2004 Yellow Book
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OFFICE OF MENTAL HEALTH (Summary) View Details

		Adjusted Appropriation 2003-04	Executive Request 2004-05	Change	Percent Change

AGENCY SUMMARY
	General Fund	1,251,799,000	1,352,526,000	100,727,000	8.0%
	Special Revenue-Other	674,061,000	586,860,000	(87,201,000)	-12.9%
	Special Revenue-Federal	41,401,000	42,401,000	1,000,000	2.4%
	Capital Projects Fund	42,000,000	43,000,000	1,000,000	2.4%
	Mental Hygiene Capital Improvement
	Fund-389	173,482,000	95,494,000	(77,988,000)	-45.0%
	Internal Service Fund	2,304,000	2,415,000	111,000	4.8%
	Enterprise	8,284,000	8,349,000	65,000	0.8%
Total for AGENCY SUMMARY:		2,193,331,000	2,131,045,000	(62,286,000)	-2.8%

* 2000-01 through 2002-03 reflect enacted appropriations. * 2003-04 and 2004-05 reflect Executive recommended appropriations.

ALL FUNDS PERSONNEL BUDGETED FILL LEVELS
Fund	Current 2003-04	Requested 2004-05	Change

General Fund:	16,293	16,184	(109)
All Other Funds:	523	523	0
TOTAL:	16,816	16,707	(109)

Budget Highlights

The Office of Mental Health (OMH) administers an extensive statewide mental health network, including community based mental health services, 17 State- operated psychiatric centers for adults, six State-operated psychiatric centers for children, three forensic psychiatric centers and two research institutes. The State-operated inpatient mental health system serves approximately 7,600 persons annually. Outpatient services are provided to an additional 37,000 patients each year. In addition to serving outpatients, OMH provides other community-based services, including community residences, residential care centers for adults and children, intensive and supportive case management, and supportive employment. There are more than 2,500 not-for-profit, municipal and proprietary mental health service providers in the community, meeting the needs of over 500,000 persons annually. All community-based providers are licensed by OMH.

The Executive projects having a workforce of 16,707 Full- Time-Equivalent (FTE) positions by the close of State Fiscal Year (SFY) 2004-05, a net decrease of 109 positions from SFY 2003-04 levels. The Executive proposes downsizing the State operated inpatient system by eliminating 100 adult non-geriatric beds and 21 children’s beds, with a related decrease of 145 full time equivalent positions. The Governor further proposes the elimination of 30 funded, vacant research positions at the NYS Psychiatric Institute and the Nathan Kline Institute. The Governor proposes several actions as part of a cost-cutting initiative, including: the consolidation of the administration of all children’s psychiatric centers located downstate, to achieve a five- percent savings target in local assistance funding; closure of the Middletown Psychiatric Center by the end of the 2004-05 fiscal year in order to avoid making capital improvements to the facility; maximization of Medicaid funding for community-based mental health programs; and elimination of the Alternative Rate Methodology (ARM) for Article 28 hospitals.

In order to assess future mental health system needs and to formulate recommendations for facility closures based on those assessments, the Governor proposes the creation of an eight-member Blue Ribbon Commission. Four members would be appointed by the Executive, two members by the Senate and two members by the Assembly. The previously mentioned closure of the Middletown Psychiatric Center would take place outside of the Blue Ribbon Commission process, however. Currently, the Middletown Psychiatric Center workforce numbers 366 FTE positions. The closure of the facility would affect them as follows: 186 FTE would be transferred to Rockland Psychiatric Center; 60 FTE positions would remain to staff the outpatient program, bringing total outpatient program staffing to 121, and 59 positions would be eliminated. The date set for closure is April 1, 2005 with workforce impacts happening in the 2005- 06 budget year.

The Executive also proposes extending the Community Mental Health Support and Workforce Reinvestment Act through 2010 and investing one-half of the savings gained through facility closures in State-operated community services. The proposed budget, however, eliminates the separate Community Mental Health Reinvestment funding stream, first established in 1994, and instead appropriates those funds through the existing Adult Services Program and Children and Youth Services Program. The practical effect will be to make tracking Community Reinvestment funds more difficult.

Furthermore, the Executive is proposing an expansion of mental health services provided in Department of Correctional Services (DOCS) facilities with the addition of 264 beds to serve seriously mentally ill inmates. Office of Mental Health staff would provide clinical services and DOCS would be responsible for security and any needed capital development.

The Executive also proposes a $10,000,000 appropriation in the Department of Health to enhance case management, medication management, and rehabilitation and advocacy services to mentally ill persons residing in adult homes. This effort results from findings of the Adult Homes Work Group, formed in response to allegations of adult home resident abuse and neglect.

The Executive does not propose new capital appropriations for the construction of community-based beds to serve persons with mental illness.

This agency is found in the Health and Mental Hygiene appropriation bill.

State Operations

The Executive recommends All Funds State Operations appropriations of $1,130,776,000, a net increase of $1,425,000 or 0.13 percent. The State Operations General Fund appropriation increases by $85,475,000, primarily due to a loss of $69,201,000 in Special Revenue offset funds (Patient Income Account), together with net increases of $16,274,000. The Executive proposes the following changes in State Operations General Fund appropriations:

an increase of $20,534,000 related to personal service salary adjustments and overtime, the increased cost of atypical psychotropic drugs and utilities, and costs associated with a scheduled review by the Joint Commission on Accreditation of Health Care Organizations;

an increase of $7,000,000 for the Forensic Services Program to fund an expansion of forensic treatment services provided by the Office of Mental Health by adding 66 nurses and psychiatrists to the number of clinical personnel stationed in Department of Correctional Services (DOCS) facilities. A total of 264 beds would be added to provide forensic services: 102 Behavioral Care Unit beds, 75 Special Treatment Program beds and 87 Intermediate Care Program beds. The Behavioral Care Unit (BCU) is a new, highly intensive treatment model, designed to serve inmates with the most severe mental illness. The BCU would serve as an alternative to DOCS Special Housing Units (SHU). The Executive proposes adding 38 BCU beds at Great Meadow and 64 BCU beds at Sullivan correctional facilities. There are currently 43 Special Treatment Program (STP) beds, located at the Attica and Five Points correctional facilities. The STP provides specialized therapeutic services and support, including on-site 24-hour crisis services to inmates in SHUs. This initiative would add three new, 25-bed units at correctional facilities as yet to be designated. The Intermediate Care Program (ICP) is the “step-down” program that prepares mentally ill inmates for return to the general population. The ICPs are dedicated, residential units that provide enhanced rehabilitation, treatment and supports for inmates with serious mental illness. There are 565 Intermediate Care Program beds distributed throughout the DOCS system. This initiative would bring the total number of Intermediate Care Program beds to 652. The costs for capital development and increased security would be borne by DOCS;

a restoration of $2,500,000 in nonpersonal service funding to the Administration Program; and

a decrease totaling $13,760,000, derived from the annualization of savings from 90 beds closed in State Fiscal Year (SFY) 2003-04; the attrition of 140 full-time equivalent positions, associated with the elimination of 100 non-geriatric, adult inpatient beds in SFY 2004-05; the elimination of 30 funded, vacant positions at the two State-operated psychiatric research facilities; the elimination of 21 children’s inpatient beds, and the implementation of operational efficiencies and controls over nonpersonal service spending. Administration will be consolidated and five “cabinet-level” staff positions at children’s psychiatric centers downstate will be eliminated as part of the effort to achieve operational efficiencies.

The Executive recommends a net decrease in non-General Fund appropriations of $14,849,000, primarily resulting from the dissolution of a special revenue account that had been established to facilitate the transition of Shared Staff positions to local government control.

Aid To Localities

The Executive recommends an All Funds Aid to Localities appropriation of $861,775,000, a net increase of $13,277,000 or 1.56 percent. This change results from the following actions:

an increase of $10,312,000 for operational costs associated with new community bed development, including both single room occupancy (SRO) and scatter-site housing.

an increase of $8,646,000 resulting from: growth in debt service requirements for the operation of community beds; an adjustment in the rate paid to residential treatment facilities for children and youth (RTF) to cover the cost of a 3.4 percent trended increase to Medicaid reimbursements; a rise in the cost of atypical psychotropic medications and increased costs for education of children in RTFs; an increase in State share Medicaid support for the Kids Oneida Program under the Home and Community Based Services Waiver, and the addition of 400 supported employment slots;

the phase-in of funding for expanded adult and children’s services under the Community Mental Health Support and Workforce Reinvestment Program from the closure of 100 State-operated adult non-geriatric beds and 21 children’s State operated inpatient beds. The adult bed closures would generate $3,500,000 for community-based adult services in SFY 2004-05, growing to $7,000,000 in SFY 2005-06 while the closure of children’s beds would result in $1,300,000 for community-based children’s services in SFY 2004-05, growing to $2,600,000 in SFY 2005-06;

an increase of $9,100,000 for the Community Residence program to support more intensive programming and services, including the costs of more expensive atypical psychotropic medications for a hard to serve population of persons who are seriously mentally ill;

a General Fund savings of $9,100,000 achieved through the conversion of 100 percent State aid supported programs to Medicaid funding, including some programs receiving Community Mental Health Reinvestment funds, community residences, assertive community treatment (ACT) teams, and supportive case management services; and

a decrease of $8,506,000 resulting from elimination of the Alternative Rate Methodology (ARM) reimbursement for 10 general hospitals across the State and a reduction in support for non-critical mental health services. Local governments would be asked to work in cooperation with OMH in targeting the reductions.

Capital Projects

The Executive recommends new All Funds capital appropriations of $138,494,000, a net decrease of $76,988,000 or 35.73 percent. Although the hard dollar or "pay as you go" funding level would remain virtually static, growing by only $1,000,000, no new request is made for bonding to support construction of community based mental health beds.

Article VII

The Executive proposes Article VII legislation that would: authorize the closure of the Middletown Psychiatric Center beginning April 1, 2005; provide for the creation of an eight-member Blue Ribbon Commission, appointed by the Executive and the Legislature, to review capacity needs of the OMH institutional system and to provide recommendations for facility closures, based on an overall assessment of need for State inpatient beds. The Commission must submit recommendations for closures in a report to the Governor and the Legislature by April 1, 2005; extend the Community Mental Health Support and Workforce Reinvestment Act to 2010. The Governor is proposing that one-half of the cost savings achieved through future facility closures be re-invested into State-operated community based services; and restructure the rate system for reimbursing freestanding Article 28 mental health clinics, dually licensed by OMH and DOH.

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