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Major Changes in NY’s Publicly-Funded Outpatient Mental Health System
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Major Changes in NY’s Publicly-Funded Outpatient Mental Health System

Peter Beitchman, DSW, LMSW, Executive Director, The Bridge

Over the past several years, New York State has embarked on a multi-pronged initiative to restructure the publicly-funded mental health treatment and rehabilitation system. On October 1, 2010 the State Office of Mental Health (OMH) implemented mental health clinic restructuring on an interim basis, pending final approval by the federal Centers for Medicaid and Medicare Services (CMS). And in New York City, the first OMH-licensed Personalized Recovery Oriented Services Programs (PROS) have been launched over the past few months, replacing Continuing Day Treatment and other programs as the core outpatient rehabilitation program for persons with serious mental illness.

During the development of the restructuring plan there was board consultation and advocates have applauded several aspects of the plan — the ability to provide multiple reimbursable services on the same day, the establishment of the indigent care funding pool, HIPPA protections, the ability to provide more integrated health and mental health services in clinics, recently passed companion legislation that will bring Medicaid managed care reimbursement rates more in line with the cost of providing services, and the increase in the base Medicaid rate for clinic services. However, serious concerns remain.

First, in the absence of CMS approval, providers are dealing with the administrative challenges of an enormously complicated interim billing system. Further, CMS has yet to approve OMH’s plan to allow reimbursement for off-site services to the home-bound elderly and children, who lost reimbursable services on October 1, 2010. While OMH has reached to the City Department of Health and Mental Hygiene to remedy the off-site services problem, a solution has not yet been found.

In the absence of CMS approval, the promised indigent care pool has not been established to provide services to the non-insured, leaving thousands of New York City residents vulnerable to losing mental health services. And although Medicaid managed care reimbursement rates to clinics will be increased, the issue of inadequate reimbursement by private insurance companies has not been addressed.

Beyond these immediate concerns, advocates fear for the long-term viability of the mental health clinic system. A study conducted by The Coalition of Behavioral Health Agencies, for example, found that when restructuring is fully phased-in, its representative sample of clinics will experience significant financial deficits that will threaten their ability to operate.

Given both these short- and long-term concerns, clinic restructuring will continue to unfold with significant scrutiny by the advocacy community.

NASW-NYC and the social work community will play an active role in monitoring the impact of restructuring on those who use and need mental health services and the agencies that provide them.

PROS implementation is a second major reform developed by OMH. Based on the principles of psychiatric rehabilitation and recovery, PROS programs provide services designed to assist persons with serious mental illness in their efforts to achieve their individual recovery goals, including more integrated living in the community, employment, housing, and positive social, family and intimate relationships.

Social workers have a major role to play in PROS programs. The profession’s long-time focus on client strengths, shared decision-making and goal-focused services are consistent with the intent and structure of PROS. Two major concerns have been expressed about the model: 1) how will it apply to persons with serious mental illness who do not have more independent living goals, particularly older persons in the system; and 2) will PROS be a severely time-limited program for its participants, who, in the absence of progress toward achieving their goals or once having achieved them, would be expected to be discharged, losing services that may be essential for them to live successfully in the community. As with clinic restructuring, the implementation of PROS will be monitored carefully by mental health advocates, including NASW-NYC.

At a time of significant changes in New York’s mental health system, these major reforms offer challenges to recipients in the system, those in the community who need services but are currently not served, as well as the agencies and practitioners that provide services. In observing the impact of these changes, NASW- NYC will play an important role in advocating for its vision of an accessible, responsive mental health system, providing quality services to support recipient recovery.

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