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November 30, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

Federal Overtime Rule Now on Hold

A federal judge has ruled to put a new overtime policy on hold. Set to begin Dec. 1, the policy would have made more workers eligible for overtime pay, and experts believe behavioral health organizations would have had high rates of noncompliance because of tricky scheduling at treatment centers.

Currently, employees who earn a salary of $455 per week ($23,660 per year) or more could be classified as "exempt"-not eligible for overtime pay. The new rules would have increased the salary for the exempt classification significantly to $913 per week ($47,476 per year), a level that will be adjusted for inflation periodically.

For some treatment center operations, the new overtime rules could translate into higher payroll costs as more employees clock in extra time beyond the benchmark 40 hours per week.

According to  NPR, the rule would have extended overtime pay to as many as 4 million Americans. Employers believe the added payroll costs ultimately could lead to layoffs.

Read more about the overtime rules  here.
OMH: New Yorkers Can Access Remote Psychiatric Services 

The New York State Office of Mental Health (OMH) last week announced the adoption of new regulations which will expand the availability of psychiatric services in communities throughout New York. The new regulations will allow virtual psychiatry appointments between any providers licensed under Article 31 of the Mental Hygiene Law, with specific provisions to ensure quality of care and patient confidentiality. Previous regulations enacted in February 2015 limited the use of telepsychiatry between Article 31 licensed clinics.

"Due to a nationwide shortage of psychiatrists, especially in rural communities, access to psychiatric services can be difficult to find," said New York State Office of Mental Health Commissioner Dr. Ann Sullivan. "Under these new regulations, a patient in Vestal will now be able to receive mental health services from a psychiatrist in Valhalla, with minimal wait time. Telepsychiatry is yet another tool in our expanding service package that will provide earlier and easier access to mental health services for New Yorkers."

The expanded regulations open telepsychiatry services up to 250 mental health providers who were not previously permitted to use the technology, such as Comprehensive Psychiatric Emergency Programs, Inpatient Programs and Partial Hospitalization Programs. The regulations exclude Assertive Community Treatment and Personalized Recovery Oriented Services programs, as the model for success of these programs are based upon face-to-face interactions between providers and individuals in care. The revised regulations continue to include a number of safeguards to ensure quality of care, patient confidentiality, and add provisions to monitor the impact upon the programmatic resources of OMH-licensed providers.  Read more here .
How Value-Based Payment Arrangements Should Measure Behavioral Health

Value-based payment (VBP) models have the dual aim of reducing costs and improving quality of care. A typical VBP approach identifies potential savings by establishing baseline health care costs for specific conditions or populations. The model assumes that the potential for sharing savings generated against the baseline costs will incentivize providers within the network to use more effective treatments and improve outcomes.

A key challenge is to document that providers are in fact offering better quality of care and are being paid for value, as opposed to generating shared savings by limiting access to services. To do this, VBP arrangements incorporate performance measures that document health care processes and outcomes, with the proviso that providers can share savings only if specific performance measure thresholds are met.

One area that will be key to successful health care transformation and payment reform efforts is behavioral health conditions, which are among the  costliest in the United States, accounting for $201 billion in health spending in 2013. Yet, the current state of behavioral health performance measurement presents major obstacles to incentivizing change and ensuring quality.  Read more here .
Where Are All the Social Workers Going?

Turnover in public-sector jobs is a ubiquitous problem. But when it comes to social services, the problem is particularly painful.

One well-known study found that with one caseworker, the chance for a child to achieve a permanent and stable living situation was 74 percent. If a child had two caseworkers in one year, the odds dropped to 17 percent. With three caseworkers, it was a mere 5 percent.

Once turnover persists, it creates conditions that lead to a seemingly never-ending cycle: experienced caseworkers don't have time to mentor new ones, caseloads increase, backlogs develop, tempers flare, pressures rise and burnout shows no signs of fading.   This is an issue in most of America, but in some places, it has recently reached crisis levels.

The difficulty in hiring and retaining social workers has pushed agencies to make changes.  Read more here.



CTAC is offering a 6-part webinar series on the broad principles and core competencies of documentation for direct service providers and supervisors. 




RPC Advisory Committee 
December 1:  8 am
GTM Only

Officers & Chairs - Call In
December 7:  8 am

RPC Advisory Committee 
December 8:  8 am
GTM Only

Children & Families Committee
December 13:  11:30 am - 1 pm
GTM Only

RPC Advisory Committee 
December 15:  8 am
GTM Only  

Directors/Executive Committee
December 20:  9:30 - 11:30 am
GTM Only

Office Closed - Christmas
December 26

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
DSRIP Mid-Point Assessment Initial Recommendations

The Independent Assessor (IA) for New York's Delivery System Reform Incentive Payment (DSRIP) Program has completed its Mid-Point Assessment of all twenty-five Performing Provider Systems (PPS).
The Department is pleased with the findings of the review, as all twenty-five PPS demonstrated that they are on a track towards success and effective project implementation. There were no findings for any PPS that would warrant any major restructuring intervention, which is a testament to the hard work and dedication of those who are fundamentally changing the healthcare delivery system in New York State.
The IA has prepared a Mid-Point Assessment Report for all twenty-five PPS as well as the following three appendices for each PPS containing additional data used in the completion of the Mid-Point Assessment review:
  • Data from the 360 Survey responses received from sampled network partners.
  • Partner engagement tables for all Domain 2 and 3 projects provided by the PPS as part of their DY2, Q2 reporting.
  • Project and organizational narratives submitted by the PPS as part of the DY2, Q1 PPS Quarterly Reports.
The IA has also developed a "Mid-Point Assessment Report Companion Document" that provides details on the Mid-Point Assessment process and methodology as well as a summary of the results for all PPS.
PPS and the public are invited to submit comments in response to the IA's initial recommendations through December 21, 2016. All comments should be submitted to
Following the initial comment period, the IA will review all comments from the PPS and the public and determine if any modifications to the initial recommendations are necessary. The IA will then release its final recommendations by January 3, 2017, along with a compilation of all comments received during the initial comment period. The final recommendations will be available for public comment through January 23, 2017. These recommendations will then be presented to the Project Approval and Oversight Panel (PAOP) from January 31 - February 3, 2017. The full Mid-Point Assessment timeline can be found on the DSRIP website here.  

All Mid-Point Assessment reports and recommendations can be found on the DSRIP website here .
OMH Transformation Plan Status Report - September 2016

The Office of Mental Health issues monthly and annual reports that include State Psychiatric Center (PC) descriptive metrics; descriptions and status of community service investments; and psychiatric readmissions rates to hospitals and emergency rooms for State PC, Article 28, and Article 31 hospital discharges.

For the most current data available, click  here to review the latest OMH Facility Performance Metrics and Community Service Investments report (September 2016).
Governor Cuomo Announces More than $10 Million to Fund Employment and Re-Entry Services Throughout New York

Governor Andrew M. Cuomo today announced more than $10 million in funding to support programs providing job training and other re-entry services to individuals currently under community supervision. Additionally, these grants will create a new state-supported County Re-Entry Task Force in Queens and allow 19 other existing Task Forces across the state to assist more people returning to their communities after serving state prison sentences.

The first $6.4 million in grants will be awarded to 13 agencies and non-profit organizations across the state to provide employment-focused services to individuals on parole, those supervised by probation or referred by the court to alternatives to incarceration programs. These grants will be distributed across the state and will allow services to be available for the first time in five counties, which include Ontario, Orleans, Steuben, Tompkins and Wayne counties. 

The 13 organizations receiving funding will use evidence-based strategies to reduce recidivism and reliance on incarceration. These programs, which range in duration from three months to up to a year, include job placement services, as well as cognitive behavioral intervention and services to increase job readiness, including transitional employment. Approximately 2,500 individuals will be served by these programs annually.  Read more here.
WNY Representatives Vow to Block Albany Plan to Close Youth Psych Center - Again

The New York State Office of Mental Health and Governor Andrew Cuomo are again pursuing a plan to close the Western New York Children's Psychiatric Center and move patients into the Buffalo Psychiatric Center. Once again, state legislators representing Buffalo-area districts vow to unite and fight the plan.

Members of the Western New York State Legislature Delegation joined at least two dozen community and labor activists to denounce plans to close the West Seneca-based facility. State Senator Patrick Gallivan says he and his peers recently learned of plans by the Cuomo Administration to issue a request for proposals to redevelop the site, while the young patients move into Buffalo.

"We have children here as young as four and we're going to send them to a place where we have Level 3 sex offenders," said State Senator Robert Ortt, who chairs the Senate's Committee on Mental Health and Developmental Disabilities. "That only isn't stupid, it's reckless. It's dangerous."

Assemblyman Michael Kearns stated that the delegation's research determined six Level 3 sex offenders are admitted at the Buffalo Psychiatric Center.

Read more
here .
When a Homeless Alcoholic Bounces In and Out of the ER

The sun rose as the overnight shift at my emergency department (ED) came to an end. Mr. P had been with us all evening. He had arrived in an ambulance hours earlier after wandering into a homeless shelter, intoxicated. According to the information the ambulance staff delivered to us with Mr. P, he had been disruptive and argumentative at the shelter. According to Mr. P, the shelter staff members had been unreasonable, and he had just been minding his own business.

I performed a brief physical exam, describing in my notes a frail man, 56 years old and probably Caucasian, who had a thick gray beard and blue eyes dulled from alcohol, with subtle icterus (a yellowing of the eyes). His nose had been flattened from previous falls, and his skin was deeply sunburned, almost purple. The city's dirt had merged with his epithelial layer, giving it a rough, Velcro-like appearance.

He had unremarkable vital signs, with no new trauma and no specific medical complaints. He blew a 310 on the breathalyzer. The textbooks would tell us that at that level, Mr. P - whom I'm identifying only by his initial for privacy reasons - was in serious danger of alcohol poisoning, but as we already knew, he lived at this rarefied level and stumbled and slurred only moderately.  Read more here.
Governor Cuomo Announces Grand Opening of $24.4 Million Mixed-Use Housing Development in West Seneca

Governor Andrew M. Cuomo recently announced the grand opening of the $24.4 million Ebenezer Square apartments in West Seneca, Erie County. The mixed-use development replaces a long vacant and blighted big box store and offers 25 affordable apartments integrated with a 75-unit licensed residential program serving individuals with behavioral health concerns. 

Operated by Living Opportunities of DePaul, the three-story, 124,000-square-foot building at 2400 Seneca Street features one and two bedroom apartments. In addition to offering modern, well-appointed apartments, Ebenezer Square offers stable housing in a service-enriched, recovery-oriented setting to adult individuals with a psychiatric disability. Licensed by the OMH, residents will have 24/7 access to care and can receive living skills training, medication management, linkages to medical and dental care, health education, as well as educational and vocational services. 

Residents will also have access to off-street parking, lounge areas on each floor, outdoor picnic areas, and a community room. Staff and security are on-site 24-hours a day. Read more here.
Clinics Help Keep People With Serious Mental Illness Out Of ER

SAN ANTONIO- Yolanda Solar has battled a life-threatening disease for more than three decades.   The disease nearly killed her last summer, and Solar, a 73-year-old grandmother, was rushed to the hospital by ambulance.   When Solar was discharged one week later, she received bad news: She would have to wait until March to see a doctor.

Waiting seven months for treatment would be unthinkable if Solar had cancer or heart disease. But Solar suffers from severe depression, and waiting that long for help is typical - and potentially dangerous.

Although San Antonio has earned widespread praise for its success in keeping people with mental illness out of jail, patients here routinely wait months to see psychiatrists, who are in short supply across the country. The number of available psychiatrists who specialize in the care of the elderly or children is even smaller.

Without routine medical care, patients like Solar, who tried to kill herself in August with an overdose of pills, can quickly deteriorate. Many return to the emergency room. Some don't survive.   Read more here .
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.