8           Senator John E. Brooks
 9           Assemblyman William Colton
10           Assemblyman Chris Burdick
11           Assemblywoman Judy Griffin
12           Assemblyman Erik M. Dilan
13           Senator James Tedisco
14           Assemblywoman Rebecca A. Seawright
15           Assemblyman Kenneth Zebrowski
16           Senator Peter Oberacker
17           Assemblyman Jarett Gandolfo
18           Assemblywoman Mathylde Frontus
19           Assemblyman Keith P. Brown
20           Assemblyman Edward C. Braunstein
21           Senator Simcha Felder
22           Assemblywoman Diana C. Richardson
23           Assemblywoman Karen McMahon


 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3                   LIST OF SPEAKERS
 4                                    STATEMENT  QUESTIONS
 5  Ann Marie T. Sullivan
 6  NYS Office of Mental Health           13         23
    Theodore Kastner 
 8  Commissioner 
    NYS Office for People With
 9   Developmental Disabilities          152        159
    Arlene Gonz�lez-S�nchez 
11  Commissioner
    NYS Office of Addiction 
12   Services and Supports (OASAS)       245        251
13  Denise M. Miranda 
    Executive Director
14  NYS Justice Center for the
     Protection of People with 
15   Special Needs                       301        307
16  Melissa Genadri
    Poverty & Health Policy Associate
17  Children's Defense Fund-New York
18  Andrea Smyth
    Executive Director
19  NYS Coalition for Children's
     Behavioral Health                   
20      -and-
    Jeffrey L. Reynolds, Ph.D.
21  President and CEO
    Family and Children's 
22   Association                         354        364



 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3                   LIST OF SPEAKERS, Continued  
 4                                     STATEMENT  QUESTIONS
 5  Leslie Feinberg
 6  Supporting Our Youth and Adults
     Network (SOYAN)
 7      -and-
    Luis Alvarez
 8  Chair
    CUNY Coalition for Students
 9   with Disabilities                   380
10  Ruth Lowenkron
    Director, Disability Justice
11   Program
    NY Lawyers for the Public Interest
12      -and-
    Harvey Rosenthal 
13  Executive Director 
    NY Association of Psychiatric
14   Rehabilitation Services             386
15  Christine Khaikin
    Health Policy Attorney
16  Legal Action Center                  
17  Briana Gilmore
    Community Advocate                   394
    John J. Coppola
19  Executive Director
    NY Association of Alcoholism 
20   and Substance Abuse Providers
21  Allegra Schorr
22  Coalition of Medication-Assisted
     Treatment Providers & Advocates
23      -and-
    Dr. Angelia Smith-Wilson
24  Executive Director
    Friends of Recovery New York         402        411


 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3                   LIST OF SPEAKERS, Continued  
 4                                      STATEMENT  QUESTIONS
 5  Glenn Liebman
 6  Mental Health Association
     in New York State                   
 7      -and-
    Kelly A. Hansen
 8  Executive Director
    NYS Conference of Local
 9   Mental Hygiene Directors            
10  Wendy Burch
    Executive Director
11  National Alliance on Mental 
     Illness of New York State            
12      -and-
    Amy Dorin
13  President and CEO
    The Coalition for 
14   Behavioral Health                   423
15  Russell Snaith
    Founding Member
16  New York Alliance for
     Developmental Disabilities
17      -and-
    Sebrina Barrett
18  Executive Director
    Association for Community Living
19      -and-
    Susan Platkin
20  New York Self-Determination
21      -and-
    Susan Constantino
22  President and CEO 
    Cerebral Palsy Associations
23   of New York State
        -on behalf of-
24  New York Disability Advocates
     (NYDA)                              438        454


 1  2021-2022 Executive Budget
    Mental Hygiene
 2  2-5-21
 3                   LIST OF SPEAKERS, Continued  
 4                                      STATEMENT  QUESTIONS
 5  Carlene Braithwaite
    Executive Committee Member
 6  NYC Fair
 7  Kevin Allen
 8  Local 372 NYC Board of Education 
     Employees, DC 37 AFSCME
 9      -on behalf of-
    Substance Abuse Prevention and
10   Intervention Specialists 
11      -and-
    BJ Stasio
12  President
    Self-Advocacy Association
13   of New York State
14  Nick Cappoletti
15  LIFEPlan CCO NY                      462        476







 1                 CHAIRWOMAN KRUEGER:  Good morning.  My 

 2          name is Liz Krueger.  I'm the chair of the 

 3          Senate Finance Committee.  And my partner in 

 4          these dual hearings is Helene Weinstein, 

 5          chair of Assembly Ways and Means.  

 6                 Today is Friday, February 5th, it's 

 7          9:30.  We're having our seventh virtual joint 

 8          legislative hearing on the 2021 Executive 

 9          Budget, the sections of the budget that 

10          relate to mental hygiene.

11                 Let's see.  Just -- I got out of order 

12          already, which is fine.  These hearings are 

13          conducted pursuant to the New York State 

14          Constitution and Legislative Law.

15                 Today the Senate Finance Committee and 

16          the Assembly Ways and Means Committee will 

17          hear testimony concerning the Governor's 

18          proposed budget for the Office of Mental 

19          Health, the Office for People With 

20          Developmental Disabilities, the Office for 

21          Addiction Services and Supports, and the 

22          Justice Center for the Protection of People 

23          With Special Needs.  

24                 Following each testimony there will be 


 1          some time for questions from the chairs of 

 2          the fiscal committees and other legislators 

 3          on the relevant committees for today's 

 4          hearing.

 5                 I will now introduce members from the 

 6          Senate and Assembly.  And Assemblymember 

 7          Helene Weinstein, chair of Ways and Means, 

 8          will introduce members from the Assembly.  I 

 9          will also then be, in between, introducing 

10          Senator Tom O'Mara, ranking member of the 

11          Senate Finance Committee, who will introduce 

12          members from his conference, and the Assembly 

13          will follow suit.  

14                 We have lots of Senators here already 

15          today.  So, let's see, I see Pete Harckham, 

16          chair of Alcoholism and Substance Abuse; 

17          Roxanne Persaud, John Mannion, John Liu, John 

18          Brooks.  Continuing along, Diane Savino.  I 

19          think that's the Senate Democrats so far.

20                 But as more people come online, we 

21          will be introducing them during the course of 

22          the hearing.  

23                 And why don't I just quickly hand it 

24          to Tom O'Mara, ranker on Finance, to 


 1          introduce the other members of his 

 2          conference.

 3                 (Zoom interruption.)

 4                 CHAIRWOMAN KRUEGER:  Mute your phone.

 5                 SENATOR O'MARA:  Good morning.  Thank 

 6          you, Chairwoman Krueger.  

 7                 We are joined on our side this morning 

 8          by our Republican Minority Leader Rob Ortt.  

 9          We're still waiting for a couple other of our 

10          members to join us, and I will announce them 

11          as they do.  So thank you, and good morning.

12                 CHAIRWOMAN KRUEGER:  Good morning.  

13          Thank you.

14                 And again, just to clarify for 

15          everyone, because we have so many 

16          representatives of the government today, that 

17          when you are the chair for the relevant 

18          committee, you get 10 minutes to ask 

19          questions.  But since we have technically 

20          chairs of multiple committees here, you only 

21          get -- please mute yourself if you're not 

22          actually supposed to be talking on-screen.  

23          Thank you.

24                 So, for example, Ann Sullivan will be 


 1          the first commissioner to testify for the 

 2          Office of Mental Health.  Then we will let 

 3          the others testify.  So we'll go through the 

 4          four commissioners first, and then we will 

 5          take the questions from the chairs and 

 6          rankers and then other legislators.  

 7                 So for those of us who are just 

 8          listening, let's just get comfortable for a 

 9          while.  And the clock is set for 10 minutes, 

10          Commissioner --

11                 CHAIRWOMAN WEINSTEIN:  Uh --

12                 CHAIRWOMAN KRUEGER:  Oh, I'm so sorry.  

13          I'm not doing any of that now.  I'm first 

14          handing it to Helene Weinstein to introduce 

15          the Assemblymembers.  I apologize.  More 

16          coffee this morning.

17                 CHAIRWOMAN WEINSTEIN:  Thank you, 

18          Senator.  

19                 So we have with us Assemblywoman 

20          Gunther, chair of our Mental Health 

21          Committee, Assemblyman Phil Steck, chair of 

22          our Alcoholism Committee, Assemblyman 

23          Abinanti, chair of our Disabilities 

24          Committee; Assemblyman Anderson, Assemblyman 


 1          Aubry, Assemblyman Bronson, Assemblyman 

 2          Burdick, Assemblywoman Cook, Assemblyman 

 3          Cusick, Assemblyman Dilan, Assemblyman 

 4          Epstein, Assemblywoman Griffin, Assemblyman 

 5          Santabarbara, Assemblywoman Seawright, and 

 6          Assemblyman Zebrowski.  And I'm sure there 

 7          will be more members joining us.  

 8                 Now I'd like to just turn it to our 

 9          ranker on Ways and Means to introduce the 

10          members of his conference before we begin.

11                 ASSEMBLYMAN RA:  Sorry, I was muted.  

12          Good morning.  

13                 We are joined by Assemblywoman Missy 

14          Miller, who is our ranker on the Disabilities 

15          Committee; Assemblyman Jarett Gandolfo, who 

16          is our ranker on Mental Health; as well as 

17          Assemblywoman Mary Beth Walsh.  And I think 

18          our ranker on the Alcoholism Committee, 

19          Assemblyman Keith Brown, will be joining us 

20          shortly as well.

21                 CHAIRWOMAN KRUEGER:  Great, thank you.  

22                 And we've also been joined by Senator 

23          Samra Brouk.  So good morning.  

24                 And also -- he's an Assemblymember, 


 1          but my Assemblymember in my district as well, 

 2          so happy birthday, Harvey Epstein.  And I'm 

 3          glad that you are spending your birthday with 

 4          us.

 5                 On that note, we have Commissioner -- 

 6          I'll read all their names now, just so you 

 7          know who to be expecting.  But we have 

 8          Ann Marie Sullivan, commissioner of the 

 9          Office of Mental Health, first.  Dr. Theodore 

10          Kastner, commissioner of the Office for 

11          People With Developmental Disabilities.  Then 

12          Arlene Gonzalez-Sanchez, commissioner of the 

13          Office of Addiction Services and Supports.  

14          Then followed by Denise Miranda, executive 

15          director, Justice Center for the Protection 

16          of People With Special Needs.  

17                 And we're going to be starting with 

18          Ann Marie Sullivan, from the Office of 

19          Mental Health.  Please put 10 minutes on the 

20          clock.  

21                 Good morning, Commissioner.

22                 OMH COMMISSIONER SULLIVAN:  Good 

23          morning.  Good morning.  I am Dr. Ann 

24          Sullivan, commissioner of the New York State 


 1          Office of Mental Health.  

 2                 Chairs Krueger, Weinstein, Brouk, 

 3          Gunther and members of the respective 

 4          committee, I want to thank you for the 

 5          invitation to address OMH's 2021-'22 proposed 

 6          budget.  

 7                 From the very beginning of the 

 8          COVID-19 pandemic, the Office of Mental 

 9          Health developed and promoted resources to 

10          help New Yorkers manage the stress, 

11          depression and anxiety that often accompany a 

12          crisis situation.  In March of last year, at 

13          the direction of Governor Cuomo, we initiated 

14          the COVID-19 Emotional Support Helpline.  The 

15          helpline provided guidance on managing 

16          anxiety, dealing with loss, strengthening 

17          coping skills, and referrals for community 

18          mental health services when needed.  

19                 Today, thanks to a grant from the 

20          FEMA, the New York Project Hope Emotional 

21          Support Helpline is staffed by crisis 

22          counselors who continue to provide free, 

23          confidential, and anonymous counseling.  To 

24          date, the helpline has handled more than 


 1          50,000 calls from New Yorkers seeking help, 

 2          including non-English-speaking individuals 

 3          and individuals who are deaf or hard of 

 4          hearing.  

 5                 Through the Project Hope grant, we are 

 6          also initiating more intensive crisis 

 7          counseling services throughout 

 8          community-based agencies located in New York 

 9          City and the seven counties across the state 

10          most severely impacted by COVID-19.  And 

11          crisis counselors will still be available to 

12          all New Yorkers through the helpline. 

13                 OMH also developed and distributed 

14          guidance and educational materials for 

15          New Yorkers on managing anxiety and staying 

16          safe during these anxious times.  OMH also  

17          implemented "Coping Circles," the first 

18          program of its kind in the nation, which 

19          provided free six-week support and resilience 

20          virtual group sessions. 

21                 In addition, OMH continuously monitors 

22          and assesses the needs of the most 

23          vulnerable, who predominantly use the public 

24          mental health system, as well as the needs of 


 1          all New Yorkers, especially during this 

 2          ongoing pandemic.  We employ various sources 

 3          of data in this effort, including but not 

 4          limited to data claims, hospital emergency 

 5          room and inpatient bed utilization, 

 6          state-operated referrals and bed utilization, 

 7          clinic appointments and utilization in the 

 8          voluntary provider system, and prescription 

 9          orders and refills.  

10                 And of course throughout the pandemic 

11          we have continuously communicated with our 

12          partners, community-based providers, 

13          advocates and other stakeholders to provide 

14          guidance on infection control, utilizing 

15          telehealth, regulatory changes in response to 

16          COVID, and other issues.  

17                 OMH surveyed recipients of care to 

18          ascertain the impact of COVID-19 on their 

19          lives and access to care.  The survey found 

20          that 89 percent of the more than 

21          6,000 respondents participated in telehealth  

22          services, and 85 percent indicated that 

23          telehealth was easy and effective.  Overall, 

24          there are positive findings to suggest that 


 1          access to care, including telehealth, 

 2          medications, and physical health care, were 

 3          largely uninterrupted, and telehealth claims 

 4          from licensed OMH clinics increased from 

 5          35 percent of claims in March of 2020 to 90 

 6          percent of claims in April of 2020.  

 7                 The Governor proposes comprehensive 

 8          telehealth reform to help New Yorkers take 

 9          advantage of telehealth tools.  These reforms 

10          will address key issues like eliminating 

11          outdated regulatory prohibitions on the 

12          delivery of telehealth, removing outdated 

13          location requirements, addressing technical 

14          unease among both patients and providers 

15          through training programs, and establishing 

16          other programs to incentivize innovative uses 

17          of telehealth.  

18                 In accordance with the longstanding 

19          agreement with the Legislature to efficiently 

20          utilize taxpayer dollars within our state 

21          hospital system, OMH continues to right-size 

22          our state hospitals by closing inpatient beds 

23          which are vacant for 90 days or more.  Since 

24          2014, more than $100 million has been 


 1          reinvested into community-based mental health 

 2          services across New York State.  

 3                 OMH has been able to provide services 

 4          to nearly 125,000 new individuals, bringing 

 5          the total to over 800,000 people served in 

 6          the public mental health system through a 

 7          myriad of community-based services.  Because 

 8          these services are available, New Yorkers can 

 9          get the support they need to avoid 

10          hospitalization, access inpatient services 

11          only when needed, and live successfully in 

12          their communities.   

13                 However, fiscal challenges confronting 

14          the state require the proposed budget to 

15          temporarily not withstand the Reinvestment 

16          Act of 2021-'22, meaning that the reduction 

17          of vacant beds will not realize reinvestment 

18          in this fiscal year, but savings associated 

19          with these closures will be honored in the 

20          outyears.  

21                 The budget continues the $20 million 

22          investment from FY 2021 supporting existing 

23          residential programs, a part of the 

24          cumulative increase of $70 million annually 


 1          since FY 2015.  In addition, $60 million in 

 2          capital funding will preserve community-based 

 3          housing.  The budget also includes full 

 4          support for the residential  pipeline, 

 5          including 900 new beds coming online.  

 6                 The Empire State Supportive Housing 

 7          Initiative has allocated resources to support 

 8          over 5,000 housing units since 2016, of which 

 9          approximately 1500 units are for individuals 

10          with serious mental illness.  And the 

11          commitment to ESSHI continues.  

12                 To better serve New Yorkers, the state 

13          has partnered with John Hopkins University to 

14          develop a comprehensive crisis response 

15          system.  The budget authorizes the launch of 

16          Behavioral Health Crisis Stabilization 

17          Centers.  On average, more than 100,000 

18          individuals per year benefit from crisis 

19          intervention services. These centers will be 

20          open 24/7 and accept all admissions, 

21          including drop-offs by law enforcement and 

22          other first responders.  

23                 The budget continues implementation of 

24          the $50 million for capital investments to 


 1          expand crisis capacity.  Additionally, this 

 2          effort will also involve training of police 

 3          officers and first responders to divert 

 4          individuals they encounter toward crisis 

 5          services rather than jails and emergency 

 6          rooms, providing stabilization and 

 7          reintegration for individuals in crisis.  

 8                 To better serve individuals with 

 9          addiction and mental illness, the Executive 

10          Budget integrates the Office of Mental Health 

11          and the Office of Addiction Services and 

12          Supports into a new Office of Addiction and 

13          Mental Health Services.  OMH and OASAS 

14          jointly held statewide listening sessions in 

15          the fall, with over 160 stakeholders 

16          providing testimony and comments.  Overall, 

17          the vast majority of participants were 

18          supportive of integrating the two systems.  

19                 This budget proposal continues the 

20          collaborative work OASAS and OMH have 

21          undertaken over the past eight years to 

22          better coordinate and ensure access to care.  

23                 To support the significant number of 

24          people with co-occurring disorders, and to 


 1          create important government efficiencies, the 

 2          Governor's budget also proposes legislation 

 3          to enable outpatient providers to more easily 

 4          integrate physical health care with mental 

 5          health and addiction services.  The 

 6          legislation will establish a single license 

 7          authorizing the licensee to provide a full 

 8          array of physical, addiction, and mental 

 9          health services.  

10                 Additionally, OMH and OASAS have been 

11          working together with the Department of 

12          Health and the Department of Financial 

13          Services to implement a strong regulatory 

14          framework to ensure insurers comply with 

15          parity and that they are using appropriate 

16          criteria to make coverage determinations for 

17          addiction and mental health services. The 

18          joint parity oversight and enforcement 

19          efforts have been strengthened by the Parity 

20          Reporting Act, under which insurers will 

21          submit information about claims denials and 

22          reimbursement rates in 2021.  

23                 School-based mental health clinics are 

24          another area where New York State continues 


 1          to increase access to treatment by providing 

 2          services on-site.  Currently there are almost 

 3          900 school-based mental health clinics in New 

 4          York State -- and four years ago, there were 

 5          less than 300.  

 6                 The budget again includes funding to 

 7          support the School Mental Health Resource and 

 8          Training Center that has reached over 35,000 

 9          teachers, students, families and community 

10          members, providing education and information 

11          to support mental health and wellness in 

12          schools.  

13                 Suicide prevention must be a priority 

14          issue.  OMH has partnered with state agencies 

15          and communities to implement recommendations 

16          from the Governor's Suicide Prevention Task 

17          Force.  The task force also identified gaps 

18          in suicide prevention efforts and made 

19          recommendations for at-risk populations where 

20          increased engagement efforts are needed, 

21          including Latina youth, the LGBTQ community, 

22          Black youth, veterans, and individuals living 

23          in rural communities.  

24                 Finally, OMH's goal is to increase 


 1          access to prevention and community services 

 2          prior to the need for more intensive and 

 3          costlier care.  For those who continue to 

 4          need inpatient hospitalization, New York 

 5          State has the highest number of psychiatric 

 6          inpatient beds per capita of any large state 

 7          in the nation, and we will continue to 

 8          preserve access to inpatient care as we 

 9          transform the system.  

10                 Again, thank you for this opportunity 

11          to report on our efforts to support and 

12          continue the work that we have jointly 

13          embarked upon to transform New York's mental 

14          health system.  

15                 Thank you.  

16                 CHAIRWOMAN KRUEGER:  Thank you very 

17          much, Commissioner.  

18                 You know what, I was just having a 

19          discussion with my colleague.  I think 

20          normally in this hearing we allow each of you 

21          to testify and then the questions in between 

22          you, so I think we're going to shift to that 

23          and allow people to ask questions of you, and 

24          then we'll go on to the next commissioner and 


 1          the next commissioner, et cetera.

 2                 So in explaining that, I want to 

 3          clarify, again, that for the questions of the 

 4          Mental Health commissioner, Senator Brouk and 

 5          then Assemblywoman Gunther each get 10 

 6          minutes to ask questions, followed by the 

 7          rankers on the committee getting five minutes 

 8          each.  

 9                 And since we're joined by the 

10          Minority Leader today, he will also have five 

11          minutes.  I don't know whether he chooses to 

12          use that with any group of people or any 

13          commissioner, but I just wanted to state that 

14          for the record also.

15                 So with that, I'm going to hand it 

16          over to Senator Samra Brouk.  

17                 Put the clock on 10 minutes.  Thank 

18          you.

19                 SENATOR BROUK:  Thank you so much, 

20          Senator Krueger.  And thank you so much, 

21          Commissioner Sullivan.  Good morning.  Thank 

22          you for all the work that you and your office 

23          do, especially during this really tough time 

24          that we have.


 1                 On that note, I want to acknowledge 

 2          the moment that we're in right now.  We've 

 3          living in the middle of the COVID pandemic, 

 4          but as you mentioned we're also seeing a 

 5          mental health pandemic.  New Yorkers are 

 6          struggling with feelings of isolation, fear 

 7          and anxiety.  We're seeing record increases 

 8          in depression, suicide attempts and 

 9          overdoses.  And we're also facing a reckoning 

10          around racial justice.  And I think in 

11          particular relevance to our work here today, 

12          we're facing an inflexion point about how our 

13          law enforcement systems respond to people in 

14          moments of this mental health crisis.

15                 As many of you know, today marks one 

16          week since a 9-year-old Black girl in my City 

17          of Rochester was handcuffed, pepper-sprayed, 

18          and put in the back of a police car during a 

19          mental health crisis.  We've all seen the 

20          footage, and we're outraged.  And now our 

21          mental health system will be left to address 

22          the hurt and trauma that was inflicted on 

23          this little girl.  The wounds we're making 

24          today are the trauma, illness and addiction 


 1          that we must treat in the decades to come.

 2                 I bring this up to say that the work 

 3          we do here today at this budget hearing 

 4          matters.  It matters what programs we're 

 5          funding, where we locate our services, how 

 6          much we reimburse our providers, and it 

 7          matters if culturally competent care is 

 8          available to our most vulnerable populations.  

 9                 This week, with the support of our 

10          community, we introduce two pieces of 

11          legislation, one that would ban chemical 

12          irritants on minors, and the second, which is 

13          Daniel's Law, in the name of Daniel Prude, 

14          who died last year in police custody while 

15          having a mental health crisis.  It outlines 

16          how New Yorkers experiencing crises like 

17          this, or substance abuse crises, can be 

18          better served with a public health response.

19                 So we begin today's work today holding 

20          that little girl in Rochester in our heart, 

21          because her care and support will determine 

22          our future.  And we're holding Daniel Prude 

23          and his family in our heart, because this 

24          work here today matters deeply to the people 


 1          not only in my community, but it matters to 

 2          all New Yorkers.

 3                 So with that, I have several questions 

 4          for you this morning, and we'll get through 

 5          as many as we can.  The first is in order to 

 6          save some time, I have a request for some 

 7          information.  I, along with some of my 

 8          colleagues, have concerns about the closing 

 9          and moving of the inpatient beds from the 

10          Rockland Children's Psychiatric Center, and 

11          as you talked about the suspension of the 

12          reinvestment requirements for closing OMH 

13          facilities.  

14                 Would you be able to follow up with 

15          the following information for the past three 

16          years?  I'm looking for bed census data, 

17          including counties where children are 

18          admitted from, data on hospital referrals to 

19          RCPC within the catchment area, waitlists at 

20          hospitals while waiting for a bed space, 

21          readmission data at the Rockland Children's 

22          Psychiatric Center, and staffing data.  

23          Instead of using our time today, would you be 

24          willing to follow up and give us that 


 1          information?  

 2                 OMH COMMISSIONER SULLIVAN:  I can get 

 3          that to you right away, Senator.  And any 

 4          other information you'd like to see.  Thank 

 5          you so much, yes. 

 6                 SENATOR BROUK:  Thank you so much, 

 7          Commissioner.  And so I want to keep going on 

 8          that.  

 9                 You know, the other thing that has 

10          come up of concern is -- and you mentioned 

11          this.  I know we're in a dire budget 

12          situation in this state.  But this suspension 

13          of the reinvestment statute may be used to 

14          close this one Children's Psychiatric Center, 

15          but it's also suspended statewide and for an 

16          entire year.  So I'm wondering, does OMH plan 

17          on closing any other facilities in the state 

18          under this suspension?  

19                 COMMISSIONER SULLIVAN:  No, 

20          absolutely -- there's no other facilities 

21          that are planned to be closed.  

22                 And just to clarify, while we are 

23          converting Rockland Children's from an 

24          inpatient facility to community-based 


 1          services, the 15 beds at Rockland Children's 

 2          will still be there; they will be in the 

 3          Bronx Psychiatric Center.  So it's not 

 4          actually a closure, it's a conversion 

 5          redesign of the center, with the beds moving 

 6          to another location.  

 7                 But no, there are absolutely no other 

 8          plans for any other -- no closures in the 

 9          mental health system.  No, absolutely not.

10                 SENATOR BROUK:  So on that topic as 

11          well, normally we would see this reinvestment 

12          in the community.  So how much is the total 

13          reinvestment that would have been made in 

14          this community that they won't be able to 

15          realize this year?  

16                 COMMISSIONER SULLIVAN:  It's about $22 

17          million.  It's $110,000 for every bed that is 

18          closed, is what it's traditionally been for a 

19          reinvestment.  So this would be $22 million.  

20                 And the $22 million will be in the 

21          future budgets -- or future budgets next 

22          budget years and will be continued with after 

23          that.  But no, yes, it's $22 million.

24                 We've had $100 million so far, over 


 1          the past five years, reinvested into the 

 2          community total, because of closures of beds 

 3          at OMH.  And all that money is out there and 

 4          being utilized.

 5                 SENATOR BROUK:  Yeah, I would imagine.  

 6          Thank you for sharing that.

 7                 OMH COMMISSIONER SULLIVAN:  Sure.  

 8          Sure.

 9                 SENATOR BROUK:  And so thank you, I 

10          appreciate that question.  And since we're 

11          getting that follow-up information, I'll 

12          leave that there.  

13                 The other question I wanted to bring 

14          up is -- you know, I mentioned that we have 

15          just introduced this legislation around 

16          community response to individuals in a moment 

17          of crisis.  And so it really brings up the 

18          fact that we're trying to create this in some 

19          ways continuum of care for people in crisis.  

20          And so I want to dig in a little bit into 

21          these crisis stabilization centers.

22                 Are there other states that have 

23          created centers like this that we can look at 

24          and see what their -- the positive impact 


 1          it's had?

 2                 COMMISSIONER SULLIVAN:  Yes.  The 

 3          crisis -- I would think about a quarter of 

 4          the states have crisis stabilization centers.  

 5          Arizona is one of the ones that has the most 

 6          developed system.  Texas, interestingly, also 

 7          has a pretty developed system.  

 8                 And we've looked at what is in those 

 9          other states, and that's part of the design 

10          that we will be using to develop our crisis 

11          stabilization centers.  Also some experience 

12          that we've had with the center -- for 

13          example, the DASH center on Long Island, and 

14          one of the upstate centers.  So we -- yes, 

15          we're gathering information from across the 

16          country.  

17                 And the crisis stabilization centers 

18          are felt to be a really critical piece of the 

19          crisis system in New York.  We do have a fair 

20          amount of mobile crisis services, but where 

21          those mobile crisis services interact has 

22          often been -- with someone in acute distress, 

23          it might be an emergency room, which you 

24          don't want to do.  


 1                 So really the crisis stabilization 

 2          centers offer that other opportunity and help 

 3          fill the crisis continuum, which is so, so 

 4          critical.  You need mobile ability, you need 

 5          crisis stabilization centers, you need a 

 6          call-in center where calls are received and 

 7          appropriately triaged, and then you need the 

 8          continuum of care after from the crisis 

 9          stabilization center, with things like 

10          intensive outpatient clinics and other 

11          in-person services that will be available 

12          through the clinic system.

13                 SENATOR BROUK:  Okay.  So if I'm 

14          understanding that correctly, this would not 

15          be a place per se that might feed into the 

16          carceral system.  If anything, you would feed 

17          folks into these other kind of intensive 

18          outpatient programs or something like that to 

19          continue getting the care they need.

20                 COMMISSIONER SULLIVAN:  Absolutely.  

21          Absolutely.  And we have an array of -- we 

22          have, for example, outpatient intensive -- 

23          well, partial hospitalization programs, which 

24          are outpatient.  We also have intensive 


 1          outpatient, which can give you daily services 

 2          for a while, which many need.  We have crisis 

 3          residence beds, where individuals could stay 

 4          overnight.  And those are being expanded in 

 5          the budget as well and will be linked to the 

 6          crisis stabilization centers.

 7                 So -- and then we have, of course, all 

 8          the long-term housing and everything else 

 9          that we have established over time.  

10                 But it's building all those crisis 

11          supports that's really critical to make the 

12          system work.  Because it -- it's not -- you 

13          really have to have the backbone of that 

14          continuum, as you said, Senator.  

15          Just answering crisis calls isn't as helpful 

16          if you don't have that in place.  And that's 

17          what we're building.

18                 SENATOR BROUK:  That's helpful.  Thank 

19          you.

20                 And we'll see if we can get this last 

21          question in in our last couple of minutes.  

22          The other thing that I wanted to highlight 

23          was this expansion of the criteria for 

24          involuntarily committing someone.  A lot of 


 1          folks I've talked to have different thoughts 

 2          about what this means.  There might be pros, 

 3          there might be cons.  But the one central 

 4          thing is there is this concern about a 

 5          violation of someone's individual civil 

 6          rights to move from, you know, quote, likely 

 7          to cause harm to serious harm, to going to 

 8          substantial risk of being unable to provide 

 9          food, clothing, shelter or personal safety, 

10          which is a very broad definition and 

11          criteria.  

12                 My concern is that historically 

13          anytime there's measures like these there are 

14          folks who get disproportionately targeted and 

15          end up -- this kind of criteria may be used 

16          on.  So I just want you to speak to what 

17          measures OMH can take to ensure that doesn't 

18          happen and that we're still only committing 

19          folks who truly need that kind of level of 

20          support and services.

21                 COMMISSIONER SULLIVAN:  Well, thank 

22          you.  This is a very important question.  And 

23          I agree, there's -- you have to be very 

24          careful.  


 1                 What was written was written pretty 

 2          narrowly.  It's complete -- complete neglect.  

 3          It's not, you know, the issue of oh, a little 

 4          -- you know, an issue of {inaudible}, it's 

 5          complete neglect of basic needs so as to 

 6          render the person likely to have a high 

 7          probability of serious illness, accident 

 8          or -- illness, accident or death.

 9                 So the statute, first of all, as a 

10          protection is written narrowly.  I mean, that 

11          is not a statute that if you read that as a 

12          definition, a judicial interpretation of 

13          substantial harm, that it gives you a lot of 

14          leeway -- it's tight.  

15                 The second piece is that there will be 

16          -- we, as the Office of Mental Health, will 

17          very carefully work with providers as to what 

18          this would mean, and we will look at the use 

19          of the statute.  And we will keep an eye that 

20          it is done only for a very small number of 

21          individuals who are at very, very high risk.  

22          These are individuals whose medical 

23          conditions are putting them at high risk and 

24          are not capable of understanding the severity 


 1          of the illness.  

 2                 For example, someone who's become 

 3          acutely ill but is living on the street, is 

 4          refusing all kinds of services, is breathing 

 5          fast, you know that they might probably have 

 6          a fever, you know that they might be in 

 7          danger -- that's the kind of individual you 

 8          would bring for assessment under the statute.

 9                 This is a very narrow expansion, but 

10          for a very small group of very vulnerable 

11          individuals.  And we will be watching that 

12          and working with our legal staff, et cetera, 

13          to make sure that this statute is 

14          appropriately implemented if it's passed.

15                 SENATOR BROUK:  Thank you so much.  I 

16          look forward to hearing more about that with 

17          you, of how we can track and analyze to make 

18          sure that it gets implemented correctly.  

19          Thanks for your time.

20                 COMMISSIONER SULLIVAN:  Thank you very 

21          much.

22                 CHAIRWOMAN KRUEGER:  Assembly.

23                 CHAIRWOMAN WEINSTEIN:  Before we go to 

24          our Mental Health chair, I just wanted to 


 1          acknowledge some of the members who have 

 2          joined us since we began:  Assemblyman 

 3          Braunstein, Assemblywoman Richardson, 

 4          Assemblywoman McMahon, and Assemblyman 

 5          Colton.  

 6                 And I just want to remind my 

 7          colleagues that if you wish to ask a 

 8          question, you should use the raise-hand 

 9          function in Zoom.  Also, the chat is enabled, 

10          and periodically both myself and 

11          Senator Krueger will post the order of our 

12          colleagues, the Assembly and Senate 

13          respectively, so you can see where we are.

14                 With that being said, we go to our 

15          chair of Mental Health, Aileen Gunther, for 

16          10 minutes.

17                 CHAIRWOMAN KRUEGER:  And as she starts 

18          to speak, I will just note -- sorry -- we've 

19          been joined by Senator Gustavo Rivera and on 

20          the phone by the Mental Health ranker, 

21          Jim Tedisco, who I understand is having some 

22          kind of systems problem in wherever he might 

23          be today.  So I think we just may have him on 

24          phone for the day.  


 1                 Thank you, Helene.  

 2                 SENATOR O'MARA:  And if I may add, 

 3          yes, I was going to say that --

 4                 ASSEMBLYWOMAN GUNTHER:  Is this part 

 5          of my time?

 6                 SENATOR O'MARA:  -- that we've been 

 7          joined by Senator Peter Oberacker, ranker on 

 8          Alcohol and Substance Abuse.

 9                 CHAIRWOMAN KRUEGER:  Thank you.

10                 No, we did not eat up your time, 

11          Aileen, you have your full 10 minutes.

12                 ASSEMBLYWOMAN GUNTHER:  Good morning.  

13          And I'm just going to get to the questions 

14          right away, I'm not going to do an opening 

15          statement.  

16                 For the 200 inpatient beds that would 

17          be eliminated, where are they and when will 

18          they be taken offline?

19                 OMH COMMISSIONER SULLIVAN:  We -- 

20          we --

21                 ASSEMBLYWOMAN GUNTHER:  I just kind of 

22          want quick answers because I have quite a few 

23          questions.  So I only have 10 minutes.

24                 OMH COMMISSIONER SULLIVAN:  Quick 


 1          answer, they're all across the system, and we 

 2          determine them as we have either a 90-day 

 3          vacancy or longer.  So they vary across the 

 4          entire system.

 5                 ASSEMBLYWOMAN GUNTHER:  Okay.  My 

 6          other question is when you say 90 days or 

 7          longer, one of the things during COVID, which 

 8          is going on since March, is that we have 

 9          avoided putting people in beds in the 

10          hospital as much as we can.  We also know 

11          there's an increase in the number of children 

12          and adults that are having mental health 

13          issues.

14                 So are we going to close these beds -- 

15          and I don't know where they're going to be 

16          closed, but before we evaluate the impact of 

17          COVID on the residents of New York?

18                 OMH COMMISSIONER SULLIVAN:  We're very 

19          carefully looking at the need for beds.  That 

20          includes the -- these are long-term-care beds 

21          that are referred from the Article 28s.  So 

22          we are looking at the need from the Article 

23          28s, we monitor that extremely closely, we 

24          have been since COVID.  And when those 


 1          beds are needed, they are there for the 

 2          patients.  These are --

 3                 ASSEMBLYWOMAN GUNTHER:  Remember, 

 4          we're avoiding admitting, so I just -- I want 

 5          -- we're avoiding admitting and we're 

 6          watching in a period of a pandemic.  So, you 

 7          know, I don't know that if you're going to 

 8          delay it an extra year once we have some 

 9          normalcy in New York State.

10                 OMH COMMISSIONER SULLIVAN:  Many of 

11          the beds we're proposing to close have been 

12          vacant for over seven months.  We're not 

13          talking about brief -- most of them have been 

14          vacant for a longer period of time.  

15                 We watch it very, very closely.  We 

16          are not avoiding admissions at this point of 

17          time.  The state hospital system is open.  We 

18          are expecting admissions across the system.  

19          We do very careful admissions, and we monitor 

20          for the virus, we do all kinds of testing, we 

21          keep people in isolation until they're ready 

22          to be part of the community in the hospitals.  

23          But we have not decreased the admissions that 

24          are needed across the system.  That has not 


 1          happened.

 2                 ASSEMBLYWOMAN GUNTHER:  So I talk to 

 3          employees of OMH, and they have said that, 

 4          you know, for some strange reason, even 

 5          though the incidence of mental health issues 

 6          are rising, that there has been some 

 7          hesitancy to admit people.  I can understand 

 8          COVID, but this is not a normal period of 

 9          time that we should use to make decisions for 

10          the future about closing beds.

11                 And I also must say that this year's 

12          reinvestment of $22 million -- can you tell 

13          me what programs that money is going to and 

14          this funding would have gone?

15                 OMH COMMISSIONER SULLIVAN:  Where it 

16          will probably go next year will be to enhance 

17          the crisis system across the state, will be 

18          one use of those dollars.  

19                 The rest of the use of the dollars, we 

20          traditionally work with the counties and we 

21          talk with the county mental health directors, 

22          and we get information from them about where 

23          they have gaps in services and what they will 

24          need.  So there will be planning at -- 


 1                 (Zoom interruption.)

 2                 UNIDENTIFIED MALE SPEAKER:  And that's 

 3          this year's proposal?  We had some Medicaid 

 4          --

 5                 OMH COMMISSIONER SULLIVAN:  I'm sorry.  

 6          So basically some of that money will 

 7          definitely be used for expansion of the 

 8          crisis services system, which I've talked 

 9          about in terms of crisis residential, crisis 

10          stabilization centers.  

11                 Another chunk of the money next year 

12          would be utilized based on what the 

13          communities and the counties need.  That's 

14          the way we've traditionally done 

15          reinvestment, we've talked with the counties 

16          about what's important.  

17                 So I'm assuming a lot of that 

18          importance will include crisis services, but 

19          sometimes it's also clinic services, other 

20          things that they need in the community.  So 

21          that really is tailored to what's needed 

22          across the state.  

23                 ASSEMBLYWOMAN GUNTHER:  Article 28s 

24          aren't admitting people, so they're really 


 1          not referring people to the Article 28s, 

 2          because they are not admitting.  

 3                 Also, we have Rockland Psych Center.  

 4          This is a place where children with mental 

 5          health needs, usually acute needs, are going.  

 6          And we're hearing that there will be bed 

 7          closings there.  

 8                 Now, I know that I live in Sullivan, 

 9          County and then there's Orange County and 

10          many other counties that refer children to 

11          the Rockland Psych Center.  And right now 

12          they are not -- those referrals aren't 

13          happening.  So I feel like we don't have our 

14          finger on the pulse of really what's 

15          happening in the community.  

16                 And again, during this time many 

17          children out there -- and you know better 

18          than I do, Doctor, that when we give psych 

19          meds, psych meds are not like the kind of med 

20          -- like a blood pressure.  We can't measure 

21          the efficacy of them; it takes a while.  So 

22          observation is so very important.  

23                 So what I'm saying is I think we're 

24          putting the cart before the horse.  We have 


 1          not been reinvesting in mental health for a 

 2          very long time.  We have been closing beds.  

 3          We have an increase of homelessness in 

 4          New York City and across New York State, and 

 5          most of these people are impacted by mental 

 6          health.  

 7                 And I don't understand regarding 

 8          reinvestment taking money away from really 

 9          people that are in really tragic situations.  

10          And you know what?  We have to assess, we 

11          have to get down on the streets, we have to 

12          talk to counties before we do this.  We can't 

13          legislate from the top down.  We've got to 

14          legislate from the bottom up.  And we have to 

15          talk to people in the field.  

16                 And I have been talking to them.  I 

17          have been talking to them, and they're saying 

18          we don't have places to put these kids, we're 

19          closing the beds, people are losing their 

20          jobs in the middle of COVID, and yet we know 

21          there's going to be a tsunami coming.

22                 OMH COMMISSIONER SULLIVAN:  The 

23          conversion at Rockland will provide 

24          community-based services which are high 


 1          intensity services, such as crisis 

 2          residential beds, crisis outreach ACT teams 

 3          that will serve 500 individuals in that area.  

 4          So we are actually expanding the services.  

 5          The inpatient beds will move.  They are not 

 6          closing.  The inpatient beds will move.  But 

 7          that --

 8                 ASSEMBLYWOMAN GUNTHER:  Where are they 

 9          going?

10                 OMH COMMISSIONER SULLIVAN:  They're 

11          going to Bronx Children's Psychiatric Center.  

12          So it's a --

13                 ASSEMBLYWOMAN GUNTHER:  So if I'm a 

14          parent of a child and I live in Orange or 

15          Sullivan County, the most important thing 

16          that we can do during a therapeutic time is 

17          have family involvement.  How are you going 

18          to get people without cars, in the COVID, 

19          they're not getting paid, to get on a bus for 

20          60 bucks to go down to the Bronx?  

21                 I certainly -- I'm glad the Bronx is 

22          open, but you're not really dealing with 

23          people in their community.  They have to go 

24          back to their community.  Where is the 


 1          community care?  Rockland was far enough.  

 2          You closed the psych beds in Middletown, that 

 3          was a big loss in the Orange-Sullivan- 

 4          upstate area.  Now you're closing the one in 

 5          Rockland?  And how far are we going to go 

 6          before people will be -- increased 

 7          homelessness and wandering the streets?

 8                 OMH COMMISSIONER SULLIVAN:  Just to 

 9          clarify, in the Rockland area there are 300 

10          acute-care beds for youth.  That's one of the 

11          highest concentrations of acute-care services 

12          for youth.  There are always vacant beds in 

13          that acute-care system.  We have tracked up 

14          to 40 to 50 beds at any point in time.  

15                 So there are lots of community-based 

16          services.  What's lacking -- and 

17          community-based inpatient services.  What's 

18          lacking are the kinds of crisis and other 

19          services that can help individuals and their 

20          families and youth not to have to go into a 

21          hospital.

22                 So I'm --

23                 ASSEMBLYWOMAN GUNTHER:  Commissioner, 

24          one size does not fit all.  


 1                 You know, the census dropped by over 

 2          50 beds in March and April.  Is that a 

 3          coincidence of pause?  It's just a little bit 

 4          -- you know, it's kind of hard to believe 

 5          that all of a sudden everybody's okay, the 

 6          census drops by 50, and they're getting care 

 7          not in -- you know, not in the hospital, but 

 8          they're getting care someplace else.  

 9                 And then, you know, we always talk 

10          about people that have mental health issues, 

11          they're wandering the streets, whether it be 

12          upstate, downstate, Buffalo, Long Island -- 

13          because they can't get access to care.  I 

14          mean, 50 beds in March and April it dropped.  

15          And it doesn't make sense that all of a 

16          sudden, you know, God came down and healed 

17          this census and made it lower.  

18                 It just doesn't make sense to me.  The 

19          numbers don't make sense.  The closing of 

20          children's beds don't make sense to me.

21                 OMH COMMISSIONER SULLIVAN:  Truly, I 

22          understand your concern --

23                 ASSEMBLYWOMAN GUNTHER:  And you know I 

24          like you, we're friends.  But I'm 


 1          emotionally -- I just can't believe that 

 2          we're putting -- you know, we're taking 

 3          money, putting it in one place but taking it 

 4          away from the most vulnerable population.

 5                 OMH COMMISSIONER SULLIVAN:  But the 

 6          highest need right now, I believe -- just to 

 7          say this -- is the kind of services we need 

 8          to happen in the communities.  The beds have 

 9          been stable, the beds that we are closing 

10          have been stably open for a long period of 

11          time.  These beds -- money and the dollars 

12          and the investment in time and effort should 

13          be in the community, so people don't have to 

14          be in long-term beds.  

15                 Let me just say one other statistic 

16          which is very real across the nation.  

17          Basically we're a long-term state, we're long 

18          term.  Long-term beds do not go up in crisis 

19          situations.  The need is in the community, 

20          not necessarily in the long-term beds.

21                 ASSEMBLYWOMAN GUNTHER:  But that's the 

22          part of stabilization.  And then the 

23          community, then you give a report to a 

24          community practitioner and it goes from 


 1          stabilization, which doesn't take a day or 

 2          two days or an emergency room visit.  We know 

 3          that.  And then with that stabilization.  And 

 4          without that reinvesting of the $22 million 

 5          this year, I don't see how it's going to 

 6          work.  You're saying you're going to delay 

 7          the reinvestment and then -- he who giveth 

 8          and then taketh away in a vulnerable 

 9          community -- it's like our DD community, our 

10          mental health community.  We are the voice 

11          for these people.  I am the voice, my 

12          colleagues are the voice.  The parents, their 

13          voice has been heard by me and I know my 

14          counterpart in the Senate, and I'm listening 

15          to them.  And I'm saying we're not even doing 

16          enough as is, and we're going to take more 

17          away.  

18                 These children that have really very, 

19          very difficult mental health, they need 

20          observation.  You know, and there are short 

21          lengths of stay as we are.  And I know that, 

22          because parents have called me.  

23                 So I know I'm preaching to the choir.  

24          I know.  But I am upset, and I don't think 


 1          we're doing the right thing.  And I'm here as 

 2          an elected official to do the right thing, 

 3          and I don't think we're doing the right thing 

 4          for vulnerable people.  I get the care 

 5          outside, I do.  But I also get that we don't 

 6          reinvest, we're going to wait a year to 

 7          reinvest.  It's like it's a shuffle game of 

 8          money, and you're taking it away from poor 

 9          people that have such difficult lives.  And 

10          that's what I feel.

11                 CHAIRWOMAN WEINSTEIN:  Assemblywoman, 

12          thank you.  You'll have an additional five 

13          minutes after we go through the first round.

14                 So we go back to the Senate now.

15                 CHAIRWOMAN KRUEGER:  Thank you, 

16          Assemblywoman.  

17                 Our first questioner is the 

18          Minority Leader, Robert Ortt.

19                 SENATOR ORTT:   Thank you, 

20          Senator Krueger.  

21                 Commissioner, good to see you.  

22                 And I will say very quickly I was 

23          always proud, when I was chair of this 

24          committee, to call Aileen Gunther a 


 1          colleague, and I am so this morning as well.  

 2          Assemblywoman Gunther I thought raised some 

 3          very good points.

 4                 Commissioner, I wanted to talk to you, 

 5          though, about a glaring omission in the 

 6          Governor's budget that is directly within 

 7          your department, and it is the lack of 

 8          funding for the Joseph P. Dwyer Program.  It 

 9          is not a ton of money when you talk about 

10          $170 billion -- or, in this year's case, $190 

11          billion.  And yet once again it is not listed 

12          in the Governor's budget -- $4.5 million, 

13          which as you know goes to prevent suicide 

14          amongst veterans, who have a much higher risk 

15          of suicide than even the general 

16          population -- and that was before COVID.

17                 And as the former chair of Mental 

18          Health, as a former ranker on Veterans, and 

19          as a combat veteran myself, I will tell you I 

20          know firsthand, as I'm sure you do, the 

21          impact that this program has had for not a 

22          lot of money on saving lives and helping and 

23          assisting with mental health of our 

24          veterans -- and, by extension, their 


 1          families, you know, their children, their 

 2          spouses.  It has saved marriages, and it has 

 3          saved lives and it has saved relationships.  

 4                 And not only was it not included in 

 5          this year's budget, but last year's funding 

 6          has not been released.  It has not been 

 7          released.  And that is very problematic to me 

 8          at a time when all I hear about is isolation 

 9          and the pandemic and suicide rates are 

10          higher.  All these things, we talk about 

11          them, here's a program that works.  It works.  

12          We get maximum leverage from our dollar.  

13                 And the Governor -- and I know, we all 

14          know what goes on with the budget, and 

15          there's some trading and negotiating.  I get 

16          that.  We all get that.  This is not one of 

17          those things that should be leveraged or 

18          horse-traded or negotiated.  This is an easy 

19          thing for the Governor to include in his 

20          budget and just be done with it.  And 

21          instead, we've got to buy it back, we've got 

22          to negotiate it back in.  

23                 But again, last year's money -- which 

24          we did put back in there, and I credit my 


 1          colleague Senator John Brooks, because I know 

 2          he was a champion for that funding.  But it 

 3          has not been released.  

 4                 So I want to ask you, why isn't that 

 5          in this year's budget, and why hasn't the 

 6          funding from last year been released?

 7                 OMH COMMISSIONER SULLIVAN:  Thank you, 

 8          Senator Ortt.  Last year's money we just 

 9          recently received -- and I'm sorry, I'm not 

10          entirely clear if it was from the Senate and 

11          Assembly, but the paperwork that would cause 

12          the release -- the funds flow through the 

13          Department of Mental Health.  

14                 So as soon as we receive them, we are 

15          moving that forward to Budget.  Budget's 

16          going to review last year's funding.  They 

17          are getting the paperwork now from -- I 

18          believe it's the Assembly.  Or maybe it was 

19          the Senate, I'm not sure.  And then if the 

20          other house can please give us their 

21          paperwork, we'll push it right through to 

22          Budget, and Budget will make their decision.  

23          Budget is making the decision on this.

24                 SENATOR ORTT:  Okay, so two things.


 1                 OMH COMMISSIONER SULLIVAN:  You know, 

 2          you're absolutely right that these are 

 3          tremendous -- the veterans need these 

 4          services, that the Dwyer program is a 

 5          valuable program.  And I think that, you 

 6          know, it's been a -- it's a very tough budget 

 7          year.  But we're doing everything to move the 

 8          paperwork to Budget to make the decision 

 9          about last year's investment.

10                 SENATOR ORTT:  I would like to know -- 

11          if you could follow up, I would like to know 

12          which house submitted the paperwork and which 

13          house did not.  

14                 Certainly if it's the Senate, I would 

15          certainly call on my colleagues, who I know 

16          support this program, to make sure that 

17          paperwork gets submitted, because it is very, 

18          very important that it gets out.

19                 And again, I would ask -- can you 

20          speak to why it's not included, though -- it 

21          wasn't included in last year's budget by the 

22          Governor, and it's not included in this 

23          year's.  Can you speak to that and to your 

24          feeling on the program and the need for it?


 1                 OMH COMMISSIONER SULLIVAN:  Well, 

 2          veterans need services.  We do coordinate 

 3          services with the Division of Veterans 

 4          Services, and we do so with prevention, we do 

 5          a lot of outreach work and services.  It has 

 6          not been included in the budget.  And I think 

 7          it's -- this year it's really a piece of a 

 8          lot of issues with just how desperate we are 

 9          if we don't get these dollars from the 

10          federal government.  And I think that that's 

11          just a very serious issue.  But no, it has 

12          not been included in this year's budget.

13                 SENATOR ORTT:  Well, I appreciate 

14          that, Commissioner.  And like I said, I think 

15          it is, to me, absolutely unconscionable that 

16          we would not have released the money by now, 

17          whatever the procedure is.  I understand what 

18          you're saying, but that needs to happen.  

19                 But again, I was greatly disappointed 

20          to see that the Governor did not include it 

21          in this year's budget, and I call on my 

22          colleagues to make sure it is included in the 

23          final budget.  It is $4.5 million.  It saves 

24          lives.  It is invaluable to our veterans.  


 1          And at a time when we always give I think lot 

 2          of lip service to these issues, this is a 

 3          program that our actions can back up our 

 4          words.  

 5                 And I thank you for the time, 

 6          Madam Chair.

 7                 OMH COMMISSIONER SULLIVAN:  I will get 

 8          you the follow-up on the paperwork, 

 9          absolutely, right after this hearing.

10                 SENATOR ORTT:  Thank you very much, 

11          Commissioner.  

12                 CHAIRWOMAN KRUEGER:  Thank you.  And 

13          I'll be saying it throughout the course of 

14          the day:  Whenever any individual member has 

15          asked you for follow-up on paper, please make 

16          sure to forward it to Helene Weinstein and 

17          myself as well, so we can make sure everyone 

18          has access to the information.  Thank you.

19                 Assembly.  

20                 CHAIRWOMAN WEINSTEIN:  We go to 

21          Assemblyman Gandolfo, the ranker on Mental 

22          Health.

23                 ASSEMBLYMAN GANDOLFO:  Thank you, 

24          Chair.  And thank you, Commissioner, for 


 1          being here with us this morning and for your 

 2          testimony.

 3                 And thank you to the chairwoman of the 

 4          Mental Health Committee, Aileen Gunther.  I 

 5          really appreciate the passion you have for 

 6          these issues, and I'm happy to serve 

 7          alongside you.

 8                 I want to just bring it back really 

 9          quick to what my colleague in the Senate just 

10          mentioned.  That was my concern.  He had 

11          asked the question I was planning to ask.  

12          But I just want to emphasize his concerns on 

13          that as well.  

14                 The Dwyer project, it's just really a 

15          great project.  It originated here in Suffolk 

16          County, and we're very proud of it.  They've 

17          done great work.  

18                 And I know in your testimony, 

19          Commissioner, you mentioned the need to 

20          support suicide prevention services.  And in 

21          light of a recent report by the United States 

22          Department of Veterans Affairs, I believe 

23          they said 18 veterans commit suicide every 

24          day, and it totals about 6600 veteran 


 1          suicides each year.  So I just hope that 

 2          you'll do whatever you can to release last 

 3          year's funding.  Anything we can do to help, 

 4          please reach out.  I'm happy to help make 

 5          sure this funding goes out.

 6                 I'm also very disappointed that again 

 7          this funding was not included in the 

 8          Governor's proposal.  It's something that the 

 9          Legislature is again going to have to 

10          negotiate back in, which is -- you know, it 

11          should just be a permanent fixture.  

12                 And you've already kind of spoken to 

13          your thoughts on it, and I just want to say 

14          thank you for also recognizing the need for 

15          this funding.  And again, if there's anything 

16          we can do to help move this along, please 

17          reach out.  

18                 And with that, I'll yield the 

19          remainder of my time.  And thank you again, 

20          Chair and Commissioner.

21                 OMH COMMISSIONER SULLIVAN:  Thank you.  

22                 CHAIRWOMAN KRUEGER:  Okay, thank you.  

23                 Senator Jim Tedisco, ranker for the 

24          Mental Health Committee.  And thank you, Jim, 


 1          for letting me jump your leader Robert Ortt 

 2          before you.  Are you with us, Jim?  

 3                 SENATOR O'MARA:  I think Senator 

 4          Tedisco is still having technical 

 5          difficulties.  The phone isn't working now.

 6                 CHAIRWOMAN KRUEGER:  I see him on, but 

 7          then he's on mute.  So perhaps it's just not 

 8          coming together.

 9                 SENATOR O'MARA:  He texted me that his 

10          audio wasn't working.

11                 CHAIRWOMAN KRUEGER:  Okay, I 

12          apologize.  Thank you.  

13                 Before I just jump, do you have any 

14          questions, Tom?  

15                 SENATOR O'MARA:  I will, but you can 

16          move mine {inaudible}.  

17                 CHAIRWOMAN KRUEGER:  Okay, thank you.  

18          And again, reminding people, put their hands 

19          up if they do have questions.

20                 So I have a few questions, 

21          Commissioner.  I'm very concerned about the 

22          use of -- I'm sorry, I'm forgetting the 

23          terminology, but where you make a decision 

24          that someone is not capable of caring for 


 1          themselves, although they would no longer 

 2          need to prove that they were at risk of doing 

 3          harm to themselves or others, and that the 

 4          state would then be able to place them in a 

 5          facility without their permission.  

 6                 One, can you explain a little bit to 

 7          me, where they would be placed?

 8                 OMH COMMISSIONER SULLIVAN:  Well, the 

 9          first is that it gives the ability to 

10          transport -- to help to bring people in for 

11          assessment.  And that's the way it's mostly 

12          used.  

13                 And then when the assessment would be 

14          at either a medical emergency room or a 

15          psychiatric emergency room, one of our CPEPs.  

16          That assessment is done by a physician after 

17          they have been brought in to determine, 

18          again, based on -- by the statute, whether or 

19          not services in the community or all kinds of 

20          things would help, or whether the situation 

21          is dire enough to actually need admission to 

22          an acute-care hospital.  

23                 And then there are various protections 

24          for that admission.  They are reviewed by a 


 1          judge.  They have to be recertified within 

 2          two days, and then there has to be a review 

 3          by a judge at the patient's request.  

 4                 So the commitment laws are very tight 

 5          in terms of getting people the ability to 

 6          pursue -- and they have mental health legal 

 7          services, a lawyer who works with them when 

 8          they are admitted.  But they would first be 

 9          brought for an assessment.  And then after 

10          the assessment, if -- and it might not -- for 

11          many cases, that might not be the case, they 

12          might be admitted to an acute-care hospital, 

13          would be one possibility.

14                 CHAIRWOMAN KRUEGER:  So I'm from 

15          New York City, and everybody's closing their 

16          psychiatric units, and our emergency rooms 

17          and our hospitals are filled with patients 

18          with COVID, and people who don't have COVID 

19          are being advised not to go to the hospital 

20          unless they're in an emergency surgical 

21          situation.  

22                 So I'm very confused.  We want who, 

23          the police, to bring people that they're 

24          evaluating as being in some category into 


 1          emergency rooms that can't handle them at 

 2          this point?

 3                 OMH COMMISSIONER SULLIVAN:  This is 

 4          usually done by outreach teams that have been 

 5          working with individuals.  We have -- as you 

 6          know, in the city there are outreach teams 

 7          that work with the homeless on the streets.  

 8          And usually that's the group that would bring 

 9          a person in.  Sometimes they do it with 

10          police assistance.  

11                 But those are the groups that would be 

12          bringing forward these cases, because they 

13          are not individuals who are obviously in need 

14          of being brought in by the police.  The more 

15          subtle question is do individuals have 

16          serious, serious medical problems that are 

17          not being addressed.  

18                 And this does happen.  It's a very 

19          small group, Senator.  This is not a large 

20          number of people by any means, but it does 

21          exist.  And I think we have a responsibility 

22          for those individuals.

23                 CHAIRWOMAN KRUEGER:  And because 

24          again, at least in New York City, we have 


 1          almost no psychiatric inpatient hospital beds 

 2          anymore, where would they be placed?

 3                 OMH COMMISSIONER SULLIVAN:  Oh, we do.  

 4          We have over 2,000 psychiatric beds.  Now, at 

 5          this moment, some of them are reduced.  But 

 6          we're down -- we watch it very closely.  From 

 7          close to 2700 beds, we're at 2200 beds that 

 8          are still available in New York City for 

 9          psych.  And they are open.

10                 Now, depending upon an individual's 

11          COVID status, there's the moving them from 

12          hospital.  But we still have over 2,000 beds 

13          that are open right now.  

14                 And we're hoping most of them that 

15          have temporarily been downsized from COVID, 

16          about 400, will come back.  We're really 

17          concerned about maybe a hundred that seem to 

18          be saying they may not be reopening.  But the 

19          vast majority of those beds will be coming 

20          back.  Or are present now.  We still have 

21          over 2200 beds that are operating in New York 

22          City.

23                 CHAIRWOMAN KRUEGER:  So when I 

24          reviewed the language of existing involuntary 


 1          commitment, it sounds like you already have 

 2          these powers.  So where would you be 

 3          expanding your power?

 4                 OMH COMMISSIONER SULLIVAN:  You're 

 5          absolutely right.  It is a clarification.  

 6          The issue here is that many people, whether 

 7          the statute actually said -- they read it as 

 8          you have to either be homicidal or acutely 

 9          suicidal.  

10                 What most states have done -- because 

11          that particular use has been to add one other 

12          thing, that when we talk about serious harm, 

13          it can also include serious, complete 

14          neglect.  

15                 And that's why.  Because most often 

16          when you try to bring someone in like this 

17          for an evaluation, someone will say, well, 

18          he's not threatening to kill himself or to 

19          hurt anybody else, and then you present all 

20          these other issues.  And people are 

21          reluctant -- and appropriately so, at 

22          times -- to maybe do -- to admit if 

23          absolutely necessary.  

24                 This is the clarification of the 


 1          statute that under those extreme 

 2          circumstances, yes, you could use an 

 3          involuntary commitment -- hospitalization.  A 

 4          hospitalization.  It's always for involuntary 

 5          hospitalization at an acute-care facility.

 6                 CHAIRWOMAN KRUEGER:  So you're saying 

 7          you have 2200 psychiatric beds in New York 

 8          City today.

 9                 OMH COMMISSIONER SULLIVAN:  Yes.

10                 CHAIRWOMAN KRUEGER:  Do you know what 

11          number of them are involuntary?  

12                 OMH COMMISSIONER SULLIVAN:  The vast 

13          majority.  The vast majority.

14                 CHAIRWOMAN KRUEGER:  And --

15                 OMH COMMISSIONER SULLIVAN:  Well, 

16          wait, they're not all -- everybody is an 

17          involuntary, but we have the capacity to take 

18          in voluntary beds, yes. 

19                 CHAIRWOMAN KRUEGER:  So but of the 

20          current 2200, approximately what percentage 

21          or number are there for an involuntary 

22          placement?

23                 OMH COMMISSIONER SULLIVAN:  In that 

24          2200, probably 60, 70 percent.  Time.  Time.


 1                 CHAIRWOMAN KRUEGER:  And what's the 

 2          process for them being allowed out?  Is it 

 3          two psychiatrists needed to sign them out?

 4                 OMH COMMISSIONER SULLIVAN:  Yes.  Yes.  

 5          But -- well, no, if they -- as they improve, 

 6          they are discharged.  Almost all -- many of 

 7          them convert to voluntary after they're -- a 

 8          brief period of time.  But they do have 

 9          mental health legal services that meet with 

10          them immediately upon admission, and if they 

11          wish to leave before the recommendation of 

12          the psychiatrist, it goes to court.

13                 CHAIRWOMAN KRUEGER:  So we also have a 

14          different program where you are in prison for 

15          some kind of criminal act, you've done your 

16          time, but then we, the state, determine you 

17          are of danger to yourself or others if let 

18          go.  So we then shift you to a psychiatric 

19          facility, perhaps in a prison or perhaps 

20          separately.  

21                 Is that under OMH's authority?

22                 OMH COMMISSIONER SULLIVAN:  Yes.  But 

23          those all have hearings with the court as 

24          well.  They do not come without that.


 1                 CHAIRWOMAN KRUEGER:  But those also 

 2          require someone to determine you no longer 

 3          are at risk to yourself or others in order to 

 4          be let out, right?

 5                 OMH COMMISSIONER SULLIVAN:  Yes.  Yes.

 6                 CHAIRWOMAN KRUEGER:  How many have we 

 7          let out?

 8                 OMH COMMISSIONER SULLIVAN:  Oh, the 

 9          vast majority of individuals who have serious 

10          mental illness leave prison and come into a 

11          whole host of services that we have.

12                 CHAIRWOMAN KRUEGER:  No, no, no.  Of 

13          those people who got directed from prison 

14          into a mandatory psychiatric facility.

15                 OMH COMMISSIONER SULLIVAN:  Oh.  I 

16          don't think I can give you an exact number, 

17          but the vast majority of them over time are 

18          let out.  Some quickly, some are discharged 

19          quickly into the community.  Others can spend 

20          some increased time in the state civil 

21          psychiatric centers, yes.  

22                 But again, once they're in a civil 

23          center, all their legal rights and the 

24          representation by mental health legal 


 1          services begins.  So that all is always there 

 2          all the time as well.

 3                 CHAIRWOMAN KRUEGER:  And you think 

 4          there's adequate mental health services 

 5          available?

 6                 OMH COMMISSIONER SULLIVAN:  For those 

 7          individuals -- for -- in terms of the 

 8          long-term inpatient beds?

 9                 (Zoom interruption.)

10                 CHAIRWOMAN KRUEGER:  Please go on 

11          mute, whoever is on the phone.  

12                 Okay, sorry, keep going.

13                 OMH COMMISSIONER SULLIVAN:  -- 

14          sometimes need to have assistance is with the 

15          community-based services, for individuals who 

16          have a forensic history.  But that's where we 

17          have some issues, is making sure that they 

18          get housing -- you know, there's reluctance 

19          sometimes in communities or even in housing 

20          to provide housing for people, depending upon 

21          their forensic history, how severe it was.  

22                 And also making sure that we have the 

23          provider community -- we're constantly 

24          working to increase this -- who know how to 


 1          work with those patients.  That's where we 

 2          really have some struggles in terms of making 

 3          sure that we have enough services for 

 4          forensic-involved patients in the community.

 5                 CHAIRWOMAN KRUEGER:  So thank you.  

 6          Clearly, my concern is we already have a 

 7          system that at least I have heard you can 

 8          never get out of once you're in.  So I would 

 9          look forward to seeing the stats --

10                 (Zoom interruption.)

11                 CHAIRWOMAN KRUEGER:  Okay, put 

12          yourself on mute.  Thank you.  

13                 I would like to see the stats on the 

14          number of people who go from prison to 

15          psychiatric and then never get let go.  

16                 And also my concern is that we will 

17          somehow, in our inability to have the right 

18          services at the community level, we will 

19          respond by taking people off our streets and 

20          putting them into psychiatric facilities 

21          against their will where they may also never 

22          get let go.  So that's basically my concern.

23                 OMH COMMISSIONER SULLIVAN:  I 

24          understand your concern, Senator.  But we 


 1          work very, very hard to keep people out of 

 2          hospitals and to get them out -- I don't mean 

 3          this in a bad way -- to move them from our 

 4          hospitals as quickly as possible, because we 

 5          understand exactly what you're saying, that 

 6          clients should be in hospitals only for the 

 7          minimal amount of time that is needed.  

 8                 And we work very hard to get our 

 9          clients out, and we're pretty good in the 

10          state system.  Very few come back once we get 

11          them out.  We get into them housing, we get 

12          them into services.  

13                 But yes, that's our goal as well, it 

14          really is.  But we will get you those 

15          statistics.

16                 CHAIRWOMAN KRUEGER:  Thank you very 

17          much.

18                 Back to the Assembly.

19                 CHAIRWOMAN WEINSTEIN:  Yes, we've been 

20          joined by Assemblywoman Frontus.  

21                 And before I go to the next member, I 

22          just wanted to clarify for all of the members 

23          and all the witnesses that when the clock 

24          goes down to zero, it starts to then count 


 1          how much time you're over.  We're not giving 

 2          you extra minutes.  Senator Krueger and I 

 3          aren't -- we've been doing this for a lot of 

 4          days, you know.  

 5                 But it's to remind you of how much 

 6          time you are over.  And we really do want 

 7          people to try and pay attention to the clock.

 8                 So now we go for five minutes to our 

 9          ranker -- I'm sorry, to Assemblyman Abinanti, 

10          the chair of our new Committee on People with 

11          Disabilities.

12                 Tom, you have five minutes.

13                 ASSEMBLYMAN ABINANTI:  There we go.  

14          Thank you.  Thank you very much to all of you 

15          for putting together this hearing.  

16                 Commissioner, thank you very much for 

17          joining us.

18                 I'm a little concerned about the 

19          state's commitment to mental hygiene services 

20          in general.  What we have here sounds good on 

21          paper.  Let me repeat that:  It sounds good 

22          on paper.  That sounds a little strange, I 

23          think, though, as a budget proposal.

24                 The state monies for mental hygiene 


 1          agencies over the last 10 years have actually 

 2          decreased dramatically.  From what I see, in 

 3          2015 we actually spent $7.72 billion.  We're 

 4          now proposing $5.6 billion.  This is six 

 5          years later.  

 6                 And it's affected the manpower in your 

 7          department.  Your department, on March 31, 

 8          2010, had 16,173 employees.  You are now 

 9          proposing at the end of this fiscal year, in 

10          this budget, that we have 13,246 employees.  

11          That's a dramatic decrease.  

12                 And it's affected the voluntary OMH 

13          agencies.  The All Funds disbursements in 

14          2010, with $3.3 billion, that's the same 

15          thing you're proposing in this budget, 

16          10 years later.  

17                 So I'm very, very concerned about the 

18          state's commitment to mental hygiene 

19          services.

20                 Now, given that, let's talk a little 

21          bit about the new proposal that you're 

22          talking about with crisis intervention.  

23          Again, it sounds good on paper.  It's what 

24          I've been calling for since I became an 


 1          Assemblyman 10 years ago.  So I very much 

 2          appreciate the outline you've given.  

 3                 How much money is behind it?  How much 

 4          money is in this budget to set up the 

 5          services and then to pay for the ongoing 

 6          services?

 7                 OMH COMMISSIONER SULLIVAN:  The 

 8          services that we're working on for this year 

 9          will be to strengthen the three currently 

10          operating crisis centers.  Each of those 

11          costs in the range of about $4 million.  Some 

12          of them have already been receiving --

13                 ASSEMBLYMAN ABINANTI:  Commissioner, 

14          so we're not talking about this new program 

15          that you outlined, then.

16                 OMH COMMISSIONER SULLIVAN:  Oh, yes, I 

17          am --

18                 (Overtalk.)

19                 ASSEMBLYMAN ABINANTI:  -- you're 

20          talking about the police and stabilization 

21          and all of that.

22                 OMH COMMISSIONER SULLIVAN:  I'm sorry, 

23          yes, we are.  For this year we have --

24                 ASSEMBLYMAN ABINANTI:  How much new 


 1          money is in the budget to do this?

 2                 OMH COMMISSIONER SULLIVAN:  The new 

 3          money in the budget for the expansion, 

 4          further expansion next year, some of that 

 5          will come from the reinvestment dollars.

 6                 Within this year, this is state aid 

 7          which has been available for counties and 

 8          which some of these crisis centers already 

 9          have.  Which we will continue -- 

10                 ASSEMBLYMAN ABINANTI:  Well, I'm not 

11          quite sure where you're talking about crisis 

12          centers, because I know in Westchester they 

13          were talking about setting one up and the 

14          money just wasn't there to help them do it.  

15          And they've been doing a very good job, we've 

16          got a very good commissioner, et cetera.  

17                 So you're basically saying we're just 

18          moving money from one place to another, 

19          there's no new monies to --

20                 OMH COMMISSIONER SULLIVAN:  Not in 

21          this year's budget.  The monies that are in 

22          this year's budget are being moved within the 

23          state aid, yes.

24                 ASSEMBLYMAN ABINANTI:  Okay.  So 


 1          there's no new --

 2                 OMH COMMISSIONER SULLIVAN:  Wait just 

 3          a second.  But next year, with the 

 4          reinvestment dollars, those reinvestment 

 5          dollars will be utilized to expand --

 6                 ASSEMBLYMAN ABINANTI:  You're saying 

 7          next year, not the budget we're going to vote 

 8          on now, but the next budget we're hoping to 

 9          --

10                 OMH COMMISSIONER SULLIVAN:  Also in 

11          this year we are working with them to be able 

12          to bill Medicaid for the services that they 

13          are providing.  Then --

14                 ASSEMBLYMAN ABINANTI:  But if the 

15          person is not Medicaid-eligible, then we 

16          can't help them.

17                 OMH COMMISSIONER SULLIVAN:  We work 

18          with commercial payers.  Yes, we work with 

19          those --

20                 ASSEMBLYMAN ABINANTI:  If they don't 

21          have that either?  I mean, when somebody has 

22          a problem, they get picked up and so the 

23          first thing you ask is can you afford to pay 

24          for this service?


 1                 OMH COMMISSIONER SULLIVAN:  Not for 

 2          these services, no.

 3                 ASSEMBLYMAN ABINANTI:  Well, I'm 

 4          not -- okay.

 5                 (Overtalk.)

 6                 OMH COMMISSIONER SULLIVAN:  We bill 

 7          their insurance.  But no, but we do not not 

 8          provide it if you need it.

 9                 ASSEMBLYMAN ABINANTI:  Let me go to 

10          another area, then.  

11                 One of the things that I'm very 

12          concerned about is the silos.  You hear that 

13          all the time.  You hear people talking about, 

14          you know, they have comorbidity, they have 

15          co-occurring conditions.  You know, there's a 

16          famous story, there's a documentary Off the 

17          Rails with a young man named Darius McCollum.  

18          I spoke with his lawyer about a year ago.  He 

19          was arrested 32 times for impersonating New 

20          York City bus drivers and subway conductors, 

21          et cetera.  At 8 years old he was running 

22          away from bullies, and guys in the subways 

23          taught him how to run trains, run subways.  

24          He's been doing this his entire life.  


 1                 He's now in Rikers because he's never 

 2          -- he's always been in the mental health 

 3          system, but he's got autism.  He has never 

 4          been assessed by the -- by OPWDD, never had 

 5          OPWDD services.  There's a famous -- there's 

 6          a documentary out on him.

 7                 I want to know why your department, 

 8          when confronted with somebody with autism, 

 9          does not assess that person having autism and 

10          moving them over to OPWDD and working 

11          together to solve the problem.

12                 OMH COMMISSIONER SULLIVAN:  Well, 

13          you're absolutely right, that's what we 

14          should be doing.  And if we're not, in 

15          certain instances, then we need to know about 

16          it, because we should --

17                 ASSEMBLYMAN ABINANTI:  I've talked 

18          with mental health commissioners --

19                 OMH COMMISSIONER SULLIVAN:  -- you're 

20          right, and we should be working --

21                 ASSEMBLYMAN ABINANTI:  What are you 

22          going to do in this budget to solve that 

23          problem?  

24                 CHAIRWOMAN WEINSTEIN:  Quickly, 


 1          Commissioner, because the time has expired.

 2                 OMH COMMISSIONER SULLIVAN:  We are 

 3          going to be expanding, within this budget 

 4          there are dollars to open up -- I hope it 

 5          doesn't get delayed -- I mean, it's been 

 6          delayed due to COVID -- two inpatient units 

 7          that will work with us very closely with 

 8          OPWDD for youth.  We are also going to 

 9          continue to fund the Baker Victory step-down 

10          unit and we are funding an inpatient unit in 

11          Kings County for adults with disabilities, 

12          and a step-down unit for that.  

13                 Those dollars are in -- solid in the 

14          budget.  They have been given increased 

15          rates.  These are major efforts, with us 

16          working very closely with OPWDD to serve 

17          these individuals.  

18                 And in addition, within the budget 

19          there's lots of training dollars, et cetera, 

20          for our individuals to be able to better 

21          screen and do work with autism and, just as 

22          you said, be able to move those clients to 

23          the appropriate services that they need, or 

24          even give them if we're capable of doing it.  


 1                 So yes, those dollars are in the 

 2          budget.  Thank you.  Thank you.

 3                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 4                 We go back to the Senate.

 5                 CHAIRWOMAN KRUEGER:  Thank you.  I 

 6          believe we have how Jim Tedisco -- audio and 

 7          visual -- ranker, for five minutes.

 8                 SENATOR TEDISCO:  Okay.  Thank you so 

 9          much, Chair and Senator.  This has been a 

10          nightmare here for me.  Our power's been out 

11          for four hours this morning, so I had to go 

12          to my phone and I couldn't get any audio on 

13          that.  So you all look very nice to me, but I 

14          don't read lips.  So I don't know much of 

15          what has been said until the last five or 10 

16          minutes.  So -- but I'd like to ask a 

17          question of the commissioner, if that is 

18          possible.  

19                 Commissioner, thank you for answering 

20          my questions.  In the spring of 2020 we had, 

21          I believe, close to 8,000 retirees, students, 

22          student volunteers who were giving 24/7 

23          no-cost mental health counseling.  Has there 

24          been any ability or idea to retain these 


 1          professionals post-COVID to help with the 

 2          cost and the services that we provide for 

 3          some of our most needy in this area?  

 4                 OMH COMMISSIONER SULLIVAN:  Yes, we 

 5          have definitely kept in touch with them.  We 

 6          have a list of all the individuals who were 

 7          kind enough and generous enough to volunteer, 

 8          and we will be calling them from time to time 

 9          for specifics issues that we need.  It's a 

10          very good suggestion.  

11                 You know, it's not -- they have -- 

12          some of them have more limited time than some 

13          others, but we are looking into this, 

14          especially as we expand out the whole crisis 

15          counseling program with COVID.  

16                 Some of those counselors are paid for 

17          by FEMA, but they won't be able to cover 

18          everything.  So we are thinking again of 

19          working with them.  Some of them did our 

20          Coping Circles, and we are thinking of again 

21          asking them or others if they would be 

22          willing to do that with us.  

23                 So yes, we keep in touch.  And you're 

24          right, it's a -- they're very generous 


 1          people, and they're a great piece to the 

 2          workforce.  Thank you.  

 3                 SENATOR TEDISCO:  Okay.  Secondarily, 

 4          we've had kind of an outmigration of 

 5          population over the last three years, over 

 6          the last 10 years, but some of the mental 

 7          health service providers and those who would 

 8          be here providing services are needed, I 

 9          think, in our state.  

10                 Is there any plan or is there any 

11          long-term consideration or plan to retain or 

12          attract mental health service providers to 

13          New York State to keep them here?  Do we have 

14          any long-term plan, ideas about that?

15                 OMH COMMISSIONER SULLIVAN:  Well, we 

16          do a lot of -- I'm sorry.  We do a lot of 

17          training of professionals in New York State.  

18                 And what we are doing is reaching out 

19          and doing -- we have a program now with -- I 

20          think it's over 20 social work schools, for 

21          example, where we work with them, we do some 

22          special evidence-based {inaudible}, very 

23          small stipends for them to be a part of 

24          working with us on mental health issues, to 


 1          recruit them from social work schools into 

 2          the mental health field.  And we give them 

 3          placements, for example, in our facilities if 

 4          they're interested in that -- or other 

 5          community-based.  Not just us, but 

 6          community-based.  

 7                 So we are reaching out to schools to 

 8          enable -- we do a lot of training.  We want 

 9          to hold those individuals.  We want to keep 

10          them, also if possible, in the public sector.  

11          So that's one thing that we're doing.

12                 The other thing that we're doing with 

13          physicians, because there's always a shortage 

14          of physicians, is we have the ability to 

15          repay physician's loans in the state system, 

16          the state hospital system, up to $150,000 if 

17          they stay with us for five years.  And I 

18          think that that's been successful.  We've 

19          been able to recruit about 25, 26 

20          psychiatrists for that within the state 

21          system.

22                 So programs like that help to keep 

23          people in New York.  We do a lot of training, 

24          and also get them interested in the mental 


 1          health field.

 2                 SENATOR TEDISCO:  Yeah, I and others 

 3          fought for and won student loan forgiveness 

 4          for health professionals.  

 5                 Is there any concept of continuing 

 6          some of that or expanding some of that, 

 7          student loan forgiveness for health 

 8          professionals?  I mean especially nurses, 

 9          mental health nursing and nurses in general, 

10          because nursing homes -- we talk about 

11          expanding the workforce and the allotment of 

12          time that they should be limited to, but it's 

13          not the finances for many programs, it's the 

14          ability to find the staff and the workers.  

15                 So possibly we could expand some 

16          tuition forgiveness or expansion or help in 

17          that, in loans.  Is that a possibility?

18                 OMH COMMISSIONER SULLIVAN:  It's 

19          something to -- I mean, I think I -- I don't 

20          know exactly the programs you're talking 

21          about.  But yes, we can look into that.  

22          There might not be anything in this budget, 

23          but those are things we can look into.  We 

24          can look into that.


 1                 SENATOR TEDISCO:  You know, the beds 

 2          I'm talking about -- because in the Executive 

 3          Budget is to eliminate 200 state-operated 

 4          inpatient beds and an additional 100 

 5          state-operated community residence beds, you 

 6          know.  I don't know what the rationale is, 

 7          probably to save money.  Is that what that 

 8          is?

 9                 OMH COMMISSIONER SULLIVAN:  Those are 

10          vacant beds.  We only close beds when they're 

11          vacant.  And over the past five or six years 

12          we've closed about 700 beds total.  

13                 The reason we're able to close beds is 

14          because we've expanded community services and 

15          we want as many of our patients not to be in 

16          hospitals but to be in the community.  

17                 So yes, there's money saved when you 

18          do it, but it's not like "we need money, 

19          close the beds."  That's not the issue.  The 

20          issue is that we've been able to have the 

21          community-based services strong enough to be 

22          able to have individuals live, truthfully, 

23          successfully in the community.  

24                 And that gives us the ability to close 


 1          some of those beds, especially some of our 

 2          long-stay clients who have been with us way 

 3          too long, to give them the wraparound 

 4          services that they need to be in the 

 5          community.

 6                 SENATOR TEDISCO:  Well, if you wanted 

 7          community-based beds, the projection is to 

 8          close an additional 100 state-operated 

 9          community residence beds.

10                 OMH COMMISSIONER SULLIVAN:  We're 

11          moving them to the community.  

12                 We're also under something called the 

13          Olmstead Act, which says that you shouldn't 

14          be having long-term community beds on state 

15          hospital campuses.  So they really want those 

16          beds in the communities.  

17                 It's not a reduction, that's a 

18          movement.  That's a movement from the campus 

19          to the community.  Those beds will exist.

20                 SENATOR TEDISCO:  Thank you, 

21          Commissioner.  Appreciate that.

22                 OMH COMMISSIONER SULLIVAN:  Thank you.  

23                 CHAIRWOMAN KRUEGER:  Thank you very 

24          much.  Assembly?  


 1                 CHAIRWOMAN WEINSTEIN:  We go to 

 2          Assemblyman Brown for three minutes.

 3                 THE MODERATOR:  I'm asking him to 

 4          unmute.  I don't know if he is available.

 5                 CHAIRWOMAN WEINSTEIN:  Okay, then we 

 6          can go -- let's go to Assemblywoman Miller 

 7          for three minutes.

 8                 THE MODERATOR:  No, Assemblyman Brown 

 9          is here.

10                 CHAIRWOMAN WEINSTEIN:  Oh, you have 

11          him?  Okay.  Sorry, Missy, we'll be back to 

12          you.

13                 ASSEMBLYMAN BROWN:  Can you all hear 

14          me okay?

15                 OMH COMMISSIONER SULLIVAN:  Yes, we 

16          can.

17                 ASSEMBLYMAN BROWN:  Okay.  So good 

18          morning.  

19                 As a new member of the Assembly, I 

20          asked to be placed on the Assembly Committee 

21          of Alcoholism and Substance Abuse.  I was 

22          extremely pleased to be named minority ranker 

23          of the committee, since this issue is very 

24          personal to me.  I've been involved with 


 1          Outreach Long Island for many years now, and 

 2          the issue is one that I'm all too familiar 

 3          with on several levels.  

 4                 Just at first blush, just on a general 

 5          level, my Assembly district office and 

 6          district is located in Suffolk County, which 

 7          as you know leads the nation in the highest 

 8          number of overdoses.  And I feel that we are 

 9          not doing enough and we need to do more.  

10                 I'm deeply troubled by the 

11          announcement by the Governor to place in the 

12          budget the legalization of marijuana.  The 

13          coronavirus impact on mental health is 

14          palpable; we're seeing a rise in drug use, 

15          suicides, anxiety, depression, et cetera, as 

16          a result of COVID.  And I'm equally concerned 

17          about the proposed Executive Budget proposal 

18          for treating mental health and vulnerable 

19          people afflicted with mental health issues.  

20                 And finally, I'm concerned about the 

21          proposal to merge OASAS into the Office of 

22          Mental Health, and I have several questions 

23          with regard to that.  

24                 So I know I have additional time to 


 1          speak later with respect to OASAS, so I'm 

 2          going to save my questions now for those 

 3          questions related to mental health.  And with 

 4          respect to addiction and mental health, I was 

 5          wondering if there's any data on the office's 

 6          current treatment for cannabis addiction.  

 7          And does the office anticipate the need for 

 8          increased capacity for cannabis addiction 

 9          treatment due to the possibility legalization 

10          of cannabis?

11                 OMH COMMISSIONER SULLIVAN:  Well, one 

12          of the major mental health issues with 

13          cannabis is the effect of cannabis on youth 

14          that have psychiatric issues.  So there is 

15          dollars in the cannabis legislation that 

16          would enable a great deal of education to 

17          families and to youth about the risk for 

18          individuals, youth who are at risk for 

19          psychosis.  

20                 We know that cannabis use can 

21          sometimes increase that risk or even make the 

22          psychotic episodes occur sooner.  We also 

23          know that cannabis use among individuals with 

24          serious mental illness can sometimes 


 1          interfere with their progress and recovery, 

 2          et cetera.

 3                 So there is a lot of work that's being 

 4          done to prepare for the education that has to 

 5          be out there -- which we're already doing 

 6          much of because some of our clients are 

 7          already using cannabis -- but to expand on 

 8          the education and the work to help prevent 

 9          the use for individuals who are at risk for 

10          cannabis use, even recreational cannabis use.  

11                 So we're going to be working with 

12          that.  There's a lot of education, and we're 

13          already doing some of it, but we will 

14          continue to do more if the cannabis 

15          legislation passes.

16                 ASSEMBLYMAN BROWN:  So I --

17                 CHAIRWOMAN WEINSTEIN:  Thank you.  

18                 Excuse me, the time has expired.  You 

19          know, I just want to remind members to keep 

20          an eye on the clock, make sure it's on your 

21          home page.

22                 So we're going to go to the Senate 

23          next.

24                 CHAIRWOMAN KRUEGER:  Thank you very 


 1          much, Assemblywoman.  

 2                 Tom O'Mara, ranker on Finance, five 

 3          minutes.

 4                 SENATOR O'MARA:  Thank you, Senator.

 5                 And I would add that we have been 

 6          joined on our side by Senator Sue Serino and 

 7          Senator Tony Palumbo, who are with us now. 

 8                 Following up, Commissioner, with 

 9          Senator Ortt's questions on the Dwyer 

10          program, since he has departed.  He's advised 

11          me that he's learned that the Dwyer program 

12          money that was in last year's budget that has 

13          not been released is stuck in the Senate 

14          awaiting the Senate Majority's approval of 

15          the release of those funds.  

16                 So I would request Senator Krueger to 

17          take a look at that, please, to see if those 

18          funds can be utilized.  I think that's a 

19          critically important program to provide 

20          mental health stability to many of our 

21          veterans, and I think it's a very important 

22          program going forward.

23                 Commissioner, two years ago there was 

24          funding in the mental health budget of I 


 1          think it was $1.5 million for crisis 

 2          intervention teams.  In my understanding, 

 3          that was to help with training of police 

 4          officers in dealing with mental health 

 5          emergencies.  And, you know, in light of -- 

 6          first of all, why was that not continued last 

 7          year?  

 8                 (Zoom interruption.)

 9                 SENATOR O'MARA:  Why was that not in 

10          last year's budget?  Why is it not proposed 

11          again in this year's budget?  And in light of 

12          all the certainly high-profile incidents that 

13          we've seen in New York State and across the 

14          country with the difficulty in responding to 

15          these emergencies by the police, why wouldn't 

16          we be focusing more and providing funding for 

17          that program?

18                 OMH COMMISSIONER SULLIVAN:  I just 

19          hope I have this right, Senator.  But I 

20          believe that the funding for CIT was 

21          actually -- in the past has been a 

22          legislative add.  OMH does a lot of in-kind 

23          support for it, we organize it, we do some of 

24          the training.  But the actual dollars that 


 1          appear, I think, on the line for CIT -- I 

 2          hope I'm not wrong about this -- are actually 

 3          legislative adds.

 4                 Within -- and then we do the -- it 

 5          flows through OMH, and OMH does a lot of 

 6          in-kind support to organize it, to do some of 

 7          the training, et cetera.

 8                 Within our current budget within -- 

 9          not as a line item, but within the services 

10          that we provide through our training and 

11          state aid, et cetera, for our crisis 

12          stabilization centers, we will definitely be 

13          increasing the use of CIT training.  So 

14          that's embedded in the budget.  

15                 But I think the particular 

16          1.5 million, I believe, for CIT training was 

17          as a legislative -- 

18                 SENATOR O'MARA:  You're correct on 

19          that.  Two years ago, it was.  Yet it wasn't 

20          included as continued funding in the 

21          Executive Budget last year, and the 

22          Legislature didn't add it, and it's not in 

23          the Executive Budget this year.  

24                 Do you not feel that the crisis 


 1          intervention teams was a successful program?  

 2          Or do you think that we should be looking, 

 3          from our side, to add back into that for this 

 4          important social issue that we have these 

 5          days?

 6                 OMH COMMISSIONER SULLIVAN:  It's an 

 7          important program.  I think it does -- 

 8          there's been -- it's a nationally 

 9          evidence-based program, CIT training.  And I 

10          think we've supported some -- we will be 

11          supporting some through our crisis 

12          stabilization centers.  

13                 But it's a good program and something 

14          that is important in terms of helping police 

15          be able to appropriately work with 

16          individuals with mental illness in crisis.

17                 SENATOR O'MARA:  Okay.  Thank you very 

18          much, Commissioner.

19                 OMH COMMISSIONER SULLIVAN:  Thank you.  

20                 CHAIRWOMAN KRUEGER:  Thank you.  

21                 As we return it to the Assembly, we've 

22          also been joined by Senator Felder.

23                 CHAIRWOMAN WEINSTEIN:  We go to 

24          Assemblywoman Miller for three minutes.


 1                 Missy, you're on.  We can't hear you.  

 2          You're unmuted, but we --

 3                 THE MODERATOR:  The Assemblywoman is 

 4          unmuted, but we are not getting any sound.

 5                 CHAIRWOMAN WEINSTEIN:  Right.  We 

 6          can't hear you, though you are unmuted.  Do 

 7          you want to -- maybe we'll skip --

 8                 CHAIRWOMAN KRUEGER:  Why don't you 

 9          skip, come back, and they can get to the 

10          bottom of it.

11                 CHAIRWOMAN WEINSTEIN:  We'll skip you, 

12          and you'll work that out.  

13                 So we'll go to Assemblywoman Barrett 

14          for three minutes.

15                 ASSEMBLYWOMAN BARRETT:  Thank you.  

16          Thank you, Chairs.  

17                 And thank you, Commissioner.  Thank 

18          you for your leadership through this very 

19          challenging time.  I think we all agree we 

20          are in the midst of a mental health crisis 

21          unlike anything we've seen before.  

22                 I applaud the new agency merger.  You 

23          know, I think there's -- in the vast majority 

24          of times, substance abuse is co -- you know, 


 1          has dual diagnosis with other mental and 

 2          behavioral health challenges, so I'm glad to 

 3          see that.  

 4                 I do want to point out that we have, 

 5          in Dutchess County, a crisis stabilization 

 6          center, which people should take advantage of 

 7          coming to visit if they would like to see how 

 8          that works and how that's structured.

 9                 My main question, Commissioner, as 

10          chair of Veterans Affairs, is to reiterate 

11          the comments of Senator Ortt and others that 

12          Dwyer is such a fantastic program, it's been 

13          so effective.  We are really troubled that 

14          the Governor has not reached, you know, the 

15          decision to make sure that that's in the 

16          budget every year.  

17                 And I would like to know, given that, 

18          whether you would support us switching the 

19          Dwyer funding -- you know, making sure that 

20          everybody gets what they've been entitled to 

21          from last year, get it in the budget this 

22          time.  But would you support that we move 

23          that to the Division of Veterans Services?  

24          It doesn't seem to be a real fit for your 


 1          agency, and it -- obviously, it gets lost in 

 2          a lot of other things.  So would you support 

 3          that going forward?

 4                 OMH COMMISSIONER SULLIVAN:  I think 

 5          there could be discussion about that.  I 

 6          think it's a great program, I think it has a 

 7          lot to offer, and I think that's an idea that 

 8          could be brought forward.

 9                 ASSEMBLYWOMAN BARRETT:  I mean, I 

10          think the opportunity -- it's only in, at 

11          this point, 25 counties.  We added -- last 

12          year we added two counties and New York City 

13          to the mix.  There's a lot of counties across 

14          the state.  

15                 We were talking to the commissioner or 

16          the head of the veterans program in Columbia 

17          County the other day; he was saying they get, 

18          you know, a lot of people from other 

19          surrounding counties because of the work that 

20          they're doing.  

21                 I think that this is something that 

22          could be more robust and be more effective if 

23          it really was focused, you know, within the 

24          veterans community.  So I would urge you to 


 1          support that as we -- we're going to put that 

 2          certainly in our one-house budget, I'm 

 3          hoping, and I would hope that you would 

 4          support that going forward.  

 5                 Thank you.

 6                 CHAIRWOMAN WEINSTEIN:  So we go back 

 7          to the Senate.  

 8                 CHAIRWOMAN KRUEGER:  I think at the 

 9          moment we are out of Senators with questions, 

10          but we'll get more, so please keep going, 

11          Assembly.

12                 CHAIRWOMAN WEINSTEIN:  Okay, we have 

13          quite a few.  

14                 So I'm not sure, I think -- 

15          Assemblywoman Miller, you want to try it 

16          again?  

17                 ASSEMBLYWOMAN MILLER:  Yes.  Can you 

18          hear me now?

19                 CHAIRWOMAN WEINSTEIN:  Yes, now we 

20          can, thank you.

21                 ASSEMBLYWOMAN MILLER:  Okay.  

22                 Good morning, Commissioner, how are 

23          you?  

24                 So I think a lot of what I'm hearing 


 1          is again this desperate need for our state 

 2          agencies to learn how to coordinate for 

 3          evaluations, reimbursements -- like we need 

 4          this coordination.  As my colleague 

 5          Assemblymember Abinanti says, one size does 

 6          not fit all.  These silos, these -- you know, 

 7          they get locked in.  So I just want to 

 8          reiterate that point, I think it's so 

 9          important.  

10                 Do we know how this behavioral health 

11          parity compliance fund is working?  Is it 

12          fully funded?  I know that there's still this 

13          desperate need to find providers.  And I also 

14          know firsthand, just from my mom with 

15          Alzheimer's, trying to access a psychiatrist.  

16          There's a several-month waiting list if 

17          they're even taking new patients.  They 

18          accept no insurance or Medicaid or Medicare.

19                 Like, how are we helping people find 

20          the treatment when they can't even find the 

21          psychiatrist or the professional to help 

22          start the process?  

23                 OMH COMMISSIONER SULLIVAN:  Parity 

24          work is ongoing.  The compliance fund is 


 1          going to be based on fines and dollars 

 2          received, and those have not been issued yet, 

 3          but the work is going on.  

 4                 The work is going on to look at 

 5          basically what's happening with the insurers.  

 6          The Parity Reporting Act will happen this 

 7          year.  There's a lot of work going on behind 

 8          the scenes, a lot of contact with the 

 9          insurers.  

10                 And just remember that there's 

11          something called the CHAMP program.  The 

12          CHAMP program basically will take a request 

13          from anybody who's having trouble finding 

14          services or getting approvals from insurance 

15          companies.  The CHAMP program is there for 

16          providers, it's there for individuals, it's 

17          there for family members.  

18                 And I don't have the number, but it's 

19          available.  Anyone can call.  They've seen 

20          over I think 600 cases so far, and they've 

21          been very active in helping individuals work 

22          with insurers who may not be following 

23          strictly the kind of rules for parity.

24                 So the parity compliance fund doesn't 


 1          -- is not really -- it's there to receive 

 2          those dollars.  It's not there yet.

 3                 ASSEMBLYWOMAN MILLER:  Okay.  And then 

 4          just back to Assemblymember Gunther's, you 

 5          know, issue with closing these -- the 

 6          children's long-term beds.  You know, just as 

 7          we keep hearing from our health 

 8          commissioners, from medical experts how 

 9          during the pandemic we can't ignore our 

10          existing conditions, our existing health 

11          issues, nor can we ignore especially 

12          children's existing mental health issues or 

13          remove their treatments if they need a 

14          long-term treatment bed.  

15                 If the numbers are down, maybe it's 

16          because -- I know even with my son, with 

17          medical issues, I was deathly afraid of 

18          bringing him to the hospital.  I would do 

19          anything -- we did try many things to keep 

20          him out of the congregate environment during 

21          the pandemic.  I don't think it's really a 

22          true reflection of an improvement.  I think, 

23          if anything, we're about to see a dramatic 

24          increase from the isolation and from, you 


 1          know, the exacerbation of their underlying 

 2          conditions for not getting treatment during 

 3          the pandemic or not having available 

 4          treatment.  

 5                 And as we know, the suicide risk is 

 6          crazy and looms above us all.  So it's a 

 7          significant concern.

 8                 OMH COMMISSIONER SULLIVAN:  Yes.  But 

 9          just to clarify again, for Rockland, that 

10          those beds will be moving.  It may be that 

11          they have an increased distance for some 

12          families, but we are actually enhancing the 

13          services in Rockland.  Those services will be 

14          increased for youth in Rockland.

15                 ASSEMBLYWOMAN MILLER:  Thank you.  

16                 CHAIRWOMAN WEINSTEIN:  Thank you.  

17                 Since there are no Senators, we have I 

18          believe eight Assembly members.

19                 CHAIRWOMAN KRUEGER:  Actually, we have 

20          one Senator.  Sorry.

21                 CHAIRWOMAN WEINSTEIN:  Okay, so we're 

22          going to go back to the Senate.

23                 CHAIRWOMAN KRUEGER:  Thank you.    

24                 John Brooks.  I think he couldn't get 


 1          his hand up, but he texted me.

 2                 Are you there, John?

 3                 SENATOR BROOKS:  I'm here.  Thank you, 

 4          Madam Chairman.  I appreciate the opportunity 

 5          to speak for a moment here.

 6                 There's been a lot of discussion on 

 7          the Dwyer program, which is an excellent 

 8          program.  You know, every single year, as has 

 9          been mentioned, it's cut out of the budget.  

10          I think with absolute certainty this 

11          budget -- it is misplaced in the budget.  We 

12          don't have an opportunity, as the Veterans 

13          Committee, even to comment in this hearing.  

14          I'm commenting via my membership of other 

15          committees.  

16                 But the veterans program has been 

17          exceptionally successful.  The demand is 

18          greater than ever, with the pandemic and what 

19          is happening.  We're in a situation where the 

20          director's position is empty.  We have been 

21          trying to get these funds out to the units.  

22                 And to me, as was mentioned by other 

23          members, it's incredible that this program is 

24          not in the budget year after year after year.  


 1          Everybody and his brother -- and his sister, 

 2          I guess, to be correct -- understands the 

 3          great success and the need to have this in; 

 4          in fact, the need to increase the funding for 

 5          this program.

 6                 I believe we really have to rethink 

 7          what we're doing with veterans within the 

 8          budget.  It probably should be part of the 

 9          cabinet.  We've got individuals who serve 

10          this state and this nation in an outstanding 

11          way.  We know, particularly with some of our 

12          Vietnam vets, they're having additional 

13          problems now as they get older.  We've 

14          changed the role of the military, in that 

15          what was once a part-time soldier becomes a 

16          full-time soldier.  You know, I spent six 

17          years in the National Guard.  We were never 

18          federally activated at all at that time.  Now 

19          it's a common practice.  

20                 And it puts these individuals in 

21          significant stress.  You go from a peacetime 

22          environment, walking down a street, and maybe 

23          two months later you're in a hazardous zone.  

24                 So I share with everybody that's 


 1          commented it's incredible that this isn't 

 2          even in the budget.  And then, you know, for 

 3          me even to speak to the departments that are 

 4          controlling the budget, we had to go through 

 5          a back door to allow us to do that.

 6                 We've got to rethink what we're doing.  

 7          And this past year we lost three members, 

 8          just recently, in the National Guard on a 

 9          service mission.  We have people that are 

10          having a great deal of stress, suicide risk.  

11          The Dwyer program works.  We should all be 

12          ashamed that it's not in this budget.

13                 CHAIRWOMAN KRUEGER:  Thank you.  And 

14          thank you for allowing us the leeway of 

15          Senator Brooks not actually asking a 

16          question, just being the chair of the 

17          Veterans Committee where this technically 

18          won't come up because it's in the mental 

19          health budget.  

20                 I think -- I think we all are agreeing 

21          this is a serious issue, both houses, both 

22          parties.  So thank you, Assembly.

23                 SENATOR BROOKS:  Thank you.

24                 CHAIRWOMAN WEINSTEIN:  Yes.  We go to 


 1          Assemblywoman Griffin, three minutes.

 2                 ASSEMBLYWOMAN GRIFFIN:  Good morning.  

 3          Good morning, Commissioner Sullivan.  

 4                 I just wanted to say I'm deeply 

 5          concerned about the cuts in residential beds 

 6          and the cuts to mental health counseling and 

 7          suicide prevention.  

 8                 I'm also concerned about the proposal 

 9          to delay the $1 million investment in suicide 

10          prevention for veterans, first responders and 

11          law enforcement.  These groups are 

12          particularly vulnerable and can't afford a 

13          delay in services.

14                 Over the past four years there has 

15          been a significant increase in suicides in 

16          ages 14 through 25 in my district.  Really 

17          startling.  And -- it's like we have a couple 

18          a year.  And it's very devastating for 

19          families, students, everyone.

20                 And I heard you mention specific 

21          groups that sounded like they were increasing 

22          suicide prevention.  I just wondered if you 

23          could elaborate on that.

24                 OMH COMMISSIONER SULLIVAN:  Yes, thank 


 1          you.  We have -- when you look at the suicide 

 2          data, there are certain high-risk groups that 

 3          are particularly at risk.  

 4                 And one particular group, just to 

 5          describe one, is the Black youths group.  

 6          Young Black children in the ages of even up 

 7          to 9 to 12 have seen the largest increase in 

 8          suicide nationally of any group.  And it's 

 9          very, very tragic and terribly sad.

10                 So we brought together experts from 

11          NYU, Dr. Lindsey and others, into a Black 

12          Youth Suicide Workgroup, for example, and 

13          that workgroup has now made recommendations 

14          which we're following up on.  And they will 

15          include working with those -- with Black 

16          communities on the issues of suicide.  

17                 One particular piece will be working 

18          with the church faith groups on alerting 

19          people on how to assess, on what we call 

20          mental health first aid, what are the risks 

21          and risk factors of suicide, working with the 

22          schools in those communities to be able to 

23          talk in a way that can be understood by the 

24          youth and the teachers as to what they need.  


 1                 So we're talking about some very 

 2          intense grassroots work with those 

 3          communities to talk about suicide, to talk 

 4          about mental health issues, and to talk about 

 5          being open about asking for help.

 6                 You know, suicide prevention has many, 

 7          many pieces that have to come together.  You 

 8          have to work with the community, you have to 

 9          work with teachers, you have to work with the 

10          -- which is another initiative we have with 

11          healthcare providers.  Pediatricians, for 

12          example, for the Black youth group are 

13          critical for them to understand, to be 

14          attuned to what can be activities or ways 

15          that kids are acting that could actually end 

16          up resulting in something as tragic as a 

17          suicide.  So all those groups.

18                 What we've found is, though, that you 

19          have to hone it down to specific populations 

20          sometimes.  You can't just do a generic.  And 

21          I think that's one of the things -- for 

22          example, we're doing Black youth, the other 

23          group is Latina adolescents, and the other 

24          very high risk group is the LGBTQ young 


 1          people.  I mean, I think they have one of the 

 2          highest rates of suicide attempts and, sadly, 

 3          successful suicides.

 4                 So we're working with someone called 

 5          the Trevor Foundation, for example, on that, 

 6          who's done tremendous work with LGBTQ.  They 

 7          have a hotline for youth that is specifically 

 8          for individuals who are LGBTQ.  

 9                 So those are the kinds of things that 

10          we're doing.  And as we move it, we're going 

11          to be moving it out across the state to those 

12          affected communities.

13                 ASSEMBLYWOMAN GRIFFIN:  Thank you very 

14          much.

15                 OMH COMMISSIONER SULLIVAN:  Thank you.  

16                 CHAIRWOMAN KRUEGER:  Thank you.  I 

17          don't think we have any more Senators right 

18          now --

19                 CHAIRWOMAN WEINSTEIN:  Okay, so then 

20          we're going to go to --

21                 CHAIRWOMAN KRUEGER:  Oh, oh, oh, 

22          Michelle Hinchey raised her hand, excuse me.  

23                 Senator Michelle Hinchey.

24                 SENATOR HINCHEY:  Hello.  I'm trying 


 1          to start my video, but for some reason I'm 

 2          not allowed to.

 3                 CHAIRWOMAN KRUEGER:  There you are.

 4                 OMH COMMISSIONER SULLIVAN:  We can see 

 5          you.

 6                 SENATOR HINCHEY:  Wonderful.  Thank 

 7          you so much.  

 8                 Commissioner, thank you so much for 

 9          being here.  

10                 Farming is a stressful business in the 

11          best of times, and this year we see how 

12          disruptions in the food supply chain have 

13          made it more so.  New York FarmNet, which is 

14          a mental and financial distress hotline 

15          specifically for the farm and agricultural 

16          community, has reported that farm caseloads 

17          have not only increased from previous years, 

18          but that the percentage of farmers dealing 

19          with significant stress and mental health 

20          challenges has doubled.  

21                 Yet the Executive Budget has again 

22          eliminated $400,000 in funding.  Can you 

23          share why the Governor's budget proposal is 

24          not providing adequate funding for New York 


 1          FarmNet in a time when mental health services 

 2          have never been more important?

 3                 OMH COMMISSIONER SULLIVAN:  Let me 

 4          just say that we know the importance of 

 5          mental health in the rural communities, and 

 6          we're doing a lot of work in those 

 7          communities with telehealth to kind of spread 

 8          some of the ability for mental health 

 9          professionals to be there and to work on 

10          something very effective and very helpful.  

11                 On the FarmNet issue, I know that that 

12          was one of the issues that was pushed into -- 

13          {audio feedback} -- were not moved in the 

14          budget this year, but last year's -- I don't 

15          know if they've been moved from last year or 

16          not, I'm not that familiar with it.  Yes, 

17          they were not approved.  They were not 

18          approved at this point in time.

19                 SENATOR HINCHEY:  Okay, thank you.  

20          And --

21                 OMH COMMISSIONER SULLIVAN:  I think if 

22          those -- paperwork for something like that 

23          comes through to OMH, we'll forward that 

24          {continued audio feedback}.  From last year.


 1                 SENATOR HINCHEY:  Thank you.  And 

 2          within that, you mentioned how important 

 3          mental health is in our rural communities.  

 4          Can you talk about where in the budget 

 5          support for mental health is specifically for 

 6          rural communities?

 7                 OMH COMMISSIONER SULLIVAN:  It's not 

 8          specific.  It's embedded in the work we do 

 9          with telehealth, the work that we do with 

10          mobile crisis teams, the work that we do with 

11          the expansion of clinic services.  

12                 For example, some of our CCBHCs are in 

13          -- well, we have one in Franklin County, 

14          which is rural communities.  So it's not a 

15          specific line.  It's embedded in the overall 

16          work we do and the state aid that we give.  

17          And then the counties often are a partner 

18          with us to use those dollars.

19                 SENATOR HINCHEY:  Thank you.  I'll 

20          just say from my experience in my 

21          communities, we are losing mental health and 

22          detox beds repeatedly in our rural 

23          communities, and it's definitely something -- 

24          these are communities that are ravaged by 


 1          these types of needs, and yet we're losing 

 2          them repeatedly.  So it's something that is 

 3          an absolute priority for me and those of us 

 4          who live in the rural communities.  

 5                 So thank you, and I appreciate you 

 6          looking into it.

 7                 OMH COMMISSIONER SULLIVAN:  Yes, and I 

 8          absolutely agree with you {continued audio 

 9          feedback} -- I think we need to {feedback}-- 

10          beds are critical in those areas, and we work 

11          very hard with the providers in those areas 

12          not to close psych beds because ours aren't 

13          as lucrative as some other beds in the 

14          medical system.  

15                 But yes, I agree with you, there are 

16          areas, pockets, where those acute-care beds, 

17          acute-care beds need to be there.

18                 SENATOR HINCHEY:  Thank you.

19                 CHAIRWOMAN KRUEGER:  Thank you.  

20                 Assembly.

21                 CHAIRWOMAN WEINSTEIN:  We go to Ken 

22          Zebrowski.  

23                 The next order for Assemblymembers, 

24          just for your information, is then Burdick, 


 1          Epstein, Byrne -- actually, it's Burdick, 

 2          Bronson, Epstein.

 3                 So we go to Assemblyman Zebrowski now, 

 4          Ken Zebrowski.

 5                 ASSEMBLYMAN ZEBROWSKI:  Thanks, Chair 

 6          Weinstein.  And good morning, Commissioner.  

 7                 When I raised my hand to speak, it was 

 8          right as Chair Gunther was speaking, so I 

 9          have to say that I can attribute many of my 

10          comments to her frustrations.  

11                 And I also want to touch briefly on 

12          the Rockland psych beds.  I've got to say 

13          that I think it would be far more beneficial 

14          and helpful for us to be able to get to the 

15          bottom of these beds and the need over the 

16          next year than to do this in this budget.  

17                 We're hearing different things than 

18          some of the data you're giving us now.  We're 

19          hearing that those beds aren't utilized not 

20          because there isn't a need, but because 

21          they're not being filled.  And, you know, I 

22          have to say that in the downstate region 

23          there is a difference between travel in 

24          Rockland, Orange, Putnam than there is 


 1          crossing over the river and into the New York 

 2          City area.

 3                 So I'm not sure that, you know, 

 4          replacing the beds from Rockland or sending 

 5          folks down to the Bronx is just a hop, skip 

 6          and a jump for folks that are in the 

 7          Hudson Valley region.  You know, there's not 

 8          great mass transit options.  You know, if -- 

 9          earlier this week I was talking to the head 

10          of the MTA about, you know, our lack of train 

11          access and there's bus limitations and things 

12          like that.  So I know it's, you know, a 

13          bigger catchment area than just Rockland 

14          County, but the entire region sort of uses 

15          these beds.  

16                 So we're concerned about eliminating 

17          these beds right now.  We don't think it's 

18          the right thing to do in the middle of COVID 

19          when I feel like there can't be a sort of 

20          proper analysis.  And also, I'm really 

21          concerned about the employees.  There's a lot 

22          of confusion as to what their options would 

23          be, where they would be going.

24                 So in my opinion -- you know, I 


 1          appreciate your comments here today.  I just 

 2          think that this is something that we should 

 3          take out of the budget, eliminate, and have a 

 4          conversation over the next year with maybe 

 5          some roundtables and things like that with 

 6          certainly your participation and the 

 7          leadership of both committee chairs in the 

 8          Senate and the Assembly and both ranking 

 9          members.  

10                 Thank you.

11                 CHAIRWOMAN KRUEGER:  Thank you.  

12                 Assembly, please continue.

13                 CHAIRWOMAN WEINSTEIN:  We've been 

14          joined by Assemblywoman De La Rosa and 

15          Assemblywoman Jackson, and we go to 

16          Assemblyman Burdick, to be followed by 

17          Assemblyman Bronson.  Three minutes.  

18                 ASSEMBLYMAN BURDICK:  Thank you.  And 

19          I want to thank the chairs and commissioners 

20          for holding this.  

21                 And clearly, what we hear repeatedly 

22          is that we have a crisis which has deepened 

23          with the pandemic.  And I support the 

24          impassioned pleas of so many of my colleagues 


 1          to restore funding.

 2                 I want to speak for a moment about one 

 3          of the missions of OPWDD, to work closely 

 4          with nonprofit partners to help individuals 

 5          with developmental disabilities find 

 6          residential housing.

 7                 I had direct experience some seven 

 8          years ago as supervisor of the Town of 

 9          Bedford at that time, when Cardinal McCloskey 

10          Community Services applied for a permit to 

11          provide housing in Bedford to four young 

12          autistic men who had aged out.  

13                 I have two questions on that; the 

14          first I would ask that you get back to me on.  

15          And the first is what appropriation level is 

16          proposed for the funding for such facilities 

17          in the budget, how does that compare to the 

18          existing level, and can we please have the 

19          actual expenditures over the last three 

20          years, and in comparison to the appropriation 

21          levels.  

22                 The main question I have relates to 

23          the process itself.  It was very painful.  I 

24          understand that several years previously this 


 1          statute had been revised to facilitate the 

 2          siting.  There still are serious issues.  And 

 3          what recommendations might you have to 

 4          facilitate Cardinal McCloskey and others to 

 5          be able to get their approvals?

 6                 OMH COMMISSIONER SULLIVAN:  

 7          Assemblyman Burdick, that really falls within 

 8          Dr. Kastner, who will be testifying later, 

 9          OPWDD.  I am not the -- this is --  

10                 ASSEMBLYMAN BURDICK:  Okay, I'm sorry.  

11          I will hold off on that.  I apologize.

12                 OMH COMMISSIONER SULLIVAN:  Thank you.  

13                 CHAIRWOMAN WEINSTEIN:  So then we're 

14          going to go to Assemblyman Bronson.

15                 ASSEMBLYMAN BRONSON:  Hello, 

16          Commissioner.  Nice to see you.  

17                 I'm going to ask two questions, or 

18          actually two areas.  The first I just want to 

19          point out, you know, some of my colleagues 

20          mentioned that we're facing three crises 

21          simultaneously, the first being the COVID-19 

22          health crisis and pandemic as well as the 

23          resulting downturn in the economy, and then 

24          racial injustice -- you know, three at the 


 1          same time.  And this has really had an impact 

 2          on the emotional health of our citizens.  

 3                 And here in Rochester, you know, we 

 4          had the tragic death of Daniel Prude last 

 5          year and the recent pepper-spraying of a 

 6          9-year-old child.  This has rightfully 

 7          outraged our communities and shown that real 

 8          change is needed to prevent more tragedies 

 9          like these from occurring.

10                 Yesterday, myself and Senator Brouk 

11          introduced legislation which will help ensure 

12          our most vulnerable friends and neighbors are 

13          directly connected to trained mental health 

14          professionals who will treat them with 

15          compassion at their time of greatest need.  

16          You know, simply put, New Yorkers that are 

17          experiencing mental health and substance 

18          abuse crises are best served by a public 

19          health response, one that maximizes consent, 

20          treatment and services and minimizes the role 

21          of law enforcement and the use of force.

22                 We have to have transformative change 

23          that moves us away from a model of control 

24          and force to one of compassionate, care and 


 1          treatment.

 2                 So, you know, Daniel's Law has been 

 3          introduced.  I hope that you and the Governor 

 4          can take a close look at that and partner 

 5          with us so that we get it right and that we 

 6          can get that measure passed.

 7                 As for my question, as you know, three 

 8          years ago there was a robust group of 

 9          behavioral health advocates who came together 

10          and worked with your staff, the Governor's 

11          staff and other agencies to address the 

12          exemption from licensure for those working in 

13          state licensed or operated facilities.  That 

14          exemption was extended for another three 

15          years with an agreement.  

16                 And now the exemption is due to sunset 

17          in June, and nothing has been done.  Agencies 

18          don't want to hire anyone at this point for 

19          fear they will not be able to practice at the 

20          top of their education.  All of this is 

21          happening in the middle of a behavioral 

22          health and workforce crisis that I mentioned 

23          earlier, so I was kind of surprised not to 

24          see anything.  


 1                 Does your agency have a plan for June?  

 2          I mean, where do we stand on getting this 

 3          exemption to make sure it goes beyond June or 

 4          making it permanent?

 5                 OMH COMMISSIONER SULLIVAN:  There are 

 6          some -- I know that there are some 

 7          discussions about moving it because of the 

 8          disruption of COVID to longer than June, but 

 9          that has not been decided yet.  

10                 And I think that there has been a 

11          tremendous amount of dialogue on this issue, 

12          and we do have procedures for how agencies 

13          can work and appropriately do the required 

14          supervision, et cetera.  But the grandfather 

15          issue, which I think is one of the issues 

16          that you're bringing up, yes, technically it 

17          would be in July, but I know there are 

18          discussions to see if that could be extended.  

19          But I do not know.  I do not know.

20                 ASSEMBLYMAN BRONSON:  Thank you.

21                 CHAIRWOMAN WEINSTEIN:  Thank you.  

22                 We go to Assemblyman Epstein.

23                 ASSEMBLYMAN EPSTEIN:  Thank you, 

24          Commissioner.  Thank you for your work.  


 1                 Commissioner, do you think it's in the 

 2          best interest of New York to do cuts like 

 3          what is proposed here, including the 

 4          200 beds?

 5                 OMH COMMISSIONER SULLIVAN:  I think 

 6          that you have to use healthcare dollars right 

 7          now, and all dollars, wisely.  I think if you 

 8          don't do that -- me, as the commissioner -- I 

 9          don't think I'm being responsible.  

10                 So I do think it is important to look 

11          at beds that we have looked at, and we'd be 

12          glad to share the data with everyone on how 

13          long they've been vacant, why they've been 

14          vacant, that there's no reason that those 

15          beds should not be closed and that those 

16          healthcare dollars should not be spent on 

17          something that is not being utilized.

18                 ASSEMBLYMAN EPSTEIN:  So you don't 

19          think we need the beds, then, Commissioner?

20                 OMH COMMISSIONER SULLIVAN:  The beds 

21          that are being closed, no, I do not think we 

22          need them.  As we close them.  We close them 

23          very slowly, very carefully for --

24                 ASSEMBLYMAN EPSTEIN:  So you don't 


 1          think that there are people with mental 

 2          health issues who aren't getting access to 

 3          beds, then?

 4                 OMH COMMISSIONER SULLIVAN:  The state 

 5          hospital or long-term-care beds?  And I think 

 6          that's a -- that is different from the 

 7          community beds.  The community beds across 

 8          New York State have only decreased slightly, 

 9          and we've fought very hard to keep those 

10          community beds up.  And they basically have 

11          -- I think we've lost about 200 over a couple 

12          of years, something like that.  It's not been 

13          a lot.  That's where I think a lot of the 

14          work is.  

15                 These are long-term-care beds, and 

16          many of these individuals that we are closing 

17          the beds for have been with us for a long 

18          time and we've been successfully able to move 

19          them successfully into the community, opening 

20          up that bed as a vacant bed.

21                 ASSEMBLYMAN EPSTEIN:  Okay, so it 

22          sounds like you think closing the long-term 

23          beds makes sense, but additional community 

24          beds might be useful.


 1                 OMH COMMISSIONER SULLIVAN:  Yes.  

 2          Critical.  Critical.  Community beds are 

 3          critical.  Please don't get me wrong.  

 4                 But the long-term beds I think for 

 5          many individuals who have been with us too 

 6          long, we now have the opportunity to go to 

 7          housing that has come up, et cetera, to help 

 8          those individuals move successfully into the 

 9          community.  That has helped us tremendously 

10          to lower our bed use.

11                 ASSEMBLYMAN EPSTEIN:  So, 

12          commissioner, I know I only have a minute  

13          left, but I know Assemblymember Abinanti 

14          raised a lot of issues around cuts to 

15          services, you know, the cuts to providers.  

16          I'm wondering if you think that's in the best 

17          interests of New Yorkers that those cuts move 

18          forward, in the best interests of New Yorkers 

19          with mental health needs or people with 

20          disabilities.

21                 OMH COMMISSIONER SULLIVAN:  Well, I 

22          think there's an -- you know, the 5 percent 

23          reductions which -- to state aid I think are 

24          hard on the providers, and it's something 


 1          that I think will -- if we can get a 

 2          significant federal input, which I think New 

 3          York needs and deserves, if we can get those 

 4          dollars, then that 5 percent, as has been 

 5          said by the Department of Budget, that that 5 

 6          percent cut to the providers will go if -- if 

 7          we get the federal aid.  I think everyone in 

 8          the state right now is in the bucket of 

 9          having to deal with the fact that we don't 

10          have sufficient federal aid to balance the 

11          budget.

12                 ASSEMBLYMAN EPSTEIN:  Right.  Well, 

13          Commissioner, I appreciate it.  We agree, we 

14          want as much federal aid as possible.  But 

15          the state could step up too.  The state could 

16          raise additional revenue sources that could 

17          facilitate this.  So I would encourage you 

18          not just to talk about federal aid, but 

19          additional state revenue, because in times of 

20          crisis we can raise revenue and we have lots 

21          of tools available to do that.  And I would 

22          encourage you to support moving forward with 

23          more revenue, not less.  

24                 Thank you, Commissioner.


 1                 OMH COMMISSIONER SULLIVAN:  Thank you.

 2                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 3                 We go to Assemblyman Byrne.

 4                 ASSEMBLYMAN BYRNE:  Yes, thank you, 

 5          Chairwoman.  

 6                 And thank you, Commissioner, for your 

 7          testimony and answering my colleagues' 

 8          questions.  I'm going to echo all the calls 

 9          for the Joseph P. Dwyer Peer-to-Peer Program.  

10          It is extremely upsetting to see that while 

11          the Governor likes to laud the program, it's 

12          conspicuously absent in the Executive's 

13          proposed budget each and every year.

14                 So I'd like to echo those calls for us 

15          to restore that in the final budget 

16          agreement.  

17                 But my question specifically to you, 

18          Commissioner, is more about the jail-based 

19          substance use disorder treatment and 

20          transition services and the significant 

21          cut -- I believe it's a 50 percent cut, cuts 

22          in half from what we had last year, from 

23          $3.75 million, and it takes away 

24          $1.9 million.  


 1                 I can understand that -- I think the 

 2          argument is that the jail population is 

 3          reduced because of things like bail reform.  

 4                 What I would caution and just try to 

 5          express to you is that many of these people 

 6          that are in county jails, they're not just 

 7          numbers.  The need is still there, very much 

 8          so.  It may even be exacerbated, I believe, 

 9          by the COVID-19 pandemic.  And a lot of our 

10          county governments, they use these state 

11          dollars to leverage additional federal 

12          assistance for these types of services.  

13                 And I would like to ask if you would 

14          be supportive of the Legislature seeking to 

15          restore those fundings, bringing it back.

16                 OMH COMMISSIONER SULLIVAN:  I believe 

17          -- I'm not sure exactly the funding you're 

18          referring to.  I think it might be under 

19          OASAS and Dr. Sanchez, Arlene Sanchez.  

20                 Because it sounded like substance 

21          abuse treatment leaving prisons.  We don't -- 

22          we work with the seriously mentally ill 

23          leaving prisons.  And we have not cut that.  

24          So --


 1                 ASSEMBLYMAN BYRNE:  Sure.  Thank you.  

 2          That's my mistake.  You know what, we're 

 3          doing this virtually and I have this long 

 4          witness testimony list, and sometimes it's 

 5          hours and hours before we get to speak.  So 

 6          my mistake.  I gave a heads-up to the other 

 7          commissioner for when I ask that question 

 8          later on.  

 9                 But I will go back to my initial point 

10          and just echo my colleagues on the importance 

11          and value of the Joseph P. Dwyer Program, 

12          making sure that the dollars that were 

13          already committed by previous budgets are 

14          given to the counties for the service, and it 

15          does a tremendous amount of good.  

16                 So thank you, Madam Commissioner.

17                 CHAIRWOMAN KRUEGER:  Thank you.  

18                 Assembly, still yours.

19                 CHAIRWOMAN WEINSTEIN:  Mary Beth 

20          Walsh, then.

21                 ASSEMBLYWOMAN WALSH:  Thank you.  

22                 Good morning, Commissioner.  

23                 My question has to do with the 

24          Executive Budget's proposal which would allow 


 1          the commissioner to create a schedule of 

 2          penalties for violations of operating 

 3          certificates.  Why is this necessary?

 4                 OMH COMMISSIONER SULLIVAN:  Let me 

 5          just say that we've had several -- we've had 

 6          instances where, for example, beds, 

 7          psychiatric beds -- acute psychiatric beds in 

 8          the community were closed precipitously.  The 

 9          communities were upset, basically, et cetera.  

10                 The penalty for that, for not 

11          consulting with DOH, for not consulting with 

12          OMH, is so small -- it's like $15,000 total, 

13          total, that you could be fined.  That's 

14          really not a deterrent to anybody to do those 

15          things precipitously.  So that's one example 

16          where it's really important, I think, that 

17          there be some teeth in the regulations.  

18                 For example, when a hospital comes to 

19          us -- and often the hospital's having 

20          financial problems -- and they say they want 

21          to close beds, acute beds in the community, 

22          we work very closely with them about setting 

23          up the necessary community-based services.  

24          Sometimes we figure it out so they don't have 


 1          to close the beds.  

 2                 But it's really not acceptable for 

 3          them to just close the beds and give us 

 4          notice that they no longer have a psychiatric 

 5          unit.  

 6                 That's happened a couple of times -- 

 7          that's just one example -- of where the 

 8          ability to say to a certain system, like 

 9          hospital systems, You can't just do this 

10          without consulting with us -- so that's an 

11          example of why, the penalties are just so low 

12          that they don't -- the other issue, sometimes 

13          it comes up in terms of care.  But usually 

14          it's someone who hasn't let us know that 

15          they're doing something kind of dramatic in 

16          the community and they have not come forward 

17          to discuss it with us.

18                 ASSEMBLYWOMAN WALSH:  Thank you, 

19          Commissioner.  Do you have an idea of -- or a 

20          thought as to if $15,000, say, is too low, do 

21          you have a sense of whether those violation 

22          penalties would be doubling, tripling?  You 

23          know, can you give us some insight as to what 

24          your thinking is on that?


 1                 OMH COMMISSIONER SULLIVAN:  I think 

 2          we're still working on that.  We're working 

 3          on -- you know, I think we have to look at 

 4          the kinds of penalties that other places do.  

 5          I mean, we don't want to be over -- you don't 

 6          want to go overboard, but you also want to 

 7          make the penalties something that would make 

 8          people think twice before not letting you 

 9          know.  

10                 So we're still in the process of doing 

11          that, so I can't give you a number.  But it 

12          would be considerably more.

13                 ASSEMBLYWOMAN WALSH:  Okay, 

14          Commissioner.  And is there a sense of where 

15          that money, the penalty money would be -- 

16          would it go right back into the budget, do 

17          you have it earmarked for some other purpose?  

18          Or what is your thinking on that?

19                 OMH COMMISSIONER SULLIVAN:  I think 

20          the plan at this time is it would go back 

21          into the budget.

22                 ASSEMBLYWOMAN WALSH:  Okay.  Thank you 

23          very much.

24                 OMH COMMISSIONER SULLIVAN:  Thank you.


 1                 CHAIRWOMAN WEINSTEIN:  We go now to 

 2          Assemblyman Aubry.

 3                 ASSEMBLYMAN AUBRY:  Good morning, 

 4          Commissioner.  I thank you for your testimony 

 5          and the time you've taken.

 6                 My question concerns the issue of your 

 7          relationship with the Department of Community 

 8          Corrections, who oversees that delivery of 

 9          services of mental health?  How much money in 

10          the budget is directed toward what goes on in 

11          the prisons?  As well as your view, if you 

12          have one, on the use of special housing units 

13          in the prisons and how you manage services 

14          under those circumstances.

15                 OMH COMMISSIONER SULLIVAN:  We have a 

16          Division of Forensics which does all the 

17          forensic services.  We work very closely with 

18          the Department of Corrections.  We have a 

19          whole array of services that include 

20          inpatient psychiatric services, what we call 

21          crisis residential beds.  We have also 

22          residential beds.  We also have treatment of 

23          the general population.

24                 I don't know the number offhand of 


 1          breaking off the cost, but I could get that 

 2          to you.  So we can get that.  But we have a 

 3          whole array of services, almost like 

 4          community services and inpatient services we 

 5          have in the community are in the prison 

 6          system.  So we are working very closely.  

 7                 We also have discharge planning 

 8          services that are very intense.  We do some 

 9          wraparound services when seriously mentally 

10          ill individuals are leaving prison.  We have 

11          some specialized housing when they leave 

12          prison.

13                 Actually, in the prisons we have two 

14          what we call transition units which are 

15          two -- and I think it's in now three of the 

16          prisons, for individuals who have serious 

17          mental illness go for anywhere from 24 to 48 

18          months before they leave prison to give an 

19          idea of what it would be like to go into the 

20          community.  Because we don't want individuals 

21          being -- returning to prison.

22                 So we have a whole array of services 

23          that we fund in the prison system for both 

24          the seriously mentally ill and for the other 


 1          issues, people with a mental illness.  I 

 2          believe the total of individuals on our 

 3          caseload are about 8,000 in the prison 

 4          system.  About half of those -- a quarter of 

 5          those have serious mental illness.  So about 

 6          8,000 individuals in a prison system of about 

 7          fifty -- 49,000, 50,000.  

 8                 We work very closely with the 

 9          Department of Corrections.  You have to be 

10          partners with them if you're doing this work.

11                 ASSEMBLYMAN AUBRY:  And your position 

12          about the use of isolation for individuals in 

13          prison and what effect that has.

14                 OMH COMMISSIONER SULLIVAN:  Yeah, it's 

15          a very complicated issue.  But we are very 

16          happy to have two pilot programs that are 

17          going on, one in Bedford Hills, which is a 

18          women's prison, and the other -- I don't want 

19          to say the wrong one -- which are really 

20          diminishing the use of SHU tremendously for 

21          our clients who have mental illness.  And 

22          basically those pilots are in close 

23          conjunction with the Department of 

24          Corrections.  So we work very closely 


 1          together.  

 2                 We also screen all patients in SHU and 

 3          work with any patients who need our 

 4          assistance in SHU.  But those pilots are very 

 5          exciting in terms of working with how to help 

 6          individuals with mental illness who may, as 

 7          part of their issues, do the kind of 

 8          behaviors that could get them into SHU, to 

 9          avoid that and get mental health treatment.

10                 ASSEMBLYMAN AUBRY:  And Bedford Hills 

11          is a women's facility, which tends to be 

12          smaller and less restrictive because of the 

13          way in which women are treated.  

14                 I'm interested in what happens with 

15          the men's prisons with the majority of those 

16          incarcerated there.  And also, how do you 

17          deliver cultural competency in a prison 

18          setting, particularly when prisons are, for 

19          the most of them, are located in upstate 

20          regions where finding staff might not be as 

21          easy or have associations with the 

22          relationships with most of the prisoners who 

23          come from the downstate area?

24                 OMH COMMISSIONER SULLIVAN:  Yeah, 


 1          that's a struggle.  It's a struggle for 

 2          staffing.  We do a lot of training, and a lot 

 3          of that training includes, you know, how you 

 4          work with individuals who are incarcerated.  

 5          It also talks about cultural competency.  We 

 6          do a lot of work, we do a lot -- we also do 

 7          some telework, especially with psychiatrists 

 8          in our prisons.  

 9                 But yes, the recruitment and retention 

10          and training people appropriately is 

11          something we're constantly doing.  But you're 

12          right, Assemblyman, it's a struggle in the 

13          prison system.  But we work very hard to do 

14          the very best we can.

15                 ASSEMBLYMAN AUBRY:  Do you know how 

16          you have --   

17                 CHAIRWOMAN WEINSTEIN:  Thank you.  I'm 

18          sorry, Assemblyman, the time has expired.

19                 ASSEMBLYMAN AUBRY:  Thank you so very 

20          much.

21                 CHAIRWOMAN WEINSTEIN:  We go to 

22          Assemblyman Ra, ranker on Ways and Means, for 

23          five minutes.

24                 ASSEMBLYMAN RA:  Thank you.  


 1                 Good morning, commissioner.  Just -- I 

 2          have a couple of questions about telehealth, 

 3          but just quickly, I know a number of my 

 4          colleagues mentioned the Rockland Children's 

 5          Psych Center.  I just wanted to, on behalf of 

 6          my colleague Mike Lawler, you know, convey 

 7          his concerns with that proposal as well.  

 8                 But I think Chairwoman Gunther covered 

 9          it quite well, as did several other 

10          colleagues from that region.

11                 Regarding -- you mentioned the 

12          telehealth reform proposal earlier.  And one 

13          of the things that I guess is somewhat 

14          unclear to me was the inclusion of audio-only 

15          services for coverage.  Can you speak about 

16          that and if that would be included in the 

17          proposals?

18                 OMH COMMISSIONER SULLIVAN:  Yeah, 

19          currently in all the emergency orders 

20          audio-only is included.  And we are working 

21          to see if that's possible.  I think there is 

22          support to do it.  There are some glitches 

23          with Medicare and the influence that Medicare 

24          not yet kind of approving that, the influence 


 1          that that has on Medicaid's ability to 

 2          approve it.

 3                 I think there is a desire to approve 

 4          it for Medicaid.  I think the Department of 

 5          Health and others are working out those legal 

 6          issues.  And we are certainly lobbying, I 

 7          know whole groups are lobbying in Washington 

 8          to get Medicare to approve it.  So there's a 

 9          lot of push to ensure that we can have audio.  

10                 It's worked well, and I think that it 

11          has been very helpful for our clients over 

12          this period of the pandemic, the audio has 

13          been very successful.  

14                 ASSEMBLYMAN RA:  Okay, thank you for 

15          that.  I think it's definitely both -- 

16          sometimes, you know, just in terms of access, 

17          certain people having an easier time doing 

18          those type of settings and then certainly, 

19          you know, sometimes just in terms of the 

20          technological side of it, which, you know, 

21          we've even seen this morning.  

22                 So this stuff is great when it works, 

23          but it doesn't always.  And it causes great 

24          frustration when it doesn't.  So thank you, 


 1          Commissioner.

 2                 OMH COMMISSIONER SULLIVAN:  It's very 

 3          helpful.  It's very strong.  And I think, 

 4          having done some of it myself, the old 

 5          telephone can work very well.

 6                 ASSEMBLYMAN RA:  Thank you.

 7                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 8                 We're going to go to Assemblywoman 

 9          Gunther for a second five minutes.

10                 ASSEMBLYWOMAN GUNTHER:  So there's 

11          quite a bit of work behind the scenes, so 

12          I'll go quickly, I'll ask the questions and 

13          then you can answer it and then I can 

14          respond.

15                 What is the total amount for these 

16          reductions in funding?  For the 5 percent 

17          withheld, can you provide me a list of what 

18          programs will be impacted, first of all.  We 

19          heard from providers that the state is 

20          planning to restore all but 5 percent of the 

21          20 percent withheld, but there has not been 

22          any official word.  Is there going to be 

23          official word on that?  Can you commit today 

24          that those agencies will get their funding 


 1          cuts back retroactively and provide a 

 2          timeline for when that would happen?  

 3                 And also, can you give me more detail 

 4          about your plan for the transfer of the 100 

 5          state-operated community residence beds to 

 6          voluntary agencies, including where in the 

 7          state will this transfer be implemented and 

 8          how capacity in these beds was used to make 

 9          this determination?  

10                 So there's a few questions there 

11          regarding some of the budget priorities that 

12          you have, and I just kind of need some 

13          answers to be able to answer to my 

14          constituency.

15                 OMH COMMISSIONER SULLIVAN:  Yeah, it's 

16          my understanding that the 5 percent cut is 

17          going forward.  What that will look like, we 

18          are working with the -- that's a cut to state 

19          aid going forward to the counties, and that's 

20          something that we are working with the 

21          counties on how they will -- a lot of the 

22          decisions will be made at the local level 

23          with us about those reductions, that 5 

24          percent of state aid primarily to the local 


 1          counties.  The --

 2                 ASSEMBLYWOMAN GUNTHER:  You know, 

 3          during -- I just want to say for the 

 4          counties, and to defend the counties at this 

 5          point, the revenue is going down in the 

 6          counties, the number of people that are 

 7          having issues are going up.  And to withhold 

 8          5 percent to smaller counties and upstate 

 9          counties really has a definite impact.  

10                 So I just want to respond to that.  

11          And if you would keep going, thank you so 

12          much.

13                 OMH COMMISSIONER SULLIVAN:  Thank you.  

14          The other is it is my understanding that the 

15          15 percent of that 20 percent withhold will 

16          be reimbursed and that it will be 

17          retroactive.  That's if -- so it's what if.  

18          If that $6 billion -- if we get that minimum 

19          of $6 billion from the federal government, 

20          that that will happen, and that will be 

21          retroactive.

22                 ASSEMBLYWOMAN GUNTHER:  Will you 

23          commit that these agencies will get their 

24          money back?  Because a lot of times we really 


 1          need a commitment to make sure that if we're 

 2          getting money from the feds, that the money 

 3          is going to go back into their hands.

 4                 OMH COMMISSIONER SULLIVAN:  It's my 

 5          understanding that that's what has been 

 6          committed to.

 7                 ASSEMBLYWOMAN GUNTHER:  But we don't 

 8          need -- you know, I understand that.  But I'm 

 9          asking for a commitment.  For my counties 

10          across New York State, I think a commitment 

11          is very important about that.

12                 So it's evident that this pandemic is 

13          going to have a long-lasting impact on people 

14          with mental health.  Our not-for-profit 

15          service providers and their staff have worked 

16          tirelessly, again and again.  The Executive 

17          Budget is enacted and we're waiting for the 

18          -- there's a deferral of the COLAs.  Will 

19          these non-for-profits get this money back?  

20                 They are -- they are having a very 

21          difficult financial time.  They are providing 

22          most of the services, these non-for-profits, 

23          to people in our communities, so they need 

24          this 5 percent in order to continue to exist 


 1          in our communities.  Is there a commitment 

 2          that this money will go back to these 

 3          agencies that are vital to all of our 

 4          communities?  

 5                 You know, sometimes, you know, we take 

 6          money from the most needy -- the most needy 

 7          areas and we don't, you know, consult with 

 8          people like me that represent all those 

 9          people in these communities.  So we really 

10          need a commitment to give that money back to 

11          these non-for-profits.  They will not stay in 

12          existence.  Five percent means a lot to them.

13                 OMH COMMISSIONER SULLIVAN:  Whether or 

14          not that 5 percent is restored will depend 

15          upon the degree of federal aid.  I can't give 

16          you a commitment on that.  That's a decision 

17          that will be made based upon the amount of 

18          federal aid, as I understand it.  But I can't 

19          give you a commitment on that 5 percent.  Not 

20          from me.

21                 ASSEMBLYWOMAN GUNTHER:  Okay, so we're 

22          going to close 100 state-operated community 

23          residence beds.  Can you tell me where that 

24          money is going to go and into what 


 1          communities?  And are you evaluating 

 2          communities in accordance to need?

 3                 OMH COMMISSIONER SULLIVAN:  Yes.  

 4          We're evaluating -- thank you.  We're 

 5          evaluating the communities in accordance to 

 6          need.  Those -- the dollars will support the 

 7          beds in the community.

 8                 And as I said before, we -- these will 

 9          be evaluated primarily if they are truly 

10          long-term beds that are on our campuses.  We 

11          shouldn't be having long-term beds on our 

12          campuses.  That's a violation of Olmstead, 

13          that's something that we should be fixing.  

14                 So basically we're doing it slowly, 

15          we're looking at these hundred beds, but 

16          there will be a hundred comparable beds in 

17          the community, and those individuals -- when 

18          those beds of those individuals are moved to 

19          those community-based beds.  

20                 But we're looking at that across the 

21          system.  And I can give you -- as we decide, 

22          Assemblywoman, I'll be glad to let you know 

23          where they are.

24                 ASSEMBLYWOMAN GUNTHER:  So at this 


 1          point in time our communities and our 

 2          counties have very little money.  In order to 

 3          create these beds, you also need money for 

 4          our non-for-profits for, you know, increased 

 5          employees.  So is the money that you're 

 6          investing in our communities because you feel 

 7          that they shouldn't be institutionalized, 

 8          et cetera, in those institutions -- so are 

 9          you going to support the creation of 

10          appropriate care for our folks with mental 

11          health in the communities?  You know, this 

12          isn't a cheap thing.  We need 24-hour care, 

13          correct, we need reimbursement to our 

14          communities, we need the money for the 

15          purchase of buildings, et cetera, that we 

16          don't have at this moment.

17                 So when you say that we're going to 

18          support the community, community beds are 

19          great -- and also about the money for jobs.

20                 CHAIRWOMAN WEINSTEIN:  Thank you --

21                 ASSEMBLYWOMAN GUNTHER:  You're saving 

22          $4 million from closing those beds.  Why are 

23          you only investing $2 million?  So we need 

24          every bit of that $4 million.


 1                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 2          Thank you, Assemblywoman.

 3                 Commissioner, there's a number of 

 4          questions there.  Perhaps you can send some 

 5          information in writing and we can share it 

 6          with all the members, not just with 

 7          Assemblywoman Gunther.  

 8                 OMH COMMISSIONER SULLIVAN:  Mm-hmm.  

 9          (Nodding.)

10                 CHAIRWOMAN WEINSTEIN:  Senate, do you 

11          have anybody else?

12                 CHAIRWOMAN KRUEGER:  No.

13                 CHAIRWOMAN WEINSTEIN:  We do have one 

14          other Assemblymember.

15                 CHAIRWOMAN KRUEGER:  No, there's just 

16          the one more Assemblymember.

17                 CHAIRWOMAN WEINSTEIN:  We have 

18          Assemblyman Anderson for three minutes.

19                 ASSEMBLYMAN ANDERSON:  Thank you.  Can 

20          I be heard?

21                 CHAIRWOMAN WEINSTEIN:  Yes.

22                 ASSEMBLYMAN ANDERSON:  Okay, thank 

23          you, Chairwoman Weinstein.  Thank you, 

24          Commissioner, for being here.  And also thank 


 1          you, Chairwoman Gunther, and all of our 

 2          leaders who are here today.

 3                 So I have several questions and 

 4          concerns regarding the cuts to the Office of 

 5          Mental Health.  I think that when we're 

 6          looking at cuts to this degree, this 

 7          5 percent that my colleague mentioned, it's 

 8          also important for us to mention early 

 9          intervention, prevention.  I know there's 

10          some cuts to the crisis intervention budget.  

11                 So I want to know in terms of -- 

12          separate from the reliance on the federal 

13          budget, what are some steps that your agency 

14          is going to take to ensure that services are 

15          still met even with all of these cuts to the 

16          three programs that I've mentioned?  Or the 

17          focus areas, excuse me that I mentioned.  So 

18          that's early intervention, crisis 

19          intervention, and prevention -- or early 

20          intervention, early prevention and crisis 

21          intervention, those programs or areas of 

22          expertise.  Can you answer that?

23                 OMH COMMISSIONER SULLIVAN:  The early 

24          intervention programs that we fund are not -- 


 1          we're not cutting those.

 2                 ASSEMBLYMAN ANDERSON:  The prevention, 

 3          the crisis prevention.  

 4                 OMH COMMISSIONER SULLIVAN:  Oh, the 

 5          crisis prevention?  We're not cutting those.

 6                 ASSEMBLYMAN ANDERSON:  Yes.

 7                 OMH COMMISSIONER SULLIVAN:  We're -- 

 8          I'm sorry --

 9                 ASSEMBLYMAN ANDERSON:  If I understand 

10          correctly, I'm looking at page 72 of our book 

11          here, it looks like there is a reduction for 

12          that office, care coordination and -- I'm 

13          just looking at it here.  

14                 I just want to make sure that there's 

15          a plan to kind of fill in those services.  If 

16          you look at, for example -- I'm sorry?

17                 OMH COMMISSIONER SULLIVAN:  I'm 

18          sure -- please, if you can get us that, 

19          because I'd be glad to get you back the 

20          details, Assemblyman.  I'm just not familiar 

21          with the --

22                 ASSEMBLYMAN ANDERSON:  Okay, that's 

23          fine.

24                 OMH COMMISSIONER SULLIVAN:  I'm sorry, 


 1          but I'm not.

 2                 ASSEMBLYMAN ANDERSON:  And -- okay, 

 3          that's fine.

 4                 So when we're also talking about the 

 5          downsizing -- and I guess I'm looking at it 

 6          in a different light than you in that 

 7          respect.  If we're looking at the downsizing 

 8          here, the state-operated facilities, you're 

 9          talking about a reduction in 200 beds.  For 

10          me, that's -- that's inter -- you know, a 

11          prevention mechanism to be able to have those 

12          services, wraparound services under one roof.  

13                 But what I'm asking is in terms of 

14          making sure that we preserve those services, 

15          what is your plan or strategy to preserve 

16          those services?

17                 OMH COMMISSIONER SULLIVAN:  So 

18          basically the individuals who -- the cutting 

19          -- lowering those beds enables -- we'll be 

20          moving individuals into the community.  And 

21          as we move them into the community, we have 

22          what we call mobile integration teams with 

23          our hospitals, we have Pathways to Home teams 

24          with our hospitals.  They all help these 


 1          individuals move into the community and stay 

 2          in the community.  And it's the movement of 

 3          those long-term patients that enable us to 

 4          close the beds.  

 5                 So basically those services will 

 6          continue.  That's what we've been doing all 

 7          along in terms of the reduction in beds that 

 8          we've had.  And we wrap these services around 

 9          the individual.  They then get hooked into 

10          all the community-based services that we 

11          support -- the clinic services, the rehab 

12          services.  All the services that are 

13          available -- the home-based crisis 

14          intervention services, all those services.  

15          So we will be maintaining those, the 

16          individuals.  

17                 And only when beds have absolutely 

18          been vacant for a protracted period of time 

19          do we close them, so we're sure that we've 

20          been able to move people successfully and 

21          that we don't have a need at the front door, 

22          either, for individuals to come in.

23                 ASSEMBLYMAN ANDERSON:  Don't you think 

24          --


 1                 CHAIRWOMAN WEINSTEIN:  Thank -- thank 

 2          you.  Thank you, Commissioner.  

 3                 So now we are -- I'm going to turn it 

 4          back --

 5                 ASSEMBLYMAN ANDERSON:  But Chairwoman, 

 6          I had one follow-up.  I just had one 

 7          follow-up.  

 8                 CHAIRWOMAN WEINSTEIN:  Your time has 

 9          expired.  You can send -- if you could share 

10          with my staff, and we will make sure that the 

11          commissioner gets that information.

12                 ASSEMBLYMAN ANDERSON:  Thank you, 

13          Chairwoman.  

14                 CHAIRWOMAN WEINSTEIN:  So I'm going to 

15          turn it back to Assemblywoman -- I'm sorry, 

16          Senator Krueger, because -- since this panel 

17          has ended, and she will be calling the next 

18          witness.  Thank you.

19                 CHAIRWOMAN KRUEGER:  Thank you very 

20          much.  

21                 And thank you very much, Commissioner 

22          Sullivan, for answering the questions.  And I 

23          think you have quite a few homework 

24          assignments for following up with us.


 1                 OMH COMMISSIONER SULLIVAN:  Thank you.

 2                 CHAIRWOMAN KRUEGER:  Thank you.

 3                 I would next like to call up the 

 4          New York State Office for People With 

 5          Developmental Disabilities, Dr. Theodore 

 6          Kastner, commissioner.  

 7                 Then, again, just reminding everyone 

 8          of the rules of the road.  Then Senator 

 9          Mannion and Assemblymember Abinanti, as the 

10          two chairs, will each have 10 minutes of 

11          questioning, then their rankers have five 

12          minutes of questioning, and then everyone 

13          else who's a member of the committees 

14          participating with us today will have three 

15          minutes.  But when you ask a question -- so 

16          everybody get ready -- the answer has to come 

17          within that time period also.  That's why we 

18          have the clock there.  And we've added a 

19          flash when it gets to zero.  

20                 And simply because there are so many 

21          government witnesses today and we are already 

22          at almost noon and we're coming to number two 

23          out of quite a few pages of testifiers, 

24          unfortunately Helene and I will have to be 


 1          strict gatekeepers.

 2                 So with that, welcome, 

 3          Commissioner Kastner.

 4                 OPWDD COMMISSIONER KASTNER:  Thank 

 5          you.  And good morning, Chairs Krueger, 

 6          Weinstein, Mannion, Gunther, Abinanti and 

 7          other distinguished members of the 

 8          Legislature.

 9                 I'm Ted Kastner, commissioner of the 

10          New York State Office for People with 

11          Developmental Disabilities.  Thank you for 

12          the opportunity to provide testimony about 

13          Governor Cuomo's fiscal year 2021-2022 

14          Executive Budget and how it benefits the more 

15          than 126,000 New Yorkers served by OPWDD.

16                 Governor Cuomo continues to make 

17          strategic investments in the OPWDD service 

18          system designed to maintain access, increase 

19          equity and enhance the sustainability of our 

20          community-based, person-centered service 

21          system.  These investments have enabled OPWDD 

22          to invest approximately $710 million in the 

23          salaries of direct support professionals and 

24          clinical staff since January 1, 2015.


 1                 These investments have also enabled 

 2          OPWDD to increase the number of individuals 

 3          supported through most of our programs, 

 4          including the Home and Community-Based 

 5          Waiver, which increased by nearly 28 percent 

 6          over the past seven years; Self-Direction, 

 7          which increased by more than 160 percent over 

 8          the past four years; independent living 

 9          arrangements, which increased by 170 percent 

10          in the past eight years; day program and 

11          employment options, which increased by 11 

12          percent over the past five years; and an 

13          increase in the number of people receiving 

14          respite by 22 percent over the last five 

15          years.  

16                 In addition, our care coordination 

17          organizations have increased enrollments by 6 

18          percent between July 2019 and June 2020.  

19                 OPWDD also continues to offer housing 

20          supports in the community to more than 36,000 

21          people who are currently living in certified 

22          community-based residential programs.  These 

23          residential opportunities alone support a 

24          budget of $5.2 billion in public resources 


 1          annually.  

 2                 The Governor's fiscal year 2022 budget 

 3          builds upon these accomplishments. Despite 

 4          the global pandemic, in fiscal year 2022 

 5          growth in state spending on OPWDD programs 

 6          will increase to almost $4 billion, or more 

 7          than $9.1 billion when all shares funding is 

 8          included.  These new resources, which 

 9          increase state spending on OPWDD supports by 

10          about $110 million, or 2.8 percent year over 

11          year, will fund minimum wage increases for 

12          staff in the nonprofit sector with a new 

13          investment of $32 million in state resources, 

14          which equates to $58 million in all shares 

15          funding to support the transition to a 

16          $15-per-hour minimum wage.  

17                 The new resources will also support 

18          new services for OPWDD-eligible individuals 

19          and their families for the eighth consecutive 

20          year and commit an additional $15 million in 

21          new capital funding to  continue efforts to 

22          expand the availability of affordable housing 

23          opportunities for the seventh consecutive 

24          year.  


 1                 In addition, the budget supports 

 2          OPWDD's ongoing efforts to enhance our 

 3          ability to deliver person-centered services.  

 4          In fiscal year 2022, OPWDD will increase 

 5          access to residential services in the most 

 6          integrated settings by expanding the options 

 7          available to individuals across our continuum 

 8          of supports, including apartments with 

 9          wraparound support and family care.  OPWDD 

10          will also assist individuals who have aged 

11          out of their residential schools to move to 

12          appropriate adult residential opportunities.  

13                 OPWDD will continue to allow 

14          individuals to receive community habilitation 

15          and respite using tele-modalities and make 

16          investments in respite opportunities for 

17          those families in need of short-term support.  

18                 Finally, we will enhance and 

19          strengthen the quality of research for people 

20          with developmental disabilities by 

21          transitioning the Institute for Basic 

22          Research from OPWDD to the Office for Mental 

23          Health, leveraging their research expertise.  

24          OMH will work with its partners, including 


 1          the New York State Psychiatric Institute, to 

 2          improve and expand the quality and scope of 

 3          research activities supporting our needs.  

 4                 I would also like to take this 

 5          opportunity to recognize the impact that 

 6          COVID-19 has had on our community.  Our 

 7          highest priority has always been to preserve 

 8          the health and safety of our individuals and 

 9          families.  I deeply appreciate the 

10          extraordinary sacrifices that individuals and 

11          families have made.  

12                 Our response to COVID-19 has been made 

13          possible only by the incredible work of the 

14          direct support professionals and clinical 

15          staff who daily have demonstrated courage, 

16          commitment and compassion in supporting 

17          individuals with developmental disabilities 

18          over this past year.  These amazing women and 

19          men have been at the front lines of our war 

20          against the pandemic, and I am personally 

21          grateful for their continued dedication.  

22                 And finally, the many leaders of our 

23          voluntary provider organizations, in addition 

24          to our state operations staff, have been 


 1          fully engaged in this effort and have been 

 2          key partners in quickly and effectively 

 3          mounting our statewide response.  

 4                 Our response to the pandemic included 

 5          the creation of COVID-19 specific data 

 6          reporting systems that were later modified 

 7          and expanded to include mandatory reporting 

 8          through a 24-hour hotline which informed 

 9          deployment of statewide resources. We 

10          dedicated over 100 staff to contact-tracing 

11          efforts within our system of supports.  We 

12          provided financial and regulatory relief to 

13          the service providers.  We issued over 80 

14          guidance documents and offered countless 

15          trainings to assist providers in ensuring the 

16          health and safety of our families, 

17          individuals and their staff.  

18                 We also quickly launched mitigation 

19          and containment efforts, which included 

20          visitation restrictions and program 

21          suspensions.  We worked with providers to 

22          establish additional facilities to treat and 

23          house individuals who contracted the virus 

24          both in residential settings and in the 


 1          community, and we greatly expanded provider 

 2          flexibility through Appendix K and waiver 

 3          authorities.  

 4                 We have met regularly -- at the 

 5          beginning of the pandemic, this occurred 

 6          several times per day.  We continue to meet 

 7          biweekly with our stakeholder groups, 

 8          including provider associations, family and 

 9          self-advocacy support groups, and care 

10          coordination organizations, to share 

11          information, including data related to COVID 

12          infections, for feedback and to answer 

13          questions.  

14                 We've also revamped our website and 

15          integrated a new listserv application to help 

16          us improve our communication with all 

17          stakeholders.  

18                 The pandemic has taught us a lot about 

19          being flexible.  We've made a number of 

20          changes to the way we deliver services in our 

21          system.  One of these changes is the delivery 

22          of teleservices.  We support the Governor's 

23          executive proposal to expand telehealth 

24          services, which will make services more 


 1          accessible to individuals, particularly those 

 2          in rural areas of the state.  

 3                 With these thoughts in mind, I want to 

 4          thank you for your continued partnership and 

 5          your support for individuals with 

 6          developmental disabilities.  I look forward 

 7          to answering any questions you may have. 

 8                 CHAIRWOMAN KRUEGER:  Am I now unmuted?  

 9          Yes.  Thank you very much, Commissioner.

10                 Our first questioner will be the chair 

11          of the committee, Senator John Mannion.

12                 SENATOR MANNION:  Thank you, Senator.  

13                 Thank you, Commissioner, for your 

14          report.  And it's nice to see you again.  

15                 As chairman of the new Senate 

16          Committee on Disabilities, I'm 

17          extraordinarily concerned about the 

18          state-funded services, or lack thereof, for 

19          individuals with developmental disabilities 

20          and intellectual disabilities.  These 

21          programs are chronically underfunded in the 

22          best of times, and when times get tough, 

23          budgetary times get tough, like the one we're 

24          in the midst of now, they seem to be the 


 1          first to get cut.  And I'm hoping that we can 

 2          begin to change that destructive pattern.

 3                 I can assure you, my colleagues, and 

 4          those watching the feed that I will 

 5          vigorously object to any cuts when we should 

 6          be doing the opposite and investing in the 

 7          system.

 8                 So, Commissioner, I ask within the 

 9          Executive Budget Proposal Book, it states 

10          that OPWDD will undertake several initiatives 

11          to manage access to residential 

12          opportunities, with the goal of ensuring that 

13          people live in settings that most 

14          appropriately align with their needs.  So 

15          ensuring that people live in these settings 

16          and it aligns with their needs, can you 

17          explain exactly what that means and what 

18          assurances you can provide that people who 

19          need access to 24/7 care will still be able 

20          to find it?

21                 OPWDD COMMISSIONER KASTNER:  Well, 

22          thank you.  And congratulations on your 

23          appointment as chair of the committee.  We 

24          look forward to working with you, and I hope 


 1          this is a long and productive relationship.  

 2                 There are opportunities for us, 

 3          particularly in light of COVID, to refocus 

 4          our energy on providing person-centered 

 5          services, in particular to try to address the 

 6          individual needs of our individuals and 

 7          families around residential services.

 8                 We're proposing several modifications, 

 9          and the first is to strengthen our ability at 

10          the point of contact, which is typically the 

11          regional offices, to offer families new to 

12          the residential service system opportunities 

13          that may be more reflective of their needs 

14          and may be more person centered.

15                 We will be consolidating access to all 

16          of our residential opportunities through that 

17          point of contact, and that will include not 

18          just access to supervised and supported IRAs, 

19          but also access to independent living in 

20          apartments, with potentially some wraparound 

21          services, and also access to the Family Care 

22          Program.

23                 We've experienced an increase in 

24          demand for both apartment living and access 


 1          to family care.  We think coordinating access 

 2          to those services at a single point of entry 

 3          will improve our ability to deliver services 

 4          in a more person-centered manner.  

 5                 In terms of individuals who are 

 6          currently residing within our system, there 

 7          is an opportunity for us to look at how we 

 8          support those individuals, our provider 

 9          system, and in particular to focus on our 

10          reimbursement methodology.  We currently have 

11          a cost-based reimbursement methodology which 

12          pays a provider a certain rate regardless of 

13          what the needs of the individual might be.  

14          We believe -- and we've actually discussed 

15          this with all of our stakeholders, our 

16          residential providers, our families and 

17          individuals.  But we believe that a payment 

18          model that's based on the needs of the 

19          individual and reflect the individual's 

20          acuity is a more appropriate model.  

21                 As I said, we've been working with our 

22          stakeholders, we're working with the 

23          actuaries.  We will propose later in the year 

24          a redesign of the payment methodology.  We 


 1          will incorporate that into our waiver, which 

 2          means there will be public comments and 

 3          opportunity for greater feedback on the 

 4          proposal.  But our hope is that later in the 

 5          fiscal year we can integrate a new payment 

 6          methodology which will be more reflective and 

 7          responsive to the needs of individuals based 

 8          on their acuity.  

 9                 SENATOR MANNION:  Thank you for that.  

10          I will be interested to see that and 

11          hopefully work collaboratively to try to land 

12          at a good spot.  

13                 In relation to the residential 

14          facilities, how many certified residential 

15          vacancies are there currently within the 

16          system?

17                 OPWDD COMMISSIONER KASTNER:  I'm 

18          sorry, how many vacancies are there?

19                 SENATOR MANNION:  Yes.

20                 OPWDD COMMISSIONER KASTNER:  I 

21          actually don't have a count on the number of 

22          vacancies.  I apologize for that.

23                 SENATOR MANNION:  Okay.  I appreciate 

24          that, Commissioner.  And I believe we 


 1          provided these questions ahead of time.  

 2                 And, you know, as you can imagine, 

 3          individuals and families are very concerned 

 4          about the availability when they -- when it 

 5          has been deemed that they need to enter a 

 6          facility.  So I just want to I guess 

 7          highlight that, that if there are vacancies 

 8          available and people are on a list, that 

 9          hopefully that those average -- the average 

10          length of time that those vacancies are in 

11          place is as short as possible so that those 

12          people can get into the settings that work 

13          best.

14                 You know, so another question, I guess 

15          I would say, is who's responsible for 

16          approving the level of residential services 

17          required for individuals?  If you could just 

18          kind of run me through that, I would 

19          appreciate it.

20                 OPWDD COMMISSIONER KASTNER:  Sure.  We 

21          have a process whereby individuals and their 

22          families who request residential services 

23          undergo an assessment through our regional 

24          offices.  Our regional offices, with the 


 1          families, make a determination about the 

 2          level of need and the types of support that 

 3          they may require.  

 4                 As I said, we want to expand the 

 5          options that are made available to families 

 6          at that point of contact so that we can 

 7          provide them with the most appropriate, least 

 8          restrictive setting that might be necessary 

 9          to meet their needs.  

10                 So that planning process occurs at the 

11          regional level, a more local level.  It's not 

12          centralized within OPWDD's central office.

13                 SENATOR MANNION:  Gotcha, I appreciate 

14          that.  And, you know, I understand the 

15          commentary you made before.

16                 Moving a little bit beyond that, the 

17          Executive Budget includes more than 

18          $330 million in cuts to voluntary providers.  

19          And this, combined with the October 1st, now 

20          May 1st cuts to residential programs, amount 

21          to more than $550 million.  

22                 While I'm glad that the proposed 

23          reductions to residential providers for the 

24          occupancy factor and therapeutic leave days 


 1          were delayed, I still am concerned about the 

 2          impact those reductions will have on the 

 3          provider's ability to provide high-quality 

 4          supports for the most vulnerable people that 

 5          need that help.  

 6                 Are there additional cuts that OPWDD 

 7          is planning on?

 8                 OPWDD COMMISSIONER KASTNER:  Well, let 

 9          me try to unpack a little bit of what you've 

10          described.

11                 So as I testified at this committee 

12          last year, OPWDD was required by the budget 

13          to make the equivalent of a 2 percent 

14          reduction in spending.  We did not offer a 

15          specific plan at that time, but all of our 

16          stakeholders knew that we were going to have 

17          to make a reduction during the fiscal year.

18                 Shortly after that testimony, in 

19          March, we began to experience the impact of 

20          the COVID pandemic, and we thought very 

21          carefully about what our reductions should 

22          be.  We met with numerous stakeholders and 

23          asked for their input as to where we should 

24          prioritize our investments and consequently 


 1          look at where we could make reductions.

 2                 We determined that at the time it was 

 3          best that we preserve the funding that we had 

 4          just gained for the salary increases for 

 5          DSPs.  We also made a commitment to all of 

 6          our stakeholders to preserve services and to 

 7          minimize any impact on loss of service.  We 

 8          also looked for opportunities to maximize 

 9          federal financial participation and enhance 

10          the match.

11                 Having prioritized our service system 

12          and potential revenue reductions in that 

13          manner, we then looked at the elements that 

14          you described, things like the occupancy 

15          factor.  The occupancy factor is a payment 

16          made to providers to pay for the maintenance 

17          of a vacant residential opportunity.  There 

18          are no individuals in that bed, if you would 

19          like to call it.  We felt that it was prudent 

20          to avoid cutting DSP salaries, cutting 

21          service from other stakeholders, and to focus 

22          our efforts on these narrowly defined 

23          targeted reductions in the occupancy factor.

24                 Unfortunately, that did mean that the 


 1          burden of the cuts fell on our residential 

 2          providers.  I recognize that that is a 

 3          hardship for them.  But at the same time, no 

 4          individual lost access to services as a 

 5          result of the elimination of funding for the 

 6          occupancy factor.

 7                 The second area that you mentioned was 

 8          that of the therapeutic leave.  Therapeutic 

 9          leave was an open-ended opportunity for 

10          individuals to leave their residential 

11          setting for whatever reason, for whatever 

12          length of time, and in the prior therapeutic 

13          leave OPWDD would pay the provider their full 

14          rate for that open-ended period of time.  

15                 We felt that that was an opportunity 

16          to rationalize the payments that were made to 

17          support that activity.  We capped the number 

18          of days of therapeutic leave at 96 per year, 

19          which we still think affords families the 

20          opportunity to bring their loved ones back 

21          home for periods of time over the course of a 

22          year.  

23                 We also were forced to reduce the 

24          payment from 100 percent of the residential 


 1          provider's effective rate to 50 percent of 

 2          the provider's rate.  Again, I recognize that 

 3          that created a hardship for our residential 

 4          providers.  However, we believe it was a 

 5          superior alternative to reducing DSP 

 6          salaries, cutting other services or other 

 7          activities.

 8                 CHAIRWOMAN KRUEGER:  Commissioner, 

 9          we've gone over, so I'm going to --

10                 OPWDD COMMISSIONER KASTNER:  Oh, I'm 

11          sorry.

12                 CHAIRWOMAN KRUEGER:  That's okay.  

13          There will be other people who follow up on 

14          this question, I have no doubt, since it's 

15          important to so many.

16                 I'm going to now hand it over to the 

17          chair of the Assembly Committee on People 

18          with Disabilities, Assemblyman Abinanti.

19                 ASSEMBLYMAN ABINANTI:  Thank you, 

20          Senator.  

21                 Good morning, Commissioner.

22                 I'm going to start off by saying we 

23          have a crisis of capacity.  You rightfully 

24          highlighted that we have an increasing number 


 1          of people who need services, but frankly 

 2          we're not providing them.  

 3                 But let's start off with any good 

 4          department that intends to meet the needs of 

 5          people in the state does good planning.  Can 

 6          you tell me why no 5.07 Plan has been filed 

 7          for OPWDD since 2012?  When do we expect to 

 8          get the next OPWDD 5.07 Plan, a five year 

 9          plan?

10                 OPWDD COMMISSIONER KASTNER:  There 

11          will be an OPWDD 5.07 Plan filed this year.

12                 ASSEMBLYMAN ABINANTI:  Filed this 

13          year, thank you.  

14                 And what about the autism study?  In 

15          2018 the Legislature passed and the Governor 

16          signed a bill that was A261 at the time that 

17          said that -- excuse me, that said we needed a 

18          study to determine what the needs of people 

19          with autism are and what it would cost the 

20          State of New York to meet those needs.  When 

21          do we expect we'll get that study?

22                 OPWDD COMMISSIONER KASTNER:  That 

23          study will be completed this year also.

24                 ASSEMBLYMAN ABINANTI:  Thank you.  


 1                 Now, I'm a little concerned about the 

 2          commitment of the state to people with 

 3          special needs.  I'm looking -- in 2014 the 

 4          state All Funds spent $4.7 billion.  You're 

 5          proposing here a $4.9 billion budget, which 

 6          is a $60 million decrease from last year.  

 7          What kind of a commitment, how are you going 

 8          to meet all those needs if we have all of 

 9          these people seeking more and more of these 

10          services, and yet there's going to be a 

11          decrease, and it's virtually the same as it 

12          was seven years ago?  

13                 And if we take a look, this is also 

14          affecting -- this is also affecting our 

15          voluntary agencies.  If you look at the 

16          actual Aid to Localities in 2019, it was $3.2 

17          billion.  But in 2020 it was only 

18          $1.9 billion.  And now you're projecting, for 

19          2021, about $3 billion.  With all of the 

20          increased needs -- first of all, what 

21          happened in 2020?  Why did we spend so 

22          little?  How much is outstanding to the 

23          providers and people with disabilities?  How 

24          much do we owe?


 1                 OPWDD COMMISSIONER KASTNER:  

 2          Assemblyman, I must apologize.  Can you run 

 3          the --

 4                 ASSEMBLYMAN ABINANTI:  Sure.  2019 was 

 5          $3.2 billion, 2020 was $1.9 billion -- is 

 6          projected for the next few months -- and 

 7          2021, you're asking for 3 billion in Aid to 

 8          Localities.

 9                 OPWDD COMMISSIONER KASTNER:  Well, our 

10          local assistance payments are much, much 

11          smaller than that.  They're on the order of 

12          300 to 400 million dollars per year.  I 

13          apologize, I don't know where you got these 

14          numbers.

15                 ASSEMBLYMAN ABINANTI:  These are 

16          actual disbursements.  They're published 

17          numbers.

18                 OPWDD COMMISSIONER KASTNER:  For 

19          OPWDD?

20                 ASSEMBLYMAN ABINANTI:  Yes.  

21                 All right, let me ask you, how much -- 

22          how much of the monies that you spent this 

23          year are accounted for in the rollover from 

24          the Medicaid of last year?  What percentage 


 1          of your expenditures were actually for last 

 2          year's bills?

 3                 OPWDD COMMISSIONER KASTNER:  We don't 

 4          have a rollover.  We operate on a cash basis.  

 5                 Our providers have a period of about 

 6          three months to submit --

 7                 ASSEMBLYMAN ABINANTI:  No, no, 

 8          commissioner, at the end of the quarter of 

 9          last year the Governor withheld payments on 

10          Medicaid, and he rolled them over into this 

11          year.  It was something like a billion 

12          dollars of the last quarter that got rolled 

13          over.  You're not familiar with that?

14                 OPWDD COMMISSIONER KASTNER:  No, that 

15          was not something that had an impact on 

16          OPWDD.

17                 ASSEMBLYMAN ABINANTI:  Well, your 

18          department has Medicaid.  All of the people 

19          who get your services must be on Medicaid, 

20          correct?

21                 OPWDD COMMISSIONER KASTNER:  Not 

22          necessarily.  We have a small number of 

23          individuals who we can --

24                 ASSEMBLYMAN ABINANTI:  Okay, but 


 1          almost all.

 2                 OPWDD COMMISSIONER KASTNER:  That's 

 3          fair enough, sure.

 4                 ASSEMBLYMAN ABINANTI:  So you're not 

 5          affected by a rollover of Medicaid from last 

 6          year.

 7                 OPWDD COMMISSIONER KASTNER:  We have a 

 8          fiscal plan with a target, and we operate on 

 9          a cash basis.  We spend to that --

10                 ASSEMBLYMAN ABINANTI:  Any of the 

11          money that came from COVID relief, did any of 

12          that go to the voluntary agencies like it did 

13          in other states?

14                 OPWDD COMMISSIONER KASTNER:  The New 

15          York State Division of the Budget manages the 

16          receipt of COVID relief funds, and each --

17                 ASSEMBLYMAN ABINANTI:  Right.  So 

18          you're not aware of any money having passed 

19          through your department going to the 

20          voluntary agencies, correct?

21                 OPWDD COMMISSIONER KASTNER:  The 

22          monies that are used by DOB, received from 

23          the federal government by DOB, are used to 

24          support all programs.  They're not passed 


 1          through, they're used to --

 2                 ASSEMBLYMAN ABINANTI:  Now, 

 3          Commissioner, I'm understanding that there is 

 4          a very significant waiting list just to get 

 5          processed for eligibility for services.  How 

 6          long is that waiting list, do you know?

 7                 OPWDD COMMISSIONER KASTNER:  We have a 

 8          process of -- called the Front Door, which 

 9          supports --

10                 ASSEMBLYMAN ABINANTI:  How many people 

11          have gone through the Front Door and are 

12          still waiting to be processed?

13                 OPWDD COMMISSIONER KASTNER:  I don't 

14          know that I fully understand the question, 

15          but I --

16                 ASSEMBLYMAN ABINANTI:  In the Lower 

17          Hudson Valley I am aware of several hundred 

18          people on a waiting list just to get approved 

19          for eligibility.  So what is it statewide?

20                 OPWDD COMMISSIONER KASTNER:  There is 

21          a process with people --

22                 ASSEMBLYMAN ABINANTI:  So you don't 

23          know the number.  

24                 OPWDD COMMISSIONER KASTNER:  -- 


 1          engaged in determining their eligibility --

 2                 ASSEMBLYMAN ABINANTI:  Commissioner, 

 3          you're not aware of the number, you just tell 

 4          me there's a process.

 5                 OPWDD COMMISSIONER KASTNER:  Yeah, and 

 6          I think, you know, it sometimes means they've 

 7          got to come back and collect information 

 8          about --

 9                 ASSEMBLYMAN ABINANTI:  Commissioner, 

10          I'm very concerned about -- on March 31 of 

11          2010, OPWDD had 21,500 employees.  You are 

12          proposing in your budget that on March 31, 

13          2022, there will be 18,600 employees.  That's 

14          almost 3,000 employees fewer than you had in 

15          2010.  Could that be why we have such waiting 

16          lists and why people can't get declared 

17          eligible for services?

18                 OPWDD COMMISSIONER KASTNER:  We 

19          process every application for every 

20          individual who applies for services.  

21          Sometimes --

22                 ASSEMBLYMAN ABINANTI:  Eventually.  

23          Eventually.

24                 OPWDD COMMISSIONER KASTNER:  No, 


 1          there's a process, and sometimes it's a 

 2          lengthy one because reports, assessments and 

 3          other types of material need to be collected.

 4                 ASSEMBLYMAN ABINANTI:  Commissioner, 

 5          right now somebody in Westchester County 

 6          who's going into the system for the first 

 7          time must go through an entire process with 

 8          about seven steps, maybe eight steps, and it 

 9          takes two years.  Are you aware of that?

10                 OPWDD COMMISSIONER KASTNER:  I can't 

11          speak to the length of time for any specific 

12          individual.

13                 ASSEMBLYMAN ABINANTI:  Commissioner, I 

14          would ask that you maybe look into it.

15                 OPWDD COMMISSIONER KASTNER:  I would 

16          be happy to.

17                 ASSEMBLYMAN ABINANTI:  Now, you're 

18          talking about money for minimum wage.  Is 

19          there any new money in your budget to pay for 

20          minimum wage?  My understanding is you're 

21          actually proposing that we defer the cost of 

22          living for DSPs so that we can pay for the 

23          minimum wage, is that correct?

24                 OPWDD COMMISSIONER KASTNER:  No, there 


 1          is an appropriation of $32 million, state 

 2          share --

 3                 ASSEMBLYMAN ABINANTI:  Correct.

 4                 OPWDD COMMISSIONER KASTNER:  -- which 

 5          when --

 6                 ASSEMBLYMAN ABINANTI:  Now, but you 

 7          are also proposing we defer the 

 8          cost-of-living increases, the COLAs, correct?

 9                 OPWDD COMMISSIONER KASTNER:  There's 

10          no cost-of-living increase in the budget.

11                 ASSEMBLYMAN ABINANTI:  Right.  So 

12          we're deferring what was supposed to be a 

13          COLA and we're instead going to get a new 

14          headline that says we're going to meet the 

15          minimum wage, correct?

16                 OPWDD COMMISSIONER KASTNER:  I'm 

17          sorry, I can't comment on -- on --

18                 ASSEMBLYMAN ABINANTI:  Okay.  Part of 

19          your system -- in July of 2018, the Governor 

20          -- or your department created this system of 

21          care coordination organizations, July of 

22          2018.  For the first two years it was paid 

23          for 90 percent by FMAP funds, federal 

24          Medicaid funds.  As soon as it became a state 


 1          fifty-fifty match, last year, July 2020, you 

 2          imposed a 16 percent rate cut, correct?  A 

 3          $73 million savings, is that correct?

 4                 OPWDD COMMISSIONER KASTNER:  Yes --

 5                 ASSEMBLYMAN ABINANTI:  All right, now 

 6          you're proposing for this May another 23 

 7          percent rate cut, is that true, another $309 

 8          million, quote, savings?

 9                 OPWDD COMMISSIONER KASTNER:  There is 

10          a rate cut of approximately $53 million.  

11          There's also a withhold of approximately $40 

12          million.

13                 ASSEMBLYMAN ABINANTI:  Okay.  So what 

14          we're saying here, then, is that you're 

15          basically going to cut almost 40 percent of 

16          the rate for the entry level for anybody 

17          going into OPWDD.  Before they get anywhere 

18          near OPWDD, they need to have a care 

19          coordinator.  And now we're going to cut the 

20          rate that we pay care coordinators 40 

21          percent, is that what you're saying?

22                 OPWDD COMMISSIONER KASTNER:  No.  

23          As -- as you mentioned, this was a new 

24          program that launched in 2018.  Prior to July 


 1          of 2018 we contracted with approximately 350 

 2          agencies called Medicaid --

 3                 ASSEMBLYMAN ABINANTI:  But now we have 

 4          seven statewide agencies with about 3,000 

 5          people handling all of the people who want to 

 6          get into the system or are already in the 

 7          system.  These people do a huge amount of 

 8          work, and yet we're going to cut them 40 

 9          percent, is that correct?

10                 OPWDD COMMISSIONER KASTNER:  As I -- I 

11          think the context in understanding the 

12          targeted reduction is that we increased 

13          spending on care coordination by 60 percent, 

14          between the MSC program and the CCO program.  

15          On July 1st of 2018 our total --

16                 (Overtalk.)

17                 ASSEMBLYMAN ABINANTI:  Because you put 

18          it into effect then.  Now everybody who wants 

19          to get into the system has to have a care 

20          coordinator, is that correct?

21                 OPWDD COMMISSIONER KASTNER:  No, it's 

22          not --

23                 ASSEMBLYMAN ABINANTI:  Are you aware 

24          that there are not enough care coordinators 


 1          and there are not enough fiscal 

 2          intermediaries and there are not enough any 

 3          of the people that you've set up?  You've got 

 4          like an eight-step process before anybody can 

 5          get any services, and now you're not paying 

 6          them enough and there's not enough of them to 

 7          handle all of the applications, Commissioner.  

 8                 I ask that you take a look at that and 

 9          take another look at your budget.  

10                 I think my time is out, thank you.

11                 CHAIRWOMAN WEINSTEIN:  Thank you.  

12                 We go to the Senate.

13                 CHAIRWOMAN KRUEGER:  Thank you very 

14          much.  I'm just checking, is our ranker 

15          Senator Martucci here with us?  No.

16                 THE MODERATOR:  We have not seen him.

17                 CHAIRWOMAN KRUEGER:  We've not seen 

18          him.  Okay, then we will skip him and we will 

19          go to the Assembly ranker -- I'm sorry, we 

20          don't go to the Assembly, we go to a 

21          different Senator.  Excuse me.  And I'm just 

22          double-checking whether we have other Senate 

23          hands up yet.  And we don't, so we are going 

24          to go to the Assembly for now.


 1                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 2                 We go to Assemblywoman Miller, the 

 3          ranker on OPWDD, for five minutes.

 4                 ASSEMBLYWOMAN MILLER:  Hi, good 

 5          morning.  

 6                 Good morning, Commissioner, how are 

 7          you?

 8                 OPWDD COMMISSIONER KASTNER:  It's nice 

 9          to see you again.

10                 ASSEMBLYWOMAN MILLER:  Nice to see 

11          you.  Thank you for being here.  

12                 As you know, I live in the world of 

13          people with disabilities who are serviced 

14          through OPWDD, and I've made it pretty public 

15          that I have a child in the system who has the 

16          ability to fall through many cracks.  As you 

17          also know, I'm very committed to representing 

18          those like Oliver who have such difficulty 

19          accessing what's supposed to be available to 

20          help them.

21                 I want to say on record that having 

22          met you and spoken with you so many times, I 

23          really do believe that you have a great 

24          understanding of our population's needs and 


 1          truly believe that you're listening to us, 

 2          which is refreshing, and trying to improve 

 3          the system.  So I want to thank you for that.  

 4                 I can't imagine -- I know it must be 

 5          very difficult to try and do this in our 

 6          state where we, where you, OPWDD, is not ever 

 7          a priority in our budget.  With a population 

 8          that, as you said, is growing and growing, 

 9          you're asked to make more and more cuts.  

10          Money is there in our budget, but it goes 

11          elsewhere instead of to help our most 

12          vulnerable.  So I don't envy your task.

13                 As Tom was alluding to, you know, 

14          these cuts, there's more cuts that have come 

15          out about 40ish percent towards CCOs.  That 

16          being said, you know, with all of these cuts 

17          and you're being accused of cutting here and 

18          cutting there, how do you allocate -- I'm 

19          just going to ask the several questions that 

20          I have and then you can answer at the end, if 

21          that's okay.

22                 So the first is, how do you allocate 

23          your monies?  How do you decide what gets 

24          cut?  Like is it CCOs or therapeutic leave 


 1          days?  Or are there ever cuts from within 

 2          your administration, the administrative 

 3          offices, rather than just spitting it out to 

 4          program services, other organizations?  

 5                 My next question is regarding day 

 6          programs.  As you know, many are still closed 

 7          due to the COVID, the lowered census, but 

 8          which leaves so many people just languishing 

 9          at home with nothing to do.  

10          What alternatives -- it's almost a year -- 

11          are we coming up with that are being offered?  

12          And are you going to advocate strongly to 

13          reopen all the day programs to continue the 

14          mission of integrating our loved ones into 

15          the community?  

16                 It seems like our population is 

17          forgotten during COVID.  We were in no 

18          phases, there were lots of excuses.  We're 

19          still not being considered.  When budget cuts 

20          need to occur, somehow we seem to be at the 

21          top of this list.  So it's funny to me how 

22          we're not even a thought during phases and 

23          pandemic strategies, but we're the top of the 

24          list, the first thought, for budget cuts.


 1                 And lastly, regarding that, this 

 2          vaccine distribution.  You know, I was very 

 3          happy to see that people with disabilities 

 4          were included in the vaccine distribution 

 5          phases, but only for those in congregate 

 6          settings.  While I understand that, what 

 7          about those living at home, which are way 

 8          more numerous?  They are stuck.  We're stuck, 

 9          can't go out, can't go to day programs, can't 

10          go to school, can't -- unless they are 

11          considered to receive the vaccine.  And will 

12          you advocate for them to have a phase here, 

13          to have a voice here?  I know I've been 

14          writing and calling and emailing, but can you 

15          advocate for them?

16                 OPWDD COMMISSIONER KASTNER:  Well, 

17          Assemblywoman, I apologize that in the minute 

18          I have I won't be able to respond to every 

19          question.  

20                 But in terms of how we allocate our 

21          funding, I tried earlier to outline our 

22          prioritization as we approached last year's 

23          budget, and I would say we will continue to 

24          prioritize in the same fashion in this year 


 1          going forward.  We will try to preserve our 

 2          DSPs' salaries so that we stabilize our 

 3          workforce.  We will try -- 

 4                 ASSEMBLYWOMAN MILLER:  Do you ever cut 

 5          from within the administrative, within those 

 6          offices, rather than outward?

 7                 OPWDD COMMISSIONER KASTNER:  I don't 

 8          believe it's a secret, but there has been a 

 9          freeze on salaries for state employees.  

10          There's also been a freeze on hiring for 

11          non-clinical roles within OPWDD.  

12                 So in terms of state-operated 

13          functions, there is an effort to look at 

14          cost-containment activities.

15                 ASSEMBLYWOMAN MILLER:  Okay, we're not 

16          going to get to the other questions.  I would 

17          hope that they could be answered and 

18          addressed in some other way if not -- we 

19          can't speak about it on here.  I would 

20          appreciate that.

21                 OPWDD COMMISSIONER KASTNER:  

22          Certainly.

23                 CHAIRWOMAN WEINSTEIN:  Commissioner, 

24          if you could share the answers to the 


 1          Assemblywoman's questions with my office and 

 2          Senator Krueger's office, and we'll make sure 

 3          they're distributed both -- not only to 

 4          Assemblywoman Miller, but to all of the 

 5          members who are on the call today.

 6                 We go now to the Senate.

 7                 CHAIRWOMAN KRUEGER:  Thank you.  

 8                 Actually, Commissioner, that was where 

 9          I was going to start, that these questions 

10          being asked of you, we would love to see the 

11          numbers broken out somehow by region on a 

12          statewide basis.  Because we'll have 

13          individual members talking about the 

14          experiences from their own districts, but I 

15          don't think there's any of us who are hearing 

16          a different story.

17                 So I want to ask you specifically 

18          around Manhattan, where I come from, in New 

19          York City, we have seen such enormous 

20          waitlists for adults living with elderly 

21          parents where the elder parent is trying to 

22          plan for, unfortunately, their own passing 

23          and what's going to happen to their adult 

24          children who they have amazingly been able to 


 1          keep with them for 40, 50, even 60 years but 

 2          can't possibly function independently.  

 3                 Where are we on keeping track and 

 4          actually having waitlists that are either 

 5          going up or down for making sure that these 

 6          folks are not left unattended when the 

 7          parents can no longer care for them or, 

 8          particularly in light of COVID, the parents 

 9          pass?

10                 OPWDD COMMISSIONER KASTNER:  So I 

11          realize that's a difficult situation for 

12          older parents.  

13                 As people come to the regional office 

14          and ask for access to residential services, 

15          there is a prioritization process.  We 

16          identify approximately 800 families who have 

17          an emergent need during that assessment.  

18          Each year we have turnover within our 

19          existing residential capacity of 

20          approximately a thousand opportunities per 

21          year.  We are able to meet the need for 

22          everyone who has an emergent need for 

23          residential services.  And that would 

24          include, I think, the older parents that 


 1          you're describing.  

 2                 There's some people who are very 

 3          proactive and they come to us and seek 

 4          residential services at some point in the 

 5          future, particularly for younger children and 

 6          individuals.  We don't consider those to be 

 7          urgent.  We do maintain a list of them, but 

 8          they would not be the priority for placement.  

 9          Priority would go to folks who are older, as 

10          you described it, people who are ill, who 

11          have COVID and can't take care of their 

12          children, things of that type.

13                 CHAIRWOMAN KRUEGER:  And you're saying 

14          you have adequate placement services, that 

15          everyone who comes to you with this story 

16          gets a placement for their adult child?

17                 OPWDD COMMISSIONER KASTNER:  We can 

18          support everyone who is in the emergency 

19          category for placement each year, through 

20          turnover in our existing residential 

21          capacity.

22                 CHAIRWOMAN KRUEGER:  So I'm not nearly 

23          the expert that the chair, Tom Abinanti, is.  

24          So when he was talking about not being able 


 1          to get through the I guess gatekeepers.  So 

 2          when you answered that question for me, that 

 3          is for people who have successfully gotten 

 4          through the gatekeepers?

 5                 OPWDD COMMISSIONER KASTNER:  There is 

 6          an eligibility process for OPWDD services.  

 7          The process is called the Front Door.  

 8          Individuals and families need to present 

 9          evidence that the individual has a disabling 

10          condition that results in significant 

11          functional deficits and is expected to last 

12          for the lifetime of the individual.  

13                 CHAIRWOMAN KRUEGER:  So if I've been 

14          in OPWDD nonresidential, I don't have to go 

15          through a new review process at that time?

16                 OPWDD COMMISSIONER KASTNER:  Correct.  

17          You would go through a process of assessment 

18          of need relative to the request for 

19          residential services.

20                 CHAIRWOMAN KRUEGER:  Got it.  All 

21          right.

22                 I just want to quickly make an 

23          announcement.  Apparently it's worth having 

24          these budget hearings, because I have been 


 1          told that there will be an immediate release 

 2          of the funds for the suicide services that 

 3          everyone has been so concerned about and 

 4          talking about, mostly in the previous Office 

 5          of Mental Health section of this hearing.  

 6          But I think that we can all give ourselves a 

 7          hand that we all spoke out and talked about 

 8          how critical emergency service suicide is, 

 9          and so suicide now apparently has been moved 

10          to a category of release of funds, 

11          recognizing that suicide should be treated as 

12          an emergency, particularly in times of 

13          COVID -- I would argue at all times.  So I 

14          just wanted to throw in that we have some 

15          good news here.

16                 And I will cede the rest of my time to 

17          the Assemblywoman.  

18                 CHAIRWOMAN WEINSTEIN:  Thank you.  

19                 Now we go to Assemblywoman Gunther for 

20          five minutes.

21                 Aileen, you have to just unmute 

22          yourself to begin.  There you go.

23                 ASSEMBLYWOMAN GUNTHER:  So -- good 

24          morning, everybody.  


 1                 So my first question is due to the 

 2          COVID pandemic, what is the level of savings 

 3          that was achieved by OPWDD because of the 

 4          decreased disbursements?  And also that we 

 5          have heard from several provider agencies 

 6          across the state who are dealing with 

 7          exceptionally high vacancies in their 

 8          districts to support their workforce.  Does 

 9          OPWDD have a plan to help them?

10                 OPWDD COMMISSIONER KASTNER:  Thank 

11          you.  A pleasure to see you again.  

12                 It -- it -- we're still in the process 

13          of collecting the data from our providers as 

14          to the costs that they incurred as a result 

15          of COVID and the cost of the services that 

16          they provided.

17                 But I don't believe that there are 

18          substantial savings that resulted as a result 

19          of program closures or suspension of 

20          activities.  I'll give you an example of day 

21          programs in particular.  On March 24th, we 

22          closed all day programs across the state, but 

23          we continued to pay the providers for day 

24          program services all the way through the 


 1          middle of July, using what were called 

 2          retainer payments which were approved through 

 3          our Appendix K application to CMS.  

 4                 So from March 24th through July, there 

 5          were no savings on day program services.  

 6          Providers received the full amount of funding 

 7          that they had received, and they were able to 

 8          redeploy those staff --

 9                 ASSEMBLYWOMAN GUNTHER:  Till July, 

10          right?

11                 OPWDD COMMISSIONER KASTNER:  -- to 

12          different settings, including residential 

13          programming.

14                 In addition, at the same time we 

15          expanded the range of opportunities for 

16          people to receive day program services.  So 

17          we added what was called COM-HAB R, the 

18          ability to provide community habilitation in 

19          residential settings, and made that available 

20          to the 35,000 people -- 36,000 people in 

21          certified residential who could no longer go 

22          to a day program.  

23                 So we were effectively paying for day 

24          program services twice, once through the 


 1          retainer program and the second through 

 2          COM-HAB R.

 3                 For those families who were --

 4                 ASSEMBLYWOMAN GUNTHER:  That was only 

 5          for the first six months, though, right?

 6                 OPWDD COMMISSIONER KASTNER:  -- at 

 7          home and couldn't access their day program, 

 8          we afforded the opportunity to receive 

 9          COM HAB on a tele basis.  So we tried to 

10          support the 20,000 families who had 

11          individuals at home who lost access to their 

12          day program.  So again, we were paying for a 

13          duplication of service for those four months.

14                 The federal government ended the 

15          retainer program for day programs in the 

16          middle of July.  At that time the pandemic 

17          was waning.  We removed the order to close 

18          all day programs.  We allowed every day 

19          program to reopen based upon whether they 

20          wanted to.  If they chose to reopen, they had 

21          to submit a safety plan.  We received 225 

22          safety plans from our day program providers.  

23          Many providers told us that they didn't have 

24          the same demand as previously, partly in part 


 1          due to the now availability of competing 

 2          services, Community HAB R and the delivery of 

 3          COM HAB via tele.  

 4                 We increased the rate, effectively 

 5          doubled the rate paid to day program 

 6          providers by reducing the length of service 

 7          required to bill for both full-day and 

 8          half-days.  That effectively doubled the rate 

 9          for the services that we provided through day 

10          program, simultaneously with the ongoing 

11          commitment to COM HAB R and the delivery of 

12          COM HAB in a family's home via tele.  

13                 So I think it's clear in terms of what 

14          we were doing that we actually bore more 

15          costs in providing these services than we had 

16          previously.

17                 ASSEMBLYWOMAN GUNTHER:  Thank you.  

18                 So, you know, during -- I had a lot of 

19          calls from parents during the time when their 

20          loved ones weren't going out to these 

21          programs, and a lot of them said there was a 

22          lot of difficulty in isolation, so I was 

23          concerned about that.  

24                 So you had a little bit of savings 


 1          this year, and I just want to know how you're 

 2          going to reinvest it.

 3                 OPWDD COMMISSIONER KASTNER:  Well, 

 4          Assemblywoman, I'm not sure that we have 

 5          savings this year as a result of --

 6                 ASSEMBLYWOMAN GUNTHER:  Okay, thank 

 7          you.

 8                 CHAIRWOMAN KRUEGER:  Thank you.  

 9                 Senator Diane Savino, whose hand won't 

10          be raised for some reason.

11                 SENATOR SAVINO:  I'm coming, I'm 

12          coming.  Oh, there I am.  Now I can't seem to 

13          -- the video won't open.  Oh, there --

14                 CHAIRWOMAN KRUEGER:  We've got you 

15          both ways.

16                 SENATOR SAVINO:  All right, thank you.  

17                 Dr. Kastner, I'll be brief, because I 

18          know there have been so many issues that 

19          people want to cover with you.  But I want to 

20          cover an issue that is close to home to us 

21          here on Staten Island, specifically the fate 

22          of IBR.  So if you could talk to us about -- 

23          what we're hearing is the closure of IBR 

24          again, the shifting of the researchers that 


 1          are there.  

 2                 What's happening, and what can we do 

 3          about this?  Because there's a lot of concern 

 4          about the loss of the Institute for Basic 

 5          Research.

 6                 OPWDD COMMISSIONER KASTNER:  Well, the 

 7          institute is not being lost.  As I described 

 8          in my testimony, we are transferring 

 9          responsibility for the operation of IBR from 

10          OPWDD to OMH.  

11                 OMH has experience running three 

12          research institutes; this would be their 

13          fourth.  We believe that that can be 

14          effective in improving the quality of the 

15          research that's being performed there.  OMH 

16          has numerous partners that they can work 

17          with, most notably the New York State 

18          Psychiatric Institute, and we hope that that 

19          can improve, again, the quality of the 

20          research that's being performed at IBR.

21                 SENATOR SAVINO:  But what guarantee 

22          can -- do we have?  I mean, are we talking 

23          about transferring the physical location of 

24          the Institute for Basic Research or just the 


 1          administrative oversight of it?

 2                 OPWDD COMMISSIONER KASTNER:  The 

 3          programmatic component, the staff and the 

 4          programs that are affiliated with those 

 5          staff.

 6                 SENATOR SAVINO:  So you're taking it 

 7          off of Staten Island, out of the facility 

 8          that houses it.


10          is transitioning the responsibility for 

11          operating the program to OMH.

12                 SENATOR SAVINO:  Right, okay.  That I 

13          understand.  But will the Institute for Basic 

14          Research remain in its current building and 

15          then be operated by OMH?  I think that's the 

16          question I'm asking.

17                 OPWDD COMMISSIONER KASTNER:  The 

18          program will remain at Staten Island.  I 

19          can't speak to specifically what OMH would do 

20          with its various partners in terms of the 

21          specific research programs.

22                 SENATOR SAVINO:  Okay.  But it will -- 

23          the jobs will remain there, the program will 

24          remain there, you won't supervise it anymore, 


 1          they will.

 2                 OPWDD COMMISSIONER KASTNER:  All I can 

 3          say is we have no plans to reduce any of the 

 4          staff that are currently involved at that 

 5          site, but I can't describe what OMH will do 

 6          because I don't know how they propose to 

 7          implement the program with their partners.

 8                 SENATOR SAVINO:  But their overall 

 9          mission of research, particularly into the 

10          areas of autism, will continue, as far as you 

11          are aware of?

12                 OPWDD COMMISSIONER KASTNER:  Yes, that 

13          is our hope, that actually it not just 

14          continue, but it will -- {audio dropped}.  

15                 SENATOR SAVINO:  Okay.  I'll Probably 

16          reach out to you and to the commissioner of 

17          OMH offline to get some more detail on that.  

18                 And I just want to echo the concerns 

19          that were raised by Senator Krueger.  I'm a 

20          little concerned that you think we have 

21          enough capacity for parents who are 

22          approaching end of life and are concerned 

23          about what's going to happen to their adult 

24          children, who also are getting older and 


 1          older.  I don't think we have that capacity.  

 2                 But thank you again for your efforts 

 3          and what you're doing.  Thank you.

 4                 CHAIRWOMAN KRUEGER:  Thank you.

 5                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 6                 We go to Assemblywoman Griffin for 

 7          three minutes.

 8                 ASSEMBLYWOMAN GRIFFIN:  Good 

 9          afternoon, Commissioner Kastner.

10                 As Assemblywoman Missy Miller 

11          mentioned, I too am very concerned that the 

12          intellectually and developmentally disabled 

13          who live at home have not been prioritized to 

14          get a COVID-19 vaccine.  These individuals, 

15          you know, still yet remain ineligible.  And 

16          many of my constituents take care of their 

17          adult children and younger children at home, 

18          and they have been struggling immensely 

19          throughout the pandemic due to all of the 

20          issues that have come up with COVID-19.

21                 One constituent describes how his 

22          adult nonverbal son with autism, his whole 

23          life has been turned upside-down.  He 

24          can't -- you know, for a while his day hab 


 1          was closed, he couldn't go anywhere, he was 

 2          isolated.  Now the day hab is open, it's 

 3          sponsored by AHRC, but the van that picks him 

 4          up no longer can pick him up because of 

 5          COVID.  

 6                 But worse yet is a lot of the 

 7          activities they normally do, they're not 

 8          doing, again because of COVID.  So if they 

 9          were to get prioritized and get the vaccine, 

10          along with their family caregivers, that 

11          would be immensely helpful to these families.

12                 The other issue is the cuts that are 

13          pending for AHRC and other services are 

14          posing a great threat.  So this is a facility 

15          in Oceanside, there are many throughout 

16          Nassau County and New York State; this may 

17          permanently close.  So when everything would 

18          get turned back on after the pandemic, he may 

19          not have access to this wonderful facility 

20          that gave him, you know, great advantages 

21          while, you know, being a 23-year-old and 

22          wanting to have some purpose and 

23          socialization.

24                 So my questions to you are what is 


 1          your position on this population still yet to 

 2          be made eligible and a priority for the 

 3          vaccination, and also what is your position 

 4          on the funding cuts that are causing AHRCs in 

 5          Nassau County and around New York State to 

 6          potentially close?

 7                 OPWDD COMMISSIONER KASTNER:  Well, I 

 8          assume in terms of AHRCs you're referring to 

 9          day program operations.

10                 ASSEMBLYWOMAN GRIFFIN:  Yeah.

11                 OPWDD COMMISSIONER KASTNER:  I think 

12          it's a very challenging time for providers of 

13          day programs.  There's really a fundamental 

14          change in the business model.  It's a new 

15          paradigm when we are now offering day program 

16          or habilitative services in residential 

17          settings, and we're also offering 

18          habilitative services in people's homes.  

19          That has fundamentally decreased the demand 

20          for day program services.

21                 And we've asked our day program 

22          providers to re-look at their business 

23          models, to try to come up with 

24          non-center-based options that would allow 


 1          them to be more flexible, to scale more 

 2          easily, both up and down.  But that's going 

 3          to be a challenging transition.

 4                 As far as vaccine, we're hopeful that 

 5          we can make a lot of progress.  We're 

 6          grateful that we've got our residential 

 7          individuals categorized as 1a.  We're working 

 8          very quickly to ensure that they get access 

 9          to the vaccine as soon as possible.  And 

10          hopefully as New York's supply increases, it 

11          can expand to other populations.

12                 ASSEMBLYWOMAN GRIFFIN:  Okay, thank 

13          you very much.

14                 OPWDD COMMISSIONER KASTNER:  Thank 

15          you.  

16                 CHAIRWOMAN KRUEGER:  Thank you.  

17          Senator Tom O'Mara for five minutes, ranker 

18          on Finance.  

19                 And then we will be turning it back 

20          over to the Assembly for a number of 

21          Assemblymembers.  

22                 For people who don't necessarily know 

23          this, the Assembly has two and a half times 

24          the number of members we do, so it just takes 


 1          a little bit longer to get through their 

 2          questions.  Thank you.

 3                 Tom.

 4                 SENATOR O'MARA:  Thank you, Senator 

 5          Krueger.

 6                 Thank you, Commissioner, for your time 

 7          here today.  I appreciate it.

 8                 Can you give us the status -- for the 

 9          last several years, due to the -- primarily 

10          the $15 fast-food minimum wage, it has really 

11          hurt the workforce for the developmentally 

12          disabled across upstate New York.  We still 

13          have not, across the board, reached that $15 

14          minimum wage in upstate New York, and our 

15          providers are still struggling with employees 

16          that choose to flip burgers at McDonald's 

17          because they can get paid more.

18                 Where do we stand this year on the 

19          extra funds that were budgeted to make up 

20          those wage differences, and where do you see 

21          us going forward to help with that 

22          differential?

23                 OPWDD COMMISSIONER KASTNER:  Well, as 

24          I said, we've made a sustained and 


 1          significant commitment to our direct support 

 2          professionals.  Over the past five years, we 

 3          have increased funding for our DSPs by $710 

 4          million, in an effort to increase their 

 5          compensation and make it more competitive 

 6          with the types of other jobs that you're 

 7          describing.

 8                 In this year we will be increasing the 

 9          amount of funding again to support an 

10          expansion of that effort.  We are part of a 

11          consortium of 20 states that provides data, I 

12          think it's to the University of Minnesota, 

13          and we look at our efforts to raise the wages 

14          of DSPs relative to other states.

15                 I didn't look this year; last year we 

16          were I think fourth in the country in terms 

17          of the average annual starting salary.  We 

18          were in the high $13 per hour range.  I think 

19          with this increase we should get into the low 

20          $14 per hour range.  We're getting closer and 

21          closer to the $15 minimum wage.

22                 But it's a priority.  We keep making 

23          investments in it, and hopefully we can 

24          continue to make progress in the years to 


 1          come.

 2                 SENATOR O'MARA:  I would think that 

 3          being fourth on that list nationwide, if you 

 4          actually compared that to what the cost of 

 5          living is in New York State, we would be much 

 6          farther down that list in the desirability of 

 7          this type of work.  When we have individuals 

 8          that really have a calling to do it, yet have 

 9          to make that choice to take a fast-food job 

10          to put more money on the table at home, it's 

11          concerning.  And this minimum wage has caused 

12          an imbalance in many areas.

13                 But you're saying that since we 

14          started trying to make up this difference for 

15          minimum wage, the state is paying 

16          $710 million a year more to offset that 

17          minimum wage loss?

18                 OPWDD COMMISSIONER KASTNER:  Since 

19          2015 we've invested $710 million in funding 

20          in our DSP salaries.

21                 SENATOR O'MARA:  What is that on an 

22          annual basis that we're doing?  And what's 

23          your projection on where we're going with 

24          that?


 1                 OPWDD COMMISSIONER KASTNER:  Well, as 

 2          I said, we're making progress and moving 

 3          towards a $15 per hour minimum wage.  And 

 4          every year we get closer to that goal.

 5                 I don't know quite how else to respond 

 6          to the question.

 7                 SENATOR O'MARA:  Okay.  Well, I guess 

 8          suffice it to say that our providers are 

 9          still struggling with disparities in the 

10          workplace and being able to work at a higher 

11          wage in certainly much less important work, I 

12          think, from our perspective and I'm sure 

13          yours as well.

14                 To move on to another quick subject, 

15          on vaccinations.  What is being done to help 

16          the -- those with developmental disabilities 

17          that are living in their home or with family, 

18          to get them on the priority list to receive a 

19          vaccine?  Because it's certainly restricting 

20          everyone else in the household's ability to 

21          get back to a more normal life, with the 

22          concerns of bringing COVID home to an 

23          individual that they're caring for, keeping 

24          it out of a home or out of the system, so to 


 1          speak.  

 2                 How are we working to help get 

 3          vaccines to those individuals?

 4                 OPWDD COMMISSIONER KASTNER:  I 

 5          understand that that's a significant hardship 

 6          for families.  The Centers for Disease 

 7          Control established the priorities for 

 8          vaccination.  We were fortunate that the 1a 

 9          designation included all of our individuals 

10          who live in congregate care, and all of their 

11          staff.  The subsequent expansions have 

12          included all of our direct support 

13          professionals and clinical staff working with 

14          individuals, so that includes not just staff 

15          in residential settings but staff throughout 

16          our system working in self-direction, working 

17          in families' homes, working in day programs.

18                 New York, just like every state, is 

19          challenged by a lack of supply.  New York 

20          received approximately 300,000 doses per 

21          week, and that was reduced to about 250,000 

22          doses per week.  With the announcement last 

23          week that the state would receive an 

24          additional 16 percent supply, we've been able 


 1          to focus on ensuring that all of our 

 2          individuals in congregate care have access to 

 3          the vaccine.  We've created a distribution 

 4          channel through the county Departments of 

 5          Health.  We've activated our Office of 

 6          Emergency Management to interface with them 

 7          directly and provide them with any logistical 

 8          support.  We have surveyed our providers to 

 9          identify every individual who wants a vaccine 

10          who's in congregate care, and every staff 

11          person who wants a vaccine, to try to 

12          coordinate their access to vaccine --

13                 CHAIRWOMAN KRUEGER:  Thank you, 

14          Doctor.  You're a minute over, so we're going 

15          to cut you off here.  But we'll be happy to 

16          hear more from you.  Thank you.

17                 Assemblywoman.

18                 CHAIRWOMAN WEINSTEIN:  Yes, so we're 

19          going to go to Assemblyman Ra for five 

20          minutes.

21                 ASSEMBLYMAN RA:  Thank you very much, 

22          Chairwoman.

23                 Commissioner, good afternoon.

24                 I know you did speak a bit earlier 


 1          about reimbursement rates for retainer day 

 2          and therapeutic leave days.  Just a plug on 

 3          that in terms of there does seem to be some 

 4          confusion out there in terms of what agencies 

 5          are communicating to families.  I know that 

 6          was delayed.  But there seems to be some 

 7          confusion out there in what families are 

 8          being told about, you know, their loved ones 

 9          coming home to visit from those facilities.  

10          And certainly I think it's something that we 

11          need to look at opportunities to maybe make 

12          some restorations there and simplify that 

13          once again, because the costs are steady for 

14          the agencies housing those individuals.

15                 But I wanted to talk about another 

16          housing issue with regard to self-direction.  

17          And I know there's a restoration, but there 

18          remains a 5 percent cut that could affect the 

19          budget allocation for many of these 

20          individuals that they use towards rent, which 

21          allows them to live independently.

22                 I know on Long Island there's a $1339 

23          maximum for rent for a one-bedroom apartment.  

24          High cost of living here, and it's very 


 1          unlikely that you're going to find an 

 2          apartment for that, so some use other money 

 3          to supplement.  

 4                 But given that a cut like this 

 5          directly affects the ability of these 

 6          individuals to find appropriate housing, is 

 7          it possible to restore some of the kind of 

 8          flexibility and discretion that had been in 

 9          the past, to maybe use, you know, other 

10          allotments that are for other things that are 

11          not fully used to help with these costs?

12                 OPWDD COMMISSIONER KASTNER:  So when 

13          the 20 percent withhold was enacted, it was 

14          for non-Medicaid local assistance payments, 

15          and that did include some rental subsidy 

16          payments, in addition to environmental 

17          modifications and assistive technology.

18                 We were able to carve those out of the 

19          cut, or out of the withhold.  So there was no 

20          withholding of funding for payments to 

21          support apartments and individuals, you know, 

22          living independently.  We were very pleased 

23          with that, and I think that's important for 

24          folks to know.


 1                 ASSEMBLYMAN RA:  Okay, thank you.  

 2          Definitely, you know, a very important -- 

 3          both of those issues, obviously, that and, 

 4          you know, the issue I mentioned previously 

 5          are -- have an impact on individuals and 

 6          their living situations.  

 7                 So I thank you for your work and your 

 8          answer.  Thanks for being here.

 9                 OPWDD COMMISSIONER KASTNER:  Thank 

10          you.

11                 CHAIRWOMAN WEINSTEIN:  We're going to 

12          just go to the next Assemblymember.  The 

13          order is, for your information, Epstein, 

14          Bronson, Cusick, Burdick, and Anderson.  Then 

15          we'll go to the Senate for a second round.

16                 ASSEMBLYMAN EPSTEIN:  Thank you, Chair 

17          Weinstein.

18                 And thank you for your time, 

19          Commissioner.

20                 So 30 years after the ADA, people with 

21          disabilities have really stubborn high 

22          unemployment rates.  And I'm wondering, 

23          especially with people with developmental 

24          disabilities, you know, do we need a new 


 1          approach to this?  Because it doesn't seem 

 2          like we're moving the needle at all in our 

 3          current approach.

 4                 OPWDD COMMISSIONER KASTNER:  Well, 

 5          thank you for the question.  We actually were 

 6          making progress.  Unfortunately, COVID set 

 7          those efforts back substantially.

 8                 We've asked our day program providers, 

 9          as I described earlier, to look at 

10          alternatives to site-based support --

11                 ASSEMBLYMAN EPSTEIN:  So, 

12          Commissioner, you know, I only have three 

13          minutes.  So like how much money is in the 

14          budget for employment programs for people 

15          with disabilities?

16                 OPWDD COMMISSIONER KASTNER:  I don't 

17          know exactly.  I apologize.

18                 ASSEMBLYMAN EPSTEIN:  You agree that 

19          it's a high rate of unemployment for these 

20          New Yorkers, right?

21                 OPWDD COMMISSIONER KASTNER:  Yes.

22                 ASSEMBLYMAN EPSTEIN:  And so I hear 

23          what you're saying about making progress, but 

24          it's -- you know, it feels like it's moving 


 1          at a snail's pace.  We really need a real -- 

 2          like a Marshall Plan, to get people 

 3          employment opportunities that want to work.  

 4          Right?

 5                 OPWDD COMMISSIONER KASTNER:  This year 

 6          was extremely challenging -- 

 7                 ASSEMBLYMAN EPSTEIN:  A hundred 

 8          percent, for so many New Yorkers.  You know, 

 9          millions losing their jobs.  But that doesn't 

10          mean we don't need to marshal our forces now 

11          to have a real plan.

12                 OPWDD COMMISSIONER KASTNER:  As I 

13          said, we have a tremendous commitment in 

14          funding to our day program services.  We've 

15          asked our providers to look at alternatives 

16          to site-based day programming, to look at 

17          things like supported employment, job coaches 

18          and other types of roles, where we can 

19          redeploy those funds and that service to 

20          support people in more competitive employment 

21          environments.

22                 ASSEMBLYMAN EPSTEIN:  I'd love to know 

23          the numbers of people -- you say you've made 

24          real progress.  I'd love to see those 


 1          numbers.  Can you share that with the chairs 

 2          so they can distribute it amongst the 

 3          members?

 4                 OPWDD COMMISSIONER KASTNER: Certainly.

 5                 ASSEMBLYMAN EPSTEIN:  And so when you 

 6          say to redistribute money, you mean taking 

 7          money away from other programs so they can be 

 8          put into these employment programs?

 9                 OPWDD COMMISSIONER KASTNER:  So we're 

10          asking -- we've been asking our day program 

11          providers since the summer to try to come up 

12          with alternatives to delivering services in 

13          congregate settings.  Because of the risks of 

14          COVID, because of now I think in some regard 

15          a lesser degree of interest in that service 

16          model, there's an opportunity for our 

17          providers to look at being more involved in 

18          supported employment and other opportunities 

19          that are not site-based.

20                 ASSEMBLYMAN EPSTEIN:  Right.  (Pause.)

21                 OPWDD COMMISSIONER KASTNER:  I'm still 

22          here.  I'm sorry, did you have a question?

23                 CHAIRWOMAN WEINSTEIN:  Harvey, I 

24          believe you've been frozen.


 1                 We have to see if we can do that for 

 2          some other hearings.

 3                 (Laughter.)

 4                 CHAIRWOMAN WEINSTEIN:  I think you 

 5          answered the question.  

 6                 So now we go on to Assemblyman 

 7          Bronson.  Harry?

 8                 ASSEMBLYMAN BRONSON:  Okay, I think 

 9          I'm here, thank you.

10                 Commissioner, I want to talk about an 

11          issue that I brought up when we were talking 

12          to the commissioner of OMH -- and it impacts 

13          OPWDD, OASAS, as well as OMH -- and that is 

14          the exemption for Article 163 mental and 

15          behavioral health professionals.  

16                 That exemption expires at the end of 

17          June this year.  It was last extended for 

18          another three years, and there was an 

19          agreement that we would work on legislation 

20          and work with your agencies to modernize the 

21          scope of practice, including diagnosis for 

22          those various professionals licensed under 

23          Article 163.

24                 Earlier when I was talking to OMH, 


 1          they pointed out that there's no plan in 

 2          place to address not only the end of the 

 3          exemption from licensure, but also the 

 4          licensed mental health professionals working 

 5          in state facilities, even though there was a 

 6          commitment to work on modernizing the 

 7          delivery of those services, including 

 8          diagnosis.

 9                 So what is your understanding of 

10          what's happening among your agencies on this 

11          issue?  Can we commit to move forward on the 

12          critically important diagnosis issue?  We 

13          need this.  We need this to help address the 

14          workforce crisis and address the access to 

15          care crisis that we're facing.  And we were 

16          facing it before COVID, and it's only gotten 

17          worse.

18                 So where is your agency on this, and 

19          can we try to work to get this resolved?

20                 OPWDD COMMISSIONER KASTNER:  Well, I 

21          have to apologize, but I don't think that 

22          what you're referring to has much 

23          applicability to the OPWDD service system.  I 

24          can go back and look, but I think this is 


 1          primarily a mental health issue.

 2                 ASSEMBLYMAN BRONSON:  Well, it 

 3          actually crosses all the O agencies, if you 

 4          will.  These professionals work in many of 

 5          the facilities for OPWDD, and certainly the 

 6          community-based organizations as well.

 7                 But if you could take a look at that.  

 8          You know, my understanding is previously, 

 9          before I was involved in this area, that 

10          there were conversations among those three 

11          agencies.  That's where the exemption came 

12          up.  There was an exemption six years ago, a 

13          renewal of the exemption three years ago with 

14          a commitment to actually talk about and work 

15          toward the scope of practice and in 

16          particular diagnosis.

17                 So if you could check on that, and I'd 

18          appreciate it if you'd get back to me and all 

19          of us on this hearing.  Okay?

20                 OPWDD COMMISSIONER KASTNER:  Sure, I'd 

21          be happy to do that.

22                 ASSEMBLYMAN BRONSON:  Thank you.

23                 CHAIRWOMAN WEINSTEIN:  Thank you.  

24                 Assemblyman Cusick.


 1                 ASSEMBLYMAN CUSICK:  Hi.  Hi, 

 2          Commissioner.  Thank you.  Thank you for 

 3          appearing here today.

 4                 And, you know, because of time 

 5          constraints, I'm not going to ask a question 

 6          about the Institute of Basic Research that 

 7          was brought up.  Your staff has briefed me 

 8          before the budget announcement.  But it is 

 9          something I do want to sit down with you and 

10          your staff on.  There are concerns that I do 

11          have.

12                 I understand that the IBR section that 

13          houses the Jervis Center will remain, but I 

14          do have concerns about possible staff moving, 

15          office staff moving off of Staten Island for 

16          the research part in the merger with OMH.  

17          And those are things that I certainly want to 

18          continue discussing with you and your staff.

19                 And I want to also just say, you know, 

20          with the budget -- this budget includes, as 

21          my colleagues have said, you know, many cuts, 

22          and cuts to the residential provider agency 

23          rates for therapeutic leave and retainer day 

24          payments at 50 percent, and on top of that 


 1          the 1 percent across the board for the 

 2          Medicaid.

 3                 In talking with a lot of the families, 

 4          and with the Staten Island Developmental 

 5          Disabilities Council on Staten Island -- 

 6          which you have met with personally in my 

 7          office, and I thank you for that -- they've 

 8          stated that there will be a real struggle for 

 9          a lot of these agencies with paying operating 

10          costs for group homes and due to these 

11          proposed cuts.  Residential provider agencies 

12          will still need to pay their mortgages, 

13          utilities, you know, all of the expenses that 

14          go into running these agencies.

15                 My question is a general question, but 

16          I know in the past this has been done.  When 

17          your budget team is looking at these cuts -- 

18          you know, we have a Staten Island 

19          Developmental Disabilities Council, but do 

20          they bring in the agencies and the families 

21          and the folks that are on the ground to 

22          confer as they're deciding these budget cuts?

23                 OPWDD COMMISSIONER KASTNER:  So we had 

24          a public process last year, meeting with our 


 1          stakeholders and talking about what they 

 2          would recommend as to specific cuts.  And it 

 3          wouldn't be a surprise to say that there were 

 4          very few stakeholders that volunteered that 

 5          -- the programs that they were particularly 

 6          interested in should not be the cut target.

 7                 ASSEMBLYMAN CUSICK:  Okay --

 8                 OPWDD COMMISSIONER KASTNER:  That was 

 9          a position that --

10                 ASSEMBLYMAN CUSICK:  I didn't mean to 

11          cut you off, Commissioner, I apologize, but I 

12          just see my time running down to 20 seconds.

13                 I would just -- you know, the folks I 

14          deal with on Staten Island would probably 

15          argue that they don't have a say in this 

16          process and that they would like more input 

17          on this.  And I would work with your team to 

18          include more of the on the ground folks who 

19          are really, you know, providing these 

20          services and the families that are involved 

21          to be part of this process, particularly now.  

22          Right?  Even as we're negotiating the budget, 

23          to be included and have some communication 

24          from OPWDD.


 1                 OPWDD COMMISSIONER KASTNER:  Yes, 

 2          thank you.

 3                 ASSEMBLYMAN CUSICK:  I know my time 

 4          has run out, Madam Chair.  Thank you.

 5                 CHAIRWOMAN WEINSTEIN:  Thank you.

 6                 Assemblyman Burdick.

 7                 ASSEMBLYMAN BURDICK:  Thank you.  I 

 8          wish to thank the chairs and also the 

 9          commissioner for the presentation.

10                 I share the view that the 

11          developmentally disabled should be 

12          prioritized for vaccination.  

13                 I wanted to talk about the Padavan Law 

14          and about group homes.  I completely support 

15          the mission of OPWDD to work closely with 

16          nonprofit partners to help individuals with 

17          developmental disabilities.  And I had direct 

18          experience with that, actually, some seven 

19          years ago as supervisor of the Town of 

20          Bedford, when Cardinal McCloskey Community 

21          Services, under the Padavan Law, had applied 

22          for a permit to provide a group home for four 

23          young adult autistic men who had aged out.

24                 I have two questions.  The local 


 1          process was painful, as I'm sure you're 

 2          aware.  And I understand that at one point 

 3          the state statute was revised to make it 

 4          somewhat easier, but it still raises great 

 5          questions and push-back from communities and 

 6          long waits for determinations from the 

 7          community.  And these waits have human tolls.

 8                 Do you feel that revisions in the 

 9          Padavan Law may help reduce the wait for 

10          placement?  And if so, what areas do you 

11          think we might consider?

12                 OPWDD COMMISSIONER KASTNER:  Well, I 

13          think you're specifically talking about a 

14          site in the Hudson Valley where they're 

15          trying to develop a group home for four 

16          individuals with autism.  

17                 We work very closely with local 

18          authorities to assist in any way that we can 

19          to improve the process.  We think it's gotten 

20          better since there were amendments to the 

21          law.  I haven't heard an overwhelming number 

22          of concerns about that specific issue, and I 

23          think that it's working reasonably well at 

24          this point.


 1                 ASSEMBLYMAN BURDICK:  Well, what I'm 

 2          hearing -- what we had, and I've heard it 

 3          from other chief electeds, is that you have 

 4          neighborhoods that would rise up against it, 

 5          we had unfounded concerns regarding the 

 6          impact on their neighbors -- on the  

 7          neighborhood, and that's the concern that I 

 8          had.  

 9                 And as I say, it's a painful process.  

10          And maybe offline I could explore with you, 

11          you know, in greater detail what we went 

12          through on that.  I mean, it -- I had 

13          supported it from the outset, that it was 

14          something that I felt was greatly needed.  

15          There wasn't an over-concentration.  But I'd 

16          like to see if it can be facilitated for 

17          people who desperately need this help.

18                 OPWDD COMMISSIONER KASTNER:  We'd be 

19          happy to talk further about that.

20                 ASSEMBLYMAN BURDICK:  Thank you so 

21          much.

22                 OPWDD COMMISSIONER KASTNER:  Thank 

23          you.

24                 CHAIRWOMAN WEINSTEIN:  We now go to 


 1          Assemblyman Anderson, for three minutes.

 2                 ASSEMBLYMAN ANDERSON:  Thank you.  

 3          Thank you, Chairwoman, and thank you, 

 4          Commissioner, for the presentation. 

 5                  I have several questions, some I'm 

 6          going to ask in the beginning, and others I'm 

 7          going to ask you to just address at another 

 8          time, just in respect for the limited time we 

 9          have.

10                 So I notice that the Executive Budget 

11          mentions some program eliminations.  They've 

12          proposed about $440,000 in a reduction in 

13          targeted grants for community-based 

14          providers.  What impact do you think that 

15          this cut will have on the extension of 

16          services for people in this population?

17                 OPWDD COMMISSIONER KASTNER:  I'm not 

18          sure that that's a cut that's -- would be 

19          made to our budget.

20                 ASSEMBLYMAN ANDERSON:  It is.  It is a 

21          cut of $440,000 in targeted grants to 

22          community-based providers.

23                 OPWDD COMMISSIONER KASTNER:  Within 

24          OPWDD?


 1                 ASSEMBLYMAN ANDERSON:  Correct.

 2                 OPWDD COMMISSIONER KASTNER:  I'll look 

 3          at that.  I apologize for not knowing about 

 4          it.

 5                 ASSEMBLYMAN ANDERSON:  But -- so 

 6          knowing that this information is in the 

 7          Executive Budget, what sort of impact will 

 8          that have for the agency?

 9                 OPWDD COMMISSIONER KASTNER:  Again, I 

10          apologize for not having specific information 

11          about that specific cut, so I can't really 

12          answer --

13                 ASSEMBLYMAN ANDERSON:  Understood.

14                 OPWDD COMMISSIONER KASTNER:  I 

15          apologize.

16                 ASSEMBLYMAN ANDERSON:  Access VR is a 

17          -- no problem, Mr. Commissioner.

18                 Access VR services provide technology 

19          opportunities for folks who live with 

20          intellectual and developmental disabilities, 

21          among other different health concerns.  And 

22          so they generally participate in this program 

23          for young people ages 21 and up who have aged 

24          out of the school system.


 1                 What role does your agency have with 

 2          Access VR?

 3                 OPWDD COMMISSIONER KASTNER:  I'd have 

 4          to look specifically and find out what 

 5          services we may contract with them to 

 6          provide.

 7                 ASSEMBLYMAN ANDERSON:  Okay.  And last 

 8          question on this before I go on to my next -- 

 9          I'm running out of time here.  But in terms 

10          of the community-based expansion -- I mean, 

11          sorry, in terms of the care coordination, I 

12          know that you're absolutely aware of the $20 

13          million in reductions that CCOs will receive.  

14          Can you explain what impact that would have 

15          on the agency's ability to provide care 

16          coordination for folks who need it?

17                 OPWDD COMMISSIONER KASTNER:  Sure.  

18          Our goal is to ensure that we're paying the 

19          correct amount for the services that are 

20          being provided.  

21                 The context of the CCO program is that 

22          when we launched the program in 2018, we 

23          actually increased the rate paid to CCOs by 

24          about 60 percent above what we had previously 


 1          been paying to the Medicaid service 

 2          coordination organizations.  So that was 

 3          intended to address the fact that this was a 

 4          new program, these were organizations that 

 5          were just starting and had just launched.

 6                 Over the past two budget cycles, your 

 7          questions are correct, we have --

 8                 ASSEMBLYMAN ANDERSON:  Commissioner, 

 9          I'm sorry -- Commissioner, I'm running out of 

10          time here.  But let me just say this.  That 

11          program is vitally important to helping 

12          people who are on Medicare/ Medicaid, one, to 

13          be able to navigate the system but, two, be 

14          able to navigate services.  So it's vitally 

15          important.

16                 And I just want to know what the 

17          impact of losing these funds will be for 

18          folks that need services.

19                 OPWDD COMMISSIONER KASTNER:  I agree 

20          it's vitally important, and we believe that 

21          the cuts will not reduce access to services 

22          through the CCO program.

23                 ASSEMBLYMAN ANDERSON:  So you can 

24          honestly say that there will be no reduction 


 1          in service for folks who need this program, 

 2          quality service or -- I'm just -- I want to 

 3          be perfectly clear.

 4                 OPWDD COMMISSIONER KASTNER:  We 

 5          believe that the funding will be appropriate 

 6          to the level of service that's provided, and 

 7          there should not be a reduction in services 

 8          to people as a result of that reduction.

 9                 ASSEMBLYMAN ANDERSON:  Okay, and I'll 

10          follow up with you -- I guess you all will 

11          follow up with me on that question around 

12          Access VR and the $440,000 budget cut, is 

13          that correct?

14                 OPWDD COMMISSIONER KASTNER:  Yes, 

15          we'll be happy to do that.

16                 ASSEMBLYMAN ANDERSON:  Okay, thank you 

17          very much, Commissioner.  Thank you, 

18          Chairwoman.

19                 OPWDD COMMISSIONER KASTNER:  Thank 

20          you.

21                 CHAIRWOMAN WEINSTEIN:  Thank you.  

22                 So now we go to the Senate for a 

23          second round.

24                 CHAIRWOMAN KRUEGER:  Thank you.  For a 


 1          second round for the chair of the 

 2          Disabilities Committee, Senator John Mannion.

 3                 SENATOR MANNION:  Thank you, Senator.  

 4          Thank you, Commissioner.  

 5                 Just following up on my questions 

 6          earlier about residential vacancies, I have 

 7          to say, you know, there should never be this 

 8          paradigm that we have with the open beds and 

 9          people sitting on a waiting list waiting to 

10          get in.  You know, it's really the opposite 

11          of what we're trying to achieve.  And I'm 

12          also, you know, hearing that there's fewer 

13          and fewer staff to help connect these people 

14          to these services.

15                 So I'm just wondering, you know, in 

16          the grand scheme of this, you know, why is 

17          this happening, why do we have so many beds 

18          that are vacant out there and so many people 

19          on the waiting lists, and how can we fix 

20          these problems that are clearly evident to 

21          not just the people who are asking the 

22          questions today, but also the families that 

23          are out there?

24                 Thank you.


 1                 OPWDD COMMISSIONER KASTNER:  Well, as 

 2          I described earlier, we think there's an 

 3          opportunity to improve the quality of 

 4          operation of the overall residential program.

 5                 Again, for the new folks, we're going 

 6          to try to improve the function of the Front 

 7          Door, their access to the continuum of 

 8          services.  

 9                 But for those individuals who are 

10          currently in residential, I think there's an 

11          agreement between OPWDD and our providers, 

12          our individuals, that a payment methodology 

13          based on the needs of the individuals would 

14          be more appropriate than one based on the 

15          agency's costs.  That will help agencies 

16          support individuals with high needs, it would 

17          match funding to the specific individuals, 

18          and hopefully address any vacancies that 

19          might occur.

20                 We also believe that there is an 

21          opportunity to help individuals currently in 

22          more restrictive settings move to 

23          less-restricted settings.  We hope that in 

24          the context of an acuity-based payment 


 1          methodology that we can create a pilot 

 2          program, which would then assist individuals 

 3          who are in a more-restrictive setting move to 

 4          a less-restrictive one, and that we can use 

 5          an alternative payment model which would 

 6          support providers who undertake that 

 7          transition of individuals.

 8                 So we think there's an opportunity to 

 9          improve the manner in which we support our 

10          residential providers, and we've had a lot of 

11          discussion about it, we're looking forward to 

12          working with them in the future.

13                 SENATOR MANNION:  Do we know, you 

14          know, how many vacant beds there are out 

15          there and how many people are on the waiting 

16          list?

17                 OPWDD COMMISSIONER KASTNER:  We know 

18          how many people are currently in the three 

19          different categories of requests for 

20          residential services.   As I said earlier, 

21          we're able to meet the needs of all families 

22          who are in the emergency category due to 

23          turnover within our residential system. 

24                 The question as to the number of 


 1          vacant beds is somewhat in flux because we 

 2          have had agencies that are taking beds 

 3          offline because they have been vacant and 

 4          they're currently not occupied, so they may 

 5          be changing their certificates of need to 

 6          reflect that.

 7                 SENATOR MANNION:  Do we know how many 

 8          people -- and can I have what that number is 

 9          if you do know it -- that are in that 

10          emergency category where they are awaiting, 

11          you know, a residential setting?

12                 OPWDD COMMISSIONER KASTNER:  It's 

13          generally in the range of 800 or so families 

14          per year.  We can get you specific 

15          information on that.

16                 SENATOR MANNION:  I appreciate that.

17                 And I know the time is running a 

18          little bit short for me here.  I'm going to 

19          jump to another issue, which is in regards to 

20          the Federal Medical Assistance Percentages 

21          that the state received and how much money 

22          was allocated to OPWDD.

23                 Do we have that number about how much 

24          money was allocated from that program?


 1                 OPWDD COMMISSIONER KASTNER:  As I 

 2          said, in the context of this year, DOB 

 3          provided support to OPWDD, for example, when 

 4          we asked to fund retainer payments, which 

 5          effectively doubled the costs of our day 

 6          program when we expanded our capacity to 

 7          provide COM HAB R and COM HAB via tele.

 8                 I can't put a specific dollar figure 

 9          on funds that moved from DOB to OPWDD.  All I 

10          can tell you is that we did receive support 

11          from DOB to make modifications to our system 

12          on the fly, which actually increased our 

13          costs.  And we feel that that was a 

14          reflection of DOB's commitment to our 

15          individuals and the programs that we support.

16                 SENATOR MANNION:  Thank you.

17                 In the interests of time, a quick 

18          question.  Does OPWDD have a current Section 

19          5.07 Plan?

20                 OPWDD COMMISSIONER KASTNER:  As I 

21          described earlier in response to a question, 

22          we will have one completed by the end of this 

23          year.

24                 SENATOR MANNION:  End of the year, 


 1          correct, yes.  Thank you.

 2                 OPWDD COMMISSIONER KASTNER:  Thank 

 3          you.

 4                 CHAIRWOMAN KRUEGER:  Thank you.

 5                 Assembly, to close.  

 6                 CHAIRWOMAN WEINSTEIN:  We go to 

 7          Assemblyman Abinanti for five minutes.

 8                 ASSEMBLYMAN ABINANTI:  Thank you, 

 9          Commissioner.  You know what, I'm hearing you 

10          say over and over again you want to be 

11          person-centered, yet it appears that you're 

12          cost-cutting-centered.  And I think you're 

13          reflecting some misplaced priorities here and 

14          failing to fully recognize the humanity of 

15          your clients.  

16                 Like, for example, you talk of -- 

17          group homes are not a combination of beds to 

18          be dispensed out, you know, randomly.  Group 

19          homes are homes for a group of people.  And 

20          when you say that they can't go out on a 

21          therapeutic leave, they can't go home without 

22          being penalized, you're basically saying it's 

23          not your home, it's an institution, because 

24          we're going to pay only when you're in that 


 1          bed.

 2                 Now you're saying that for the first 

 3          96 days that somebody is not in the bed -- so 

 4          that means if they go home every weekend to 

 5          visit their parents or their loved ones or go 

 6          on a vacation, the agency or whoever is 

 7          running the group home is only going to get 

 8          50 percent of the daily rate.  And if they go 

 9          over 96 days, even if they're in the 

10          hospital, they're going to lose the entire 

11          daily rate.  

12                 Now tell me, what assisted living 

13          facility penalizes a senior citizen for going 

14          to visit family?  What college dorm penalizes 

15          a college student for going home to visit the 

16          family?  

17                 Is this a human way to run an agency 

18          that's supposed to be person-centered?

19                 OPWDD COMMISSIONER KASTNER:  As I said 

20          earlier, we do not restrict the ability of 

21          individuals to visit their families on the 

22          weekend.

23                 ASSEMBLYMAN ABINANTI:  But you're 

24          going to take 50 percent of the payment, of 


 1          the rate, every time they go home.  So that's 

 2          taking money out of running the home.  So 

 3          that may mean they can't paint the room again 

 4          for another two years, or they can't fix the 

 5          steps or they can't do something else, 

 6          correct?

 7                 Commissioner, I am told there are 

 8          3,000 vacant beds, if we talk about beds, in 

 9          the voluntary sector, and that your agency 

10          has told them you don't have the money to pay 

11          for people in those beds.  Is that true?

12                 OPWDD COMMISSIONER KASTNER:  I don't 

13          believe that that's --

14                 ASSEMBLYMAN ABINANTI:  All right.  

15          Well, how much money is in this budget for 

16          new placements in group homes, in other beds?  

17          Let's use your term, beds.  How much new 

18          money is this budget?

19                 OPWDD COMMISSIONER KASTNER:  There is, 

20          as I said earlier, a sufficient amount of 

21          capacity to support all individuals who have 

22          an emergency request.

23                 ASSEMBLYMAN ABINANTI:  Emergency only, 

24          Commissioner.  Now, you've got three 


 1          categories, emergency, substantial and 

 2          current, correct?  And right now I'm 

 3          understanding it takes five months to place 

 4          an emergency placement in a bed and not 

 5          necessarily an appropriate group home.  

 6          That's just placing them in a bed.  So it 

 7          could be an older man going into a group home 

 8          with four women, isn't that true?  

 9                 And then substantial takes nine 

10          months.  And if you have a current need, like 

11          you're talking about somebody living with 

12          their parents, that could take at least six 

13          months to just determine that they have a 

14          need, isn't that true?

15                 OPWDD COMMISSIONER KASTNER:  I can't 

16          speak to any specific individual --

17                 ASSEMBLYMAN ABINANTI:  Commissioner, 

18          you are in charge of the agency, not me.  If 

19          I have this information, why don't you?

20                 OPWDD COMMISSIONER KASTNER:  Because 

21          our commitment is to provide a 

22          person-centered focus in planning for the 

23          residential needs --

24                 ASSEMBLYMAN ABINANTI:  Commissioner, 


 1          you were talking about -- you're talking 

 2          about going acuity-based.  Didn't you have a 

 3          program like that where you had a high-needs 

 4          special allotment so that you could set up a 

 5          facility for people with higher needs, and 

 6          you've changed that, you've cut out that 

 7          special acuity-based increased allotment on a 

 8          rate?

 9                 OPWDD COMMISSIONER KASTNER:  Actually, 

10          we have an agreement with the federal 

11          government for a high-needs payment 

12          methodology.  That payment methodology will 

13          expire July 1st.  We need to come up with a 

14          new one.  We think that's just another 

15          opportunity for us to improve the quality of 

16          our --

17                 ASSEMBLYMAN ABINANTI:  I understand 

18          the rhetoric about wanting to improve, but 

19          it's not improving on the ground.  That's the 

20          problem.

21                 Now, you were talking about going to 

22          telemodalities.  How many of the people who 

23          need day hab have the capability of accessing 

24          a computer by themselves?  Have you done a 


 1          survey of that?

 2                 OPWDD COMMISSIONER KASTNER:  We've 

 3          provided this as an option for individuals to 

 4          choose --

 5                 ASSEMBLYMAN ABINANTI:  Commissioner, 

 6          it's being used in place of active day hab.  

 7          It's not being used in addition to.

 8                 So how many people who want day hab 

 9          have to go to telemodalities because there's 

10          no other option?

11                 OPWDD COMMISSIONER KASTNER:  Again, we 

12          have tried to expand the range of 

13          opportunities --

14                 ASSEMBLYMAN ABINANTI:  You have no 

15          numbers, you're not fact-based, you're just 

16          trying it on theory.

17                 Let me ask you a question.  If 

18          somebody has the capability of accessing a 

19          computer by themselves, why would they need a 

20          day hab program to go on the computer?

21                 OPWDD COMMISSIONER KASTNER:  We -- 

22          again, we provide opportunities for people to 

23          make decisions based on their personal 

24          preferences.


 1                 ASSEMBLYMAN ABINANTI:  Years ago day 

 2          hab used to provide training.  It used to 

 3          provide job training, an entree into the job 

 4          market.  Why does it not do that anymore?  

 5          Why has it become a babysitting service?  

 6          What are you going to do about that?

 7                 OPWDD COMMISSIONER KASTNER:  We -- as 

 8          I said earlier, we've asked our day program 

 9          providers to look at alternatives to 

10          center-based programming, to in particular 

11          look at community-based alternatives, which 

12          include supported employment --

13                 ASSEMBLYMAN ABINANTI:  All right, let 

14          me just end with one final point, 

15          Commissioner.  You said that there was no 

16          monies being cut from housing.  Yet it's a 

17          fact, isn't it, that there's a special $3,000 

18          allotment of state monies for each person, 

19          and it's called "other than personal 

20          services," and it's used to pay for telephone 

21          and computers and access to the internet, 

22          et cetera.  And yet you've cut 20 percent, 

23          you've withheld $600 from $3,000.  How much 

24          money are you saving to cut somebody off from 


 1          the internet at a time when you're saying 

 2          they should be using telemodalities?

 3                 OPWDD COMMISSIONER KASTNER:  Again, 

 4          are you referring to the local assistance 

 5          payments, the non-Medicaid local assistance 

 6          payments?

 7                 ASSEMBLYMAN ABINANTI:  I'm talking 

 8          about the non-Medicaid to the individual 

 9          people who are in self-determination who use 

10          this $3,000 to pay for the internet, to pay 

11          for their cellphone.  That's what it's there 

12          for.  But it's all state monies, and you have 

13          been withholding 20 percent.  So people who 

14          are living on Medicaid, on Medicaid wages, 

15          $2,000 a month, $12,000 a year, are expected 

16          to pick up the additional charge of the $600.  

17          To us, we're saving a few -- maybe a half a 

18          -- $500,000 a year.  But to these people, 

19          $600 is a lot of money.  Why are we doing 

20          that?

21                 CHAIRWOMAN WEINSTEIN:  Thank you -- 

22                 OPWDD COMMISSIONER KASTNER:  In those 

23          -- those -- 

24                 CHAIRWOMAN WEINSTEIN:  Thank you.  


 1                 Commissioner, I think it would be 

 2          helpful to get some answers in writing that 

 3          we could circulate to all of the members.

 4                 OPWDD COMMISSIONER KASTNER:  

 5          (Inaudible.)

 6                 CHAIRWOMAN WEINSTEIN:  And before we 

 7          end this portion of the hearing, I see 

 8          Assemblyman Byrne has raised his hand for a 

 9          question for three minutes, before we go back 

10          to the Senate.

11                 CHAIRWOMAN KRUEGER:  Okay.

12                 ASSEMBLYMAN BYRNE:  Yes, thank you, 

13          Madam Chair.  

14                 And Commissioner, I'm just going to 

15          read off a question on behalf of one of my 

16          colleagues, who's unable to ask the question.  

17          And hopefully you can provide some context 

18          and answer.

19                 Here's the question.  The, quote, IM 

20          assessment and the CAS assessment, currently 

21          the care coordinators are being asked to help 

22          input info about a consumer into the 

23          assessment.  This assessment will eventually 

24          help construct an individual's self-direction 


 1          budget.  

 2                 The concern of many is that their care 

 3          coordinators don't know their loved ones well 

 4          enough to be given this very important 

 5          information about their needs, and it can 

 6          have a detrimental influence on their future 

 7          self-direction budget.

 8                 The family should have the final 

 9          input, as they know the needs best.  Why is 

10          this being done?

11                 OPWDD COMMISSIONER KASTNER:  Well, 

12          you're referring to two instruments that are 

13          used to conduct assessments of individuals.  

14          The CAS is an assessment that we eventually 

15          plan to use with all of our individuals.  I 

16          believe at the present time we've used it to 

17          assess all individuals within our residential 

18          settings.

19                 The IM is a proprietary instrument 

20          that was developed by Partners Health Plan.  

21          There's no requirement -- I believe we waived 

22          a requirement for care coordinators to use 

23          that tool as a response to COVID.  Now it is 

24          an optional tool that can be used by care 


 1          coordinators if they feel a need is there to 

 2          perform that assessment.  But it's not a 

 3          mandatory part of our assessment portfolio.

 4                 ASSEMBLYMAN BYRNE:  Okay, thank you.

 5                 CHAIRWOMAN WEINSTEIN:  Now to the 

 6          Senate.

 7                 CHAIRWOMAN KRUEGER:  Thank you very 

 8          much.

 9                 Commissioner, I want to thank you for 

10          being with us today.  Clearly you have many 

11          things to put in writing and get back to the 

12          committees with.

13                 And I'm going to call up next the 

14          New York State Office of Alcoholism and 

15          Substance Abuse Services, Commissioner Arlene 

16          Gonz�lez-S�nchez.  

17                 Are you with us, Arlene?

18                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes, I 

19          am.

20                 CHAIRWOMAN KRUEGER:  Oh, there you 

21          are.  Hello.  Good morning --

22                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Hi, 

23          how are you?

24                 CHAIRWOMAN KRUEGER:  Good morning.  


 1          We're on No. 3 for the day, and we're already 

 2          at 2:30, for those of you keeping score.

 3                 Thank you.  Ten minutes on the clocks, 

 4          please.

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Great.  

 6          So good afternoon, Senator Krueger, 

 7          Assemblymember Weinstein, Senator Harckham, 

 8          Assemblymember Steck, and distinguished 

 9          members of the Senate and Assembly.  My name 

10          is Arlene Gonz�lez-S�nchez, and I am the 

11          commissioner of the New York State Office of 

12          Addiction Services and Supports, better known 

13          as OASAS.  

14                 Thank you for providing me with the 

15          opportunity to present Governor Cuomo's 

16          fiscal year 2022 Executive Budget as it 

17          pertains to OASAS.  

18                 Under Governor Cuomo's leadership, 

19          OASAS has taken significant steps to improve 

20          access to addiction treatment, develop new 

21          and innovative models, and expand services in 

22          communities throughout New York State.  

23                 The Executive Budget proposal allows 

24          OASAS to maintain these services and our 


 1          entire comprehensive system of prevention, 

 2          treatment, and recovery programming.  The 

 3          budget appropriates $919 million for OASAS 

 4          programs, which includes $147 million for 

 5          state operations, $90 million for capital 

 6          projects, and $682 million for Aid to 

 7          Localities.  This reflects an increase of $94 

 8          million from fiscal year 2021, which 

 9          primarily reflects additional Substance Abuse 

10          Prevention and Treatment block grant funds 

11          that we expect to receive from the federal 

12          government as part of the COVID-19 Relief 

13          Act.  

14                 The Executive Budget includes an 

15          increase in minimum wage funding for OASAS 

16          providers.  In addition, it supports OASAS' 

17          commitment to expanding access to residential 

18          addiction treatment services through capital 

19          investments for community organizations.  As 

20          a result of these efforts, more than 160 new 

21          residential treatment beds are expected to 

22          open by the end of fiscal year 2022.  

23                 Although the times pose numerous 

24          challenges for all of us, the Executive 


 1          Budget continues Governor Cuomo's commitment 

 2          to OASAS' many essential programs and 

 3          services.  These include critical treatment 

 4          and recovery initiatives such as mobile 

 5          treatment, recovery centers, and youth 

 6          clubhouses; expanding access to 

 7          medication-assisted treatment; increasing the 

 8          number of Certified Peer Recovery Advocates; 

 9          and providing training in the use of Naloxone 

10          in our ongoing effort to combat the opioid 

11          crisis.  

12                 The pandemic required swift action 

13          across the OASAS continuum of care, and our 

14          providers responded immediately.  They 

15          rapidly expanded telepractice and mobile 

16          treatment services, modified inpatient and 

17          residential treatment to ensure social 

18          distancing and proper infection controls, and 

19          expanded take-home dosing of 

20          medication-assisted treatment to protect our 

21          most vulnerable population.  Throughout the 

22          emergency and continuing today, access to all 

23          levels of treatment remain safe and 

24          available.  


 1                 Our recovery centers had over 41,000 

 2          contacts with individuals, and made 4,011 

 3          referrals, of which 95 percent resulted in 

 4          engagement in treatment.  

 5                 The OASAS prevention providers will 

 6          continue services, despite the closure of 

 7          many school buildings and the inability to 

 8          have any community-based social gatherings.  

 9          These providers, like treatment and recovery 

10          providers, are providing virtual services 

11          wherever possible.  

12                 In 2022, OASAS will continue its 

13          public education and social media campaigns 

14          to make sure that people who need help know 

15          where to access it.  Our campaigns address 

16          stigma, they raise community awareness about 

17          addiction, they highlight particular concerns 

18          related to the dangers of social isolation 

19          for individuals with addiction, and they 

20          ensure New Yorkers know treatment is 

21          available.  

22                 The Executive Budget also includes 

23          several legislative proposals to enhance 

24          prevention, treatment, and recovery services.  


 1          The Governor is proposing a comprehensive 

 2          strategy to expand telehealth.  This plan 

 3          will authorize additional staff in OASAS 

 4          programs, including peers to deliver 

 5          telehealth services and allow services to be 

 6          delivered in non-clinical settings.  

 7                 In addition, the Governor is proposing 

 8          the integration of OASAS and the OMH into a 

 9          new Office of Addiction and Mental Health 

10          Services.  This new agency will better serve 

11          those in need, by allowing for the delivery 

12          of SUD and mental health services in a more 

13          coordinated and unified system of care.  

14                 The budget also authorizes the 

15          creation of Comprehensive Outpatient Services 

16          Centers, which will be implemented by a 

17          single joint regulation issued by OASAS, OMH 

18          and DOH.  This comprehensive license will 

19          allow providers to deliver a full continuum 

20          of primary care, SUD and mental health 

21          services.  

22                 And to protect New Yorkers from 

23          predatory practices, the Governor proposes a 

24          bill that builds on the existing authority of 


 1          OASAS to credential individuals who provide 

 2          services to those suffering or at risk for an 

 3          addiction.  The proposal also would allow 

 4          OASAS to create a publicly available list of 

 5          authorized addiction professionals, to help 

 6          individuals and families make informed 

 7          decisions when choosing a practitioner.  

 8                 So as we continue to manage the system 

 9          of addiction treatment, recovery, and 

10          prevention, our number-one priority is to 

11          remain vigilant about the health and safety 

12          of the vulnerable populations we serve.  The 

13          budget will support funding for all of the 

14          critical initiatives I discussed and allow 

15          OASAS to meet the needs of those we serve.  

16                 I look forward to working with you as 

17          we continue striving to help all those who 

18          have been impacted by addiction throughout 

19          New York State.  

20                 Thank you so much.  

21                 CHAIRWOMAN KRUEGER:  Thank you very 

22          much, Commissioner.

23                 To start us off, chair of the 

24          Substance Abuse and Treatment Committee, 


 1          Pete Harckham.

 2                 SENATOR HARCKHAM:  Thank you, 

 3          Madam Chair.  

 4                 Commissioner, terrific to see you.  

 5                 First off, I want to thank you and 

 6          your entire team for the heroic work that you 

 7          do.  Many of us believe you've been 

 8          underfunded for years, and you and your 

 9          colleagues do a tremendous job.  

10                 I also want to thank you personally 

11          for being so accessible to me and my staff as 

12          we work collaboratively together.  So thank 

13          you.

14                 I have a bunch of questions, so we'll 

15          hop right into them.  This budget has some 

16          good things, it has some bad things.  So 

17          we'll start with the bad things and then 

18          we'll go to the good things.

19                 This was a very challenging year for 

20          our providers.  As we know, we had a 

21          substance use disorder and opioid use 

22          disorder crisis before the pandemic.  We 

23          asked them to make big investments in 

24          technology as they shifted their model.  


 1          Their revenues declined; there was a 

 2          20 percent withholding.  So they've had a 

 3          really tough year.  In fact, a study that the 

 4          industry did said 80 percent of them are 

 5          considering layoffs or curtailing programs 

 6          next year.  

 7                 And yet in the State Executive Budget 

 8          we're looking at a $13 million cut to the 

 9          bottom line, 5 percent shaved to local 

10          programming -- you know important things like 

11          elimination of the AIDS/HIV Early 

12          Intervention program, jail-based treatment, 

13          COLA.  

14                 What is the rationale for this, and 

15          what's your plan to remediate some of the 

16          pain that this is going to cause?

17                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  So 

18          first and foremost, the 5 percent across the 

19          board does not impact OASAS.  It does impact 

20          OMH and OPWDD, but not OASAS.  So that's good 

21          news.

22                 With respect to the 13.3 million in 

23          cuts, that includes 3.5 million from member 

24          items -- I would call them member items -- 


 1          that the Legislature puts in every year.  And 

 2          going into the year, we know that these are 

 3          only one-year items, so it's to be expected 

 4          that it's only for one year.  And the rest is 

 5          the 11.5 in, you know, savings that we have 

 6          to come up with, just like any other state 

 7          agency, given the fiscal climate that we're 

 8          facing in the state.

 9                 What I do want to say is that those 

10          targets, or those 11.5, none of those things 

11          will impact to the extent that services will 

12          be cut down.  Some of those would be 50 

13          percent cuts, and those cuts will be able to 

14          be either absorbed by the provider through 

15          billing of Medicaid or will have already been 

16          implemented.  

17                 For example, one of the items that we 

18          cut 50 percent is the day rehab.  We have 36 

19          day rehab providers throughout the state.  

20          Only five of them get state aid.  But that's 

21          a Medicaid billable service, and we are only 

22          cutting them by 50 percent, so the thinking 

23          is that they will be able to use billing and 

24          not have to use our state aid.


 1                 Similarly --

 2                 SENATOR HARCKHAM:  Can I cut you off, 

 3          just in the sake of time, because I have a 

 4          lot more questions.

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I'm 

 6          sorry.

 7                 SENATOR HARCKHAM:  Let's talk about 

 8          something positive.  Thanks to the advocacy 

 9          of a lot of folks on this Zoom, patient 

10          advocates, treatment providers, we're looking 

11          at, through Senator Schumer, the possibility 

12          of a substantial block grant increase, which 

13          you mentioned.  

14                 What is your specific plan to use that 

15          money?  Are there federal restrictions?  And 

16          how soon can you get that money out the door?

17                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  So we 

18          haven't gotten the official notification on 

19          the grant.  We do assume we will be getting 

20          it anytime soon.  I don't have the actual 

21          criteria or parameters of the grant.  I just 

22          know they will be similar to the grants we've 

23          gotten before.  

24                 But one thing I do want to make clear 


 1          is that the monies have to be used for 

 2          treatment, prevention or recovery and it 

 3          cannot be used to supplant any fundings that 

 4          we have currently.  And so we plan -- 

 5                 SENATOR HARCKHAM:  That's the key 

 6          phrase:  Not supplant, supplement.

 7                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Right.  

 8          Right.  You can't supplant, you know, 

 9          existing funding with grant dollars.  And so 

10          I assume that that will be the same criteria 

11          moving forward, and we will use this money, 

12          moving forward, to address the treatment, 

13          prevention and recovery needs that we have in 

14          our system.

15                 SENATOR HARCKHAM:  All right.  That's 

16          good news to hear.  Supplement, not supplant.

17                 Let's move on to the merger, if we 

18          can.  I personally think the merger of OASAS 

19          and OMH is a step forward -- better 

20          coordination, better to deal with 

21          co-occurring disorders, better to deal with 

22          the dual licensing, better to deal with the 

23          dual funding streams, and certainly it 

24          creates a larger entity to better advocate 


 1          for funding and programs across the 

 2          behavioral health spectrum on both sides of 

 3          the ledger.  

 4                 Patient advocates and providers, 

 5          though, are nervous about really having a 

 6          seat at the table and that treatment-specific 

 7          modalities such as CASACs, peers, things like 

 8          that, will not be lost in creating kind of a 

 9          "one size fits all" agency.  Could you 

10          comment on your approach to the merger?

11                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Sure.  

12          So to begin with, I agree that this is a 

13          great opportunity to streamline our processes 

14          to better address the needs of the population 

15          that we serve, the dual population.  And I 

16          think this is a great opportunity to do that.

17                 There's a bill that's being proposed 

18          that speaks specifically to the licensure 

19          piece.  And in it -- it's really supporting 

20          and ensuring that the CASACs and other 

21          professionals licensed through the OASAS 

22          system will stay in place as we move forward 

23          into the merged entity.  And if it's not the 

24          merged entity, we're still going to move 


 1          forward with that to ensure that these 

 2          licensures and these individuals are still 

 3          part of our continuum.

 4                 SENATOR HARCKHAM:  And will you have 

 5          some sort of an advisory group with patient 

 6          advocates and treatment providers at the 

 7          table every step of the way?

 8                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  

 9          Absolutely.  Sure.

10                 SENATOR HARCKHAM:  Okay.  Let's shift 

11          over now to the ombudsman program, something 

12          that we've worked collaboratively to build 

13          out.  We know that there's been a gap in 

14          certain geographic areas for the 

15          community-based providers of that program.  

16          So last year we established the Parity 

17          Compliance Fund dealing with insurance 

18          penalties for folks not complying with 

19          parity.

20                 How much is in that fund, and are we 

21          expanding the scope of those community-based 

22          organizations this year?

23                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes, 

24          we are expanding the scope.  


 1                 And with respect to fines, nothing has 

 2          been levied to date.  But I just want to 

 3          remind you that DOH and DFS recently released 

 4          the criterias.  And we're currently right now 

 5          evaluating the responses from the various 

 6          managed-care entities to evaluate whether 

 7          they're in compliance or not.  If they're 

 8          not, then those fines will be levied and it 

 9          will go into the fund.

10                 SENATOR HARCKHAM:  Okay.  We have 

11          about a minute and a half.  Would you address 

12          in more detail the plan on the Part DD 

13          single-rate methodology?  We know that 

14          billing, billing, billing has always been a 

15          challenge, especially when trying to deal 

16          with someone holistically from separate 

17          funding streams.  So please address that.

18                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

19          don't know how much of that I could address 

20          at this point other than to say that we are 

21          actively looking at that, and especially now 

22          as we look at this possible merger, to better 

23          -- better make responses.  I really couldn't 

24          tell you in more details about that.


 1                 SENATOR HARCKHAM:  All right.  If we 

 2          can stay in touch on that, that would be 

 3          helpful.

 4                 I'm going to ask you a question now -- 

 5          if you don't get to the answer because we run 

 6          out of time, I'll come back for five minutes 

 7          in the second round.  But this is a big deal 

 8          in that we're midst of a surge in opioid 

 9          overdoses, many of them fentanyl-based.  And 

10          the way we know it is through national data 

11          and the data of a few specific counties and 

12          the anecdotal evidence of providers and first 

13          responders.  

14                 We don't know it from state data 

15          because the most recently available data on 

16          the State Department of Health website -- and 

17          I know that's not you -- is from 2018.  Have 

18          you spoken with them on the need for current 

19          data -- we know we can do it with COVID -- so 

20          that you can better respond to this crisis?  

21                 I think my time is out, but maybe in 

22          my next round, in my five minutes, if you 

23          could address that.  Thank you.

24                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Sure.


 1                 CHAIRWOMAN KRUEGER:  Great.  Thank 

 2          you.  Assembly.  

 3                 CHAIRWOMAN WEINSTEIN:  So we go to 

 4          Assemblyman Steck, chair of our Alcoholism 

 5          and Drug Abuse Committee.  

 6                 ASSEMBLYMAN STECK:  Thank you very 

 7          much, Chairwoman Weinstein.

 8                 I also want to thank Senator Harckham 

 9          for his excellent job identifying some of 

10          these --

11                 CHAIRWOMAN WEINSTEIN:  Excuse me one 

12          minute, Phil.  

13                 This is the chair of the committee.  

14          He gets 10 minutes.

15                 ASSEMBLYMAN STECK:  I'm not used to 

16          that much time in my entire life, so thank 

17          you.  

18                 (Laughter.)

19                 ASSEMBLYMAN STECK:  So I wanted to 

20          talk first about one of the cuts that I just 

21          am having a difficult time understanding, and 

22          that is the executive proposes a 50 percent 

23          reduction in funding for jail-based substance 

24          use disorder treatment programs, resulting in 


 1          a decrease of 1.9 million.  

 2                 We've made tremendous headway in terms 

 3          of trying to take advantage of the 

 4          opportunity to give drug treatment to people 

 5          who are in jail, many of whom have mental 

 6          health and drug-related issues.

 7                 What is the rationale for a 50 percent 

 8          cut in this program?

 9                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  So, 

10          Assemblymember, thank you so much for that 

11          comment, question.

12                 You know all of the things we have put 

13          forth are very difficult.  You know, this is 

14          a very difficult year.  And for some of us, 

15          given the populations we serve, it becomes 

16          even more difficult.  Right?  

17                 So with respect to the jail-based, 

18          you're absolutely correct, it was a 

19          50 percent reduction.  Bear in mind that 

20          through the different, you know, bail reforms 

21          and other, you know, regulations that went 

22          into place, or changes that came into place, 

23          the numbers in the jails are not what it was 

24          when we first initiated these dollars to go 


 1          into the jails.

 2                 We -- we didn't just decide overnight.  

 3          We've really evaluated the numbers that are 

 4          now reporting to the jails, how many people 

 5          are there.  And we felt that once we did the 

 6          analysis, the dollars really have somewhat 

 7          rightsized, for now, the people that they are 

 8          serving.  And we're very confident that the 

 9          services will still continue to be delivered 

10          to these individuals.

11                 I have to agree, I'm the first one 

12          that supports this initiative.  I mean, this 

13          is what we want.  And I do not anticipate 

14          this is going to, you know, diminish our 

15          ongoing services to the folks in the jails.

16                 ASSEMBLYMAN STECK:  Well, I certainly 

17          appreciate your theory behind that cut, but 

18          it's very difficult to imagine that it would 

19          justify a 50 percent reduction.

20                 In the money that is supposed to be 

21          coming from the federal block grant -- first 

22          of all, my understanding is that is money 

23          that has not been delivered, that that is 

24          money that is just in theory going to be 


 1          delivered, and that the actual amount of that 

 2          SAPT block grant that OASAS would receive has 

 3          not yet been determined.  Is that correct?

 4                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  

 5          Correct.  You're correct.

 6                 ASSEMBLYMAN STECK:  So do you know 

 7          what OASAS treatment programs that money 

 8          would be headed to if in fact we receive it?

 9                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Okay.  

10          So it's -- we haven't -- I couldn't sit here 

11          and say to you we're going to allocate this 

12          one, that one, because we still have to wait 

13          to see what the criteria of the grant is.  I 

14          don't know if there are going to be 

15          additional set-asides that's going to require 

16          us to put monies aside for certain services, 

17          like prevention versus treatment versus 

18          recovery.  

19                 But all I could tell you that we are 

20          going to -- we have already been looking at 

21          where there may be some gaps in our system or 

22          where there are areas that we need to, you 

23          know, implement additional services.  And 

24          that's how we're going to do it, of course 


 1          always involving our constituents to get, you 

 2          know, advice from them and bringing them into 

 3          the process.

 4                 ASSEMBLYMAN STECK:  So, for example, 

 5          you would not be able to tell me right now as 

 6          you sit here whether in fact some of that 

 7          money could be used to eliminate that 50 

 8          percent reduction in the jail-based program.

 9                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

10          couldn't.  It could, but I couldn't tell you 

11          for sure.  And --

12                 ASSEMBLYMAN STECK:  There's a couple 

13          other cuts that I think might be appropriate 

14          to reverse if that were -- money were 

15          available.  One is the decrease in the HIV 

16          Early Intervention services.

17                 Again, the funding for public health 

18          has gone down tremendously in the last 

19          40 years.  And simply because this may not be 

20          as hot a topic as COVID, if we don't put 

21          money into it, it will come back.  I just 

22          finished reading the 620-page book on The 

23          Coming Plague, and one of the things that's 

24          identified and discussed is how HIV has 


 1          spread due to lack of public investment.

 2                 So do you think it might be possible 

 3          for some of the federal dollars to go into 

 4          reversing that cut?

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  And so 

 6          I'm going to check to be absolutely sure, but 

 7          I do want to let you know that my -- my 

 8          thinking is that the Department of Health has 

 9          taken oversight over the HIV Early 

10          Intervention.  So it's not that -- we took it 

11          out of our side because DOH is embracing this 

12          new program now.

13                 So it's not that we're really cutting 

14          it from -- it's no longer going to be under 

15          our jurisdiction.

16                 ASSEMBLYMAN STECK:  So I'm running out 

17          of time already, shockingly.

18                 So there are two funds that I want to 

19          talk about for the last few minutes that I 

20          have.  One is the opioid surcharge or tax 

21          that the Governor announced to much fanfare.  

22          Is that money going to treatment programs, or 

23          was it -- first of all, is it going to OASAS 

24          at all?  That's the question.


 1                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  You 

 2          know, there are so many different surcharges 

 3          and opioid surcharges and settlements going 

 4          on.  I can't really speak to that right now.  

 5          I am not sure where the opiate surcharge is 

 6          going.

 7                 ASSEMBLYMAN STECK:  So I understand 

 8          your answer.  And in the interests of time, 

 9          let me interrupt.  We really need to get an 

10          accounting of where that's going.  One of the 

11          problems is that if the money -- again, the 

12          Governor announced this to much fanfare.  It 

13          was supposed to be to treat people because 

14          the opioid manufacturers have engaged in 

15          skullduggery, it was supposed to be given 

16          back for drug treatment.  And if that's not 

17          being -- happened, or it's going to opioid 

18          treatment but the General Fund monies that 

19          were going to opioid treatment were being 

20          taken back, it's really not consistent with 

21          what was represented.

22                 And something in the same category 

23          that I want to ask you about is, is the 

24          opioid settlement money -- which is similar 


 1          in nature -- going to OASAS?  Is it being 

 2          used for programs, or is it being used as a 

 3          device to make sure less money from the 

 4          General Fund goes to treatment programs?

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yeah.  

 6          So with the surcharge, I know that there is 

 7          language that the anticipation is that some 

 8          of the dollars will be used for OASAS 

 9          prevention, treatment and recovery.  I can't 

10          speak to definitively how much that is or 

11          where is it.  I really can't.

12                 With the settlement money, it's the 

13          same thing.  I think that's still in 

14          discussion.  I think that some things are 

15          still in litigation.  So I really can't speak 

16          with any certainty about where it's going, 

17          where it is.  You know, I'm not trying to be 

18          evasive, I just --

19                 ASSEMBLYMAN STECK:  Well, I mean, I do 

20          think, though -- I appreciate your good 

21          faith.  You know, we've met and we've talked, 

22          so I get that aspect of it.  

23                 But unfortunately, we do need an 

24          answer to these questions regarding these two 


 1          important sources of funding.  So if you 

 2          could subsequently supplement your testimony 

 3          with an accounting as to what is happening, 

 4          where those monies are, are they being used 

 5          simply to, you know, reduce the amount of 

 6          General Funds that go to OASAS.  

 7                 Because our goal here, and I thought 

 8          the goal of those two programs, was to 

 9          increase the amount of money that was going 

10          to deal with the opioid crisis, which is in 

11          fact a crisis.  So we hope you'll follow 

12          through on that.  And if not, our committees 

13          certainly will.  

14                 Thank you very much, Commissioner.

15                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Thank 

16          you.  I -- okay.

17                 CHAIRWOMAN WEINSTEIN:  Thank you.

18                 We go to the Senate now.

19                 CHAIRWOMAN KRUEGER:  You know, we just 

20          have our chair for a second round, so let's 

21          let the Assemblypeople complete theirs and 

22          then we'll go to our chair again.

23                 CHAIRWOMAN WEINSTEIN:  Okay.  So we 

24          have our ranker, Assemblyman Brown, five 


 1          minutes.

 2                 ASSEMBLYMAN BROWN:  Can everybody hear 

 3          me?

 4                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.

 5                 ASSEMBLYMAN BROWN:  Okay, great.  

 6                 Thank you, Commissioner 

 7          Gonz�lez-S�nchez.  I really appreciate the 

 8          opportunity to speak with you.  I was 

 9          appointed to the Committee on Alcoholism and 

10          Substance Abuse.  It's something that I have 

11          a personal interest in, very much so, and I 

12          look forward to working with you in the 

13          future.  But I just wanted to introduce 

14          myself, number one, and get right into the 

15          questions.

16                 With regard to the integration of 

17          OASAS with the new Office of Mental Health, 

18          is there a cost savings that's involved with 

19          that?  And if so, do you know what it is?

20                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  No, 

21          there is no cost savings.  The intent of this 

22          integration was for better care and delivery 

23          of services.  It was never meant to have a 

24          cost savings at all.  


 1                 You know, if there's savings in the 

 2          near future, I guess that that will be 

 3          addressed at that point in time.  But that's 

 4          not what has driven this integration piece.

 5                 ASSEMBLYMAN BROWN:  Okay.  And are 

 6          there going to be any layoffs or terminations 

 7          as a result of the merger?

 8                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Not 

 9          that I am familiar with, and not that I could 

10          see from the way, you know, the legislation 

11          is being drafted.

12                 ASSEMBLYMAN BROWN:  Okay.  And how 

13          about will it impact at all any federal funds 

14          that OASAS receives?

15                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  It 

16          should not, because the federal funds are 

17          just that, and they have specific criteria.  

18          And as we develop regulations under this new 

19          entity, those are some of the things that 

20          will need to be addressed within the 

21          regulations that we develop for the new 

22          entity.

23                 So I don't anticipate that will be a 

24          problem.  But it is something that needs to 


 1          be worked out once we get there.

 2                 ASSEMBLYMAN BROWN:  And specifically, 

 3          how do you envision, as commissioner, that 

 4          this merger will help deliver services to 

 5          people struggling with alcoholism and 

 6          substance abuse?

 7                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Well, 

 8          you know, too long we see that people are 

 9          going back and forth.  There's a percentage 

10          of individuals that suffer from both 

11          illnesses, regardless of which one came 

12          first, and they usually go in and out, 

13          recidivism, you know, a vicious circle.  They 

14          go in for mental health, they get depressed, 

15          then come back out, they start -- so the idea 

16          here is to have no wrong door.  You know, 

17          where an individual who comes in who has both 

18          of these disabilities or illnesses could be 

19          addressed in one whole person, rather than to 

20          be asking the individual, who's usually at 

21          their most vulnerable time, to go first into 

22          one system, get your mental health in place, 

23          if that's possible, and then go to the 

24          addiction side and get your -- you know.  


 1                 The idea is to really be 

 2          patient-centered, be comprehensive, and 

 3          deliver both cares at the same time for the 

 4          individual.

 5                 ASSEMBLYMAN BROWN:  Are there any 

 6          downsides that have been identified?  And 

 7          what I'm speaking about specifically is in 

 8          the SAGE Commission report in 2011, did they 

 9          identify any downside to a potential 

10          integration?

11                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

12          think back then there were other concerns in 

13          place.  You know, funding.  You know, what 

14          does that mean, is one side going to lose 

15          funding, is the other one going to absorb the 

16          funding.  I think there were concerns along 

17          those lines.  

18                 And is one entity, since it's bigger, 

19          going to, you know, take over the other 

20          entity.  That is why this is not a merger, 

21          this is the creation of a brand-new 

22          department.  It's not one department taking 

23          other another, it's adapting the best of both 

24          parts to create this comprehensive, 


 1          integrated department to better address the 

 2          needs of the dual population.

 3                 So I couldn't speak to -- I'm sure 

 4          some folks may find that there are, you know, 

 5          negatives to this.  But I think people were 

 6          more concerned about budgets.  And like I 

 7          said, all of those things will be addressed 

 8          as we move forward.

 9                 ASSEMBLYMAN BROWN:  I'm sure you're 

10          aware, though, that the budget contains the 

11          prospect of legalizing cannabis in New York 

12          State.  Have you been consulted at all with 

13          the potential impacts on mental health of the 

14          residents of the state in connection with the 

15          prospect of legalizing it?

16                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yeah.  

17          We've been in conversation with the 

18          Department of Health and others, as well as 

19          OMH.  And we've been in discussion, active 

20          discussions of impacts.  

21                 From my stance -- I don't want to 

22          speak for Ann, but from my stance, you know, 

23          the fact that the creation of this department 

24          to monitoring, to have oversight of this 


 1          cannabis program, speaks to, you know, us 

 2          having a much more stringent approach on it.  

 3          And, you know, it's going -- it's better to, 

 4          you know, monitor it.  

 5                 Right now we have people in our system 

 6          that, you know, are actively using, and no 

 7          one has any oversight or monitoring.  So I 

 8          feel comfortable that with this sense of 

 9          oversight, that things will work out.

10                 CHAIRWOMAN WEINSTEIN:  Thank you --

11                 ASSEMBLYMAN BROWN:  specifically --

12                 CHAIRWOMAN WEINSTEIN:  Excuse me.  

13          Excuse me.  Assemblyman, your -- the time has 

14          expired.

15                 ASSEMBLYMAN BROWN:  May I put a 

16          question in writing to the commissioner?  

17                 CHAIRWOMAN WEINSTEIN:  I was just 

18          about to suggest that, that you should send a 

19          question to Assemblyman Ra and we will make 

20          sure that it gets to the commissioner.

21                 ASSEMBLYMAN BROWN:  Very well.

22                 CHAIRWOMAN WEINSTEIN:  So we are now 

23          going to go to the Senate.  I think you have 

24          a -- I saw that Senator Hinchey --


 1                 CHAIRWOMAN KRUEGER:  Thank you very 

 2          much.  

 3                 Senator Michelle Hinchey.

 4                 SENATOR HINCHEY:   Hi.  Thank you very 

 5          much.  

 6                 And Commissioner, thank you for being 

 7          here.  

 8                 I represent Ulster and Greene 

 9          Counties, both of which flip-flop between 

10          being the highest in opioid overdose deaths 

11          each year in New York State.  These are both 

12          largely rural counties with limited hospitals 

13          -- in fact, Greene County doesn't even have a 

14          hospital -- also with limited access to 

15          broadband services.  

16                 This has only gotten worse as the 

17          COVID-19 pandemic has led to increased 

18          isolation.

19                 How can we work to better fight 

20          substance use disorder in these more rural 

21          counties?  And what steps does the budget 

22          take to prioritize services in our 

23          hard-to-reach areas?

24                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  So 


 1          that's a great question as well.  I mean, 

 2          broadband is an issue.  But I think in 

 3          general in the budget, you know, there's a 

 4          process to try to address that.  

 5                 But during the pandemic we realized 

 6          that we have to use very innovative, 

 7          nontraditional means to be able to work with 

 8          people not only in rural areas, but, you 

 9          know, all over the state.

10                 And so, you know, telehealth has been 

11          very much a big issue for us to address needs 

12          in some of the rural areas.  And you may say, 

13          Well, but if you don't have the broadband -- 

14          but that's where telephonics comes in.  And 

15          we've been very proactive and vocal about -- 

16          it's not only telehealth, we need to 

17          envision, you know, telephonics.  

18                 You know, we also have these Centers 

19          of Treatment Innovation -- we call them 

20          COTIs -- where we have mobile capacity.  And 

21          the idea is to go and reach out to these more 

22          rural areas to ensure that we're having -- 

23          we're providing access to individuals that 

24          need it.  


 1                 And so we're going to continue to look 

 2          at how we could do that into the future -- 

 3          you know, continue to mobilize and be more 

 4          receptive to that.

 5                 SENATOR HINCHEY:   Thank you.  I 

 6          appreciate it.  It's a really big deal for 

 7          our communities, and any way we can work 

 8          together to expand those services, I would 

 9          love to do so.

10                 My final question is while our 

11          experience with COVID over the last year has 

12          shown to have the unfortunate impact of 

13          exacerbating alcohol and substance abuse, it 

14          has also pulled back the cover of new ways to 

15          reach people seeking treatment, especially in 

16          terms of the use of virtual platforms and the 

17          anonymity it provides.  

18                 Does OASAS plan on using these virtual 

19          platforms  to encourage and cultivate safe, 

20          non-judgmental spaces for people to seek 

21          treatment going forward, even as the pandemic 

22          hopefully subsides?

23                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes, 

24          absolutely.  You know, the pandemic has shown 


 1          us that there are nontraditional and more 

 2          progressive means of addressing addiction 

 3          than we've ever thought of.  

 4                 And absolutely, we don't want to go 

 5          backwards.  As a matter of fact, we're trying 

 6          to advocate for more flexibility on the 

 7          federal level to implement some of these 

 8          practices that we have seen have been more, 

 9          you know, productive -- telephonics, 

10          telehealth, doing induction of buprenorphine, 

11          you know, virtually.  These are all things 

12          that we want to continue.  

13                 I know we have waivers from the 

14          federal government, but we're going to 

15          continue to push for the feds to really give 

16          us more flexibility, because I think that's 

17          what we need.

18                 SENATOR HINCHEY:   Great.  Thank you 

19          very much.

20                 CHAIRWOMAN KRUEGER:  Thank you.

21                 Assembly.  

22                 CHAIRWOMAN WEINSTEIN:  So we go -- 

23          yes, we go to Assemblyman Byrne, then 

24          Epstein, then Griffin before we go back to 


 1          the Senate.

 2                 ASSEMBLYMAN BYRNE:  Can you hear me?

 3                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.

 4                 ASSEMBLYMAN BYRNE:  Thank you, 

 5          Commissioner.  This was asked by one of my 

 6          colleagues earlier, but I want to just 

 7          elaborate on it a little bit more.  The 

 8          Jail-Based Substance Use Disorder Treatment 

 9          and Transition Services, which was previously 

10          funded at $3.75 million, had a 50 percent 

11          reduction, lowering it in the Executive's 

12          budget proposal by 1.9 -- or to $1.9 million.  

13          Is that correct?

14                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.  

15          Hold on one second.  My -- my computer is 

16          going off.

17                 (Discussion off the record.)

18                 ASSEMBLYMAN BYRNE:  Chair, do you mind 

19          just upping the clock?

20                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Oh, 

21          I'm sorry.  Okay, sorry.  I'm sorry.  

22                 So you asked me if -- 

23                 ASSEMBLYMAN BYRNE:  The Jail-Based 

24          Substance Use Disorder Treatment and 


 1          Transition Services Program, cut in half from 

 2          $3.75 million to $1.9 million.  I want to 

 3          confirm that was correct.

 4                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.

 5                 ASSEMBLYMAN BYRNE:  And I know you 

 6          mentioned earlier, you referenced some of the 

 7          changes in the law -- namely, bail reform -- 

 8          for a reduced prison population in our county 

 9          jails as part of the cause for that.

10                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes, 

11          absolutely.

12                 ASSEMBLYMAN BYRNE:  Is it not also 

13          correct that county governments apply for 

14          this funding, it's not automatic to county 

15          governments, correct?

16                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I'm 

17          not sure what that is.  I know that county 

18          government advocated for this money.  

19                 We, together with the county and the 

20          local jails, determined how the money was 

21          going to be allocated, based on their needs 

22          and their ability and willingness to do this 

23          program --

24                 ASSEMBLYMAN BYRNE:  Thank you, 


 1          Commissioner.  I apologize for interrupting, 

 2          but I have a limited amount of time.  I just 

 3          want to make sure I get my point across to 

 4          advocate for this.

 5                 I do believe there's definitely still 

 6          need.  And when we look at the prison 

 7          population -- and I know you're passionate 

 8          about this too, and I don't doubt that for a 

 9          second.  But we can't look at these people 

10          just as simply numbers, because the need for 

11          the people suffering from addiction is very, 

12          very real.  

13                 And I wanted to bring this up because 

14          there is a constituent in Putnam County, 

15          Nancy Bruno, who lost her son, Chris Bruno, 

16          back in 2019.  And when your back is against 

17          the wall -- and it's a shame in our state and 

18          society that this is -- in some ways, it's 

19          the last opportunity to try to get someone 

20          help:  It was getting her son into jail to 

21          get services.  

22                 And when he was in Putnam County Jail, 

23          he actually got tremendous services, he 

24          attended Bible study, AA, got services.  He 


 1          was released from the county jail on July 8th 

 2          and died on July 10th.  

 3                 And it's tragic, but we need to 

 4          know -- like at least acknowledge that the 

 5          services in that county jail were extremely 

 6          important and we shouldn't be cutting it 

 7          back, we should actually be expanding it.  

 8                 And I wanted to make sure that I got 

 9          that point across that we could actually try 

10          to bring that back up, bring it back to at 

11          least where it was.  In our body, in the 

12          Assembly and the Senate, we should seriously 

13          be talking about expanding it so when these 

14          people leave the correctional facility, 

15          they're not just put back in the same 

16          situation and we give them other alternative 

17          pathways to recovery and help.

18                 Thank you.

19                 CHAIRWOMAN WEINSTEIN:  Thank you.  

20                 We go to Assemblyman Epstein, three 

21          minutes.

22                 THE MODERATOR:  I don't know if he's 

23          with us.  I'm asking him to unmute, but -- 

24                 (Pause.)


 1                 CHAIRWOMAN WEINSTEIN:  So then let's 

 2          go to Assemblywoman Griffin for three 

 3          minutes.

 4                 ASSEMBLYWOMAN GRIFFIN:  Okay, thank 

 5          you.

 6                 Good afternoon, Commissioner 

 7          Gonz�lez-S�nchez.  I am -- I have two 

 8          questions, so I'll ask them and then I'll ask 

 9          if you can respond, time permitting.  

10                 I am deeply, deeply concerned about 

11          the many proposed cuts to many essential 

12          programs that OASAS sponsors.  I represent 

13          Southwestern Nassau County, where the opioid 

14          epidemic is significant and on the rise.  And 

15          this is a time we should be providing more 

16          services and not less services.  

17                 So my first question is, how will 

18          OASAS compensate if these proposed cuts 

19          become permanent?  And then my other question 

20          is if marijuana is legalized, what plan does 

21          OASAS have in place to provide awareness 

22          about driving under the influence, health 

23          concerns, especially due to COVID -- smoking 

24          marijuana can exacerbate COVID symptoms -- 


 1          and addiction?  

 2                 So I just wondered if you can answer 

 3          those two questions.

 4                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I'll 

 5          try to do them quickly.

 6                 So the cuts that have been -- or the 

 7          savings that have been put forth, they're 

 8          not -- they're not terminating altogether any 

 9          services.  And so it's been very tough, I 

10          can't sit here and say it was easy to do 

11          this.  It wasn't.  But we've tried to 

12          minimize it to the best of our ability.

13                 And so as always, we will continue to 

14          work with our providers.  None of the 

15          providers will go out of business per se, and 

16          we will continue to support them to the best 

17          of our ability given, you know, whatever 

18          funding we get.

19                 With respect to the marijuana, we are 

20          already looking at, you know, best practices 

21          from other states that have already legalized 

22          it, and we plan to do a very aggressive 

23          campaign, similar to what we did years ago 

24          with underage drinking, to ensure that people 


 1          are aware and know more about cannabis and so 

 2          on and so forth.

 3                 ASSEMBLYWOMAN GRIFFIN:  Okay, thank 

 4          you very much.

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Sorry.

 6                 ASSEMBLYWOMAN GRIFFIN:  That's okay.

 7                 CHAIRWOMAN WEINSTEIN:  So I think we 

 8          go back now to the Senate for the second 

 9          round.

10                 CHAIRWOMAN KRUEGER:  Thank you.

11                 ASSEMBLYMAN EPSTEIN:  Hi, sorry about 

12          that.  I -- sure.

13                 CHAIRWOMAN KRUEGER:  Hello, am I on?

14                 ASSEMBLYMAN EPSTEIN:  Can you hear me?

15                 CHAIRWOMAN WEINSTEIN:  Yes, we can 

16          hear you.

17                 CHAIRWOMAN KRUEGER:  Okay, thank you.  

18          Back to me, or do we want to go to Harvey?  

19          What do you prefer, Helene?  

20                 CHAIRWOMAN WEINSTEIN:  Harvey, you're 

21          here now?

22                 ASSEMBLYMAN EPSTEIN:  Yeah, I'm here.

23                 CHAIRWOMAN WEINSTEIN:  Okay.

24                 ASSEMBLYMAN EPSTEIN:  Can I go?  Can I 


 1          go, Helene?

 2                 CHAIRWOMAN KRUEGER:  Sure.

 3                 CHAIRWOMAN WEINSTEIN:  Yes.  Next time 

 4          please let me know if you're going to be 

 5          missing, because according to our protocol, 

 6          if you're not here when your name is called, 

 7          we don't go back.  But go ahead.  

 8                 ASSEMBLYMAN EPSTEIN:  Okay, sorry.  

 9          Yeah, I'm sorry, I just got up for a second.  

10          Yeah, I'm here.

11                 So, Commissioner, I just have a 

12          question about the opioid in prisons.  In 

13          2019, what was the prison population.

14                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

15          don't have that number off --

16                 ASSEMBLYMAN EPSTEIN:  Do you know in 

17          2020 what the prison population was?

18                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

19          don't have those numbers off the top, I'm 

20          sorry.

21                 ASSEMBLYMAN EPSTEIN:  Because you said 

22          you reduced a program by 50 percent because 

23          you said there was a substantial reduction in 

24          the prison population.  What was that?


 1                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  In -- 

 2          not prison, in the jails, New York State 

 3          jails.

 4                 ASSEMBLYMAN EPSTEIN:  The jail 

 5          population, yeah.

 6                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Okay.  

 7          And DCJS did some -- they're the ones that 

 8          actually covered this.  And my understanding 

 9          is that recently it went down by 35 percent, 

10          the jail population went down by 35 percent.

11                 ASSEMBLYMAN EPSTEIN:  And you know the 

12          jail population's gone back up this year, 

13          right?

14                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

15          couldn't speak to that.  I don't have that 

16          data right here.

17                 ASSEMBLYMAN EPSTEIN:  I'm just 

18          wondering, you're proposing a 50 percent cut 

19          in your program that affects people who are 

20          in jails when we've seen a huge -- you know, 

21          we see a huge problem in those and we see a 

22          program that's really productive and 

23          effective.  

24                 I'm just wondering, if we don't see a 


 1          real decline in the population and we don't 

 2          see a decline in people who have addiction 

 3          issues -- we've probably seen an increase 

 4          during COVID -- I'm wondering -- I just still 

 5          don't understand the rationale you gave to 

 6          Assemblyman Abinanti about cutting the 

 7          program.  I don't understand it.

 8                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Well, 

 9          like I said, we took into account the 

10          decrease in population in the jails and we 

11          figured that cutting the funding by that 

12          amount, 1.9, was still going to allow the 

13          jails, the local jails, to continue doing the 

14          counseling, the assessments and the referrals 

15          that they're currently doing.

16                 Remember, this money is going to 

17          community-based organizations that are coming 

18          into the jails to do the assessments and the 

19          referrals for this jail population.

20                 You know, I --

21                 ASSEMBLYMAN EPSTEIN:  Commissioner, 

22          let's say your -- I only have a minute left, 

23          but let's say your assumptions are wrong, 

24          that we don't see a decrease, we see an 


 1          increase in opioid usage and we see a huge, 

 2          growing problem which we've seen across the 

 3          country during COVID.  Is this then making a 

 4          problem worse, Commissioner?  

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  We 

 6          haven't seen that right now.  All I can tell 

 7          you is that we will continue to be vigilant.  

 8          And if what you're indicating is accurate, we 

 9          will try to address it as we move forward.

10                 ASSEMBLYMAN EPSTEIN:  I'm going to 

11          encourage you to do that.  Senator Harckham 

12          already raised this issue earlier, that we 

13          don't have good numbers for 2021 or 2020.  

14          But we've seen anecdotally the increases 

15          across the country, an increase in opioid 

16          deaths across the country.  I would hope 

17          you'd reconsider this, knowing that this 

18          could be lifesaving for many New Yorkers who 

19          are behind bars and who really need the help 

20          that they should get from New York State.

21                 Thank you.  My time has expired.  

22          Thank you, Madam Chair, sorry I was not here 

23          earlier.

24                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Thank 


 1          you.  

 2                 CHAIRWOMAN WEINSTEIN:  Sure.  

 3                 Let's go to the Senate.

 4                 CHAIRWOMAN KRUEGER:  So Pete Harckham 

 5          for his five minutes as ranker, second round.

 6                 SENATOR HARCKHAM:  Thank you very 

 7          much, Madam Chair.  

 8                 Commissioner, Assemblyman Epstein was 

 9          a great segue to where we left about the 

10          Department of Health numbers being two years 

11          old.  

12                 Have you spoken with Commissioner 

13          Zucker about this?  And what are they doing 

14          to improve this situation?

15                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  I 

16          really can't speak for DOH.  

17                 What I can tell you is that what we 

18          are doing is we're looking at CDC data, which 

19          is, you know, between six months to maybe a 

20          year old.  And that's the data that we're 

21          currently using with respect to the 

22          overdoses.

23                 You know, I also want to interject 

24          that, you know, this -- you know, overdose 


 1          data is very complicated to gather.  It has 

 2          to go through various entities.  Right?  And 

 3          it takes a while to actually collect and then 

 4          extrapolate and then put into an actual 

 5          report.

 6                 So we're trying the best that we can, 

 7          you know, to work with the localities, the 

 8          local, you know, OMEs, the MEs, and to try to 

 9          get the data so that we are not looking at 

10          things in a vacuum.

11                 SENATOR HARCKHAM:  Yeah.  And again, I 

12          would add that this is not your direct 

13          oversight area, but other states do it on a 

14          monthly basis, and we do COVID numbers on a 

15          daily basis.  I think the Department of 

16          Health can do a lot better than two years.

17                 Another issue that impacts your 

18          services but again is not under your direct 

19          control -- but I'd like you to comment, if 

20          you're comfortable -- is the Office of 

21          Medicaid Inspector General.  

22                 I think we would agree that we want 

23          him to do audits to ferret out abuse and 

24          fraud and outright waste.  But we've seen 


 1          examples where extremely punitive fines have 

 2          been levied for clerical errors.  And there 

 3          is a facility in New York City that had $400 

 4          worth of clerical errors; they were levied a 

 5          withholding of $7.5 million.  They decided to 

 6          close their doors.  We lost 1500 treatment 

 7          slots.  The same thing is happening to a 

 8          provider in upstate New York.  

 9                 So you're jumping through hoops in 

10          your agency trying to create new beds and new 

11          treatment slots, and we have the Office of 

12          the Medicaid Inspector General with these 

13          draconian audits that are causing large 

14          numbers of beds to be lost.  

15                 Is there any coordination going on 

16          there?

17                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.  

18          You know, I have to start off by 

19          acknowledging we're very much aware and we 

20          are in ongoing conversation with OMIG and our 

21          providers around this issue, trying to see 

22          how -- you know, explore ways that we could 

23          adjust this audit, these audits, to make it 

24          more in line with what OMIG has to do -- 


 1          that's their responsibility -- but also 

 2          ensuring that our OTPs are not destabilized 

 3          and will still remain in operation.  We're in 

 4          active discussion along those lines.

 5                 But to the one provider who did close 

 6          shop, I just want to make sure that they 

 7          didn't close all their services.  And 

 8          everyone who was left without that particular 

 9          clinic that they closed down, we found a new 

10          provider.  So nobody was dropped, and nobody 

11          was left without services.  

12                 But I do understand --

13                 SENATOR HARCKHAM:  That does upset the 

14          demand for other people, though.

15                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  We 

16          currently have enough capacity, but I do 

17          understand it's not an issue of capacity, 

18          it's the time, the period and how these 

19          audits are going.  But we are actively 

20          talking with OMIG to see how we could come to 

21          some middle grounds.

22                 SENATOR HARCKHAM:  All right, thank 

23          you.  

24                 In the last 30 seconds could you just 


 1          speak to how successful, or not, the 

 2          scholarship program was that we established 

 3          two years ago, and the demand for that?

 4                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Oh, 

 5          great, thank you so much.  I first have to 

 6          start off by thanking you for that.  It's 

 7          been very successful.  I think it was 

 8          $350,000.  We've used like 275,000.  Which 

 9          shows you that it has been very successful, 

10          not only for individuals but for getting 

11          people into the field to work with our 

12          population.  So it's been very successful.

13                 SENATOR HARCKHAM:  Terrific.  Thank 

14          you very much, Commissioner.

15                 CHAIRWOMAN KRUEGER:  Thank you.

16                 CHAIRWOMAN WEINSTEIN:  Thank you.  We 

17          have an Assemblymember who wants to ask a 

18          question.  So Assemblyman Braunstein.

19                 ASSEMBLYMAN BRAUNSTEIN:  Thank you, 

20          Chair Weinstein.  Can you hear me?

21                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yes.

22                 ASSEMBLYMAN BRAUNSTEIN:  Thank you, 

23          Commissioner.  

24                 My question is -- it's unfortunate 


 1          that we don't have data on overdose deaths 

 2          for the most recent two years.  By all 

 3          indications -- go ahead, you were about to 

 4          say something?

 5                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Yeah, 

 6          I was going to say with respect to the latest 

 7          CDC, which is up to June of 2020, we do have 

 8          data.  And the data indicates that there was 

 9          like 3,500 deaths in that period of time.

10                 ASSEMBLYMAN BRAUNSTEIN:  Is that an 

11          increase over previous years?

12                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  It's a 

13          slight increase, yes.

14                 ASSEMBLYMAN BRAUNSTEIN:  So because of 

15          the increase, it's becoming more and more 

16          common for states -- nine states, most 

17          recently New Jersey, have started requiring 

18          doctors to coprescribe an opioid antagonist 

19          when -- well, like Naloxone, Naloxone, when 

20          prescribing a certain level of opioids.  Have 

21          you considered this as part of your policy 

22          moving forward.

23                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  This 

24          is something that we're currently actively 


 1          talking about.  Yes, we're in the process of 

 2          looking at this.  I'm not sure we have come 

 3          to any conclusion, but yes, we are aware and 

 4          we're looking at this.

 5                 ASSEMBLYMAN BRAUNSTEIN:  Okay.  

 6          because it's something, you know, we're also 

 7          looking at on the Assembly side.  And we're 

 8          exploring -- and obviously it would have some 

 9          financial impact through the Medicaid system, 

10          but we're looking at it.

11                 In the past, the Executive -- 

12          representatives for the Executive had said, 

13          Well, it's just enough that we encourage 

14          doctors to coprescribe, and we don't want to 

15          mandate.  

16                 And I'm just looking at a letter that 

17          my colleague John McDonald recently wrote to 

18          the newspaper -- he's been helping us on 

19          this.  And according to his data, of the 

20          800,000 people in New York State who meet the 

21          definition of at-risk for opioid overdose by 

22          the CDC, only 10,000, or about 1.5 percent, 

23          are also coprescribed Naloxone.

24                 So, you know, the argument that, well, 


 1          we encourage doctors to coprescribe, and we 

 2          think that's enough -- based on this data 

 3          that only 1.5 percent of those at high risk 

 4          are getting coprescribed, I think it's time 

 5          to reassess that argument and consider 

 6          mandating that they coprescribe.

 7                 Okay, thank you for the time.  And I 

 8          hope we could talk moving forward -- you 

 9          know, get an idea of the financial impact.  

10          Obviously that's something to consider as 

11          well.  Thank you.

12                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Okay, 

13          thank you.

14                 CHAIRWOMAN WEINSTEIN:  Thank you.  

15                 We go back to the Senate, to close.

16                 CHAIRWOMAN KRUEGER:  Thank you.  

17                 A couple of the other questions now 

18          drag me into asking you a couple of 

19          questions.  So marijuana, while we're 

20          discussing legalizing it, even within this 

21          budget, possibly, it's the most used drug in 

22          the State of New York in the illegal 

23          category.

24                 So how many of your slots are filled 


 1          with people who have a marijuana addiction?

 2                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  Well, 

 3          we've been looking at that.  I don't have the 

 4          exact number.  But it's very clear that folks 

 5          that are on marijuana should not be filling 

 6          those critical inpatient programs.  This is 

 7          something that could be treated in the 

 8          community, and those beds should really be 

 9          held for those that are more on opioids, 

10          synthetics, much stronger drugs per se.

11                 CHAIRWOMAN KRUEGER:  Thank you.  How 

12          many marijuana deaths do you see each year?

13                 COMMISSIONER GONZ�LEZ-S�NCHEZ:   I 

14          don't -- I don't have that information.  I 

15          will try to look for it.  I don't have it.

16                 CHAIRWOMAN KRUEGER:  So the CDC and 

17          the National Institute on Drug Abuse say 

18          none, because you don't actually die or cause 

19          any long-term physical illnesses from 

20          marijuana use above the age of 21.  

21                 So happily, I think you would find 

22          none, because we probably are consistent with 

23          the rest of the world that way.

24                 And then I also heard -- but I don't 


 1          know if it was a fair question of you, since 

 2          I don't think you're a medical doctor -- 

 3          someone asked you about the dangers of 

 4          marijuana and COVID.  But when I looked, I 

 5          could find no research showing cannabis has 

 6          anything to do with putting you at higher 

 7          risk of COVID or illness with COVID -- in 

 8          fact, just the opposite.  

 9                 Have you heard anything about that?

10                 COMMISSIONER GONZ�LEZ-S�NCHEZ:  No, I 

11          haven't.

12                 CHAIRWOMAN KRUEGER:  But again, that's 

13          not really your field anyway, fair enough?

14                 COMMISSIONER GONZ�LEZ-S�NCHEZ:   

15          That's fair enough.

16                 CHAIRWOMAN KRUEGER:  Thank you very 

17          much.  Thank you.  

18                 I think -- well, if there's no more 

19          Assembly, then I'm going to actually excuse 

20          you and thank you for your time with us 

21          today.  

22                 And now we're going to move to the 

23          New York State Justice Center for the 

24          Protection of People With Special Needs, 


 1          Denise Miranda, executive director.

 2                 And because of the dual 

 3          responsibilities of this agency, both 

 4          Senator Brouk and Senator Mannion and 

 5          Assemblymember Gunther and Assemblymember 

 6          Abinanti are all considered as chairs of the 

 7          relevant committees, and each of them will 

 8          get 10 minutes if they need it.  They don't 

 9          have to use it.  

10                 So I'll first turn it over to Denise 

11          for her 10 minutes of testimony.  

12                 Good afternoon.

13                 EXECUTIVE DIRECTOR MIRANDA:  Good 

14          afternoon.  Good afternoon, Chairs Krueger, 

15          Weinstein, Mannion and Gunther, as well as 

16          other distinguished members of the Senate and 

17          Assembly.  My name is Denise Miranda, and I'm 

18          the executive director of the New York State 

19          Justice Center for the Protection of People 

20          With Special Needs.  

21                 I would like to thank you for the 

22          opportunity to testify regarding Governor 

23          Cuomo's Executive Budget proposal.

24                 Today I come before you on behalf of 


 1          the more than 1 million New Yorkers in care 

 2          with special needs.  The Justice Center's 

 3          work is directed by our steadfast commitment 

 4          to protecting vulnerable people.  

 5                 While it's no surprise that our agency 

 6          has been impacted by the COVID-19 health 

 7          crisis, I want to assure you that our 

 8          commitment has not wavered.  When I appeared 

 9          before the Legislature last year, I spoke 

10          about how I see the relatively young age of 

11          the Justice Center as an advantage.  It 

12          allows us to pivot quickly when circumstances 

13          necessitate change.  This has only been more 

14          evident during this global health crisis.  

15          We're continually evaluating our processes 

16          and exploring ways to operate more 

17          efficiently, while also collaborating with 

18          stakeholders at all levels.  

19                 The role we play in keeping vulnerable 

20          populations safe from abuse and neglect 

21          cannot change, even in the face of COVID-19.  

22          Throughout the pandemic, our call center has 

23          continued taking reports around the clock.  

24          Our team of highly trained investigators has 


 1          worked tirelessly to hold the quality of 

 2          investigations to the highest standard while 

 3          ensuring the safety of everyone involved.  

 4          Our investigators have used telephone and 

 5          video interviewing techniques, when 

 6          appropriate, and followed all health 

 7          guidelines when visiting provider facilities 

 8          to do in-person work. 

 9                 Our advocates have continued victim 

10          advocacy and family support work with 

11          necessary modifications.  Some family members 

12          and individuals receiving services no longer 

13          felt comfortable appearing in person for 

14          interviews.  Our advocates adjusted quickly, 

15          using technology to support these individuals 

16          remotely.

17                 The Justice Center understands that 

18          protecting people from abuse and neglect goes 

19          beyond investigations.  We work towards the 

20          goal of preventing these incidents from 

21          happening.  It is imperative that the global 

22          health crisis not slow this work down.

23                 In 2020 the agency created two new 

24          abuse prevention toolkits for use by 


 1          providers, staff and individuals receiving 

 2          services.  These toolkits are created through 

 3          the analysis of trends in Justice Center 

 4          cases.  One recently released toolkit focuses 

 5          on proper wheelchair securement during 

 6          transport.  The other highlights the benefits 

 7          of global positioning systems in agency 

 8          vehicles.

 9                 GPS allows providers to monitor 

10          vehicles transporting individuals receiving 

11          services and address issues like speeding or 

12          unauthorized stops.

13                 We have also modified processes, where 

14          appropriate, to support providers and the 

15          dedicated workforce.  We all recognize that 

16          the COVID-19 pandemic has brought 

17          unprecedented challenges such as staffing 

18          shortages.  To respond to this challenge, and 

19          under authority granted by an executive 

20          order, we created an expedited background 

21          check process for workers that are not new to 

22          the system of care that is overseen by the 

23          Justice Center.  This allowed providers to 

24          hire staff quickly to fill the gaps without 


 1          compromising the integrity of the service 

 2          delivery system or the quality of our 

 3          background checks.

 4                 The Justice Center also evaluated and 

 5          improved several internal processes during 

 6          2020.  Staff from several units were combined 

 7          to create a more efficient approach to our 

 8          litigation work.  This promotes continuity 

 9          from the launch of an investigation through 

10          appeal, ensuring due process for all parties.

11                 Additionally, we continue to expand 

12          our three-business-day intake model.  The 

13          goal is to more accurately clarify 

14          allegations when they are made, which can 

15          have the added benefit of reducing cycle time 

16          and enhancing the quality of investigations.

17                 While we all recognize the 

18          difficulties experienced this past year, we 

19          have also found that some of our new 

20          processes will be useful when this health 

21          crisis is over.  For example, we implemented 

22          virtual appeal hearings and have found this 

23          to be an efficient way to carry on this work 

24          when in-person appearances are not feasible.


 1                 Further, the remote environment allows 

 2          us to do several different types of 

 3          interviews without the burden of travel.  

 4          These efficiencies will be carried forward as 

 5          mutually beneficial to investigators and 

 6          interviewees alike.

 7                 Finally, we all know the impact of the 

 8          COVID-19 pandemic extended far beyond the 

 9          Justice Center's work.  New Yorkers needed 

10          help from state government in ways never seen 

11          before.  Justice Center staff recognized the 

12          depth of the crisis and stepped up, assisting 

13          with things like unemployment claims, COVID 

14          testing scheduling, and paid family leave 

15          calls.

16                 Last year I closed my remarks by 

17          saying the safety and well-being of the 

18          individuals under our jurisdiction remains 

19          the foundation of everything we do.  That has 

20          certainly taken on new meaning.  The COVID-19 

21          health crisis has challenged the work of 

22          government at all levels, and the 

23          Justice Center is no exception.  But I can 

24          attest that the agency has risen to meet this 


 1          challenge.

 2                 The Justice Center's ability to adapt 

 3          quickly and adjust business practices has 

 4          allowed us to carry on our critical mission.  

 5          We will take the lessons we have learned and 

 6          continue to improve our work so we can serve 

 7          New Yorkers with special needs to the very 

 8          best of our ability.

 9                 Again, thank you for this opportunity 

10          to report on important work, and I welcome 

11          any questions you may have.

12                 CHAIRWOMAN KRUEGER:   Thank you very 

13          much.

14                 I think our first questioner will be 

15          Senator John Mannion.

16                 SENATOR MANNION:  Thank you, 

17          Commissioner --

18                 CHAIRWOMAN KRUEGER:  If you're ready.  

19          If not, it's okay.  I could also call on 

20          Samra Brouk if you'd prefer.  

21                 SENATOR MANNION:  No, I'm here.  I'm 

22          here.  I was just unmuting, so I apologize 

23          and appreciate the patience.  So thank you.

24                 Thank you, Commissioner -- or Director 


 1          Miranda, I'm sorry -- for being here today.  

 2          And I think we all agree that the state must 

 3          take all allegations of abuse very seriously 

 4          and investigate each one.  And I appreciate 

 5          all the work that the Justice Center does.

 6                 Two quick questions.  Number one, in 

 7          Part EE of the Executive Budget it proposes 

 8          getting rid of the adult home advocacy and 

 9          adult home resident council programs.  And as 

10          you know, these programs provide residents 

11          with education and awareness of their rights.

12                 Who is going to educate these 

13          residents once the program is eliminated?  

14                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  So 

15          thank you for that question.  

16                 Difficult times call for difficult 

17          choices.  And I don't think it is lost on any 

18          of us that we are in the midst of not only a 

19          health crisis but an economic and fiscal 

20          crisis.  

21                 So the Justice Center was tasked with 

22          evaluating all of our functions.  And in 

23          looking at our core functions, preventing 

24          abuse and neglect remains a core function.  


 1          This program is a legacy program that we 

 2          absorbed from C2C.  And originally, when it 

 3          was enacted, it came with appropriations.  

 4          When it arrived at the Justice Center upon 

 5          that transfer, it did not bring those funds. 

 6                 So unfortunately, despite the 

 7          incredible work that I know is done by the 

 8          individuals in the nonprofit world, and the 

 9          advocates, we had to make a choice.  And I 

10          will say the work that they are doing is 

11          extremely important.  I myself come from the 

12          advocacy world, spent countless years in the 

13          nonprofit world, and I certainly appreciate 

14          the importance of knowing-your-rights 

15          trainings.

16                 But we had to make a decision with 

17          respect to our core functions for abuse and 

18          neglect and ensure that we were not shaving 

19          off staff through layoffs or any other areas 

20          that would compromise our core mandate and 

21          mission.

22                 SENATOR MANNION:  Got it.  But 

23          obviously this is important information, so 

24          how are they actually going to receive this 


 1          information without that part of the program 

 2          being in place?

 3                 EXECUTIVE DIRECTOR MIRANDA:  Well, 

 4          certainly I expect that the nonprofits will 

 5          have to evaluate their priorities and 

 6          determine whether this is something they can 

 7          absorb within their budgets.  I can only 

 8          speak to the fact that the Justice Center is 

 9          not in a position to move forward with a 

10          contract at this point.

11                 SENATOR MANNION:  I understand.  Okay, 

12          thank you.

13                 The Justice Center also has a lawsuit 

14          coming before the Court of Appeals 

15          challenging the legal authority of the 

16          Justice Center.  So should that lawsuit be 

17          decided against the Justice Center, how do 

18          you see that decision affecting operations 

19          and the ability for them to investigate -- 

20          for you to investigate, excuse me.  Thank 

21          you.

22                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  So 

23          I think you're referring to the 

24          constitutional challenge which will be argued 


 1          before the Court of Appeals, as you correctly 

 2          noted, next week.

 3                 We're very confident that we will 

 4          prevail.  The issue there is the 

 5          constitutional authority, and the Legislature 

 6          has granted this power to the Justice Center.  

 7          There is nothing in the legislation -- I'm 

 8          sorry, there is nothing in the Constitution 

 9          that prevents the Legislature from actually 

10          granting prosecutorial authority to an 

11          executive agency.  In fact, county DAs derive 

12          their power from the legislation as well.  

13                 That said, the work that we do as it 

14          relates to the criminal work is very 

15          important work.  But thankfully there's a low 

16          number of criminal incidents that actually 

17          occur.  The majority of the work undertaken 

18          by this agency really flows throughout our 

19          administrative work, where we're able to 

20          substantiate individuals who may be 

21          committing egregious acts of abuse and 

22          neglect, depending on the category level.

23                 So I do not foresee, even in the 

24          worst-case scenario, that we do not prevail 


 1          in this argument, it having the great impact 

 2          perhaps that people are concerned about.

 3                 I also want to add that we have an 

 4          incredibly cooperative and collaborative 

 5          relationship with all 62 county DAs, and we 

 6          work very well.  And it's our expectation 

 7          that irrespective of the outcome next week, 

 8          that we will continue to work with them.

 9                 Our priority is ensuring that bad 

10          actors are removed from -- the ability from 

11          having the opportunity, quite frankly, to 

12          abuse individuals who are receiving services.  

13          And so we take that obligation very 

14          seriously, and we will work with them hand in 

15          hand irrespective of the outcome.

16                 SENATOR MANNION:  Thank you for that.  

17          I appreciate it.  

18                 If I can go back to the original 

19          question, you know, as I was a little 

20          thoughtful about it.  You spoke about how the 

21          nonprofit providers would hopefully pick up 

22          that part of the information transmitting to 

23          individuals or their families.

24                 Are they aware that this is a service 


 1          that's being pulled back?

 2                 EXECUTIVE DIRECTOR MIRANDA:  Our 

 3          agency has had those discussions.

 4                 SENATOR MANNION:  Okay.  Thank you 

 5          very much.  I appreciate it.

 6                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

 7          you.

 8                 CHAIRWOMAN KRUEGER:  Thank you.  

 9                 Assembly.

10                 CHAIRWOMAN WEINSTEIN:  So we'll go to 

11          our chair, then, of People with Disabilities, 

12          Assemblyman Abinanti.

13                 ASSEMBLYMAN ABINANTI:  Thank you.  I'm 

14          not sure what's the proper title.  Director, 

15          is that what I call you, or -- I'm not sure.

16                 EXECUTIVE DIRECTOR MIRANDA:  Director.

17                 ASSEMBLYMAN ABINANTI:  Director.  

18          Hello, Director, nice to see you again.  It's 

19          been a long time since we've had a chance to 

20          --

21                 EXECUTIVE DIRECTOR MIRANDA:  It has 

22          been.  Good to see you as well.

23                 ASSEMBLYMAN ABINANTI:  Same here.  

24                 Okay, I'm a little puzzled about your 


 1          workload.  I don't see anywhere a chart 

 2          indicating the number of cases that you 

 3          handled last year and the year before and the 

 4          year before that.  Can you provide us with 

 5          that information?

 6                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  

 7          I'll be more than happy to provide you with 

 8          that information.  

 9                 I think it's also worth pointing out 

10          that our website posts and lists information, 

11          data that we collect on a monthly basis.  I'm 

12          also happy to send to you a copy of our 

13          annual report from last year.

14                 ASSEMBLYMAN ABINANTI:  I would like to 

15          see that if I could.  I'm looking at the 

16          website, I'm not finding that information.  

17          That's why I asked.  

18                 But at any rate I would like to see 

19          whatever -- you know, how many cases you had, 

20          how many you brought to completion.  Do you 

21          have any information on how long it takes 

22          to -- turnaround on -- let's say there's a 

23          complaint against an employee in a private -- 

24          in a voluntary agency.  They have to suspend 


 1          that person, they have to set them aside, 

 2          they continue to pay them.  It used to take a 

 3          really long time to get a decision back from 

 4          your agency.  

 5                 Can you give me any indication as to 

 6          how long it now takes to do that?

 7                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  

 8                 So you're correct, the decision with 

 9          respect to discipline and leave falls within 

10          the purview of the provider, the employer.  

11          The Justice Center does not play any role in 

12          that decision.  

13                 And cycle time has significantly 

14          improved over the course of years.  As you're 

15          aware, this is a relatively new agency.  

16          We're going into our eighth year.

17                 ASSEMBLYMAN ABINANTI:  Right.

18                 EXECUTIVE DIRECTOR MIRANDA:  That 

19          said, our cycle time right now is at 79 days.  

20          And that represents an increase of 

21          approximately nine days, which is directly 

22          attributable to the impact of COVID this 

23          year.  

24                 It remains my expectation as we move 


 1          into 2021 that we are going to be able to 

 2          move forward with a lot of the technology 

 3          that we implemented, and we will see a 

 4          decrease in that cycle time.  

 5                 We appreciate the importance of cycle 

 6          time in concluding with an efficient and 

 7          thorough investigation, with the impact that 

 8          it has on providers.

 9                 ASSEMBLYMAN ABINANTI:  All right.  

10          Now, I'm interested -- I'm noticing that you 

11          say you don't have the resources to continue 

12          with that program for adults, and yet it 

13          seems that your agency was pretty much 

14          co-opted by the Health Department.  I mean, 

15          you referred to it yourself, you set up COVID 

16          testing appointments, you answered COVID 

17          questions, triaging calls for OPWDD and 

18          COVID-specific hotline, helping the Labor 

19          Department with unemployment-related calls.  

20          It seems like you were doing everything 

21          except your core mission, as you referred to 

22          it.  

23                 And I'm trying to figure out why you 

24          don't have the ability to continue that other 


 1          function or why we're maintaining your agency 

 2          at the same level.  I notice there's a slight 

 3          cut, but not much.  

 4                 EXECUTIVE DIRECTOR MIRANDA:  So, happy 

 5          to answer that question.

 6                 The Justice Center remained fully 

 7          operational throughout the entire pandemic.  

 8          In fact, we received 90,000 calls.  We 

 9          categorized approximately 11,000 cases last 

10          year as abuse and neglect.  We also closed 

11          9,000 cases.  

12                 So I just want to make sure that we're 

13          abundantly clear that the assertion that the 

14          Justice Center is not doing work during the 

15          pandemic is certainly far from true.  

16                 With respect to some of the other 

17          initiatives that I did speak about in my 

18          testimony, I am extremely proud of the folks 

19          at my agency who stepped up and volunteered 

20          their time after completing their work 

21          assignments -- on weekends and on evenings 

22          and holidays, to do a lot of this work.  

23          Because essentially --

24                 ASSEMBLYMAN ABINANTI:  You mean they 


 1          were not paid for this?  There was no 

 2          employees on state time were moved over to 

 3          other departments to pick up the slack in 

 4          these other areas?  

 5                 EXECUTIVE DIRECTOR MIRANDA:  What I 

 6          can tell you is that the overwhelming number 

 7          of individuals who contributed to those 

 8          initiatives did so on their own accord and 

 9          volunteered their time.  And I'm extremely -- 

10          I'm sorry, I'm extremely proud of our 

11          workforce, their ability to maintain the core 

12          functions at the agency as well as step up on 

13          behalf of New York.

14                 ASSEMBLYMAN ABINANTI:  I would like to 

15          see some -- a chart as to how much -- how 

16          many hours, FTEs, whatever you want to say, 

17          that they devoted to these other departments.

18                 EXECUTIVE DIRECTOR MIRANDA:  More than 

19          happy to provide that to you, yes.

20                 ASSEMBLYMAN ABINANTI:  All right, very 

21          good.  Thank you.  

22                 Now, on the issue of the Legislature 

23          granting prosecution powers to the 

24          Justice Center, I would tend to agree with 


 1          the challengers in that lawsuit.  I do not 

 2          believe we gave you the power to prosecute.  

 3          I thought the agency was intended to be a 

 4          backup for local district attorneys and that 

 5          you were going to be providing expertise to 

 6          the district attorneys, who were going to 

 7          prosecute those matters.  

 8                 And if you wouldn't mind highlighting 

 9          in the statute and sending to me -- unless 

10          you have it right handy -- where the statute 

11          gives you that power.  Unless you're talking 

12          about implied power, and I don't think that 

13          that was a statute that had any implied 

14          powers in it.  I'd love to see that 

15          information.

16                 EXECUTIVE DIRECTOR MIRANDA:  So more 

17          than happy to send you a relevant copy and 

18          section of the statute that specifically 

19          delineates that we will have concurrent 

20          authority.  

21                 I also think it's worth pointing out 

22          that this legislation passed unanimously 

23          through the Legislature.  And so I don't 

24          think there's any ambiguity in the statute 


 1          with respect to the authority that was 

 2          granted or the fact that it was concurrent.

 3                 ASSEMBLYMAN ABINANTI:  The fact that 

 4          it passed unanimously has nothing to do with 

 5          the meaning of the statute, because people 

 6          had different interpretations of it.  

 7                 In fact, as you probably are aware, I 

 8          wrote a several-page critique of the 

 9          legislation --

10                 EXECUTIVE DIRECTOR MIRANDA:  Yes.

11                 ASSEMBLYMAN ABINANTI:  -- at the time 

12          but had no choice but to vote for it because 

13          of the way it was presented.  I don't 

14          remember if it was part of the budget or if 

15          it was a separate legislation, but I had 

16          serious critiques about the way it was 

17          drafted and the way it was sold to us.  

18                 And I think your agency has wisely 

19          chosen to do certain activities and not 

20          others that we were told you were going to 

21          do.  Because the way it was presented, I saw 

22          a conflict of interest of doing some of the 

23          things.  But I think your agency has gone off 

24          in the proper direction --


 1                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

 2          you.

 3                 ASSEMBLYMAN ABINANTI:  -- with respect 

 4          to those conflicts.

 5                 I wanted to understand, during COVID, 

 6          have you had on-site visits?  How do you 

 7          interview victims who have disabilities, 

 8          et cetera?  I mean, parents are not allowed 

 9          into a facility, or were not allowed in.  And 

10          so how was it you were going into a facility 

11          and interviewing someone without a parent or 

12          a guardian present?  

13                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  So 

14          with respect to visitation schedules and 

15          access, the Justice Center does not play any 

16          role, as I'm sure you're aware.  Those 

17          protocols are set forth by the provider and 

18          the state oversight agency.

19                 With respect to our functions during 

20          the COVID pandemic, as soon as New York PAUSE 

21          was instituted, we took the opportunity to do 

22          a full assessment of all of our in-person 

23          interactions.  We recognize that going into a 

24          facility in person bears a certain degree of 


 1          risk, and we wanted to be extremely mindful 

 2          that our investigators were not going in and 

 3          possibly increasing the opportunity for COVID 

 4          to be brought into a facility.

 5                 That said, we were able to implement 

 6          video as well as phone technology and do some 

 7          of the interviews over the phone and as well 

 8          as video.  We were assessing every single 

 9          case based on the circumstances to decide 

10          whether an in-person interaction was truly 

11          necessary.  And those decisions were 

12          conferenced with supervisors, again, because 

13          the priority was ensuring the welfare and 

14          well-being of the individuals who were in the 

15          facilities receiving care.

16                 We did have boots on the ground, and 

17          we went out to facilities when the 

18          circumstances were warranted.

19                 ASSEMBLYMAN ABINANTI:  Okay.  I'm just 

20          a little concerned about that.  You know, 

21          I've been critical of you for being a little 

22          bit overly aggressive.  But on the other 

23          hand, I do want to make sure that you get the 

24          right information.  And a lot of the people 


 1          in particularly OPWDD facilities are not 

 2          capable of communicating or have difficulty 

 3          communicating in the first place and clearly 

 4          are not capable of communicating over Zoom or 

 5          something like that.

 6                 Let me ask you about possible 

 7          additional technology.  There have been 

 8          suggestions that technology could be helpful.  

 9          For example, putting cameras into group homes 

10          in various locations -- clearly not in 

11          somebody's bedroom, but perhaps in a common 

12          area or by the doorways to see who goes in 

13          and out and whatever.  And perhaps other 

14          types of information like that.  

15                 Do you have any opinion on those types 

16          of technologies?  

17                 EXECUTIVE DIRECTOR MIRANDA:  So 

18          certainly we have cases that we've 

19          investigated where video has proven to be 

20          extremely helpful in trying to ascertain 

21          exactly what happened and what transpired.  

22          And so certainly video can be useful.  But I 

23          think there also needs to be a balance with 

24          respect to the interests of privacy, as you 


 1          mentioned.  Right?  

 2                 So that falls within the authority and 

 3          the purview of the state oversight agency.  I 

 4          can attest to the value of having video, but 

 5          I also recognize that there are other 

 6          considerations that really need to be 

 7          contemplated as well.

 8                 ASSEMBLYMAN ABINANTI:  All right, I'm 

 9          going to stop at this point.  Thank you very 

10          much.

11                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

12          you.  

13                 CHAIRWOMAN KRUEGER:  Thank you very 

14          much.

15                 The next questioner, just three 

16          minutes, Senator Pete Harckham.

17                 SENATOR HARCKHAM:  Hello there, Madam 

18          Director.  Good to see you again.

19                 EXECUTIVE DIRECTOR MIRANDA:  Good to 

20          see you.

21                 SENATOR HARCKHAM:  We've had this 

22          conversation before, but I think it's worth 

23          revisiting on an annual basis.

24                 First, I want to say the work you do 


 1          is vitally important.  We want to get folks 

 2          who are either predators or don't have the 

 3          temperament to be in the business out of the 

 4          business.

 5                 But I have a number of facilities in 

 6          my district, both small and large, and 

 7          especially the ones that deal with 

 8          adolescents, a more volatile population, I 

 9          can say uniformly the employees of those 

10          facilities are terrified of you.  And it 

11          makes it harder to retain qualified staff.  

12                 Senator O'Mara referred earlier to one 

13          of the other organizations.  You know, when 

14          folks are barely making minimum wage, they 

15          can work at McDonald's and not have the 

16          liability risk, the risk of prosecution.  

17                 So, so much of your mission is also 

18          about education and prevention.  And how are 

19          you continuing to transition with that work 

20          so the people can feel less afraid of you and 

21          more secure in the knowledge that you've 

22          given them?  

23                 EXECUTIVE DIRECTOR MIRANDA:  Thank you 

24          for the question.  


 1                 So certainly the priority for the 

 2          Justice Center is to investigate abuse and 

 3          neglect, but also to prevent it, as you 

 4          pointed out.  Right?  And so we take very 

 5          seriously the obligation we have to be 

 6          accessible to answer questions, to dispel 

 7          myths, and to be transparent about the work 

 8          we do.

 9                 You know, you may be familiar, there 

10          are a lot of misconceptions about the work we 

11          do and about the purview of our authority.  

12          For example, we do not make discipline 

13          decisions, we do not set standards for care 

14          within facilities.  

15                 How do we deal with that as an agency?  

16          We deal with that through outreach.  Right?  

17          And so last year, despite the fact that COVID 

18          was here and certainly placed limitations 

19          with respect to our ability to go and do 

20          these in-person trainings, we still conducted 

21          44 outreach events.  And I certainly have 

22          spoken to various unions and employees and 

23          provider associations, making sure that we 

24          are always readily available to answer 


 1          questions.  

 2                 I believe education and outreach is 

 3          key to ensuring that people are aware that we 

 4          are here to make sure that people are safe.  

 5          And what we've found is that I have never met 

 6          a provider who's ever said that they want to 

 7          have abuse and neglect within their 

 8          environment.  And we meet countless workers 

 9          who are glad that there is someone to call if 

10          a colleague is perhaps committing abuse and 

11          neglect.  

12                 That said, I recognize that the 

13          overwhelming majority of individuals, 

14          especially in the settings that you mentioned 

15          earlier, are hardworking individuals who are 

16          committed to this work.  And certainly we do 

17          not want to be an impediment, nor an 

18          additional stressor.  

19                 I'm more than happy to set up a time 

20          where perhaps we could speak with some of 

21          these associations and share our insight and 

22          answer questions.

23                 SENATOR HARCKHAM:  Terrific.  Thank 

24          you very much.


 1                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

 2          you.  

 3                 CHAIRWOMAN KRUEGER:  Thank you.  

 4                 And now I believe we're going to 

 5          Assemblymember Gunther.

 6                 CHAIRWOMAN WEINSTEIN:  Yes, for -- I'm 

 7          back.

 8                 CHAIRWOMAN KRUEGER:  Great.

 9                 CHAIRWOMAN WEINSTEIN:  Yes, for 

10          10 minutes to Assemblywoman Gunther.

11                 ASSEMBLYWOMAN GUNTHER:  Okay, thank 

12          you very much.  I won't be 10 minutes.  But I 

13          do want -- my comment is I want to thank you 

14          because you have come to our communities, you 

15          have really explained the Justice Center, 

16          you've improved the quality of care.  And I 

17          just actually wanted to thank you because it 

18          used to be like the boogeyman, but now they 

19          really welcome your visits to the facilities 

20          because you do do teaching and it's very 

21          important and you're protecting a vulnerable 

22          population.  

23                 So I just wanted to say thank you, 

24          Denise.


 1                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

 2          you.

 3                 CHAIRWOMAN WEINSTEIN:  Okay, back to 

 4          the Senate if you have --

 5                 CHAIRWOMAN KRUEGER:  Thank you.  That 

 6          was fast.  Thank you.  

 7                 Well, also, Denise I also want to say 

 8          thank you, because I know that the whole 

 9          history of this center, the Justice Center, 

10          has, you know, been a back and forth between 

11          people not understanding what you were set up 

12          to do, and perhaps not having the best 

13          protocols in previous years, but in really 

14          working with very large numbers of people 

15          throughout multiple communities to get if 

16          right.

17                 So, first question.  We're removing 

18          your authority over adult homes in this 

19          budget?

20                 EXECUTIVE DIRECTOR MIRANDA:  No.  Our 

21          authority, as delineated within the statute, 

22          to have jurisdiction over abuse and neglect 

23          and adult homes, remains intact.

24                 CHAIRWOMAN KRUEGER:  It does.


 1                 EXECUTIVE DIRECTOR MIRANDA:  The 

 2          reference to adult homes is a contract of 

 3          approximately, I believe, $230,000 where we 

 4          fund services, advocacy services for adult 

 5          homes.  

 6                 But we will still have the same 

 7          jurisdiction that's delineated in the 

 8          statute.  That will not be impacted in any 

 9          shape or form.

10                 CHAIRWOMAN KRUEGER:  Good.  I'm very 

11          happy about that.

12                 And second -- and yes, obviously there 

13          are people who whistle-blow on their own 

14          agencies, and that's important so that you 

15          can get information.  

16                 During this time of COVID-19 have 

17          there been experiences where you learn people 

18          who probably really should have been sent to 

19          a hospital were not sent to a hospital, even 

20          when workers were saying, you know, This 

21          person's sick, I think we need to do 

22          something about this?

23                 EXECUTIVE DIRECTOR MIRANDA:  So our 

24          jurisdiction is very narrowly defined.  


 1          Right?  And our jurisdiction allows for us to 

 2          investigate abuse and neglect.  And the 

 3          threshold issue there is that there be an 

 4          allegation that a custodian committed abuse 

 5          and neglect to an actual individual who's 

 6          receiving services.  

 7                 So no, those circumstances were not 

 8          something that we encountered on a regular 

 9          basis here at the Justice Center.  

10                 But if a call were to come into the 

11          agency with some sort of allegation, even if 

12          it falls with -- outside of our jurisdiction, 

13          we take our obligation very seriously.  And 

14          we will take that information and we will 

15          make sure that it is relayed to the 

16          appropriate state oversight agency.  

17                 We also have a mechanism internally 

18          whereby, you know, allegations that perhaps 

19          are very egregious but, again, fall outside 

20          of our jurisdiction, executive staff within 

21          the agency is immediately notified and we 

22          will reach out to the state oversight agency 

23          to make sure that there is complete awareness 

24          of the situation.


 1                 CHAIRWOMAN KRUEGER:  Okay, so I am a 

 2          little confused.  So we know that immediate 

 3          family members are not being allowed to go 

 4          visit, for legitimate reasons.  But then they 

 5          might have reached out to say, I think my 

 6          family member is sick and needs a doctor or 

 7          hospital care.  Or it could have been another 

 8          worker inside the agency.  

 9                 You wouldn't define refusing medical 

10          care as an abuse or neglect situation?  

11                 EXECUTIVE DIRECTOR MIRANDA:  No, and I 

12          apologize if that was your understanding.  I 

13          wouldn't say that it's not abuse or neglect.  

14                 What I would say is that we would have 

15          to take the report, we would do a complete 

16          assessment of the circumstances surrounding 

17          the allegation.  More than likely, it would 

18          move over to our three-business-day review, 

19          which would give us an opportunity to get 

20          medical records, to get the policies and 

21          protocols from the provider for us to have an 

22          opportunity to make an appropriate 

23          evaluation, because it's critical to make 

24          sure that (a) we're within the statutory 


 1          framework, but also that we are evaluating 

 2          these cases on the totality of the 

 3          circumstances.

 4                 So certainly within the history of the 

 5          Justice Center we have had instances of abuse 

 6          and neglect where there has been a failure to 

 7          seek medical care for an individual.  We 

 8          would make an assessment, we would look into 

 9          all the circumstances and then make a 

10          determination as to whether it falls within 

11          our jurisdiction.

12                 CHAIRWOMAN KRUEGER:  And does your 

13          agency have the ability to track the rate of 

14          death by agency that you oversee?  

15                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  So 

16          there's a statutory obligation.  All 

17          residential facilities licensed, operated or 

18          certified by OMH, OCFS, OPWDD and OASAS, are 

19          mandated by law to make a report of any death 

20          that occurs within those facilities.  

21                 In fact, that requirement also extends 

22          to 30 days post-discharge.  We receive those 

23          reports and then we review them to see if 

24          there are any quality-of-care issues or to 


 1          see if there's any indicia or evidence of 

 2          abuse or neglect.  

 3                 Medically complicated cases, we also 

 4          have a wonderful resource here at the Justice 

 5          Center, and that's our medical review board, 

 6          where we will actually consult with them on 

 7          the more medically complicated cases.  

 8                 But I will point out that the 

 9          majority, the overwhelming number of reports 

10          that we get are deaths related to natural 

11          causes.  Right?  There are aged populations 

12          within these settings, and there are also 

13          individuals with multiple vulnerabilities and 

14          compromised health situations.  

15                 So we will do the report, a report 

16          will be issued.  If there are any findings, 

17          we will make sure that those go to the state 

18          oversight agency as well as the provider.

19                 CHAIRWOMAN KRUEGER:  So we can request 

20          that data from you?  

21                 EXECUTIVE DIRECTOR MIRANDA:  

22          Absolutely.

23                 CHAIRWOMAN KRUEGER:  For, say, the 

24          last 12 months, or the last time you did an 


 1          annualized report, and then for the year or 

 2          two previous as well?

 3                 EXECUTIVE DIRECTOR MIRANDA:  

 4          Absolutely.

 5                 CHAIRWOMAN KRUEGER:  I mean, you know, 

 6          we're learning more and more about what's 

 7          happening for people who are in group 

 8          settings with COVID.  So I think it would be 

 9          worth us taking a look and seeing, you know, 

10          how we're doing in the context of the 

11          agencies you oversee.

12                 EXECUTIVE DIRECTOR MIRANDA:  

13          Absolutely.  We'd be more than happy to 

14          provide that to your office.

15                 CHAIRWOMAN KRUEGER:  Great.  Thank you 

16          very much.

17                 Assembly.  

18                 CHAIRWOMAN WEINSTEIN:  We go to the 

19          ranker on People with Disabilities, 

20          Assemblywoman Miller.

21                 ASSEMBLYWOMAN MILLER:  Hi.  Good 

22          afternoon.  How are you?

23                 EXECUTIVE DIRECTOR MIRANDA:  Good, how 

24          are you?


 1                 ASSEMBLYWOMAN MILLER:  Good, thank 

 2          you.  

 3                 So on the same idea as Senator Krueger 

 4          was just talking about, I want to ask 

 5          specifically about our senior population, 

 6          many of whom have special needs.  Just, you 

 7          know, they're in skilled facilities or -- 

 8          because of their special needs.  

 9                 Do you routinely look into that 

10          population?  And if so, of the -- you said, 

11          about 90,000 calls that you received during 

12          the pandemic, were any or many of those calls 

13          from families of these seniors with special 

14          needs that were stuck in nursing homes, cut 

15          off from visitation, neglected, suffering 

16          from neglect or even abuse, and fearing for 

17          their well-being?  

18                 I know my office, we were getting tons 

19          and tons of calls and emails from worried 

20          family members.  Many times we directed them 

21          to an ombudsman or tried to help them connect 

22          with the ombudsman to look into it.  But is 

23          that something that your agency was doing?

24                 EXECUTIVE DIRECTOR MIRANDA:  So we do 


 1          receive a significant number of calls that 

 2          fall outside of the jurisdiction that I 

 3          mentioned before, right, which is abuse and 

 4          neglect committed by custodians against 

 5          individuals receiving services.  So we do get 

 6          calls at times that don't fall within our 

 7          purview, and we will make the appropriate 

 8          referral to the state oversight agency.

 9                 With respect to the aged population, I 

10          can certainly provide information to your 

11          office as it relates to the state oversight 

12          agency, a breakdown -- OASAS versus OPWDD, 

13          OMH.  I'm not sure that we are able to 

14          provide data with respect to age groups or 

15          that demographic information, but I'm more 

16          than happy to check with our folks, our data 

17          folks.

18                 ASSEMBLYWOMAN MILLER:  I guess the 

19          definition would be what's in question here.  

20          So if you are here to advocate or look after 

21          the best interests of all people with special 

22          needs, wouldn't somebody, just because 

23          they're a senior citizen also in a home if 

24          they have special needs -- if somebody has 


 1          Alzheimer's, if somebody has, you know, a 

 2          stroke and then they have special needs as a 

 3          result of that, they don't fall into that 

 4          jurisdiction.

 5                 EXECUTIVE DIRECTOR MIRANDA:  Our 

 6          jurisdiction is limited, and it's individuals 

 7          who are within residential -- I'm sorry, 

 8          individuals who are within licensed, operated 

 9          and certified settings under the state 

10          oversight agencies.

11                 So according to that jurisdiction, 

12          unless they are in one of those settings, we 

13          would not have jurisdiction.  It's very 

14          narrowly defined within the statute, and 

15          we're constrained by the parameters set forth 

16          in the statute.

17                 ASSEMBLYWOMAN MILLER:  Okay.  I will 

18          welcome that information, though, if you can 

19          email that to my office.

20                 EXECUTIVE DIRECTOR MIRANDA:  Sure.

21                 ASSEMBLYWOMAN MILLER:  Thank you.

22                 CHAIRWOMAN WEINSTEIN:  Back to the 

23          Senate.

24                 CHAIRWOMAN KRUEGER:  All right, I see 


 1          John Mannion.  But I'm curious, do you -- oh, 

 2          your hand just went down.  You had your 

 3          questions, right?  Or do you need another 

 4          question?  

 5                 SENATOR MANNION:  No, I was just going 

 6          to compliment the executive director on her 

 7          clear, concise, detailed and informed 

 8          answers.

 9                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

10          you.  

11                 CHAIRWOMAN KRUEGER:  Beautiful.  A 

12          beautiful thing.  Thank you.  

13                 Assembly.  Helene, you're on mute.

14                 Who would you like?  Assembly --

15                 CHAIRWOMAN WEINSTEIN:  Somehow the -- 

16          somehow they were muting -- they weren't 

17          letting me unmute.

18                 CHAIRWOMAN KRUEGER:  They're tired of 

19          us.  They're telling us something.

20                 (Laughter.)

21                 CHAIRWOMAN WEINSTEIN:  So Assemblyman 

22          Anderson for three minutes.

23                 ASSEMBLYMAN ANDERSON:  Okay.  Can I be 

24          heard?


 1                 EXECUTIVE DIRECTOR MIRANDA:  Yes.

 2                 ASSEMBLYMAN ANDERSON:  Thank you, 

 3          Chairwoman.  

 4                 And thank you, Executive Director -- 

 5          or Director -- for being here this afternoon 

 6          to answer questions.  Really commend the 

 7          work.  As I'm learning about the different 

 8          agencies, as a new Assemblymember, you know, 

 9          I commend the work that you all do at the 

10          Justice Center.  

11                 But I do have just one or two quick 

12          questions.

13                 EXECUTIVE DIRECTOR MIRANDA:  Sure.

14                 ASSEMBLYMAN ANDERSON:  In terms of the 

15          -- there's an Article VII to move your 

16          agency's ability to administer the Adult 

17          Advocacy Home Care Program.  Can you just 

18          explain what that does for the agency and 

19          where does that actual programmatic -- very 

20          important programmatic piece of agency go?  

21                 EXECUTIVE DIRECTOR MIRANDA:  So we 

22          don't perform that programmatic piece.  We 

23          actually will fund that piece for outside 

24          providers, non-for-profits.  So we do not 


 1          have any programmatic resources or staff that 

 2          are tied to that particular funding.

 3                 ASSEMBLYMAN ANDERSON:  But you 

 4          contract out for it.  So now that it's 

 5          leaving the agency, what happens to that 

 6          program?  

 7                 EXECUTIVE DIRECTOR MIRANDA:  So that 

 8          program, a determination will have to be made 

 9          by the various nonprofits as to whether they 

10          continue to prioritize that program and offer 

11          those services.

12                 I understand -- the program is an 

13          important program, and it does good work.  

14          And certainly our decision to advance this as 

15          a cut does not reflect the importance of the 

16          work.  But we are dealing with an extremely 

17          difficult and challenging fiscal crisis, and 

18          so we have to make --

19                 ASSEMBLYMAN ANDERSON:  But Madam 

20          Director -- Madam Director, sorry to cut you 

21          off, but my time is limited.

22                 EXECUTIVE DIRECTOR MIRANDA:  Sure.

23                 ASSEMBLYMAN ANDERSON:  But Madam 

24          Director, so I'm sure you've read the 


 1          Attorney General's report regarding nursing 

 2          homes and adult homes.  Isn't this a 

 3          critically important program to protect that 

 4          very same population of individuals who may 

 5          be put in harm's way?  Albeit via government 

 6          policy, albeit via the leadership of the 

 7          adult home or agency.  Don't you think this 

 8          is a very vitally important program that 

 9          would prevent much of what we saw?  

10                 EXECUTIVE DIRECTOR MIRANDA:  So I 

11          think there's an important distinction here 

12          that I want to make clear.  We will retain 

13          our jurisdiction over the adult homes that 

14          are delineated specifically within the 

15          statute.  That is not changing.  

16                 With respect to this contract, this 

17          contract does not fund investigations of 

18          abuse and neglect.  This contract funds 

19          know-your-rights trainings.  Which are 

20          important and certainly play a role with 

21          respect to people knowing their rights, which 

22          one could argue long term, right, prevents 

23          abuse and neglect.  

24                 But the function of the contract is 


 1          not to investigate abuse and neglect.  And so 

 2          I just want to make sure that that is clear.

 3                 ASSEMBLYMAN ANDERSON:  Got it.  

 4                 Madam Director, let me ask you, if I 

 5          have a constituent who comes in and wants to 

 6          say, hey, I'm being -- or wants to share 

 7          that, hey, this is happening to me at this 

 8          date and treatment facility in my district or 

 9          at this adult home in my district or this 

10          adult day care in my district, your agency is 

11          where I would direct them, correct?  

12                 EXECUTIVE DIRECTOR MIRANDA:  We would 

13          take that call and we would make a 

14          determination as to whether it falls within 

15          the statutorily delineated jurisdiction of 

16          the agency.  And if it does, we will classify 

17          it appropriately.  And if it doesn't and it 

18          falls outside, we would refer that matter 

19          over to the appropriate entity.  Whether it's 

20          DOH or SED, we would make that referral.  

21                 We do not ignore those calls.  I just 

22          want to make sure that we're clear.  We don't 

23          ignore those calls.  We take our commitment 

24          to individuals who are receiving --


 1                 ASSEMBLYMAN ANDERSON:  No, no, and I 

 2          wouldn't expect that you would.  But I just 

 3          want to understand that now we're losing this 

 4          funding, what happens to that population of 

 5          older folk who need that advocacy, who need 

 6          that bridge, who need that --

 7                 (Zoom interruption.)

 8                 CHAIRWOMAN KRUEGER:  Roxanne, go on 

 9          mute.  Sorry.

10                 CHAIRWOMAN WEINSTEIN:  If you could 

11          just quickly respond, since the Assemblyman's 

12          time has expired.

13                 EXECUTIVE DIRECTOR MIRANDA:  I 

14          certainly appreciate the importance of the 

15          work and the work that was being fulfilled by 

16          this contract.

17                 CHAIRWOMAN WEINSTEIN:  Thank you.  

18                 So now we'll go to the Senate.

19                 ASSEMBLYMAN ANDERSON:  Thank you, 

20          Director.

21                 CHAIRWOMAN KRUEGER:  We don't have any 

22          more in the Senate, so I think it goes back 

23          to the Assembly.

24                 CHAIRWOMAN WEINSTEIN:  Okay.  So we 


 1          have Harvey Epstein for three minutes and 

 2          then I believe Assemblyman Abinanti would 

 3          like a second round.  

 4                 So first to Assemblyman Epstein.

 5                 ASSEMBLYMAN EPSTEIN:  Hi, Executive 

 6          Director Miranda.  How are you doing?

 7                 EXECUTIVE DIRECTOR MIRANDA:  I'm doing 

 8          well, Assemblymember.  How are you?

 9                 ASSEMBLYMAN EPSTEIN:  I'm well, thank 

10          you.  It's good seeing you again.

11                 EXECUTIVE DIRECTOR MIRANDA:  Likewise.

12                 ASSEMBLYMAN EPSTEIN:  So you and I, we 

13          worked at a nonprofit together, and so we 

14          know how important those contracts are for 

15          staffing and for continuity.  If you had 

16          additional funds, if there was additional 

17          revenue, state revenue, would you make a 

18          decision to be able to allocate some of the 

19          funding to these nonprofits if there was 

20          funding available?  

21                 EXECUTIVE DIRECTOR MIRANDA:  The only 

22          reason why this program was cut was because 

23          of the lack of funding.  Right?  And so 

24          certainly, as you pointed out, yes, this is 


 1          important work and advocacy work is critical 

 2          for vulnerable populations.  

 3                 So certainly, if we were not in a 

 4          fiscal crisis, this would not even be a topic 

 5          today.

 6                 ASSEMBLYMAN EPSTEIN:  Great.  Well, 

 7          thank you.  And I encourage you, along with 

 8          us -- we're trying to get additional revenue.  

 9          You're in a different position than we are, 

10          of course.  But we want more revenue because 

11          we don't want our vulnerable populations to 

12          not get the services they need.

13                 I do appreciate all the work you do 

14          and have done.  But I would encourage you to, 

15          you know, from your side, help as much as we 

16          can as we get more revenue to assist this 

17          population that really needs it.  

18                 Thank you very much.

19                 EXECUTIVE DIRECTOR MIRANDA:  Take 

20          care.

21                 ASSEMBLYMAN EPSTEIN:  You too.

22                 Bye, Madam Chair.  Thank you.  

23                 CHAIRWOMAN WEINSTEIN:  Thank you.  

24                 So now we go to Assemblyman Abinanti 


 1          for five minutes.

 2                 ASSEMBLYMAN ABINANTI:  Thank you, 

 3          Madam Chair.  

 4                 Madam Director, I'm interested in this 

 5          issue of possible abuse or neglect with 

 6          respect to COVID.  The numbers that I got 

 7          from OPWDD indicate that as of December 16th 

 8          in 2020, they had 4,175 individuals who 

 9          resided in certified residential programs who 

10          tested positive.  And a total of 497 -- 

11          that's 10.5 percent, if these numbers are 

12          right -- passed away.

13                 Now, they're telling me this reflects 

14          all of those who had been or were in a 

15          residence.  I've been pressing to see if this 

16          includes those who went to the hospital or 

17          died in the facility or whatever.  But that's 

18          a high number even there, 10 percent.  

19                 And at the same time a total of 

20          7100 -- 7,156 staff were reported as 

21          confirmed COVID-positive.  That's a very high 

22          number.  

23                 And yet, you know, the DOH gave a 

24          guidance that if you needed to have your 


 1          employees come in even after they were 

 2          exposed to COVID, they could return to work.  

 3          That's totally contrary to every other 

 4          industry, business, the rest of the world, 

 5          where if you've been exposed you should go 

 6          quarantine for two weeks.  Now they've 

 7          reduced it to 10 days.  

 8                 So as a result, my son has been out of 

 9          school for three or four different sessions 

10          because different teachers keep getting 

11          COVID, and now the entire class is exposed so 

12          the entire class goes home.  

13                 On the other hand, if my son were in a 

14          facility, it wouldn't matter that his person 

15          was exposed to COVID, he would continue to be 

16          exposed to the -- so if a person's partner is 

17          home with COVID and the person working at the 

18          group home, let's say, is needed, then you 

19          would continue to get exposed time after time 

20          after time.

21                 It seems to me there's something wrong 

22          with that, that there's an obligation on the 

23          person, entity running the facility or the 

24          group home to find other staff.  And I was 


 1          just wondering if any complaints were made 

 2          along this line and whether your agency 

 3          actually did some investigations to see 

 4          whether the agencies improperly exposed their 

 5          residents to COVID-19.  

 6                 You know, in this case -- I mean, if 

 7          they had other employees they could have 

 8          brought in, or just go out and hire different 

 9          -- do whatever you can to protect them.  

10          Because when I'm looking at these numbers, 

11          these are very high numbers.  

12                 And so, you know, I would like -- I'm 

13          waiting to -- I really want to see the 

14          numbers that Senator Krueger asked for.  I'd 

15          like to see how many complaints were made and 

16          what investigations you made.  Particularly 

17          in light of the fact that your employees were 

18          doing all of these other things with respect 

19          to COVID, you know, that you said you were 

20          proud of.  

21                 Okay, well, did you do any 

22          investigations to see whether all of these 

23          agencies and all these residences were in 

24          fact following the proper protocols with 


 1          respect to COVID?  That's something that I 

 2          would have liked to have seen you do.

 3                 EXECUTIVE DIRECTOR MIRANDA:  Sure.  So 

 4          as I mentioned before when we spoke last, we 

 5          opened up over 11,000 abuse and neglect cases 

 6          last year during COVID.  So certainly we are 

 7          taking our obligation to ensure that people 

 8          are safe very seriously.  And we look at all 

 9          of those calls, and they're fully 

10          investigated.  

11                 A couple of things I think that I'd 

12          like to respond to with your question.  First 

13          and foremost, the DOH guidance you 

14          referenced, that is guidance set forth by 

15          DOH.  The Justice Center does not have any 

16          role in determining guidance for staffing.  

17          That is outside of our purview.  

18                 OPWDD, I believe you made some 

19          reference to some statistics.  I would not be 

20          in a position to comment on the statistics 

21          provided by OPWDD.  I will, however, make 

22          sure that our office provides the information 

23          with respect to the number of deaths and 

24          reports that were made to the agency last 


 1          year, as discussed with Senator Krueger.

 2                 And last but not least, I think it's 

 3          also important to clarify that we do not set 

 4          forth the definition of a COVID death or 

 5          COVID-related incidents.  That's not our 

 6          jurisdiction, that is not our purview.  That 

 7          is done certainly within the state oversight 

 8          agencies.

 9                 So I certainly appreciate the 

10          importance of your question, but 

11          unfortunately our limitations are clearly -- 

12                 (Overtalk.)

13                 EXECUTIVE DIRECTOR MIRANDA:  -- are 

14          clearly defined.  I'm sorry?

15                 ASSEMBLYMAN ABINANTI:  I'd like to 

16          know if you got any complaints from family 

17          members on this very issue, that they were 

18          concerned that perhaps their family members 

19          were being exposed unnecessarily.

20                 EXECUTIVE DIRECTOR MIRANDA:  So 

21          certainly --

22                 ASSEMBLYMAN ABINANTI:  Or not given 

23          healthcare properly, or were not sent to the 

24          hospital properly.  I'd like to see the 


 1          COVID-related complaints.

 2                 EXECUTIVE DIRECTOR MIRANDA:  So as I 

 3          mentioned, we take in -- we classified 11,000 

 4          abuse and neglect cases.  So certainly any 

 5          call that comes into us, we evaluate on the 

 6          totality of the circumstances, we would get 

 7          information to make sure that we're making an 

 8          appropriate classification.  And if it falls 

 9          within our statutorily defined jurisdiction, 

10          we would take that case and we would 

11          certainly investigate it.  

12                 Eleven thousand cases were opened last 

13          year.  I can't speak to the specifics, but 

14          certainly we can follow up with your office 

15          at another time if you'd like.

16                 ASSEMBLYMAN ABINANTI:  Yes.  Thank 

17          you.

18                 EXECUTIVE DIRECTOR MIRANDA:  Sure.

19                 CHAIRWOMAN WEINSTEIN:  Thank you.  

20                 So, Senator Krueger, the Assembly is 

21          done.  So I think we're --

22                 CHAIRWOMAN KRUEGER:  Thank you very 

23          much, Assemblywoman.

24                 So you also are done, Madam Executive 


 1          Director.

 2                 EXECUTIVE DIRECTOR MIRANDA:  Thank 

 3          you.

 4                 CHAIRWOMAN KRUEGER:  So thank you very 

 5          much for being here with us today.  And we're 

 6          looking forward to the materials that you 

 7          have promised us.

 8                 EXECUTIVE DIRECTOR MIRANDA:  

 9          Absolutely.  Thank you and good afternoon, 

10          everyone.

11                 CHAIRWOMAN KRUEGER:  Good afternoon.  

12                 So now we start the portion of the 

13          hearing where people are not representatives 

14          of the government but have asked to testify.  

15                 And we call them up in panels.  And 

16          the rules of the road are once the full panel 

17          has testified, then you can raise your hand 

18          for a three-minute question that's in for 

19          totality for any of the people on the panel, 

20          including their answers.  So we move into the 

21          speed-dating round of budget hearings.  

22                 And our first panel is the Children's 

23          Defense Fund, Melissa Genadri; the New York 

24          State Coalition for Children's Behavioral 


 1          Health, Andrea Smyth; and the Family and 

 2          Children's Association, Jeffrey Reynolds.  

 3                 Are you here with us, Melissa?

 4                 MS. GENADRI:  Yes, hi.  Can you hear 

 5          me?  

 6                 CHAIRWOMAN KRUEGER:  Yes, we can.  I'm 

 7          sorry, they also have three minutes each.

 8                 Yes, go right ahead, Melissa.

 9                 MS. GENADRI:  Thank you so much, 

10          Senator.  And good afternoon.  On behalf of 

11          the Children's Defense Fund of New York, I 

12          would just like to thank the Legislature for 

13          this opportunity to center the needs and the 

14          voices of vulnerable children and youth at 

15          today's hearing, particularly children of 

16          color and low-income children whose mental 

17          health has suffered so greatly at the hands 

18          of this pandemic.

19                 These children have suffered 

20          unprecedented and disproportionate parental 

21          and caregiver death, have been forced into 

22          poverty and food insecurity, and have also 

23          been spending increased amounts of time in 

24          isolation and in home environments that may 


 1          be unsafe or even abusive.  

 2                 And on top of all of this, they have 

 3          been weathering the toxic stress of systemic 

 4          racism and police violence, most recently 

 5          manifested in the horrific events which took 

 6          place last week in Rochester.  

 7                 These children have very real and very 

 8          urgent mental health needs.  And as New York 

 9          looks to expand its telehealth program, it is 

10          incumbent upon our state to ensure access, 

11          equity and quality of behavioral health 

12          services that are being delivered via 

13          telehealth.

14                 At CDF we work directly with 

15          vulnerable and impacted adolescents who 

16          either do not have the technology and access 

17          in their homes to access teletherapy services 

18          or whose home environments are unsafe, 

19          unstable, lack privacy, or are even abusive, 

20          and connecting with a therapist at home is 

21          just not an option.  So we need more 

22          investment in community-based supports for 

23          these at-risk youth, and also community safe 

24          spaces, where they can access telehealth 


 1          services outside of their homes.

 2                 There is also a great need for an 

 3          independent evaluation of the quality of 

 4          telehealth services that are being provided, 

 5          particularly with regards to teletherapy for 

 6          adolescents and children.  

 7                 And I will also say we have great 

 8          concern with the steep rise in youth suicide 

 9          and in psychiatric emergencies among young 

10          people in our state over the past year.  We 

11          applaud the state for the suicide prevention 

12          work it's been doing, and we feel that as we 

13          progress in our pandemic response efforts, 

14          youth suicide prevention needs to be 

15          ingrained into that pandemic response, 

16          particularly the very high risk populations 

17          of Latina adolescents, Black youth and LGBTQ 

18          youth, who may not be receiving the mental 

19          health services they need right now and are 

20          even at an elevated risk of suicide.  

21                 So I thank you very much for your time 

22          today, and we at CDF look forward to 

23          continuing these conversations with you in 

24          the future.


 1                 CHAIRWOMAN KRUEGER:  Thank you.  

 2                 And I should have also said we have 

 3          your full testimony, every member of the 

 4          committees, and it's up online for all the 

 5          Legislature.  So we urge you to do exactly 

 6          what our first panelist did:  Summarize your 

 7          key points in three minutes.

 8                 So next, Andrea Smyth.  

 9                 Good afternoon, Andrea.  

10                 MS. SMYTH:  Hello.  Thank you for the 

11          opportunity to comment on the Office of 

12          Mental Health budget.  

13                 There are a number of important issues 

14          -- the 5 percent cut to local assistance, 

15          state-operated bed closures without community 

16          reinvestment, minimum wage funds without 

17          addressing the rest of the workforce through 

18          the human services COLA, maintaining a 

19          moratorium on cuts to children's Medicaid 

20          mental health services, the lack of 

21          investment in children's services and the 

22          supply versus demand crisis, the June 

23          prohibition of any newly graduated licensed 

24          mental health practitioner from fully 


 1          practicing in New York State, the inclusion 

 2          of OMH-certified family peers and telehealth 

 3          reform, and the need for tools to 

 4          successfully restructure the Office of Mental 

 5          Health with the Office of Alcoholism and 

 6          Substance Abuse Services.

 7                 At 5:30 this morning the 

 8          Vice President of the United States cast the 

 9          deciding vote on the Rescue Plan, which adds 

10          $4 billion for the Community Mental Health 

11          Services Block Grant and the Substance Use 

12          Prevention and Treatment Block Grant.  This 

13          funding is on top of 1.6 billion for each 

14          block grant that was added to the December 

15          COVID project.  

16                 Fifty percent of these funds must go 

17          directly to providers to respond to COVID.  

18          Please work with us to get the necessary 

19          services to children and families.  

20          Previously, the share to children and 

21          families from these block grants has been 

22          less than equal.  

23                 There are not enough children's mental 

24          health services.  RTF beds have closed and 


 1          dropped from 517 to just 390.  There are 887 

 2          school-based mental health clinics, but 4400 

 3          buildings, school buildings.  There are 6,000 

 4          children enrolled in Home and Community Based 

 5          Waiver, and only a thousand are receiving 

 6          services.  And the 400,000 children enrolled 

 7          in the Child Health Plus program can only 

 8          access whichever behavioral health services 

 9          the Commissioner of Health identifies.  The 

10          system is under capacity, underresourced, and 

11          risks our future.

12                 Since 2002 when the Education Law 

13          licensed mental health practitioners, they 

14          have been safely practicing up to their full 

15          scope of training and education.  If we 

16          sought a single word that captures the 

17          meaning of "the use of assessment instruments 

18          and mental health counseling and 

19          psychotherapy to identify, environmental and 

20          treat dysfunctions and disorders," the word 

21          would be "diagnose."  We need to keep the 

22          pipeline of newly mastered, prepared, 

23          clinically trained, licensed mental health 

24          counselors, family therapists, and 


 1          psychoanalysts fully able to do what they're 

 2          trained to do.

 3                 And lastly, when we merge, if we merge 

 4          the Office of Mental Health with OASAS, they 

 5          need all the tools to make it a successful 

 6          reconstruction.  And one of the things that's 

 7          been missing is that the authority over 

 8          medical assistance or Medicaid has been moved 

 9          from the "O" agencies to the Department of 

10          Health.  It is a barrier to successful 

11          program development for the disabled, when 

12          the funding decisions and the rate-making 

13          decisions are in a separate agency.  And to 

14          fully support this transformation, we urge 

15          that that be changed.

16                 CHAIRWOMAN KRUEGER:  Thank you.

17                 Jeffrey Reynolds.

18                 DR. REYNOLDS:  Good afternoon.  Thanks 

19          for having me.  Just wave if you can hear me 

20          so that I know I'm not talking into an abyss.  

21          Okay, I see my friend Assemblyman Ra waving.  

22          Good to see you, Ed.

23                 My name's Dr. Jeffrey Reynolds.  I 

24          have the privilege of running Family and 


 1          Children's Association.  We're based on Long 

 2          Island and, in any given year, serve about 

 3          30,000 Long Islanders.  

 4                 Most germane to this conversation is 

 5          the fact that we run a pretty large 

 6          children's mental health program as well as a 

 7          mental health program for seniors.  We run 

 8          two OASAS-licensed chemical dependency 

 9          treatment centers, and then we run Long 

10          Island's only two recovery centers, one in 

11          Nassau and one in Suffolk County.

12                 I heard a number of you throughout the 

13          course of the day use the term "mental health 

14          crisis," and that's exactly spot-on.  I've 

15          been in the field for a long time and have 

16          never seen anything as bad as this.  And I 

17          can tell you that the implications for our 

18          young people, particularly those from Black 

19          and Brown communities, are going to span 

20          generations.  Long after everyone's been 

21          vaccinated, long after COVID is but a 

22          footnote in our history, the mental health 

23          implications are going to continue on.

24                 I will say, first and foremost, the 


 1          cuts to local assistance termed as 

 2          "withholds" have been devastating for my 

 3          organization.  It's meant immediate staff 

 4          freezes, it's meant staff layoffs, and it's 

 5          meant much longer waiting lists for kids who 

 6          are looking to access services.  It's had a 

 7          huge impact on us.  

 8                 And although we're thankful that this 

 9          state has modified regulations to allow for 

10          telehealth, none of us had the equipment to 

11          do it.  Our staff turned on a dime to make it 

12          happen.  We're working really hard to serve 

13          kids that have a very, very high level of 

14          acuity.

15                 At the same time we're trying to 

16          battle off budget cuts.  There's no elected 

17          official in this state who would not stand up 

18          and fight for PPE.  These services are our 

19          PPE and our families' PPE against suicides, 

20          against fatal overdoses and against ED visits 

21          that are unnecessary and expensive.  

22                 In the last minute I have, I do want 

23          to talk a little bit about revenues.  And I 

24          think it's very important that as we talk 


 1          about the opioid settlement dollars, that 

 2          those be segregated and tagged directly to 

 3          prevention, harm reduction, treatment and 

 4          recovery services, not dumped into the 

 5          General Fund.

 6                 I feel similarly about the expansion 

 7          of gambling opportunities here in New York 

 8          State, and I know that there's a lot of 

 9          traction behind sports betting.  There hasn't 

10          been a significant increase in the number of 

11          problem gambling programs in many, many 

12          years.  And in fact the Comptroller's done 

13          two reports about the fact that we don't have 

14          a good handle as to how many problem gamblers 

15          there are.

16                 We ought to make sure that we're 

17          setting aside a portion of that money now to 

18          do a problem gambling campaign aimed at young 

19          men who are likely to be the targets for 

20          sports betting advertising.  

21                 And then, finally, I'm aware that the 

22          issue of adult-use marijuana is once again a 

23          subject of discussion.  I would argue 

24          strenuously that that not be a part of the 


 1          budget bill and that a significant portion -- 

 2          more than is allocated now -- is set up to 

 3          deal with prevention, treatment and recovery 

 4          implications associated with legalization and 

 5          that a public health campaign be rolled out 

 6          right now to get ahead of this issue.

 7                 So thank you very much for your 

 8          attention here all day.  Thank you for your 

 9          hard work.  And I look forward to 

10          participating in the rest of the budget 

11          process.

12                 CHAIRWOMAN KRUEGER:  Okay.  I don't 

13          see the hand of any Senator -- oh, wait.  

14          Yes, Senator Samra Brouk, our Mental Health 

15          chair.

16                 SENATOR BROUK:  Thank you so much.

17                 Hello, everyone.  Thank you for this 

18          speed round of testimony.

19                 I just -- I wanted to dig in just 

20          quickly, Andrea, with some of what you talked 

21          about around the school-based mental health.  

22          Can you speak if you have any other 

23          information on where those inequities lie, 

24          and on the fact that we don't have adequate 


 1          investment today and now we're looking at 

 2          cuts?

 3                 MS. SMYTH:  School-based mental health 

 4          clinics are run by Article 31 mental health 

 5          clinics, so it's their option of whether or 

 6          not, after working with the school, whether 

 7          they can open a clinic in the school.  

 8                 There are a number of limitations to 

 9          Article 31 school-based clinics.  One is 

10          space limitations at the school.  Two is the 

11          fact that the programs don't have any base 

12          funding, so they have to bill insurance.

13                 So my providers bill as many as 

14          10 different insurance providers to make sure 

15          that any child in any particular building can 

16          come to the school-based mental health 

17          clinic.  It's a very heavy burden on the 

18          provider to operate the school-based mental 

19          health clinics.  And so there's no kind of 

20          grant funding, seed funding to start up or do 

21          anything like that.  And I believe that 

22          that's one of the reasons why the number's so 

23          low.

24                 I'm involved with a campaign, we'd 


 1          like to see a 10 percent growth in the number 

 2          of school-based mental health clinics every 

 3          year, until there's access in every school 

 4          building.

 5                 SENATOR BROUK:  Thank you.

 6                 And very quickly, I think it was 

 7          Melissa, you had talked about suicide rates 

 8          and prevention.  Can you just fill in some of 

 9          the details on that, of what you've seen and 

10          what you think you need to see to better 

11          assess where these trends might be going?  I 

12          think that was you who talked about that.

13                 MS. GENADRI:  Yes, absolutely.  Thank 

14          you so much for the question.

15                 We have definitely seen increases in 

16          psychiatric emergencies among young people 

17          statewide.  The Suicide Prevention Task Force 

18          of New York State that put out a great report 

19          last year particularly highlighted elevated 

20          rates among Latina adolescents as a 

21          population of high risk and concern.  And 

22          we've seen nationally, in the past year, a 

23          lot of data around elevated risks for Black 

24          youth.


 1                 These are two populations that we are 

 2          very concerned about, particularly given the 

 3          sort of digital divide right now, and that 

 4          these are precisely the populations of kids 

 5          who aren't able to access therapy services 

 6          right now because so many of them have 

 7          transitioned to teletherapy.  And the 

 8          students that we work with from these 

 9          backgrounds just aren't accessing those 

10          services right now.

11                 So we fear that this problem, you 

12          know, it's sort of the tip of the iceberg and 

13          maybe it's not going to be until later down 

14          the road that we see, you know, the true 

15          spikes in youth suicide in these populations.  

16          But it's of a lot of concern to us.  And it's 

17          something we desperately want to see more -- 

18          more work done around.

19                 SENATOR BROUK:  Thank you so much.

20                 CHAIRWOMAN KRUEGER:  Thank you.

21                 Assembly.

22                 CHAIRWOMAN WEINSTEIN:  Yes, we go 

23          to -- actually, we go to Assemblyman 

24          Abinanti, the chair of People with 


 1          Disabilities.

 2                 ASSEMBLYMAN ABINANTI:  Thank you.

 3                 I have two questions.  One -- Andrea, 

 4          hello again.  Nice to see you.  It's been a 

 5          long time since I've seen you.

 6                 I am intrigued by your concern that 

 7          Department of Health is making decisions for 

 8          all of the other departments in the guise of 

 9          regulating the amount of Medicaid spending 

10          that's being done by the state.  Could you 

11          elaborate on that?  And any suggestions on 

12          how we can resolve that issue?  I have a 

13          similar concern, just not sure how to deal 

14          with it.

15                 MS. SMYTH:  Thank you, Assemblyman.

16                 I can just speak to the experience 

17          that I've had with some of my programs.  So 

18          I'll speak to the residential treatment 

19          facilities.  This is a high-cost service 

20          delivery, and the Department of Health has 

21          taken over the rate-setting from the Office 

22          of Mental Health.  

23                 That would be fine, but the Office of 

24          Mental Health is still submitting policy 


 1          changes.  So the policy changes are 

 2          happening, but the rate-making isn't 

 3          changing, or we're not being informed in a 

 4          timely way of the reimbursement 

 5          methodologies.  So in this way, it is 

 6          contributing to the closing of residential 

 7          treatment beds.  Which at this time is such a 

 8          valuable resource, and especially at a time 

 9          when the state is also proposing to close 

10          children's beds.

11                 So we just feel that the programmatic 

12          ties to the reimbursement are being -- the 

13          gap is too wide for there to be good 

14          coordination, and we really think that the 

15          rate-making and the oversight of the spending 

16          should revert back to the "O" agencies.

17                 ASSEMBLYMAN ABINANTI:  Okay.  

18          Secondly, I guess to everyone, there's this 

19          proposal for a crisis center, and I'd just 

20          like a quick comment from each of you, what 

21          do you think -- if you're familiar with the 

22          proposal, what do you think of it?  And how 

23          do we make sure it actually works?  Is there 

24          anything we as a legislature can do, in the 


 1          language of the legislation or something?  

 2          Because it's a good idea.  But how do we make 

 3          sure it works?  At least I think it's a good 

 4          idea.  I'd like to hear what you guys think.  

 5          Thank you.

 6                 DR. REYNOLDS:  Assemblyman, I think 

 7          it's -- if I'm correct, it's basically the 

 8          DASH program that's been created out here on 

 9          Long Island.  

10                 And if that's the model, I will tell 

11          you it's been hugely successful.  It's been a 

12          great resource for families that would 

13          otherwise wind up in emergency rooms and kind 

14          of do that dance where the kid goes in, gets 

15          discharged, and they do it again and again.

16                 I don't know their latest numbers, but 

17          it's been a phenomenal resource for Nassau 

18          and Suffolk County, particularly during this 

19          time, and it has served its purpose very 

20          well.

21                 ASSEMBLYMAN ABINANTI:  Who did it out 

22          there?

23                 DR. REYNOLDS:  Family Service League, 

24          in conjunction with the local field Office of 


 1          Mental Health.

 2                 But I will say they've been very good.  

 3          And unlike some other projects, very good 

 4          about bringing in community partners.  And so 

 5          it's something that all the agencies have 

 6          access to and use on a regular basis.

 7                 CHAIRWOMAN KRUEGER:  Thank you.

 8                 I don't see another Senator, so 

 9          Assembly, go ahead.

10                 CHAIRWOMAN WEINSTEIN:  I'll go to 

11          Assemblyman Ed Ra, then.  Three minutes.

12                 ASSEMBLYMAN RA:  Thank you, 

13          Chairwoman.  Thank you all for being here 

14          today and the work of your organizations 

15          during a very difficult time.

16                 Jeff, you talked a lot about -- in 

17          your written testimony about the withholding.  

18          And I'm just wondering if you could further 

19          elaborate on it.  Because one of the things 

20          -- number one, we see obviously there was the 

21          uncertainty that was created by the 

22          withholding throughout the last fiscal year.  

23          And now there's a partial restoration.  But 

24          (A) have you gotten any indication of when 


 1          you would get that back?  I know it's 

 2          supposed to be reconciled in this last 

 3          quarter of this fiscal year.  

 4                 And then (B) what the long-term 

 5          implications of that 5 percent reduction 

 6          nevertheless becoming, you know, a new 

 7          baseline and becoming a permanent funding 

 8          cut.

 9                 DR. REYNOLDS:  Yeah, I'll be really 

10          direct.  The withholds have had a huge impact 

11          on us.  We have not got any notification that 

12          that's been changed.  In fact, I got our 

13          letter from Nassau County pulling another 

14          $150,000 out of the system just yesterday.  

15          And this is a system that was already 

16          threadbare to begin with.  We were barely 

17          holding on, like every other provider, with 

18          rates that are insufficient and a demand for 

19          services, and complicated cases that far 

20          exceed our ability to do that.

21                 And so whereas 5 percent doesn't sound 

22          like a lot, when you look at how we were 

23          barely holding on, it's almost like the death 

24          blow for us.  


 1                 And so our hope would be that 

 2          providers get back all the money they were 

 3          supposed to have in 2020, there be no cuts 

 4          going forward -- and I hesitate to say this, 

 5          but when I go back and look at my staff and 

 6          our clients, I'm no longer that hesitant.  

 7          The reality is that there should have been a 

 8          whole bunch of money in this proposal to deal 

 9          with the mental health crisis that we have on 

10          our hands.  

11                 There shouldn't have been:  Go talk to 

12          the feds and maybe at the end of the day 

13          you'll only have a 5 percent cut.  It should 

14          have been exactly the opposite of that.  It 

15          should have been:  We recognize this is 

16          important, as COVID, and we're going to take 

17          it seriously, and there should have been a 

18          chunk of money in the budget to support these 

19          services.  There wasn't.

20                 Instead, it was -- honestly, I can't 

21          throw a party that we're only going to have a 

22          5 percent cut.  It still decimates services.

23                 CHAIRWOMAN WEINSTEIN:  Thank you.

24                 ASSEMBLYMAN RA:  Well, thank you.  


 1          Thank you again to all of you for your 

 2          organizations' work.  I don't know if anybody 

 3          else had any thoughts or anything to add on 

 4          that.

 5                 MS. SMYTH:  Assemblyman Ra, I think 

 6          that the most chilling part of the 5 percent 

 7          withholds is that that is local assistance 

 8          funding generated through community 

 9          reinvestment of years past.

10                 Not only are we taking the money that 

11          is the legacy of the community mental health 

12          system and cutting it with paper cuts at 5 

13          percent, 15 percent, 20 percent, but we're 

14          not reinvesting in more community mental 

15          health services.  This is devastating to the 

16          providers.  They have about three months of 

17          cash on hand for operating expenses for their 

18          non-Medicaid services.  It's a crisis.

19                 CHAIRWOMAN KRUEGER:  Thank you.

20                 CHAIRWOMAN WEINSTEIN:  Thank you.

21                 We go to Assemblywoman Miller, three 

22          minutes.

23                 ASSEMBLYWOMAN MILLER:  Hi.  Can you 

24          hear me?


 1                 CHAIRWOMAN WEINSTEIN:  Yes.

 2                 ASSEMBLYWOMAN MILLER:  I just -- you 

 3          know, I'm very moved by all of your 

 4          testimonies.  And I just want to (A) thank 

 5          you all for what you're doing and (B) tell 

 6          you how much I agree with you.  I cannot 

 7          understand how, in light of what we've all 

 8          gone through, we've all experienced, but 

 9          people with -- you know, at most risk:  

10          people with mental health issues, people -- 

11          you know, these young children without the 

12          in-person nurturing and contact that they 

13          need.  We're failing on so many levels not to 

14          have this be increased in the budget and more 

15          funded.

16                 And so I couldn't agree with you more.  

17          And whatever -- you know, certainly I -- I 

18          can't speak for anybody else, but whatever I 

19          can do to help, please, I'm there.  It's just 

20          devastating to me that I agree with you, we 

21          are looking at a potential big, big crisis of 

22          mental health, and they're turning their 

23          heads the other way.

24                 So thank you for what you're doing.


 1                 CHAIRWOMAN WEINSTEIN:  Thank you.

 2                 We go to Assemblyman Bronson.

 3                 ASSEMBLYMAN BRONSON:  Good afternoon, 

 4          everyone.  Thank you for your testimony.

 5                 I'm going to direct my questions to 

 6          Andrea.  And it's going to be a three-part 

 7          question.  But in the context of what so many 

 8          of my colleagues and what you all have just 

 9          testified to, and that is the mental health 

10          crisis we're facing.

11                 You know, we had a crisis before 

12          COVID-19, and it's only gotten worse.  And 

13          our families deserve better than what the 

14          state's providing in this area.

15                 But particularly, Andrea, I'm going to 

16          talk to you about the Article 163 mental and 

17          behavioral health professionals.  As you know 

18          -- and you've worked with me on a number of 

19          bills in connection with reimbursement from 

20          Medicaid and direct reimbursement from 

21          commercial carriers -- this is really about 

22          access.

23                 So my first question is if you could 

24          explain a little bit why it's so vitally 


 1          important that we have that reimbursement 

 2          structure in place.  The Governor vetoed the 

 3          bills and said we should talk about them in 

 4          the budget.  So what better way than have you 

 5          testify to that today.

 6                 Second is the exemption that I've 

 7          asked a couple of commissioners to talk about 

 8          that expires at the end of June, and what 

 9          that means in the field in the state 

10          facilities if that exemption is not extended 

11          and hopefully made permanent.

12                 And then lastly if you could talk 

13          about expanding the diagnosis, the scope of 

14          practice, for the Article 163 professionals.

15                 MS. SMYTH:  Sure.  Thank you, 

16          Assemblyman.  I'll take the nexus between the 

17          exemption sunset and the diagnostic 

18          authority.  

19                 We would prefer that the budget 

20          address the scope of practice of the 163s so 

21          that their full training and clinical 

22          capacity is acknowledged and they're allowed 

23          to diagnose.  Then we don't need to do the 

24          exemption again.  We did the exemption in 


 1          2002, in 2010, in 2013, in 2016 and 2018.  

 2                 You have helped us write a bill that 

 3          solves the problem permanently, that's the 

 4          diagnosis authority.  They've been doing it, 

 5          they're trained, the bill standardizes their 

 6          training and their clinical practice, and 

 7          that's what we'd like to see have happen.

 8                 Regarding the medical assistants' 

 9          eligibility, this is just an issue of people 

10          who are doing this work, if they work for an 

11          agency, but they're not allowed to enroll in 

12          Medicaid and take clients from the community.  

13          We think that's wrong.  We need more people 

14          practicing, we need access to more mental 

15          health services, and this is the workforce 

16          that we have, the licensed practitioners.  

17                 We have the social workers, we do have 

18          the mental health counselors, we have the 

19          family therapists, we have the creative arts 

20          therapists, we have the psychoanalysts.  We 

21          want to use every single one of them, up to 

22          as much as they're willing to do in the field 

23          to address the crisis.

24                 ASSEMBLYMAN BRONSON:  Well, and I'll 


 1          just say this.  The situation as it exists 

 2          today, if you're a wealthy person in 

 3          Manhattan, you have access to mental health.  

 4          If you're a person living in poverty in 

 5          Rochester, New York, you don't have access to 

 6          mental health.

 7                 That's wrong.  We need to correct it.  

 8          Thank you.

 9                 CHAIRWOMAN KRUEGER:  Thank you.

10                 Are there any other members?

11                 CHAIRWOMAN WEINSTEIN:  We are done in 

12          the Assembly.

13                 CHAIRWOMAN KRUEGER:  Thank you.

14                 Only to edit Harry's last comment, 

15          Assemblymember Bronson.  If you're poor 

16          anywhere, you're not really getting mental 

17          health.  So I don't disagree with your point 

18          about people with money and private 

19          insurance, but I don't know that that's 

20          actually radically different in various 

21          cities of the state.

22                 Thank you.

23                 We're going to go on to our next 

24          panel, and we will have Leslie Feinberg, 


 1          director, Supporting Our Youth & Adults 

 2          Network, followed by the CUNY Coalition for 

 3          Students with Disabilities, Luis Alvarez.

 4                 Are we both here?  Leslie?

 5                 MS. FEINBERG:  Yes.  Yes, I'm here.

 6                 CHAIRWOMAN KRUEGER:  Okay.

 7                 MS. FEINBERG:  Can you hear me?

 8                 CHAIRWOMAN KRUEGER:  Yes, I can.

 9                 MR. ALVAREZ:  I am also here.

10                 CHAIRWOMAN KRUEGER:  Hi.  Great.

11                 Go right ahead, Leslie.

12                 MS. FEINBERG:  Sure.

13                 Greetings, Chairs Krueger, Weinstein, 

14          and members of the committees.  SOYAN is an 

15          organization of family members and 

16          self-advocates dedicated to preserving 

17          dignity and self-determination for people 

18          with I/DD, safeguarding the progress gained 

19          for them, and protecting and enhancing their 

20          quality of life in a community.  

21                 Thank you, Senator Mannion -- I hope 

22          you're listening -- for providing questions 

23          in advance to Dr. Kastner.  

24                 And Assemblyman Ra, thanks.  You have 


 1          given us comfort, knowing that OPWDD has 

 2          affirmed that rental subsidies are carved out 

 3          from the withholds.

 4                 New York State has long prided itself 

 5          on providing quality services for people with 

 6          I/DD.  We heard that OPWDD enrollment is 

 7          growing.  With fewer dollars, OPWDD will be 

 8          forced into cutting critical services to 

 9          people, eligibility changes or creating 

10          waiting lists.  New York State's image will 

11          be tarnished.

12                 We heard New York State has already 

13          received additional enhanced Medicaid dollars 

14          from the federal government.  Please ensure 

15          that OPWDD receives its share of these funds 

16          and applies it to service delivery.

17                 We applaud OPWDD's continued support 

18          of community integration.  We are concerned 

19          that lessons learned during the '80s have 

20          been forgotten.  The failure to provide 

21          sufficient community-based supports led to 

22          the well-documented high costs to safety and 

23          dignity.  Please do not replicate these types 

24          of devastating insults now to our most 


 1          vulnerable citizens.

 2                 We applaud OPWDD for including 

 3          initiatives for long-term housing.  The 

 4          process for determining an individual's 

 5          rental subsidy for self-direction in a 

 6          community, and the subsidy amount itself, 

 7          have not been recalibrated and reviewed for 

 8          years, causing many people in high-rent 

 9          counties to choose between healthy food, 

10          necessary out-of-pocket expenses, or the rent 

11          payment that they must pay their landlords 

12          above the subsidy amount.  This is not 

13          sustainable.  

14                 We heard Dr. Kastner mention 

15          wraparound services without providing 

16          details, and family care, which is similar to 

17          a foster care scenario, that relies upon host 

18          families.  Integrated community living is 

19          best achieved by working with landlords who 

20          already have rental properties.  SOYAN has a 

21          no cost to the state housing support 

22          initiative and would welcome the opportunity 

23          to discuss it in greater detail at another 

24          time.


 1                 We applaud OPWDD's recall of the 

 2          20 percent withhold against reimbursements 

 3          for non-Medicaid local assistance.  However, 

 4          that 5 percent cut that goes towards paying 

 5          for essential services such as utilities, 

 6          phones and internet for adults living on 

 7          their own, is going to be contrary to our 

 8          concerns about safety and isolation.  Please 

 9          recall these proposed cuts.

10                 In our society, adults feel empowered 

11          receiving a paycheck for a job well done, and 

12          have a sense of community by having a job.  

13          We look forward to increased solutions for 

14          meaningful employment.

15                 Thank you for permitting SOYAN to 

16          share the thoughts that run through our minds 

17          and keep us awake at night.  We need OPWDD's 

18          mission to be actualized.  Please do not cut 

19          OPWDD funding; investments are needed.  We 

20          look forward to participating in the budget 

21          process.  Thank you.

22                 CHAIRWOMAN KRUEGER:  Thank you.

23                 And next, Luis.

24                 MR. ALVAREZ:  Good afternoon, 


 1          distinguished members of the state.  My name 

 2          is Luis "Junior" Alvarez, and I'm a proud 

 3          student with a disability at Bronx Community 

 4          College, majoring in education, where I serve 

 5          as the president of the CUNY Coalition of 

 6          Students with Disabilities -- CCSD-BCC 

 7          Chapter.  I'm also honored to be the chair of 

 8          the university-wide CCSD that represents more 

 9          than 11,000 students with disabilities.

10                 According to CUNY, more than 1800 

11          students with disabilities are enrolled in 

12          our degree programs in my borough of the 

13          Bronx.  Go Bronx, yeah!  I and so many others 

14          rely on reasonable accommodations from our 

15          college to have an equal opportunity to 

16          succeed, especially in distance learning made 

17          necessary by COVID-19.  

18                 The enrollment of students with 

19          disabilities at CUNY is at an all-time high, 

20          with more than 11,000 of us enrolled at our 

21          university.  At CUNY our disabled student 

22          enrollment has grown by more than 50 percent 

23          over the last few decades, and yet our state 

24          funding for personal accommodation and 


 1          support services has remained the same for 

 2          the last 27 years.  

 3                 CCSD supports the New York State 

 4          Education Department's $7 million budget 

 5          request to enhance support services for 

 6          students with disabilities all around the 

 7          state, statewide.  This new source of funding 

 8          will supplement, not replace, existing 

 9          college and university support for students 

10          with disabilities.

11                 The CUNY Coalition for Students with 

12          Disabilities enthusiastically supports the 

13          State Education Department's budget request 

14          for students with disabilities that would be 

15          the first of its kind in the nation.  Come 

16          on, New York, let's lead the way for the rest 

17          of the country.

18                 I also want to say thank you to 

19          Abinitez {ph} and Elio {ph} for attending our 

20          CCSD virtual ceremony, and a big happy 

21          birthday to Epstein.  Thank you.

22                 CHAIRWOMAN KRUEGER:  Thank you both 

23          very much.

24                 Okay.  I'm going to go on to the next 


 1          panel.  We have Ruth Lowenkron, New York 

 2          Lawyers for the Public Interest, and Harvey 

 3          Rosenthal, New York Association of 

 4          Psychiatric Rehabilitation Services.

 5                 Hello, Ruth and Harvey, assuming 

 6          you're here somewhere.  

 7                 THE MODERATOR:  They're coming in.

 8                 CHAIRWOMAN KRUEGER:  There we go.  I 

 9          see Ruth.  Hi.

10                 MS. LOWENKRON:  Okay, hi.  Shall I get 

11          started?

12                 CHAIRWOMAN KRUEGER:  Please.

13                 MS. LOWENKRON:  Thank you, Senator.  

14          And hello to all the other Senators.  Ruth 

15          Lowenkron, I'm the director at -- Senators, 

16          is that not a horrible way to begin.  Hello 

17          to all the elected officials, no slight 

18          intended.  I'm just on a roll to get there 

19          quickly.

20                 CHAIRWOMAN KRUEGER:  Doing great.

21                 MS. LOWENKRON:  So I'm Ruth Lowenkron.  

22          I'm the director of the Disability Justice 

23          Program at New York Lawyers for the Public 

24          Interest.  


 1                 And I wanted to start with a searing 

 2          quote because I think to me this crystallized 

 3          everything when I came upon it.  From C.S. 

 4          Lewis:  "Of all tyrannies, a tyranny 

 5          sincerely exercised for the good of its 

 6          victims may be the most oppressive, and those 

 7          who torment us for our own good will torment 

 8          us without end, for they do so with the 

 9          approval of their own conscience."

10                 And I bring that up because clearly 

11          this is not a suggestion by me or by any 

12          advocates that anyone has any ill motives 

13          here.  We are all here to ensure that people 

14          with disabilities are best taken care of.  

15          But we disagree fundamentally on how to take 

16          care of people with disabilities.  

17                 And I'm going to limit my comments to 

18          the area that I am most concerned about, and 

19          that is about the amendments, potential 

20          amendments to the hospital commitment section 

21          and extending the Kendra's Law, the AOT, 

22          assisted outpatient treatment.

23                 Those are forced treatment modalities.  

24          And forced treatment is not treatment.  My 


 1          colleague Harvey Rosenthal is going to talk 

 2          much more about it.  He's in the trenches, 

 3          he'll tell you about the programs that work.  

 4          But there are programs out there that work.  

 5          Voluntary programs.  And that's where -- the 

 6          direction that we have to see ourselves in.  

 7          And we've had other speakers talking about 

 8          that as well.  

 9                 So in particular, I just want to 

10          mention the self-directed care program I 

11          don't believe anyone has mentioned today.  

12          That has been on the chopping block 

13          altogether, notwithstanding the fact that it 

14          is a brilliant program that provides people 

15          with psychiatric disabilities the opportunity 

16          to make their own plans for their treatment, 

17          so you know there's a fighting chance for 

18          them to get involved.

19                 So these options, they would not only 

20          help fulfill the Olmstead integration mandate 

21          but also they're humane, they're less costly, 

22          and they're legal.

23                 So quickly, on the psychiatric 

24          hospital commitments.  Unlike what the 


 1          commissioner said, it is not written 

 2          narrowly.  It is not a mere clarification.  

 3          It would involve potentially thousands of 

 4          people.  

 5                 And there is absolutely no need, as 

 6          Senator Krueger said, to have this amended 

 7          language because the current language would 

 8          take care of it just by virtue of the fact 

 9          that if somebody has any problem, whether 

10          it's problems with living or problems with 

11          clothing or anything of that sort, if that 

12          means that they are in imminent danger -- or 

13          danger, of course, but imminent danger, then 

14          they will be helped.  But otherwise, they 

15          cannot be forced into treatment.  

16                 And similarly -- I see my time is up, 

17          so I'm hurry-hurrying -- with Kendra's Law 

18          it's a similar situation.  All of a sudden we 

19          are going to suggest somebody's Kendra's Law, 

20          which is a reduction in liberties -- we're 

21          going to say that it's appropriate to do that 

22          without a physician coming to testify?  That 

23          is not due process.  It just simply is not.

24                 And similarly, the ability to have 


 1          someone come after six months and have their 

 2          period extended with much reduced procedural 

 3          safeguards is just inappropriate.

 4                 So in closing, there are less costly, 

 5          proven community-based peer-led alternatives.  

 6          No more forced treatment.  And to circle back 

 7          to C.S. Lewis, what he might have said is "No 

 8          more tyrannies."

 9                 CHAIRWOMAN KRUEGER:  Thank you.

10                 MS. LOWENKRON:  Thank you.

11                 CHAIRWOMAN KRUEGER:  Harvey?

12                 MR. ROSENTHAL:  Hi, I'm Harvey 

13          Rosenthal.  I'm CEO of the New York State 

14          Association of Psych Rehab Services.  We're a 

15          coalition of people with mental illnesses and 

16          providers across the state.  We fight for 

17          rehab, recovery rights, community inclusion, 

18          criminal justice reform.  And I'm here today 

19          to talk about a number of issues, so I'm 

20          going to have to talk fast.

21                 A number of the issues -- some of the 

22          issues I'm concerned about, my colleagues 

23          will talk about in terms of the pandemic and 

24          the cuts and reinvestment and housing.  So 


 1          I'll be talking more about a variety of 

 2          rights issues.

 3                 Number one, the adult home residents 

 4          have a cut of $170,000.  It's a little bit of 

 5          money for a lot of advocacy for people who 

 6          really need it.  

 7                 I too am very tied up with 

 8          self-directed care.  Strategic purchases that 

 9          really move people's outcomes -- whether it's 

10          housing, employment, transportation, 

11          education, stable housing -- improve 

12          self-care.  It's an extraordinary program 

13          with great success.

14                 Criminal justice reform, I want to 

15          thank Senator Brouk for introducing Daniel's 

16          Law.  It's really the way to go.  It's about 

17          mental health alternatives to the police.  We 

18          know the police shouldn't be first 

19          responders.  We've seen the tragedies in 

20          Rochester and throughout.

21                 Mental health responders.  And I would 

22          say to the Senator, if we can include some 

23          peer counselors, that would be really 

24          critical.  


 1                 Halt the torture of solitary 

 2          confinement.  It's abysmal.  It's outmoded.  

 3          It's torture.  The United Nations says it's 

 4          torture.  We have people in jail and prisons, 

 5          a lot of people of color, a lot of people 

 6          with mental illnesses, a lot of people who 

 7          commit suicide.  Because this is not about 

 8          rehabilitation, it's about punishment.  

 9                 The law would ban solitary confinement 

10          for people with mental illnesses.  It would 

11          extend -- it would stop the extension of time 

12          in solitary confinement.  It would build some 

13          rehab units.  The Governor says it's too 

14          expensive, the study says it's not.

15                 Back to what Ruth has said, I'm very 

16          concerned about the expansion of outpatient 

17          commitment.  It will let the state go out and 

18          take all kinds of people and cart them off to 

19          hospitals, whether that's appropriate or not.  

20                 We know how to serve people in that 

21          level of need.  We have crisis respite 

22          programs, we have peer bridgers, we have 

23          halfway home programs, peer crisis 

24          stabilization.  We know how.  And there's a 


 1          program in Westchester we helped design, 

 2          80 percent engagement rate with people who 

 3          are not supposed to be engagable.  We know 

 4          how to do that.  And we need to do that.  

 5          It's not about the law, it's about mental 

 6          health help.  That's why we're here.

 7                 And folks in need, need housing, not a 

 8          hospital.  They need compassion, not 

 9          coercion, containment and control.  The 

10          affected population is going to be much 

11          larger than the commissioner said.  It'll be 

12          hundreds and eventually thousands of people 

13          using hospital beds along the way. 

14                 It's racial inequity.  We already know 

15          forced treatment on Kendra's Law is -- 

16          two-thirds is people of color.  There's no 

17          reason to think otherwise.

18                 Also, the commissioner has to monitor 

19          whether there's abuses in overcommitment.  

20          She can't possibly do that.  They're not 

21          doing it with Kendra's Law, making sure it's 

22          a last resort.  It's too much.

23                 The Legislature has rejected an 

24          extension of Kendra's Law for 20 years.  They 


 1          know it's a controversial program, it 

 2          violates people's rights, and it -- and you 

 3          have understood that.  And instead, you have 

 4          focused on these alternative voluntary 

 5          approaches.  It cannot be increased.  We've 

 6          asked for your help, you've done it for 

 7          20 years in a row.

 8                 Finally, in crisis stabilization 

 9          centers, especially the peer ones, like we 

10          have in New York State, up in Poughkeepsie, 

11          for example -- we're in strong support of 

12          them, as long as no voluntary transport.  And 

13          they should be run by nonprofits, not 

14          hospitals.

15                 Thank you.  

16                 CHAIRWOMAN KRUEGER:  Thank you both 

17          very much.  Seeing no hands, moving along, 

18          thank you.  

19                 Christine Khaikan, Legal Action 

20          Center, and Briana Gilmore, community 

21          advocate.

22                 MS. KHAIKAN:  I think I am starting.  

23          Hi.  Thank you, chairs, members of the 

24          committee.  


 1                 My name is Christine Khaikan.  I am a 

 2          health policy attorney at the Legal Action 

 3          Center.  And we have a long history of 

 4          working to remove barriers to health 

 5          insurance coverage and care for people with 

 6          substance use disorders and mental health 

 7          needs.  And we thank everyone for the 

 8          opportunity to provide input today.

 9                 I don't have to tell all of you this 

10          is a horribly tough time, obviously the 

11          pandemic and of course these extra things 

12          caused by the pandemic -- increases in 

13          overdose, suicide, depression, isolation.  So 

14          a really strong and functioning mental health 

15          and substance use disorder system right now 

16          has never been more critical.  

17                 And it's never been more critical to 

18          not waver from a focus of equitable access to 

19          quality care, ensuring the whole full scope 

20          of treatment, prevention, recovery, harm 

21          reduction services.  So I want to address a 

22          few items in the budget.  

23                 The first is the merger of OASAS and 

24          OMH and creating a new agency.  We just want 


 1          to ensure that there's a laser focus on the 

 2          populations served by these agencies, 

 3          ensuring that the expertise they possess is 

 4          preserved.  You know, there needs to continue 

 5          to be equitable access -- in fact, expanded 

 6          access to services.  And the same goes for 

 7          moving towards integrated licenses and the 

 8          integrated centers.  

 9                 We -- this is a long time coming.  

10          Whole-person care is so important.  And 

11          again, it just needs to be hyperfocused on 

12          serving the people in need, and equitable 

13          access.

14                 Also, telehealth.  You know, we're 

15          really happy to see lifting certain 

16          regulatory barriers and expansion of those 

17          services.  But they can't become a 

18          replacement for needed in-person services.  

19          And patient choice needs to be preserved, and 

20          there needs to be access, when people want 

21          them, to broadband and the appropriate 

22          technology.  

23                 And also, we wanted to address crisis 

24          stabilization services.  You know, this is a 


 1          great thing and we laud the goal of making 

 2          sure people in crisis, mental health crisis, 

 3          substance use crisis, are not entering the 

 4          carceral system.  But we just want to make 

 5          sure, again, a strong focus on health and 

 6          social service needs.

 7                 You know, there are funding 

 8          opportunities coming through the federal 

 9          block grants, but also the opioid litigation 

10          making its way through the courts.  And we 

11          heard yesterday New York will be getting 32 

12          million from one settlement.  More will be 

13          coming.  But we just want to ensure this 

14          money needs to be dedicated exclusively to 

15          this population for treatment, prevention, 

16          recovery supports, harm reduction services.  

17          It cannot supplant existing funding.

18                 And we're really concerned about the 

19          50 percent cut in funding for jail-based 

20          transition services for substance use 

21          disorder care.  This is a really important 

22          touch point in reducing overdose services, 

23          and we really would like to see that 

24          restored. 


 1                 And in my remaining seconds, I just 

 2          want to say, you know, we continue to focus 

 3          on mental health and substance use parity 

 4          enforcement, removing prior authorization for 

 5          Medicaid.  And we want to also really thank 

 6          members of the committee for their support of 

 7          CHAMP, the ombuds program in New York that 

 8          has served as a critical lifeline for people 

 9          struggling to access their mental health and 

10          substance use disorder services and health 

11          insurance coverage.  

12                 So thank you so much.

13                 CHAIRWOMAN KRUEGER:  Thank you.  And I 

14          think no questions either -- oh, excuse me.  

15          Can we have the second person on this panel, 

16          please.

17                 MS. GILMORE:  Thank you.  Good 

18          afternoon, chairpersons and members of 

19          committee.  Thank you for hearing my 

20          testimony today.  

21                 I want to offer particular gratitude 

22          to Senator Brouk for grounding us this 

23          morning in honoring our collective grief at 

24          watching a 9-year-old child being brutally 


 1          attacked by Rochester police last week, and 

 2          for grounding us in the memory of the life 

 3          and murder of Daniel Prude in Rochester last 

 4          year.  

 5                 Every day in my advocacy work I also 

 6          honor the legacy of Dontay Ivy, a black man 

 7          in Albany, New York, who was murdered by 

 8          Albany police in 2015.  His crime was 

 9          committing -- his crime was performing his 

10          mental health in public outside of his house.  

11                 We know that Black and Brown young men 

12          across New York State are disproportionately 

13          likely to be murdered by police, victims of 

14          violence, incarcerated in jails and prisons.  

15          And if they escape that fate, they're 

16          disproportionately likely to be incarcerated 

17          by the Office of Mental Health.  

18                 It is time to end our collective 

19          delusionment that AOT and involuntary 

20          commitment are mental health programs.  These 

21          are extensions of mass incarceration, 

22          extensions of our police system.  They're not 

23          mental health care.  The research from across 

24          the country indicates that as soon as a 


 1          person is involved involuntarily in the 

 2          mental health system, they immediately 

 3          disregard any respect for that system and no 

 4          longer trust involvement in that system.  

 5                 We see, you know, decreased 

 6          involvement in meaningful work and education, 

 7          a decrease in community tenure, a decrease in 

 8          stable housing, increase in rates of 

 9          incarceration and future systems involvement.  

10          We need to roll back the extension of AOT and 

11          involuntary commitment in this year's 

12          Executive Budget.

13                 I want to switch gears rapidly and 

14          offer you something to smile about.  The 

15          easiest way for you to really hold on to a 

16          program that's offering recovery-based 

17          community services in New York this year is 

18          the self-directed care pilot, which was 

19          eliminated from the OMH budget.  This is a 

20          tiny, tiny project; you're probably already 

21          wondering why so many advocates are talking 

22          about it.  And that's because self-direction, 

23          more than any other program, holds the 

24          promise of recovery.  


 1                 When OMH implemented this pilot in 

 2          2015, they stated their intention to expand 

 3          it statewide and to research ways to really 

 4          offer it through Medicaid managed care or as 

 5          a value-based-payment initiative.  And 

 6          despite overwhelming successes in this 

 7          program, funding has been cut for it.  

 8                 Early success in the program indicates 

 9          an increase in recovery goals, both for 

10          mental health and physical health, an 

11          increase in wellness supports, increase in 

12          educational and employment attainment, 

13          increase in housing stability, decreased use 

14          of hospitalization, and even a savings -- a 

15          systemwide savings -- because of 

16          self-directed care.  

17                 I assure you, each member of this 

18          committee has constituents in their county 

19          who have been advocating for a decade for 

20          self-directed care.  A decade.  And I implore 

21          you to work with me in the coming weeks and 

22          months, and providers at Community Access in 

23          New York City and Independent Living Center 

24          in Newburgh, so we can demonstrate to you the 


 1          transformative impact of self-directed care 

 2          in your communities.  

 3                 Thank you for your time.  I look 

 4          forward to working with you this session.

 5                 CHAIRWOMAN KRUEGER:  Thank you both 

 6          very much.

 7                 Seeing no hands, we're going to keep 

 8          moving.  Panel E, the New York Association of 

 9          Alcoholism and Substance Abuse, John Coppola; 

10          the Coalition of Medication- Assisted 

11          Treatment Providers and Advocates, Allegra 

12          Schorr; and Friends of Recovery, Dr. Angelia 

13          Smith-Wilson.

14                 We'll start with John Coppola.

15                 MR. COPPOLA:  Senator Krueger and 

16          Assemblywoman Weinstein, I just want to thank 

17          you for your perseverance here and for the 

18          work that you do every year.  

19                 If you were to go back and look at the 

20          testimony that has been provided by our 

21          association over the course of the last 

22          decade, you'd see almost every year a plea 

23          for additional resources and a warning that 

24          there's a significant uptick in addiction -- 


 1          and in more recent years, driven by a real 

 2          concern about opioid overdose deaths and 

 3          addiction.

 4                 And every year we were talking about a 

 5          little bit of disbelief that from one year to 

 6          the next there was really no remedy, there 

 7          was no additional resources that were being 

 8          brought to bear on this, as we looked at the 

 9          upward trajectory.  And we have right now 

10          this juxtaposition with COVID, and we see 

11          what we're capable of doing and marshaling 

12          our resources for a serious, you know, 

13          pandemic.

14                 I want to really just talk a little 

15          bit first about how during COVID, with a lack 

16          of protective equipment, et cetera, and an 

17          escalating rate of addiction and overdose, 

18          addiction service providers did not receive 

19          the additional funds that they had requested 

20          last year.  And not only that, but they were 

21          cut.  And how do you apply a cut to a field 

22          that's dealing with the kind of crisis that 

23          we were dealing with?  

24                 I want to suggest to you -- I was 


 1          thinking a lot about Senator Brouk's remarks, 

 2          and I really appreciate the way that she 

 3          started this hearing by calling our attention 

 4          to the failures of our system, particularly 

 5          when it's inadequately funded and 

 6          inadequately financed, and the important role 

 7          that we play.  And I want to be also mindful 

 8          and ask this question:  Where is the 

 9          structural racism in our budget?  And is it 

10          possible that it's structural racism and 

11          sexism because we largely have a women's 

12          workforce, that's the reason why we're not 

13          getting the resources we need.  

14                 You have at your disposal this year 

15          resources, resources from increased block 

16          grants and the federal grant.  We have 

17          settlement funds that you could put toward 

18          this.  There's the opioid surcharge.  There's 

19          possible revenue from gambling, there's 

20          possible revenue from marijuana.  So this is 

21          not about creating new resources.  A simple 

22          question:  We have an opportunity to correct 

23          what have been serious wrongs over the course 

24          of decades.  The resources are on the table.  


 1          They can be allocated to help us or not.  If 

 2          we come back next year and say we did not 

 3          receive the additional resources, it's going 

 4          to be -- we'll be hard-pressed to explain why 

 5          that is, because there are resources there.  

 6                 We need you, Assemblywoman and 

 7          Senator, we need you to watch those resources 

 8          and make sure that they don't disappear off 

 9          our table.  Thank you.

10                 CHAIRWOMAN KRUEGER:  Thank you.

11                 Our next testifier, Allegra Schorr.

12                 MS. SCHORR:  Thank you.  Good 

13          afternoon, chairs, committee members.  I'm 

14          Allegra Schorr, president of COMPA.  COMPA 

15          represents New York State's opiate treatment 

16          programs and the medication- assisted 

17          treatment providers.  And thank you for the 

18          opportunity to testify today.  

19                 In 2016, the Surgeon General, 

20          Dr. Vivek Murthy, appeared on television to 

21          introduce the landmark 400-page report 

22          "Facing Addiction in America."  And 

23          Dr. Murthy was asked to share just one point 

24          with the audience in 30 seconds.  And 


 1          Dr. Murthy said "Methadone."  The critical 

 2          takeaway from the Surgeon General's report on 

 3          addiction was methadone.  Why?  The Surgeon 

 4          General wasn't saying that methadone was 

 5          magic, and he certainly wasn't saying that 

 6          it's the answer for everybody.  But he was 

 7          making a fundamental point.  Scientific 

 8          evidence clearly supports the effectiveness 

 9          of methadone and medication-assisted 

10          treatment for opiate use disorder.  But it is 

11          underutilized, and it is stigmatized.  So the 

12          Surgeon general was highlighting that 

13          ignorance is beating science.

14                 So we're in the midst of a worsening 

15          crisis, and the COVID-19 pandemic is 

16          colliding with an opioid epidemic, and we're 

17          seeing record overdoses.  At this point all 

18          of our treatment resources and all of our 

19          funding should be prioritized and should 

20          incentivize science, and that means 

21          medication-assisted treatment.  

22          Unfortunately, COMPA's main and most urgent 

23          concern right now is to prevent closures of 

24          opiate treatment programs, and that's because 


 1          of OMIG audits.  

 2                 This issue threatens to destabilize 

 3          the entire opiate treatment system, and this 

 4          could have a cascading impact on the public 

 5          health of New Yorkers because of the whole 

 6          pandemic.

 7                 And as you heard earlier today, an OPT 

 8          recently had to close a program site, and 

 9          that disrupted treatment for 1500 patients, 

10          after OMIG had an extrapolation of 12 

11          clerical errors, which had a total value of 

12          $400, but it resulted in a $7.7 million 

13          disallowance.  And right now a similar 

14          situation is being played out in Western 

15          New York, and there's several more audits in 

16          the pipeline.  

17                 So compliance audits of OTPs, which 

18          are conducted by OMIG, are resulting in 

19          vastly disproportional disallowances, and 

20          those have and they will continue to result 

21          in the loss of treatment slots.  

22                 So what we're asking for is a 

23          reevaluation of this OMIG's process.  And 

24          we're asking for some statutory protection 


 1          that's going to prevent the OMIG from their 

 2          actions that are going to lead to a reduction 

 3          in access to service.  And this is when 

 4          there's no fraud and no abuse whatsoever.

 5                 So I thank you for your concern and 

 6          for hearing this, and I ask you to please 

 7          prioritize science.  We need that now.  Thank 

 8          you very much for your concern.

 9                 CHAIRWOMAN KRUEGER:  Thank you.

10                 So we do have a few questions for this 

11          panel.  First, the chair of Alcoholism and 

12          Substance Abuse, Senator Pete Harckham.

13                 SENATOR HARCKHAM:  I think you have 

14          one more speaker, Madam Chair.

15                 CHAIRWOMAN KRUEGER:  Oh, I apologize.  

16          I was so excited about people wanting to ask 

17          questions.  Excuse me.  

18                 Let's go back and let Dr. Angelia 

19          Smith-Wilson testify first.

20                 DR. SMITH-WILSON:  Thank you.  Thank 

21          you.  Good afternoon.  I am Dr. Angelia 

22          Smith-Wilson, executive director, Friends of 

23          Recovery, and a family member and an ally to 

24          the recovery movement.  


 1                 I'm grateful to be invited by the 

 2          Senate Finance chair, Liz Krueger, and 

 3          Assembly Ways and Means chair, Helene 

 4          Weinstein, to examine the fiscal year 

 5          2021-2022 budget.  I'm equally honored to 

 6          share with you the collective voice of the 

 7          New York State recovery community, which 

 8          represents over 260,000 individuals.  

 9                 We are proud to bring the voice of the 

10          recovery community to discuss the potential 

11          impact of this year's budget.  And I say 

12          potential impact because there's still time 

13          to mitigate some of the reductions which, if 

14          left unmitigated, would result in a reduction 

15          of community-based recovery services, further 

16          causing harm in this time of COVID ravages 

17          and the opioid epidemic, as well as racial 

18          unrest.

19                 Recovery is not just an individual or 

20          family issue, it's a community issue.  It is 

21          and should be addressed as such by the people 

22          who were diligently elected to represent the 

23          people.  FOR-New York has worked since 2008 

24          to build an infrastructure around the state 


 1          through local recovery community 

 2          organizations, a network that saw over 44,000 

 3          visits to the recovery community 

 4          organizations last year alone.

 5                 We know that recovery works.  It wraps 

 6          itself around treatment, and it should be 

 7          treated on par as treatment.  And so we know 

 8          that the federal money has been strategically 

 9          funneled through OASAS to the state-targeted 

10          response to the opiate crisis grants.  But we 

11          know that that is not enough.  

12                 We hope that any and all funding 

13          streams, whether increased federal dollars -- 

14          which you've heard about today -- the opiate 

15          litigation funds, which could potentially 

16          bring millions of dollars, or through other 

17          tax revenue streams related to addictive 

18          substances or behaviors, be allocated 

19          specifically to prevention, treatment, 

20          recovery, as well harm reduction services.

21                 These funding streams could be exactly 

22          the ticket to filling the health gap for our 

23          vulnerable population, or they could become 

24          another Band-Aid for our state budget.  It is 


 1          our hope that they help to fill the gap.  We 

 2          ask the Legislature and the executive branch 

 3          to put this funding where it belongs, back 

 4          into addiction services and supports where it 

 5          is needed.

 6                 Thank you.  

 7                 CHAIRWOMAN KRUEGER:  Thank you.  

 8                 Now let's try Pete Harckham.

 9                 SENATOR HARCKHAM:  Thank you, 

10          Madam Chair.  

11                 And thank you to all three of you for 

12          your testimony today and your partnership and 

13          your collaboration on these important issues.  

14                 Since time is short, I'll ask my 

15          questions first to Allegra.  We -- in 

16          legislation last year, we ended prior 

17          authorization of MAT for Medicaid.  I 

18          understand that has not worked out as we had 

19          planned, and there's some issues, if you 

20          could address that.  

21                 And then to both John and Angelia, 

22          what I'm hearing in the community is that 

23          it's hard to retain staff right now.  Morale 

24          is low.  We in the state have not kept up 


 1          with the reimbursements for staff.  You 

 2          alluded to the lack of COVID funding.  So if 

 3          the two of you could also address the state 

 4          of the industry and where morale is at.

 5                 So we'll go to Allegra first.  It 

 6          looks like about a minute for each of you.

 7                 MS. SCHORR:  Sure.  Thank you so much.  

 8          And thank you, Senator, because we did -- I 

 9          think we had a really great piece of 

10          legislation, and certainly the intention was 

11          to get rid of that prior authorization, which 

12          is a real barrier to treatment.

13                 And I would say it was very successful 

14          in the -- for commercial insurance, and that 

15          had been a real barrier.  Unfortunately, on 

16          the Medicaid side, as you said, it didn't 

17          work out.  And now what we have is I think 

18          even greater disparity between people with 

19          commercial insurance and people with 

20          Medicaid.  

21                 And the difference here is that the 

22          state is planning a single formulary for our 

23          Medicaid population, and they are -- instead 

24          of having real open access to any kind of 


 1          medication-assisted treatment, for 

 2          buprenorphine product, depending on what you 

 3          have, unfortunately they've limited it to 

 4          certain -- ironically, to a brand.  So 

 5          normally you would think, well, a generic, 

 6          that's pretty common.  But in this case 

 7          they're saying a brand.  

 8                 And there are several patients that 

 9          are with addiction medicine very used to and 

10          familiar with their particular formula, and 

11          they're now going to be moved to a different 

12          product if you're Medicaid.  That will not 

13          happen if you're commercial -- if you have 

14          commercial insurance.  So that's -- that's -- 

15          we're definitely concerned about --

16                 SENATOR HARCKHAM:  All right, so let's 

17          keep in touch on that one and we can do some 

18          more work on that.

19                 MS. SCHORR:  Great.  Thank you.  

20                 MR. COPPOLA:  Senator, on your point 

21          about the state of the field, you know, 

22          morale is very, very low.  I mean, during PPE 

23          people were considered to be first responders 

24          and essential staff, but they didn't get the 


 1          equipment.  

 2                 And also, you know, in a world where 

 3          our workers are paid $5,000 to $7,000 less 

 4          than comparable workers in other fields, it's 

 5          a significant uphill battle for folks.  It's 

 6          amazing that they stay in our programs.

 7                 SENATOR HARCKHAM:  Thank you.

 8                 Angelia?

 9                 DR. SMITH-WILSON:  Yes, to speak to 

10          John's point, I think that, you know, there's 

11          an incredible amount of resiliency within our 

12          field.  But because of the work that folks do 

13          in helping people to transform their lives, 

14          that can be a lot and that can be heavy.  

15                 And it's not like work in light of 

16          reductions and hold-backs.  Obviously that is 

17          going to bring a sense of, you know, folks 

18          not being able to have the resources that 

19          they need as they continue to work with 

20          people to transform their lives.  I mean, 

21          it's just been -- it has taken away from the 

22          amount of energy that folks have to give.  

23                 But I will always say that recovery 

24          offers resiliency.  We have seen it.  Peers 


 1          in the workforce have stepped up and done -- 

 2          and in between.  But I'm not sure how much 

 3          longer that can continue with the cuts that 

 4          they are seeing.

 5                 CHAIRWOMAN KRUEGER:  Thank you.  I'm 

 6          sorry, but you ran a minute over so I had to 

 7          cut you off.  I'm sorry.

 8                 Assembly.

 9                 CHAIRWOMAN WEINSTEIN:  Yes, we go to 

10          Assemblyman Steck, chair of our Alcoholism 

11          and Drug Abuse Committee.

12                 ASSEMBLYMAN STECK:  Thank you very 

13          much.  

14                 I wanted to ask Ms. Schorr what 

15          statutory changes she felt were needed to 

16          OMIG's enabling legislation to make sure that 

17          it doesn't become an abusive process.

18                 MS. SCHORR:  Well, one thing I want to 

19          be clear, we have an understanding that 

20          compliance is important.  And we're not 

21          saying in any way, shape or form don't audit, 

22          because we're highly regulated.  We're 

23          frankly audited all the time by any number of 

24          federal as well as state and frankly local 


 1          agencies.  So there's no argument from us on 

 2          the importance, frankly, and belief in 

 3          audits.  And in compliance.  

 4                 What we're saying here is frankly, I 

 5          think, excessive and overreach and, in 

 6          particular, a sense that this is 

 7          disproportional and the -- what can you say, 

 8          the punishment doesn't match the so-called 

 9          crime.  There's actually no crime, so it's 

10          probably not an adept analogy.  But in this 

11          case what we're looking --

12                 ASSEMBLYMAN STECK:  Can you get to 

13          examples of what you mean?

14                 MS. SCHORR:  Yes.  So we're looking at 

15          situations where there may be a misstated 

16          visit or a treatment plan that they didn't 

17          find, and so they're going back in time.  As 

18          we pointed out, $400 in total claims when 

19          you're look at this universe -- and it's 

20          essentially because OTPs are -- every single 

21          visit, including medication visits, are 

22          billed separately, claimed separately.  

23          You're seeing a really huge universe that you 

24          wouldn't see in another type of modality.


 1                 MR. COPPOLA:  Sometimes it's as simple 

 2          as a caseworker did not initial a case 

 3          record.  Or did not put the date in the date 

 4          column.  There's all kinds of other 

 5          documentation that the service was provided 

 6          on a certain time and date, but there's a 

 7          technical error in the case record, and you 

 8          get a disallowance.

 9                 MS. SCHORR:  No question that these 

10          are services that were provided.  There's no 

11          question about the quality of service.  

12          There's no -- these are simply documentation, 

13          small documentation errors that are resulting 

14          in -- in this case, that resulted in a 

15          program closure.

16                 So that's where the difference that 

17          we're -- the disputes that we're having.  

18          It's clearly excessive.

19                 ASSEMBLYMAN STECK:  One question.  

20          Have you been impacted by these so-called 

21          algorithmic audits, and how so?  And what 

22          might be done to address that problem?

23                 MS. SCHORR:  Well, one thing we might 

24          I think consider is, because there's no fraud 


 1          and no abuse, the use of this kind of 

 2          extrapolation I think is not warranted, 

 3          frankly.  And so I would suggest that 

 4          legislation that limits this kind of huge 

 5          extrapolation to a penalty where there maybe 

 6          is a real intent, where clearly someone was 

 7          out to game the system in some way.  That 

 8          seems certainly reasonable, no question.

 9                 But in this case that's -- none of 

10          this is -- goes to that.  And frankly, 

11          there's -- I think providers at this moment 

12          in time are subject to a number of audits.  

13          This is -- this is -- our system is under one 

14          kind of siege at the moment.  There's a 

15          number of OPRA audits that have come up, and 

16          that affects many, many more providers.  And 

17          these are hundreds of thousands of dollars --

18                 ASSEMBLYMAN STECK:  What kind of an 

19          audit is that?

20                 MS. SCHORR:  This is an Ordering 

21          Provider Referral Audit.  And so these are 

22          audits that --

23                 ASSEMBLYMAN STECK:  Is that an OMIG 

24          audit?


 1                 MS. SCHORR:  This is another OMIG 

 2          audit.  And this is another technical audit 

 3          that's caused by -- frankly, really could 

 4          have been stopped by a simple edit in the 

 5          eMedNY system, claiming system, and did not 

 6          have --

 7                 (Overtalk.)

 8                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 9          We're going to go back to the Senate now.  

10                 CHAIRWOMAN KRUEGER:  Thank you.  

11                 Senator Diane Savino.

12                 SENATOR SAVINO:  Thank you, Senator 

13          Krueger.  

14                 I actually have a question for John 

15          Coppola.  Good to see you.  And thank you to 

16          everyone on the panel.

17                 John, I want to ask your opinion about 

18          the proposed merger of OASAS into OMH.  I've 

19          spoken to some of the providers here on 

20          Staten Island, and they're a little skeptical 

21          and a little concerned that OASAS, which has 

22          kind of always been a little -- gotten a 

23          little short shrift from the government, even 

24          in the midst of probably the worst opioid 


 1          crisis in history and drug crisis since the 

 2          crack epidemic -- might get lost in the 

 3          bigger agency.  

 4                 Do you share that concern or -- what 

 5          do you think about this proposed merger?  

 6                 MR. COPPOLA:  Thank you for the 

 7          question, Senator.  

 8                 What I would say is the field is very 

 9          divided.  There are a lot of people in the 

10          field that think the new agency would be a 

11          good idea for some of the reasons that I 

12          think Senator Harckham mentioned when he 

13          offered remarks to the commissioner a little 

14          bit earlier.

15                 But the more you talk about the 

16          concerns that people have -- so for instance, 

17          you know, will the peer professionals in the 

18          addiction field, the certified addiction 

19          counselors, will they retain their ability to 

20          continue to provide services or will there be 

21          sort of new additional academic standards put 

22          in, basically putting them out of jobs?  To 

23          what extent will the treatment models be 

24          different, et cetera?  To what extent will 


 1          people with criminal records, who are a vital 

 2          part of our workforce and frequently are 

 3          discriminated against in the mental health 

 4          system -- to what extent will they be able to 

 5          retain their jobs and to retain their 

 6          important, you know, part in our workforce?  

 7          The culture of the fields are a little bit 

 8          different.

 9                 So when people start feeling, you 

10          know, like what's at risk, what -- how can we 

11          potentially lose our identity, then people 

12          start getting nervous, and then the numbers 

13          of people saying, Well, I'm not so sure it's 

14          a good idea.

15                 So I think the process of how the 

16          agency gets designed is going to be vital.  

17          And there has to be some respect for 

18          differences.  Just a simple thing like the 

19          use of the word "prevention."  Just because 

20          it is applied differently in the two systems 

21          doesn't mean one definition is correct and 

22          the other one is incorrect.

23                 So the process of creating new 

24          departments and new service programs, it's 


 1          going to have to be really important that the 

 2          language and the culture of both systems is 

 3          respected so that the people who are 

 4          ultimately getting services are getting the 

 5          best possible services.

 6                 SENATOR SAVINO:  Thank you.  I guess 

 7          that will help inform us as we move forward 

 8          on this.  Because I think Senator Harckham 

 9          made some very good points.  For too long we 

10          did not look at addiction as anything other 

11          than a character defect.  We now know so much 

12          more about it.  

13                 But I do think you're right, we've 

14          built out a system where we brought in people 

15          who have been affected by the criminal 

16          justice system because we have criminalized 

17          addiction for so many years, and we would not 

18          want to see those people who built careers 

19          post the criminal justice system shut out of 

20          an opportunity.  

21                 So thank you for your answer.

22                 MR. COPPOLA:  You're welcome.

23                 SENATOR SAVINO:  Thank you for your 

24          work, everyone.


 1                 MR. COPPOLA:  You're welcome.

 2                 CHAIRWOMAN KRUEGER:  Thank you.  Yes, 

 3          thank you for your work, everyone.

 4                 On to the next panel, all right?  The 

 5          Mental Health Association of New York State, 

 6          Glenn Liebman; the New York State Conference 

 7          of Local Mental Hygiene Directors, 

 8          Kelly Hansen; the National Alliance on 

 9          Mental Illness, Wendy Burch; and the 

10          Coalition for Behavioral Health, Amy Dorin, 

11          in that order.

12                 MR. LIEBMAN:  Thank you.  Thank you 

13          very much, Senator.  I appreciate it very 

14          much.  Thank you to both the chairs.  And I 

15          just want to also acknowledge and thank our 

16          Mental Hygiene chairs, Assemblymember Gunther 

17          and we welcome Senator Brouk as well to our 

18          community.

19                 So my name is Glenn Liebman.  I've 

20          been the director of the Mental Health 

21          Association for the last 17 years.  We're 

22          comprised of 26 affiliates in 52 counties.  

23          And most of our members provide 

24          community-based mental health services, the 


 1          kind of services that Commissioner Sullivan 

 2          was talking a lot about this morning.  

 3                 But we're also involved a lot in 

 4          advocacy training and education.  We've 

 5          certainly been very involved in the recent 

 6          initiative around the Trauma-Informed Care 

 7          Advisory Council set up by and initially 

 8          introduced into legislation by Assemblymember 

 9          Gunther.  

10                 We're also very involved with mental 

11          health instruction in schools.  That's a 

12          mandate that New York has -- we're very proud 

13          of that -- since 2018.  We're the only state 

14          in the country that has that.  We're very 

15          proud of that.

16                 So we're here today to talk about -- 

17          really, it's about two pandemics.  We all 

18          know the one pandemic, we're all very 

19          familiar with the over 450,000 people who 

20          died, the racial injustice, the lost jobs, 

21          everything that that's about.  But I'm here 

22          to talk about the second pandemic.  And we 

23          talked about it a little bit this morning.  

24          I've heard several legislators talking about 


 1          it, and Governor Cuomo's referenced it many 

 2          times as well.  

 3                 Kaiser Permanente did a study early on 

 4          around COVID and said that 42 percent of 

 5          adult Americans are suffering from a mental 

 6          health issue.  That's up from the usual 

 7          20 percent.  That's 90 million Americans.

 8                 Those between the ages of 18 to 24, 25 

 9          percent of them have seriously considered 

10          suicide.  Think about that:  25 percent of 

11          18-to-24-year-olds.  And we certainly know, 

12          we're very familiar, we're all familiar with 

13          the school-age children and everything going 

14          on with isolation, anxiety and depression 

15          around that.

16                 We are facing the worst mental health 

17          crisis of our lifetimes.  Now, we 

18          appreciate -- the state is responding in some 

19          really strong ways.  We're appreciating what 

20          they're doing around restructuring of 

21          telehealth, the emotional support line, the 

22          crisis counseling, crisis stabilization 

23          centers.  That's all really good stuff.

24                 But the reality is the budget is very 


 1          painful.  People have talked about this.  A 5 

 2          percent across the board funding cut to our 

 3          already deeply underfunded system.  We were 

 4          here last year talking to you about 3 for 5 

 5          and the need for more funding for our 

 6          community.  And now we're facing a 5 percent 

 7          budget cut.  

 8                 We are losing $22 million in 

 9          reinvestment this year.  We talked about it, 

10          you asked a lot of great questions this 

11          morning about it.  Those are community 

12          services that are lauded by the Office of 

13          Mental Health and by our community.  It's not 

14          about reinvestment, it's investing.  You 

15          invest this funding in the community, and 

16          you're keeping people out of hospitals, out 

17          of emergency rooms, out of the criminal 

18          justice system.  So it's really an 

19          investment.

20                 And the cut that really bothers me the 

21          most is the 1 percent across-the-board COLA 

22          cut of $50 million.  That's the worst cut of 

23          all, because that is the heroes -- we're 

24          impacting the heroes who have gone in during 


 1          COVID, our mental health community heroes.  

 2          We've been talking about the larger group of 

 3          healthcare heroes?  These are our mental 

 4          health heroes.  They're going in, and 

 5          unfortunately they're not even getting a 1 

 6          percent increase in terms of the COLA.  

 7                 And not to mention, obviously, the 

 8          Dwyer, CIT, mental health first aid, the 

 9          funding cuts to -- and Harvey talked about 

10          this too, the adult homes and non-protection.  

11          I could go on and on, but I know my time is 

12          up.

13                 But really, this -- to sum it up, this 

14          is such a painful budget for many of us, for 

15          all of us.  And it's coming at the worst 

16          possible time in terms of the pandemic.

17                 Thank you very much.

18                 CHAIRWOMAN KRUEGER:  Thank you.

19                 Second?

20                 MS. HANSEN:  Good afternoon.  Can you 

21          hear me?

22                 CHAIRWOMAN KRUEGER:  Yes.

23                 MS. HANSEN:  Okay.  Good afternoon.  

24          Thank you to the committee chairs and the 


 1          members who are joining us today.

 2                 My name is Kelly Hansen.  I'm the 

 3          executive director of the New York State 

 4          Conference of Local Mental Hygiene Directors.  

 5          And who we represent are the county mental 

 6          health commissioners, who are responsible on 

 7          the local level, the community level, for 

 8          integrated services and developing 

 9          priorities, programs, funding, oversight for 

10          individuals -- adults and children -- 

11          affected by mental illness, substance use 

12          disorder, and developmental disabilities.  So 

13          from the local standpoint, these are all -- 

14          they're merged already.  They've always 

15          worked in an integrated way.

16                 I'd like to use my time today to touch 

17          quickly on two pieces and then talk much 

18          longer on the jail-based SUD funding.  

19                 So to echo my colleague Glenn and 

20          others, the 20 percent withholds are 

21          devastating.  Devastating.  This is state aid 

22          money that goes to the counties and the 

23          counties contract with providers based on the 

24          needs in their communities and their counties 


 1          to be able to provide services.  

 2                 So at the same time this funding was 

 3          withheld for 20 percent for three quarters, 

 4          the need in the community has significantly 

 5          increased due to COVID.  Our members work 

 6          very closely -- they're responsible for 

 7          crisis services in the community.  And the 

 8          calls to the crisis lines and mobile crisis 

 9          are going up significantly.  The requests for 

10          individuals who are seeking treatment, what 

11          the county commissioners would tell you is 

12          we're seeing people crossing -- coming in 

13          through our doors and seeking treatment who 

14          we have never seen before.  

15                 So the impact of COVID will be 

16          lasting, too.  We will have -- this doesn't 

17          just get, you know, fixed when a vaccine is 

18          available and everyone feels safe and 

19          comfortable.  And the cuts to state aid and 

20          local assistance -- and of course now the 

21          $22 million proposed redirect out of 

22          reinvestment into the General Fund is 

23          important as well.  

24                 The 50 percent cut to the funding that 


 1          goes to counties for SUD treatment and 

 2          transition services in jails, this was an 

 3          initiative of the conference from the county 

 4          commissioners, who kept seeing individuals, 

 5          those same folks coming in and out of jail, 

 6          in and out of jail, and they had no funding 

 7          to be able to provide services for them.  

 8                 So we, together with the State 

 9          Sheriffs Association and the New York State 

10          Association of Counties, came together and 

11          advocated for -- our budget ask at that time 

12          was $12 million.  We received $3.75 million.  

13          And then in this budget, we -- it's cut to 

14          1.8, theoretically because bail reform has 

15          reduced the number of individuals in our 

16          jails.  

17                 Well, we needed 12 million to begin 

18          with.  And so with the 3.75, there are a 

19          number of counties that got $60,000 to be 

20          able to provide group therapy, transition 

21          services, to be able to give someone a glide 

22          path as they're being discharged and part of 

23          reentry.  Peer services, which are so 

24          critically important -- the peer is always 


 1          the most important person in the room, and 

 2          they -- those are at risk of being cut as 

 3          well.  

 4                 So we ask that you restore that 

 5          funding fully.  And I'm happy to answer any 

 6          questions.  And I apologize for going 

 7          40 seconds over, but happy to answer any 

 8          questions you may have.  

 9                 Thank you.

10                 CHAIRWOMAN KRUEGER:  Thank you.

11                 Our next speaker?

12                 MS. BURCH:  Good afternoon, Senator 

13          Krueger, Assemblywoman Weinstein, chairs and 

14          members of the committee.  Thank you for the 

15          opportunity to provide testimony today.  

16                 We are seeing a significant surge in 

17          the need for behavioral health services which 

18          cannot be met without substantial efforts 

19          from our behavioral health providers, yet 

20          they have been met with crippling withholds 

21          and are now facing permanent cuts.  To avert 

22          program closures, access barriers and 

23          reductions in service availability, the state 

24          must immediately provide full funding for 


 1          mental health services and restore the 5 

 2          percent across-the-board cut the budget is 

 3          imposing on providers.

 4                 To maximize every dollar that is 

 5          supporting the system, we must ensure 

 6          reinvestment of any savings into behavioral 

 7          health community-based services.  And vitally 

 8          needed federal funds received cannot be used 

 9          to supplant existing state funds.

10                 We ask that new funds be used first to 

11          support our workforce and strengthen existing 

12          services, and then for new initiatives.  Our 

13          provider agencies are in fiscal distress, 

14          experiencing a staffing crisis, and we have 

15          been severely impacted by COVID.

16                 The creation of an adult-use cannabis 

17          program, if enacted in the final budget, must 

18          ensure that substantial revenues are 

19          dedicated to prevention, harm reduction, 

20          treatment and recovery programs.  If the 

21          Senate and Assembly approve marijuana for 

22          adult use, we ask that you include a 

23          significant commitment to this funding.

24                 The need for robust community-based 


 1          behavioral health services is also heightened 

 2          as we see psychiatric and detox inpatient 

 3          beds being disproportionately reduced by 

 4          private hospitals in order to meet state 

 5          overhead mandates.  The loss of these beds is 

 6          disturbing, both because of the increased 

 7          burden it places on the underfunded 

 8          community-based system as well as the human 

 9          toll this is taking on those in need.

10                 Along with restoring the funds to 

11          community providers, and ensuring that those 

12          most in need of care receive it, there are 

13          also funding measures that need to be put in 

14          place to ensure appropriate access to mental 

15          health services.  

16                 We also ask the Senate and Assembly to 

17          strengthen the Governor's proposed expansion 

18          of telehealth services by adding telehealth 

19          rate parity so that rates for audio-video 

20          services are the same as in-person rates, 

21          helping cover the full cost of services, and 

22          that all OMH and OASAS peers be included in 

23          telehealth reimbursement.  

24                 Now more than ever it is critical that 


 1          an individual receives the psychiatric 

 2          medicine their doctor believes would best 

 3          advance their recovery.  This is why we are 

 4          advocating for prescriber prevails language 

 5          for Medicaid services to be included in the 

 6          final budget.

 7                 NAMI-New York State is calling for 

 8          investments in services necessary for 

 9          adequate community care, like mental health 

10          housing, ACT teams, mobile intervention 

11          teams, respite centers, crisis stabilization 

12          centers, CCBHCs, telehealth, first-episode 

13          psychosis programs, and school-based mental 

14          health clinics.

15                 We also ask for continued funding for 

16          New York's Institute for Police, Mental 

17          Health and Community Collaboration, which has 

18          been so successful at addressing crisis 

19          response.

20                 With the upcoming implementation of 

21          the 988 crisis number, New York has the 

22          opportunity to transform our crisis response 

23          system.  We will be recommending measures 

24          that adhere to NAMI's model bill for core 


 1          state behavioral health crisis service 

 2          systems.

 3                 Thank you.  

 4                 CHAIRWOMAN KRUEGER:  Thank you.  

 5                 And the last on this panel, Amy Dorin.

 6                 MS. DORIN:  Thank you.  Good 

 7          afternoon.  Thank you for the opportunity to 

 8          testify this afternoon.  

 9                 I'm Amy Dorin, president and CEO of 

10          the Coalition for Behavioral Health.  The 

11          coalition represents over 100 community-based 

12          behavioral health providers who offer the 

13          full array of outpatient, mental health and 

14          substance use services to over 600,000 

15          New Yorkers annually.  

16                 With COVID and a racial reckoning 

17          affecting historically underserved 

18          communities, demand for behavioral health 

19          services is skyrocketing.  And yet 

20          one-quarter of providers can barely make 

21          payroll, showing the behavioral health system 

22          is at a breaking point.  

23                 Rather than cutting programs, the 

24          Legislature should look at the various 


 1          opportunities to raise revenue and invest in 

 2          behavioral health at this critical moment.

 3                 We are deeply concerned by the 

 4          proposed 5 percent cuts to local aid funding.  

 5          These cuts will devastate already struggling 

 6          organizations and communities and threaten 

 7          critical services.  We also oppose the 

 8          proposal to suspend community reinvestment 

 9          for one year.  It is critical that the 

10          closure of inpatient psychiatric beds is 

11          followed with a reinvestment into 

12          community-based services.  These services are 

13          essential to keep individuals from needing to 

14          be hospitalized.  

15                 Instead of these cuts, the Legislature 

16          has an opportunity this year to truly invest 

17          in behavioral health and ensure ongoing 

18          critical support to individuals with mental 

19          health and substance use disorders.  

20                 The virus may be under control soon, 

21          happily, but the behavioral health fallout 

22          will last for decades to come if we do not 

23          ensure services now.  As the state looks to 

24          legalize marijuana, we encourage revenue to 


 1          be dedicated into prevention, treatment and 

 2          harm reduction, as included in the 

 3          Legislature's proposals.  

 4                 Additionally, the opioid settlement 

 5          funds provide an opportunity to infuse new 

 6          dollars into treatment for substance use and 

 7          co-occurring disorders, and to turn the tide 

 8          on the deadly overdose epidemic.  Overdose 

 9          deaths have increased in the past year to 

10          new, ever more tragic heights.  We must 

11          invest these funds now to prevent cuts.  

12          Opioid settlement dollars must be kept out of 

13          the General Fund, and we encourage the 

14          Legislature to include language to this 

15          effect in the budget.  

16                 COVID showed a clear need to reform 

17          our telehealth laws, and the proposal in the 

18          budget makes several important changes, 

19          including allowing individuals to receive 

20          care wherever they are located.  However, the 

21          proposal falls short in two key ways.  

22          Telehealth must be covered at the same rate 

23          as in-person services.  However, rates are 

24          not mentioned in the budget.  


 1                 Telehealth requires a significant 

 2          investment from providers, including the 

 3          purchase of devices and program licenses, as 

 4          well as training staff in this modality.  

 5          This must be compensated at the same rate as 

 6          in-person care.  

 7                 The proposal also fails to include all 

 8          peers.  Peers, who are individuals with lived 

 9          experience with mental health or substance 

10          use disorders, provide critical services.  

11          They're a proven part of treatment and 

12          recovery and should not be treated 

13          differently from other professionals.  All 

14          peers who are eligible to be reimbursed for 

15          in-person services must be eligible for 

16          telehealth reimbursement.

17                 Thank you again for the opportunity to 

18          testify today.

19                 CHAIRWOMAN KRUEGER:  Thank you all 

20          very much for your testimony this afternoon.  

21          Appreciate it.

22                 Our next panel -- Panel G, for those 

23          of you following along -- the New York 

24          Alliance for Developmental Disabilities, 


 1          Russell Snaith; the Association for Community 

 2          Living, Sebrina Barrett; the New York 

 3          Self-Determination Coalition, Susan Platkin; 

 4          and the New York Disability Advocates, Susan 

 5          Constantino.  

 6                 We'll go in that order.  Russell.  

 7                 MR. SNAITH:   Great, thank you.  

 8                 Good afternoon, committee chairs, 

 9          distinguished members of the Assembly and 

10          Senate, and Committee on Mental Hygiene.  My 

11          name is Russell Snaith, and I'm the founding 

12          member of the New York Alliance for 

13          Developmental Disabilities, also known as 

14          NYADD.  With over 5,500 members across New 

15          York State, we advocate for and represent 

16          families and essentially the consumers of 

17          services.

18                 I come before you today to speak very 

19          plainly and frankly.  When it comes to 

20          funding for the disabled and those with 

21          special needs, this is not a discussion about 

22          money.  It's a referendum on morality and 

23          priorities in New York State.  So what I'm 

24          really here to do is to kind of reframe and 


 1          rebrand the context and the tone and the 

 2          tenor of this discussion away from money and 

 3          more about priorities, obligations, 

 4          responsibility and morality, as people who 

 5          are learned and in high positions, to take 

 6          care of the most vulnerable in our state.

 7                 There's never going to be enough 

 8          money.  We all recognize there's never going 

 9          to be enough money.  So we need to change the 

10          key here away from money and put it more 

11          toward priorities.  Basically, money is a red 

12          herring, but priorities are real.  And I'd 

13          just like to say that one more time, that 

14          money in the budgeting process is really a 

15          red herring because there's never enough of 

16          it and at the end of the day, there are 

17          decisions that are made to allocate money 

18          that are not always the most efficient or 

19          wise or effective decisions.

20                 So -- but priorities are real.  While 

21          we are always hopeful for federal aid, we 

22          must first manage the revenues that New York 

23          State does have.  We have to manage our own 

24          books and the revenues that we generate.


 1                 Service providers have become much 

 2          more efficient and effective in the use of 

 3          their budgets over time, but has New York 

 4          State?  Has New York State looked at the 

 5          money that it has and the efficiency of the 

 6          state and the decisions that it makes to run 

 7          the projects that it does run?  We must take 

 8          a look at and rationalize all of the waste, 

 9          the inefficiency and noncritical 

10          discretionary projects New York takes up at 

11          the expense of greater needs for greater 

12          people, and disabled and special needs.  

13                 Let's put the emphasis of special 

14          interests on those with special needs.  NYADD 

15          is a loud, clear voice for over 5,000 members 

16          who vote in New York State, and there's a 

17          real accounting in terms of the way people 

18          vote to allocate funding for those with 

19          special needs.  

20                 The state has done a reasonable job in 

21          assessing the demand for services.  And I 

22          would like to acknowledge and thank the 

23          partnership with OPWDD.  I do think that they 

24          listen and they're doing their darndest to 


 1          work with what they have.  Yet the demand 

 2          continues to rise, and funding continues to 

 3          be cut.

 4                 Service providers are being squeezed 

 5          to the brink of extinction and unhealthy 

 6          consolidation.  Incessant cuts to the 

 7          disabled are forcing policy decisions that 

 8          put service providers in precarious 

 9          situations -- policies that occur in 

10          isolation, warehousing and separation from 

11          the community and families.  

12                 We must pay direct support 

13          professionals a living wage.  They provide 

14          care to our most vulnerable citizens.  The 

15          skill set is unique and deep and is not 

16          comparable to a fast-food worker.  High staff 

17          turnover reduces care and creates risk.  It 

18          costs more money to operate like this than to 

19          pay staff properly in the first place.  

20                 So I would just like to close by 

21          saying that we're not living up to the credo 

22          of Governor Mario Cuomo.  What happened?  

23                 Thank you for your time.

24                 CHAIRWOMAN WEINSTEIN:  Thank you.  


 1                 Sebrina Barrett?

 2                 MS. BARRETT:  My name is Sebrina 

 3          Barrett, and I am the executive director for 

 4          the Association for Community Living.

 5                 Thank you to Senator Krueger, 

 6          Assemblywoman Weinstein and the chairs and 

 7          members of the Senate and Assembly Mental 

 8          Health Committees for this opportunity to 

 9          testify.

10                 ACL's members provide a home and a 

11          path to recovery for about 40,000 New Yorkers 

12          with severe and persistent mental illness.  

13          Before the pandemic -- before the pandemic, 

14          mental health housing faced a $180 million 

15          shortfall.  This is because the funding 

16          model, which was developed 30 to 40 years 

17          ago, has not kept pace with inflation and the 

18          changing demands of our community.

19                 For example, employee health insurance 

20          premiums have risen 740 percent since 1984.  

21          Our providers cannot afford health insurance 

22          for staff at current reimbursement rates.  

23          More than 30 years ago, our staff made $6 to 

24          $7 an hour, double the then-minimum wage.  


 1          Today they make just at minimum wage, leaving 

 2          them unable to afford childcare.  Many have 

 3          to work more than one job.  We are losing 

 4          staff to fast-food restaurants and retail, 

 5          which can pay them more.  

 6                 Plus, over time, these jobs have 

 7          become harder, as residents' mental and 

 8          physical needs have grown.

 9                 Today staff manage more than a dozen 

10          medications for residents, rather than one or 

11          two when these programs first started.  We 

12          are facing a staffing crisis.  We have a 25 

13          to 30 percent staff unavailability rate, 

14          vacancies that cannot be filled due to low 

15          pay, staff who must stay home to care for 

16          children, staff who themselves are ill or 

17          have had to quarantine.

18                 No one is applying for our jobs.  Even 

19          when unemployment was at its highest levels, 

20          people needed jobs, but no one wanted our 

21          jobs.

22                 This impacts recovery.  This week I 

23          spoke to a former resident whose recovery 

24          time was more than doubled because of staff 


 1          turnover.  She had more than 10 different 

 2          staff members over the course of her 

 3          treatment.  Just when she would begin to 

 4          trust a staff member and progress in her 

 5          recovery, that employee would leave and she 

 6          would have to start over at square one.  

 7                 Also, staff are on the front lines of 

 8          COVID.  Because residents have co-occurring 

 9          medical conditions, of those who became ill 

10          with COVID, more than 45 percent required 

11          hospitalization, and more than 15 percent 

12          died.

13                 New York's 2021 enacted budget 

14          included $20 million for mental health 

15          housing, but due to the fiscal crisis those 

16          dollars were never allocated.  We are pleased 

17          to see these dollars are in the '21-'22 

18          budget, and we urge that they be allocated as 

19          soon as possible.  We know New York has a 

20          difficult budget year, but the $180 million 

21          gap remains.

22                 We also hope that continued investment 

23          in existing mental health housing will be 

24          made.  In addition, we are pleased that the 


 1          proposed budget includes 250 million for the 

 2          development of new supportive housing.  This 

 3          funding is crucial for New York State to be 

 4          able to live up to its obligation to promote 

 5          strong mental health housing programs.  

 6                 Finally, mental health housing is not 

 7          only the right thing to do, it's fiscally 

 8          smart.  It is much less expensive than 

 9          hospitals, prisons, and homeless shelters.  

10          We save lives, and we save money.  

11                 Thank you.

12                 CHAIRWOMAN KRUEGER:  Thank you.

13                 Next?  

14                 (Overtalk.)

15                 MS. PLATKIN:  Can you hear me?

16                 CHAIRWOMAN KRUEGER:  There you are.

17                 MS. PLATKIN:  Good afternoon.  My name 

18          is Susan Platkin.  Thanks for the opportunity 

19          to comment on the budget.  I'm here 

20          representing the New York Self- Determination 

21          Coalition, a volunteer group which advocates 

22          for self-directed services through OPWDD.  We 

23          also mentor families going through the 

24          process.  


 1                 Self-directed services represent the 

 2          most authentic expression of the ADA, the 

 3          Olmstead decision, and the HCBS home and 

 4          community settings rule.

 5                 Essentially, self-direction allows 

 6          people with disabilities to live, volunteer, 

 7          work and play while getting the supports they 

 8          need, not just in their communities but as 

 9          part of their communities, using an 

10          individualized budget based on their level of 

11          need.

12                 I bring to this table the perspective 

13          of many families, but most importantly that 

14          of a mom to my 34-year-old daughter Ruth.  

15          Ruth loves parties, board games, and sports.  

16          She also has intellectual disabilities and 

17          bipolar disorder, and functions pretty much 

18          as a second-grader.  Because of her poor 

19          judgment, she needs continuous supervision.  

20                 Using self-directed services, she 

21          rents a house with a roommate who also gets 

22          services.  Ruth shops, cooks, cleans, does 

23          her laundry, takes out the trash -- 

24          reluctantly -- with a lot of assistance from 


 1          staff.  Despite all of her challenges, Ruth 

 2          is living a good life with friends, a 

 3          part-time job, and volunteering in the 

 4          community where she grew up and went to 

 5          school.

 6                 We appreciate that there's a small 

 7          increase in OPWDD's budget.  However, it is 

 8          inadequate.  Children with I/DD are being 

 9          born every day and living longer.  Serving 

10          more people with a minimal budget increase 

11          has the potential to significantly degrade 

12          OPWDD services for everyone.  

13                 It's not like people have a choice.  

14          They don't say, My kid is great, family's 

15          fine, let's try and get some services from 

16          OPWDD to make us happy.  People need these 

17          services to live their lives.  

18                 And this doesn't just affect the 

19          person with I/DD, it affects the entire 

20          family -- for example, a mom who can't work 

21          because she has to care for her 40-year-old 

22          son.  

23                 At the same time, we understand the 

24          need to balance the state's budget.  We urge 


 1          you to use COVID as an opportunity and 

 2          New York's financial pressures as an 

 3          imperative to right-size the system away from 

 4          an institutional model of care.

 5                 Self-directed services give people 

 6          choice in their lives and support them to be 

 7          productive citizens.  In this new age of 

 8          pandemics, we know they're safer than 

 9          congregate programs.  Relevant here, they are 

10          cost-effective.  In programs, everyone gets 

11          the same services.  People who self-direct 

12          get only the services they need, without 

13          wasted money for overhead.

14                 One other imperative.  Decisions need 

15          to be based on data and consideration of both 

16          their short- and long-term consequences.  

17          OPWDD should be required to make public all 

18          the data they use for decision-making before 

19          making significant changes to how services 

20          and supports are delivered.  

21                 We're happy to work with you on these 

22          issues.  Thank you.

23                 CHAIRWOMAN KRUEGER:  Thank you.

24                 There was one more --


 1                 MS. CONSTANTINO:  I think I'm number 

 2          four.

 3                 CHAIRWOMAN KRUEGER:  Ah, thank you.  

 4          Susan, yes.

 5                 MS. CONSTANTINO:  Good afternoon.  I'm 

 6          Susan Constantino, representing NYDA.  And 

 7          NYDA is the New York Disability Advocates.  

 8                 NYDA is comprised of seven statewide 

 9          organizations:  The Arc New York, which many 

10          of you know the name; the Alliance of Long 

11          Island Agencies; Cerebral Palsy Associations 

12          of New York State; Developmental Disabilities 

13          Alliance of Western New York; Inter-Agency 

14          Council of Developmental Disabilities; the 

15          New York Alliance for Inclusion and 

16          Innovation; and the New York Association of 

17          Emerging and Multicultural Providers.  

18                 I give you all those names because all 

19          of these groups together represent about 

20          130,000 individuals with disabilities and 

21          their families.

22                 Before COVID, about one in three of 

23          our providers was experiencing financial 

24          hardships.  You've heard us, we've been 


 1          before you before when we've talked about the 

 2          need for a COLA, the need for some kind of 

 3          increase, and you have always been 

 4          responsive, as we've looked at our direct 

 5          support staff, in providing some additional 

 6          dollars.  But we are desperately in need of 

 7          dollars now because of COVID.  

 8                 From the start of the pandemic, there 

 9          had been no reimbursement for any of our 

10          additional expenses.  The PPE, which when it 

11          was finally available, was exceedingly 

12          expensive -- and we worked for so many weeks 

13          without having enough of it.  We were also 

14          having to pay our staff.  In my written 

15          notes, as I look at them, I say we had to pay 

16          our heroes, because our heroes were there 

17          every day and they needed to be paid combat 

18          pay -- again, with no reimbursement, and 

19          again despite the fact that there was an 

20          increased FMAP from the federal government to 

21          the state.

22                 I would like to first just clarify 

23          something that Commissioner Kastner had said 

24          earlier today, and that was that the retainer 


 1          program, which was implemented to offset the 

 2          losses for the providers since the day 

 3          programs were closed, only reimbursed 

 4          providers not at 100 percent, but at 80 

 5          percent.  And this only lasted for four 

 6          months.  And generally the providers had kept 

 7          all their staff employed, so their expenses 

 8          were the same.  Even -- and there was no 

 9          double billing.  Even with COM HAB R, there 

10          was absolutely no -- no -- OPWDD was not 

11          paying twice.  

12                 We also know that statewide providers 

13          had incurred reduced revenue of about $330 

14          million, and we are concerned that OPWDD has 

15          not identified any of those savings due to 

16          the reduced disbursement to providers.

17                 We're also very concerned about the 

18          cuts that were scheduled for 10/1 and now are 

19          5/1.  These are true cuts to programs.  When 

20          there are vacancies, it takes months to fill 

21          those vacancies, and OPWDD controls that.  So 

22          there are no dollars to the providers.  And a 

23          vacant bed still costs money.  We still need 

24          to have people -- our staff there, and we 


 1          still need to pay the rent.  So it does cost 

 2          money.

 3                 The proposed 1 percent rate reduction 

 4          that's in the Executive Budget, combined with 

 5          the lack of a COLA, again, for 11 years, is 

 6          going to be devastating to our providers, 

 7          absolutely devastating.  

 8                 We do want to say how much we 

 9          appreciate the opportunity to continue on 

10          telehealth, and we are asking the Legislature 

11          to just put in a special specific amendment 

12          which is called distance site, to make sure 

13          that the providers can be -- of those 

14          services can be in another site besides a 

15          clinic.

16                 And our workforce, as everyone has 

17          said, it's getting more dire.  Our 

18          percentages are very large.  We are asking 

19          the state, with the money that they get for 

20          COVID relief from the federal government, to 

21          create a $25 million fund for recruitment, 

22          training and retention, but using that fund.

23                 Thank you so much for allowing me to 

24          be here.


 1                 CHAIRWOMAN KRUEGER:  Thank you.  

 2                 And just -- so sorry.  Okay.  Oh, I 

 3          see several hands up.  So I will pass it to 

 4          the Assembly.

 5                 CHAIRWOMAN WEINSTEIN:  Okay.  So first 

 6          we have Assemblyman Abinanti.

 7                 (Pause.)

 8                 CHAIRWOMAN KRUEGER:  Perhaps not.  Oh, 

 9          there you are.

10                 CHAIRWOMAN WEINSTEIN:  Yeah, there he 

11          is.

12                 ASSEMBLYMAN ABINANTI:  No, I'm trying 

13          to click in.  I've got all these things 

14          they're telling me I have to click here and 

15          there and --

16                 CHAIRWOMAN WEINSTEIN:  Okay.

17                 ASSEMBLYMAN ABINANTI:  Let me start -- 

18          first of all, I want to thank all of you for 

19          joining us.

20                 Either Susan -- or either Susan, there 

21          we go.  One of the things that I started to 

22          talk to the commissioner about this morning 

23          and really ran out of time was how long it 

24          takes to get into the system.  Now, I'd like 


 1          -- I mean, my understanding of the way this 

 2          works -- and I went through it myself, and 

 3          I'm still going through it, actually -- is 

 4          first you have to go to OPWDD to get somebody 

 5          to qualify you as having a disability, 

 6          correct?

 7                 MS. CONSTANTINO:  Correct.

 8                 ASSEMBLYMAN ABINANTI:  And then the 

 9          next step -- I'm trying to remember what it 

10          was.  You have to go to local social services 

11          to --

12                 MS. CONSTANTINO:  Somebody has to help 

13          you where you go to social services, right, 

14          absolutely.

15                 ASSEMBLYMAN ABINANTI:  And then you go 

16          back to OPWDD, right.  And then you go back 

17          to social services again to -- and get -- 

18          then you get a care coordinator.

19                 MS. CONSTANTINO:  Correct.

20                 ASSEMBLYMAN ABINANTI:  Now, the care 

21          coordinator helps you set up a whole outline 

22          of what your needs are and how you tie the 

23          needs into the services that are available, 

24          maybe apply for Medicaid --


 1                 MS. CONSTANTINO:  Medicaid, yup.

 2                 ASSEMBLYMAN ABINANTI:  -- or maybe 

 3          food stamps or all of the other programs that 

 4          are available, right?  

 5                 Then from the care coordinator -- now, 

 6          there's only like 3,000 of them in the state, 

 7          right?

 8                 MS. CONSTANTINO:  Right.

 9                 ASSEMBLYMAN ABINANTI:  It's a limited 

10          number.  And they're doing all of this work, 

11          and there's waiting lists for some of the 

12          care coordinators, right?

13                 MS. CONSTANTINO:  That's my 

14          understanding.  

15                 ASSEMBLYMAN ABINANTI:  Right, okay.  

16          And then the next step after care coordinator 

17          is we go to -- we go where?  Where do we go 

18          from there, for -- after care coordinator we 

19          go to fiscal intermediary?

20                 MS. CONSTANTINO:  I think you -- well, 

21          if it were self-direction -- and I would let 

22          Susan speak of that -- it might be a fiscal 

23          intermediary.  If it's not self-direction, 

24          you would be going to the Front Door of 


 1          OPWDD.

 2                 ASSEMBLYMAN ABINANTI:  Okay.  Now, 

 3          they've just announced that because they've 

 4          put in a new assessment system, CAS, they can 

 5          insert somebody else in there.  Right?  A CAS 

 6          coordinator.  

 7                 So if it's self-direction, you have to 

 8          go to a fiscal intermediary and then a 

 9          support broker and then a CAS director.  Then 

10          you get to OPWDD.

11                 Otherwise, you go -- okay.  Now, this 

12          whole process takes how long?  I figure about 

13          two years?

14                 MS. CONSTANTINO:  Well, I'm not sure 

15          if it takes that long.  Susan, you talk, 

16          because you know what happens with 

17          self-direction.

18                 MS. PLATKIN:  Yeah, with 

19          self-direction -- I was just actually 

20          speaking to somebody this morning who had two 

21          children that she was trying to get into it.  

22          And I think she was like -- she was on her 

23          like sixth care manager and had just tried to 

24          find a -- found a broker but wasn't sure what 


 1          she was doing next and had to switch brokers 

 2          because that's a whole other conversation.

 3                 ASSEMBLYMAN ABINANTI:  And the fiscal 

 4          intermediaries in the Mid-Hudson area, or the 

 5          Lower Hudson area, have a waiting list 

 6          because there's not enough of them.

 7                 MS. PLATKIN:  Right.  And you know, 

 8          part of the problem with the system is that 

 9          it's just at a whole lot of levels, things 

10          are getting slow-walked because of lack of 

11          resources within the system, I think.  And 

12          although that doesn't look like a budget 

13          change -- or a policy change, I mean, it 

14          really is a policy change because it's taking 

15          so long.  You can't really have a waiting 

16          list because you can't do that on the waiver.  

17          But things are just taking a very long time.

18                 ASSEMBLYMAN ABINANTI:  Thank you.

19                 CHAIRWOMAN WEINSTEIN:  Thank you.  

20                 Now we -- I don't believe there's any 

21          Senate.

22                 CHAIRWOMAN KRUEGER:  No Senators.  Do 

23          you have other --

24                 CHAIRWOMAN WEINSTEIN:  Let me go to 


 1          our People with Disabilities ranker, Missy 

 2          Miller.

 3                 ASSEMBLYWOMAN MILLER:  Hi.  Can you 

 4          hear me?

 5                 CHAIRWOMAN KRUEGER:  Yes.

 6                 ASSEMBLYWOMAN MILLER:  Okay.  Thank 

 7          you, everybody.  This is probably one of the 

 8          panels that I can relate most to.  

 9                 Just to pick up right where Tom left 

10          off there, that slow-walk that you're 

11          referring to, like after this ridiculous 

12          crazy process, equals people home with no 

13          services, people not even getting into the 

14          system that's available to help them, they're 

15          just sitting there at home languishing.

16                 It used to be that these services were 

17          provided -- or the intake was done through 

18          the Medicaid service coordination agency, 

19          there were waitlists for that.  We were 

20          guaranteed that the CCOs were alleviating 

21          that.  That whole nightmare was going to be 

22          washed out with the introduction of CCOs.  If 

23          anything, it just seems more cumbersome than 

24          ever.  And I just -- it's just, you know, 


 1          very, very frustrating, especially when, you 

 2          know, we -- those of us that live in this 

 3          system and rely on this, you know, can't 

 4          access what's on paper and what looks so 

 5          wonderful.

 6                 And I just want to highlight once 

 7          again what Russell was saying.  It's -- you 

 8          know, there's two very poignant parts of in.  

 9          Number one, for a population that seems to be 

10          discarded, overlooked, forgotten about 

11          repeatedly throughout this whole pandemic, 

12          it's just striking to me that they're always 

13          the first ones on the budget cut list or on 

14          the cut service providers list.  So it's kind 

15          of insulting being one of those in the 

16          population.

17                 And the other is that it's even more 

18          upsetting and frustrating because now, you 

19          know, as a parent I was just told that, and 

20          you're like, all right, what can you do, you 

21          can't get blood from a stone, right?  But now 

22          being a little bit on another side of it and 

23          having some insight into the legislative 

24          process, into the budget process, I was 


 1          appalled to hear the Governor talk about the 

 2          $306 billion of capital improvements and 

 3          other, you know, projects, special interest 

 4          projects that were in his State of the State, 

 5          but yet there's no money, we just keep 

 6          getting cut and cut.  And it's at the expense 

 7          of a growing vulnerable population.

 8                 So I just again think that the 

 9          priorities are so out of whack.  And shame on 

10          us, shame on New York State.  This is not how 

11          we were.  We were the gold standard, we were, 

12          you know, the leaders in taking care of our 

13          individuals with special needs.  And where 

14          are we headed?  

15                 So thank you all for your advocacy and 

16          for doing what you do.  I'm right there with 

17          you.

18                 CHAIRWOMAN WEINSTEIN:  Thank you.  

19                 I think we're back to you, Senator 

20          Krueger.

21                 CHAIRWOMAN KRUEGER:  Thank you.  I 

22          think we are complete with this panel.  Thank 

23          you all very much for testifying.

24                 And we're moving into Panel H, 


 1          NYC Fair, Carlene Braithwaite; Local 372, 

 2          DC 37 AFSCME, Kevin Allen; the Self-Advocacy 

 3          Association of New York State, BJ Stasio -- 

 4          who I hope is going to testify as the Muppet 

 5          picture he had for himself for much of 

 6          today -- and LIFEPlan CCO NY, Nick 

 7          Cappoletti.

 8                 So we'll start with NYC Fair.

 9                 MS. BRAITHWAITE:  Good evening.  Can 

10          everyone hear me?

11                 CHAIRWOMAN KRUEGER:  Yes.

12                 MS. BRAITHWAITE:  Yes, my name is 

13          Carlene Braithwaite, and it's my pleasure to 

14          be here representing NYC Fair.  NYC Fair is a 

15          group of families and those who support 

16          individuals with intellectual and 

17          developmental disabilities throughout the 

18          entire spectrum.  

19                 We have anxiously awaited this 

20          opportunity to talk to you today, but what I 

21          would like to do is to principally, for all 

22          of us and for all of you, rest on the 

23          testimony which we have provided you and then 

24          stick to the points that I think that have 


 1          come up over and over again today that I 

 2          think warrant clarification and certainly 

 3          further questions from the members here today 

 4          to the commissioner, to Dr. Kastner.  

 5                 And I'd like to start with the 

 6          residential issues.  We heard, from many 

 7          questions posed by the members, about how 

 8          residential opportunities, specifically those 

 9          in certified settings, are allocated.  What 

10          we know is there is a lack of transparency as 

11          to how this is done.  Families repeatedly 

12          tell us that they have been on waiting lists 

13          for inordinate amounts of time.  We know that 

14          those waiting lists are very, very long, with 

15          estimates in the thousands as to how many 

16          folks are actually there waiting.  

17                 We know that OPWDD has failed to 

18          follow 5.07, the plan required by the Mental 

19          Health Law of the State of New York.  We know 

20          that they have failed to file a report, a 

21          residential needs survey report, which the 

22          Legislature had required that they file with 

23          you every two years.

24                 And most importantly, they have simply 


 1          failed to provide any detail in how they will 

 2          migrate people into these less-restrictive 

 3          settings which they emphasize.  Which we know 

 4          will be less expensive, less of a cut on the 

 5          budget, but we know we also have an 

 6          obligation to serve this vulnerable 

 7          population.  So we're very concerned as to 

 8          how they will do that.

 9                 So I'd like to move next to the second 

10          important issue here, and that is, I think, 

11          the workforce issue.  I don't think there's 

12          perhaps an issue of more importance to the 

13          day-to-day operation of these programs than 

14          the men and women who serve, at the ground 

15          level, these folks in these programs.  These 

16          are not minimum-wage jobs.  We should all put 

17          our heads together to figure out how to get 

18          them a living wage.  

19                 We heard Kastner's testimony that he 

20          will bring them up to minimum wage, but we 

21          need them to be higher.

22                 And briefly on the October 1, 2020, 

23          cuts.  They will be rolled back to May.  They 

24          should be eliminated.  They are not 


 1          fact-based.  You've heard the testimony from 

 2          this morning.  They're based on the idea that 

 3          these beds will be empty for periods of time 

 4          for hospitalizations and therapeutic leave.

 5                 We know, it's common sense, that when 

 6          the beds are empty, the costs keep running.  

 7          If the costs keep running, they need to be 

 8          reimbursed.

 9                 And I see I'm slightly over my time.  

10          I appreciate the chairlady's indulgence.  

11          Thank you very much.

12                 CHAIRWOMAN KRUEGER:  Thank you.  Thank 

13          you.  

14                 Next?  Are you with us, Kevin Allen?

15                 MR. ALLEN:  Yes.  Yes, good 

16          afternoon --

17                 CHAIRWOMAN KRUEGER:  Good afternoon.

18                 MR. ALLEN:  -- Chairwoman Krueger.  

19          I'm here.  Good afternoon.

20                 CHAIRWOMAN KRUEGER:  Well, we would 

21          love to hear you bring --

22                 MR. ALLEN:  I'm ready.  Good 

23          afternoon, Chairpersons Krueger, Weinstein, 

24          and the distinguished members of the New York 


 1          State Senate Finance Committee and the 

 2          Assembly Ways and Means Committee.  

 3                 I, Kevin Allen, chapter chair, speak 

 4          today on behalf of President Francois and the 

 5          approximately 270 substance abuse prevention 

 6          and intervention specialists representing DC 

 7          37 and Local 372, New York City Department of 

 8          Education employees who operate in the 

 9          New York City public school system.  

10                 The SAPIS system is currently funded 

11          by the Legislature through a joint $2 million 

12          appropriation, and I am here seeking an 

13          increase of $1 million for a total of $3 

14          million in joint legislative appropriation 

15          for SAPIS.

16                 The OASAS-sponsored SAPIS program has 

17          never been more vital than now during this 

18          unprecedented time.  Our kindergarten to 

19          12th-grade students have been positively 

20          influenced by the services offered by SAPIS, 

21          with blended in-person and virtual remote 

22          classes in all New York City school 

23          districts.  We work as key members of the 

24          guidance departments in schools providing 


 1          strategies and resources that help students 

 2          to utilize relevant prevention skills through 

 3          our evidence-based program curricula, 

 4          classroom presentations, positive alternative 

 5          activities, and our group and individual 

 6          counseling groups.

 7                 Since 1971, SAPIS have provided 

 8          essential social-emotional strategies and 

 9          services to help youth remain learning-ready.  

10          The SAPIS program has always been equipped to 

11          serve the needs of one of our most precious 

12          populations in New York City.  We are 

13          12-month employees that service the entire 

14          school and provide scheduled daily classroom 

15          presentations in our school settings.  

16                 Because of the COVID-19 epidemic, the 

17          emotional, mental, economical, physical and 

18          social stress upon families cannot be 

19          measured.  SAPIS have always been a valuable 

20          part of the life of our students, schools, 

21          and our communities at large.  SAPIS are 

22          already trained and ready to respond to this 

23          COVID-19 crisis.  Our program is already 

24          tailored to address risk factors affecting 


 1          our students' lives.  

 2                 Our requested increase of $1 million 

 3          in SAPIS funding would support an additional 

 4          12 full-time SAPIS positions.  This would 

 5          create services for up to 6,000 more 

 6          students.  

 7                 On behalf of Local 372, once again I 

 8          thank the Senate and the Assembly for your 

 9          ongoing support for the SAPIS program.  We 

10          look forward to working with you all to make 

11          this possible.  I am available to answer any 

12          questions you may have.  

13                 Thank you.

14                 CHAIRWOMAN KRUEGER:  Thank you.

15                 Thank you.  Continuing on with Number 

16          27, BJ Stasio, Self-Advocacy Association of 

17          New York State.

18                 MR. STASIO:  Thank you.  

19                 SAANYS is an association founded by 

20          people with developmental disabilities.  We 

21          speak up for ourselves and others for over 30 

22          years, and it's an honor to be here today.  

23          We've spoken a lot of years, and it's an 

24          honor to be here today.  


 1                 And I'll give you a little background 

 2          about myself.  Not only am I currently 

 3          honored to be SAANYS' president -- and I'm 

 4          from Western New York, specifically 

 5          Buffalo -- but I also have worked for the 

 6          Office for People With Developmental 

 7          Disabilities for over 20 years, and I am 

 8          honored to do so.

 9                 The Self-Advocacy Association has 

10          submitted written testimony which is more 

11          detailed, but I won't be reading that today.  

12          I just want to speak from the heart.

13                 SAANYS has been testifying for a 

14          number of years.  We often speak about the 

15          many areas of supports that require 

16          investment and innovation.  However, over the 

17          past few years, it has become clear to us 

18          that there is a real risk to our system of 

19          services and supports as a whole.  The simple 

20          fact is that more and more people require 

21          services each year, and the New York State 

22          budget has not kept up with this.  

23                 While it is good that OPWDD and 

24          provider organizations are working to find 


 1          efficiencies, cost savings alone can't keep 

 2          up with growing needs.

 3                 New York State has invested an 

 4          additional 2 percent in OPWDD each year for 

 5          the past few years, and this is appreciated.  

 6          However, our understanding is that the demand 

 7          for services exceeds 2 percent and may be as 

 8          high as 10 annually.  We now see a number of 

 9          signs that our system of supports and 

10          services is at risk.

11                 Among these signs is an ongoing 

12          staffing crisis and a lack of responsive 

13          services.  We have many people waiting for 

14          new residential and other opportunities as 

15          well, people currently in services facing 

16          significant barriers to real choice when 

17          seeking new opportunities.  Signs that we are 

18          not keeping up include our staffing crisis, 

19          which has been created by a lack of 

20          investment and fair wages for DSPs, which 

21          you've heard a lot about today.  

22                 Without my DSPs, I wouldn't be able to 

23          be on this legislative meeting today, so I 

24          appreciate them.  The importance of a stable 


 1          DSP workforce can't be overstated, because 

 2          without my DSPs I wouldn't have the job that 

 3          I do, I wouldn't be able to support the 

 4          people that I work with and for, and let 

 5          OPWDD and the Legislature know their wants 

 6          and needs.  

 7                 We also see people waiting for new 

 8          services or to make a change in their 

 9          existing services.  Often a real choice isn't 

10          available and just isn't enough.  That's why 

11          we need more person-centered services so the 

12          system can survive long.  And, importantly, 

13          it cannot innovate and become more 

14          person-centered if it does not have a stable 

15          foundation.  

16                 The core value of SAANYS is to be 

17          person-centered, so it is very important to 

18          keep that in mind, and I want everybody to 

19          know that.  Investment must keep up with 

20          growth if people are to have the quality of 

21          supports and services they need.

22                 Like I said, without the quality of 

23          support, some people will fall through the 

24          cracks.  And SAANYS -- more, all of New York 


 1          State -- doesn't want that because New York 

 2          State is the greatest state in the country 

 3          for services for people with developmental 

 4          disabilities.  I want you to keep that in 

 5          mind, please.  

 6                 We are concerned that OPWDD will need 

 7          to make cuts in the budget --

 8                 CHAIRWOMAN KRUEGER:  BJ, you're a 

 9          minute and a half over, so I'm going to cut 

10          you off now, okay?

11                 MR. STASIO:  Thank you.

12                 CHAIRWOMAN KRUEGER:  We have your 

13          testimony.  Thank you.

14                 MR. STASIO:  Sorry about that.

15                 CHAIRWOMAN KRUEGER:  No, it's okay.  

16          You were very poignant.  I didn't want to cut 

17          you off.

18                 Our next speaker -- I believe actually 

19          our last speaker for the panel -- is Nick 

20          Cappoletti, from LIFEPlan.  

21                 Are you here, Nick? 

22                 MR. CAPPOLETTI:  Yes, good afternoon.

23                 CHAIRWOMAN KRUEGER:  Good afternoon.

24                 MR. CAPPOLETTI:  I want to thank the 


 1          chairs and the members of the Assembly and 

 2          Senate for holding this hearing and the 

 3          opportunity to testify today.  

 4                 My name is Nick Cappoletti.  I'm  the 

 5          CEO of LIFEPlan, one of the seven care 

 6          coordination organizations that serves people 

 7          with I/DD in New York State.  

 8                 I'm also the parent of a 30-year-old 

 9          son with a rare genetic syndrome who's also 

10          the recipient of services from OPWDD.

11                 Ten years ago Governor Cuomo committed 

12          that New York State would provide care 

13          management for all as part of the state's 

14          Medicaid Redesign Initiative.  The seven CCOs 

15          were created three years ago to provide 

16          integrated and coordinated healthcare to the 

17          over 108,000 people with I/DD in the state.  

18          Of that number, approximately 80,000 people 

19          live either on their own or with members of 

20          their family.  Many of these people have 

21          fragile support networks and are only one 

22          heartbeat away from needing crisis services 

23          or a placement.  

24                 Care coordination organizations are 


 1          specialty health homes responsible for 

 2          coordinating all aspects of an individual's 

 3          health and well-being, including medical, 

 4          behavioral health, and long-term I/DD 

 5          services.  When care coordination 

 6          organizations were started, we invested 

 7          heavily to develop a new workforce, reduce 

 8          caseloads, to provide services to medical and 

 9          behavioral health, to implement sophisticated 

10          electronic health records, build clinical 

11          departments to respond to the need and reduce 

12          unnecessary emergency room and 

13          hospitalization utilization and perform 

14          comprehensive healthcare management.

15                 Care coordination is very different 

16          than Medicaid service coordination.  

17          Commissioner Kastner referenced the fact that 

18          the care coordination rate is 60 percent 

19          higher than MSC.  It's a completely different 

20          service.  It was designed differently.  I/DD 

21          care coordination is responsible for the full 

22          scope of services:  Healthcare, primary 

23          healthcare, secondary care, coordinating 

24          those services, coordinating food and housing 


 1          supports, advocating for access to I/DD 

 2          services -- at a time when we do have 

 3          significant waiting lists for almost every 

 4          program -- preventing crisis and responding 

 5          to people's and families' needs.  And also 

 6          ensuring the quality of services.

 7                 Last July the state arbitrarily 

 8          implemented a 16 percent cut to the CCOs.  

 9          That's only been followed by a proposed 

10          23 percent cut effective July 1st.  That, 

11          combined, represents a 39 percent cut.  No 

12          Medicaid program has ever received a cut of 

13          this magnitude and survived.  

14                 The state is creating a scenario where 

15          CCOs will no longer be financially viable 

16          entities, ending the promise of care 

17          management for the most vulnerable population 

18          during a national pandemic.  Suggesting that 

19          a Medicare incentive payment will address the 

20          damage of this cut is not realistic and will 

21          only make it more difficult for us to help 

22          our members.  OPWDD has acknowledged that 

23          there's literally tens of thousands of people 

24          out there who don't even know about these 


 1          services and are not eligible yet but would 

 2          be eligible based on the definition by Mental 

 3          Hygiene Code.  

 4                 Parents like me continue to ask the 

 5          question:  Who's going to care for our 

 6          children when we are gone?  Our current 

 7          system cannot answer this question.  We have 

 8          people who are not served, we have people on 

 9          waiting lists, we need care management now 

10          more than ever.  

11                 This is a social justice issue.  This 

12          is a vulnerable population that has 

13          historically been marginalized and requires a 

14          quality care-management program.  

15                 I appreciate your interest in this 

16          program, and I'd love to take any questions 

17          that you may have.  

18                 CHAIRWOMAN KRUEGER:  Thank you very 

19          much. 

20                 I see several hands on the Assembly 

21          side.  Helene Weinstein.

22                 CHAIRWOMAN WEINSTEIN:  Yes.  So let's 

23          go to our ranker on People with Disabilities, 

24          Assemblywoman Missy Miller.


 1                 ASSEMBLYWOMAN MILLER:  Thank you.  

 2                 Do I not get five minutes?

 3                 CHAIRWOMAN KRUEGER:  No, I think it's 

 4          three minutes now for everyone.

 5                 CHAIRWOMAN WEINSTEIN:  No, on the 

 6          panels everyone just gets three minutes.

 7                 ASSEMBLYWOMAN MILLER:  Oh, okay.  

 8                 So I just want to ask a question for 

 9          Nick Cappoletti.  You know, I hear your 

10          testimony, I read it, I listened to it, and I 

11          relate to so much of what you're saying.  

12          Certainly, you know, as a parent as well, it 

13          sounds so on target.  

14                 I'm struggling still to understand.  

15          The CCOs are new, it's new to all of us.  I'm 

16          still struggling so much to understand.  It 

17          just seems that so many of our population and 

18          so many people that I hear from feel that 

19          they're not getting from the CCO what you're 

20          describing, certainly, and certainly not what 

21          we were promised would be coming.  

22                 You testified asking for more money, 

23          that we can't sustain with the proposed cuts, 

24          but we're not getting the services that are 


 1          supposedly being delivered.  In fact, from -- 

 2          in my attempt to understand, I've done a 

 3          little research of this whole system, and so 

 4          I just have a few questions based on that.

 5                 I'm going to ask my questions first so 

 6          that in case we run out of time I can ask 

 7          that you just respond to Ways and Means so 

 8          that they're on record.

 9                 The intention of New York State for 

10          creating these CCOs was to provide 

11          conflict-free case management between 

12          self-coordination and provision of services.  

13          So based on that, do you believe that this is 

14          actually happening?  When I reviewed your 

15          website, I saw that every member of your 

16          board represents a provider agency.  And do 

17          you believe this is a conflict of interest?  

18          And isn't that contrary to what was intended 

19          with respect to conflict-free case 

20          management?  

21                 My second question, on the fiscal 

22          side, can you share with us if there were 

23          surpluses generated in fiscal years '18, '19 

24          and '20, and what did LIFEPlan do with these 


 1          surpluses?

 2                 And my last question, as a for-profit 

 3          company, has LIFEPlan ever disclosed to New 

 4          York State how much revenue you've generated 

 5          so the Division of Budget can accurately 

 6          gauge your fiscal situation so that we can 

 7          move, you know, forward?

 8                 There were -- I had so many other 

 9          things as I was reading and researching, 

10          there were just so many things that pop out 

11          at me that I don't understand.  I'm not -- 

12          I'm not -- I must not be understanding how 

13          this is supposed to be working.  What I can 

14          say is on the receiving end of it, and 

15          hearing from so many others, we're just not 

16          getting any of these services.  

17                 I happen to have one of those very 

18          complex kids who has a variety of different 

19          services.  I've had multiple care 

20          coordinators.  The care coordinator that we 

21          have now calls every month and asks to speak 

22          to my nonverbal child on the phone to check 

23          in and find out what's going on.  I just 

24          don't see how this is working.


 1                 I'm sorry, I see we're already out of 

 2          time, so --

 3                 CHAIRWOMAN WEINSTEIN:  Assemblywoman, 

 4          we do have the email, all the contact 

 5          information for this panel, if you want to, 

 6          through -- either directly to me or through 

 7          Assemblyman Ra, if you prepare a list of 

 8          questions, we'll be happy to send it to the 

 9          panel and ask them to respond and make it 

10          part of the official record of this hearing.

11                 ASSEMBLYWOMAN MILLER:  That would be 

12          great.  Thank you very much.

13                 CHAIRWOMAN WEINSTEIN:  Okay, now we go 

14          to Assemblyman Abbate {sic}.  You had your 

15          hand raised, Tom?  Did you want to --

16                 ASSEMBLYMAN ABINANTI:  Oh, you're 

17          confusing me with Peter.

18                 Anyway, can you in 25 words or less, 

19          Nick, explain the function of a care 

20          coordinator?  You don't hire the people to do 

21          the work, correct?

22                 MR. CAPPOLETTI:  Correct.  Correct.

23                 ASSEMBLYMAN ABINANTI:  Tell us what 

24          you do.


 1                 MR. CAPPOLETTI:  So the design 

 2          point -- and again, this is the design point 

 3          as proposed by OPWDD -- is that the CCOs are 

 4          actually -- by design, were created by the 

 5          provider organizations.  So to address Ranker 

 6          Miller's question, that is part of the OPWDD 

 7          design, that the CCOs would be started by the 

 8          providers.

 9                 But there is a degree of separation.  

10          The point of the care coordinators is to look 

11          at the person -- first of all, we help many 

12          people, most people -- you talk about the 

13          issue between front door, going to social 

14          services, back and forth.  The care 

15          coordination organizations, we have dedicated 

16          teams that try to make that easier, but it's 

17          not an easy task given how complicated the 

18          OPWDD system is in the system of getting 

19          Medicaid.  

20                 But we assist with eligibility.  We 

21          then develop a person-centered plan and help 

22          the person apply for services.  But it needs 

23          to be recognized that OPWDD ultimately 

24          approves all services.  It's not the CCO.  


 1                 We actually combine -- the seven CCOs, 

 2          we actually track how many people are not 

 3          getting services and try to advocate for 

 4          them.  And then we're there as kind of the 

 5          safety net looking at does the person have 

 6          adequate healthcare, housing, do they get 

 7          supports as determined by OPWDD, are the 

 8          providers actually providing that support.  

 9          So there is the level of separation.  And --

10                 ASSEMBLYMAN ABINANTI:  Who actually 

11          hires -- who actually hires -- if you're 

12          talking about self-direction or that piece, 

13          who actually hires the staff?  That's not a 

14          care coordinator, correct?

15                 MR. CAPPOLETTI:  No, it is not.  So 

16          there's actually agencies that serve as 

17          fiscal intermediaries that work with the 

18          individual and family to actually identify 

19          the staff, and the person chooses who they 

20          hire.  And ultimately that organization does 

21          hire them.

22                 ASSEMBLYMAN ABINANTI:  I think part of 

23          the confusion and part of the problem here is 

24          what we're talking about today is the 


 1          totality of somebody's life.  And the job of 

 2          the care coordinator, as I understand it, and 

 3          as I've seen it work, is that that care 

 4          coordinator is supposed to look at the 

 5          totality of that person's life --

 6                 MR. CAPPOLETTI:  Correct.

 7                 ASSEMBLYMAN ABINANTI:  -- and ensure 

 8          that every piece of it is taken care of.  

 9                 So if you have an intact family that's 

10          providing services and who's really just 

11          looking for self-direction to get some money 

12          to provide those services themselves, in 

13          effect -- they can hire people, et cetera -- 

14          the care coordinator doesn't have to do very 

15          much.  

16                 But if you have a broken family with a 

17          young man who has no support, no services, no 

18          nothing, then the care coordinator becomes a 

19          substitute mother, in effect.

20                 MR. CAPPOLETTI:  So it ranges.  That 

21          is correct, Assemblyman.  The range of need 

22          is wide.  At minimum --

23                 ASSEMBLYMAN ABINANTI:  I just want to 

24          go to one other thing, then.


 1                 MR. CAPPOLETTI:  Sure.

 2                 ASSEMBLYMAN ABINANTI:  Now, 

 3          understanding that there's a 5 percent cut 

 4          this year, this budget will cement that in 

 5          place, correct?  And then they're proposing 

 6          another cut on top of the 5 percent cut from 

 7          this year.  

 8                 So if you compare what you're going to 

 9          get in April of 2021 with what you got in 

10          February of 2019, it will be 5 percent less 

11          plus another 1 percent cut, correct?

12                 MR. CAPPOLETTI:  No.  Actually, 

13          Assemblyman, it's actually worse than that.  

14                 So in July of last year we received a 

15          16 percent cut.  And it's proposed that we 

16          will receive another 23 percent cut July of 

17          this coming year, in 2021.  So, combined, a 

18          39 percent cut.

19                 ASSEMBLYMAN ABINANTI:  But the system 

20          itself also, across --

21                 MR. CAPPOLETTI:  And the system is 

22          getting cut.  And we have waiting lists for 

23          all services.  And this is a new program.  So 

24          it was a significant change in scope from 


 1          what we had with Medicaid service 

 2          coordination to moving to this health home 

 3          model and having to train over 3500 workers 

 4          on delivering a whole new model of service, 

 5          hiring clinical supports, data analytics, new 

 6          integrated health systems to support them.  

 7          So it has been a significant transition.

 8                 CHAIRWOMAN WEINSTEIN:  Thank you.  

 9          Thank you for your answer.

10                 We go to Harvey.

11                 ASSEMBLYMAN EPSTEIN:  Thank you, Madam 

12          Chair.  

13                 So I really appreciate what you're 

14          saying.  The cuts seem really horrific.  And 

15          I'm wondering how much you guys are talking 

16          about revenue, because there's an Invest in 

17          Our New York Coalition talking about raising 

18          revenue.  And, you know, I think we've heard 

19          -- you know, every day we hear of these 

20          horrific cuts.  And I'm wondering if you're 

21          putting some energy on the revenue side to 

22          try to get new revenue to New York State.  

23          And that's for anybody on the panel. 

24                 (No response.)


 1                 ASSEMBLYMAN EPSTEIN:  Because the 

 2          cuts are bad.  And, you know, the question is 

 3          are we going to divide up a smaller pie 

 4          together?  Or we're going to seek new revenue 

 5          sources so the necessary social service for 

 6          people with disabilities can happen?  And if 

 7          we have less revenue, we're all going to get 

 8          cut and we're all going to be -- we're going 

 9          to really feel the pain.  

10                 The only way around that is to have 

11          more revenue.  And that's some federal 

12          dollars, but it's also going to be New York 

13          State dollars.  And Investing in Our New York 

14          is an effort across the board, across issue 

15          areas, to put more resources in.  And, you 

16          know, as Assemblywoman Miller said earlier, 

17          this used to be where New York really shone, 

18          and now we're -- we are not.  

19                 So we could really -- I would love to 

20          see you guys engaging on the revenue side 

21          because if we don't, this is -- we're just 

22          going to have -- this conversation is going 

23          nowhere.

24                 MR. CAPPOLETTI:  And I think, 


 1          Assemblyman, we -- as part of the creation of 

 2          the CCOs, that allowed New York State to 

 3          access significantly more Medicaid dollars.

 4                 CHAIRWOMAN WEINSTEIN:  We'll be 

 5          discussing the revenue at our revenue 

 6          hearing.  It's not necessary every witness -- 

 7                 (Overtalk.)

 8                 ASSEMBLYMAN EPSTEIN:  I appreciate 

 9          that.  But just to -- just if I -- just 

10          finally, if the cuts come down as they 

11          propose, what does that mean for your 

12          programs?  What realistically is going to 

13          happen with your programs?  Can you stay 

14          afloat?

15                 MR. CAPPOLETTI:  Well, for care 

16          coordination organizations, I can tell you 

17          that all seven would be projected into a 

18          deficit either by the end of this year or 

19          certainly in 2022.  We've already given that 

20          information to OPWDD.  

21                 And to the point that Assemblywoman 

22          Miller said, the CCOs are all required to 

23          require CFRs and are in the process of doing 

24          so.


 1                 ASSEMBLYMAN EPSTEIN:  Thank you.  

 2          Thank you, Chair, I appreciate it.  Thank you 

 3          all.

 4                 CHAIRWOMAN KRUEGER:  Thank you.  Oh, I 

 5          see --  

 6                 CHAIRWOMAN WEINSTEIN:  I just want to 

 7          --

 8                 CHAIRWOMAN KRUEGER:  I see a couple 

 9          more hands, Helene.

10                 CHAIRWOMAN WEINSTEIN:  Oh, do we?  Ah.  

11          Okay.  

12                 So Assemblyman Ra, please.

13                 ASSEMBLYMAN RA:  Thank you, 

14          Chairwoman.  

15                 And as the chairwoman said, maybe I 

16          will work with Ranker Miller to follow up 

17          further in writing.

18                 But I just -- in light of 

19          Assemblywoman Miller's questions and 

20          Assemblyman Abinanti's questions, 

21          Mr. Cappoletti, if I could just ask something 

22          I guess a little more open-ended, because I'm 

23          getting a little bit more of an understanding 

24          through your answers.  


 1                 I mean, do you feel -- I know you said 

 2          there was kind of a continuum here depending 

 3          on the need of the individual, the family and 

 4          all of that.  But, I mean, do you feel that 

 5          this system is working in the way it was 

 6          intended when it was set up a few years ago?

 7                 MR. CAPPOLETTI:  So I think the care 

 8          coordination organizations are definitely 

 9          having a major impact.  I'll just give you 

10          one example.  We had -- now that we're 

11          looking at not just the I/DD services but 

12          also the person's healthcare, their 

13          behavioral health, et cetera, we have newly 

14          formed clinical teams that are working 

15          together with the care coordinators to 

16          identify people who are high users going into 

17          the ERs, hospitals, et cetera.  

18                 We're forming partnerships with 

19          non-I/DD providers like Federally Qualified 

20          Health Centers, hospitals, et cetera, to make 

21          it easier for people -- one of the big 

22          challenges, and I'm sure the other parents 

23          here could attest to this, is finding 

24          qualified primary care providers, secondary 


 1          or specialty providers who will serve this 

 2          population.  So we have a lot of work going 

 3          on right now to do that.  

 4                 Like I said, we're only 30 months into 

 5          this care coordination model, and it does 

 6          have a much broader scope than just 

 7          coordinating disability services.  So I think 

 8          we're on our way.  

 9                 But we have to recognize that there 

10          are a lot of challenges with this current 

11          system.  It's not set up to easily serve 

12          people.  It's got a lot of complicated 

13          processes between going from OPWDD front door 

14          of applying for services, going to social 

15          services, going back, applying for 

16          self-direction.  We know that there's a lot 

17          of complicated things here, and we have 

18          shared those with OPWDD to hopefully 

19          streamline some of that so that when a care 

20          manager identifies somebody who is in crisis, 

21          we can get them, you know, services.

22                 We have a young man right now that has 

23          been over three months in a hospital.  That's 

24          unacceptable.  You know, people can't -- we 


 1          can't be using our institutions, the 

 2          hospitals, the jails, the institutions as a 

 3          service.  We have to develop more 

 4          community-based services.

 5                 ASSEMBLYMAN RA:  Well, thank you.  

 6          Thank you for your answers, sir.  Thanks for 

 7          being here.

 8                 CHAIRWOMAN WEINSTEIN:  Now we go to 

 9          Assemblymember Anderson.

10                 ASSEMBLYMAN ANDERSON:  Thank you, 

11          Madam Chair.  

12                 And thank you to this panel that has 

13          testified on this critically important issue.

14                 I want to just speak to the importance 

15          of care coordination and the need for us to 

16          have care coordinators in a healthcare system 

17          that is extremely opaque and robust and large 

18          and massive.  So being able to have folks 

19          that help with folks with disabilities 

20          navigate the system, be able to get the 

21          services that they need, to get the care that 

22          they need, to make sure that they're seeing 

23          the right doctors and all the services is 

24          vitally important.  


 1                 My mom relies heavily on her care 

 2          coordinator, who checks in on her every month 

 3          to make sure that all of her services are 

 4          needed and met.  And I do want to provide 

 5          this constructive criticism to the industry 

 6          of care coordination.  I'm sure you don't 

 7          represent the whole industry, but I just want 

 8          to put this out there.  

 9                 As we're trying this new model, it's 

10          important that -- and this piggybacks off of 

11          Member Miller's point -- we've got to make 

12          sure that our outreach to the patients makes 

13          sense to the disability that that patient 

14          lives with.  There's no sense in reaching out 

15          to a nonverbal patient in a way that's not 

16          effectively and adequately communicated with 

17          that person.  

18                 You know, my mom has a variety of 

19          different ailments that I will respectfully 

20          not share.  But just finding that effective 

21          way to best communicate with folks is crucial 

22          and critical, especially in a healthcare 

23          system that has so many layers of confusion, 

24          so many layers of how to get help on how to 


 1          get resources.  

 2                 We haven't had the best experience 

 3          with care coordinators and consequently had 

 4          to switch insurances and providers and things 

 5          of that nature.  But I do believe in the 

 6          program, and I do believe in making sure that 

 7          we preserve it.  And I will encourage you to 

 8          join -- I know, Chairwoman, you've heard this 

 9          several times, but I do encourage you, 

10          Nicholas and the folks who are here today, to 

11          join us in the fight to make sure that we 

12          increase revenue so that we can continue to 

13          fund programs and models like this.  

14                 Because this is how we will improve 

15          healthcare for seniors, this is how we'll 

16          improve healthcare for folks who live with 

17          disabilities, this is how we'll improve 

18          healthcare for people who truly, truly need a 

19          navigator and someone that they can trust to 

20          support the system.  So join us in the fight 

21          for more revenue so that we can fund your 

22          program.  

23                 I yield the rest of my time.  

24                 CHAIRWOMAN WEINSTEIN:  Thank you.  


 1                 And Senator Krueger, I think it's back 

 2          to you to close us out for tonight.

 3                 CHAIRWOMAN KRUEGER:  All right, thank 

 4          you.  

 5                 I want to thank everyone who 

 6          participated today, all the panelists on all 

 7          of the panels, all of the members of the 

 8          Senate and the Assembly, all our staff who 

 9          work so hard for us to pull off these virtual 

10          hearings.  And we either had three or four 

11          this week -- I think we had four hearings 

12          this week.

13                 CHAIRWOMAN WEINSTEIN:  Three.  Three.

14                 CHAIRWOMAN KRUEGER:  Well, we had one 

15          that was a two in one day.

16                 CHAIRWOMAN WEINSTEIN:  That's true.  

17          Four hearings, correct. 

18                 CHAIRWOMAN KRUEGER:  Four hearings.  

19                 So I want to thank my partner in crime 

20          Helene Weinstein.  And we will be back not 

21          Monday, but I believe Tuesday.

22                 CHAIRWOMAN WEINSTEIN:  Tuesday morning 

23          at 9:30 for the Human Services hearing.  And 

24          we look forward to people's participation.


 1                 CHAIRWOMAN KRUEGER:  Yes, thank you.  

 2          Yes.  

 3                 So thank you all for all your good 

 4          work.  And I hope you can do something a 

 5          little more relaxing with your weekend, if 

 6          possible.  Take care.

 7                 SENATOR SAVINO:  Goodbye, everyone.  

 8                 (Whereupon, at 5:35 p.m., the budget 

 9          hearing concluded.)