Office of Mental Health
The enacted budget makes the following changes to the Executive Budget (analysis as of March 30, 2005):
· Approves the closure of Middletown Psychiatric Center on April 1, 2006. Provides that 100% of savings will be reinvested into state-operated community based services. Pursuant to an agreement between PEF and the Governor’s office, substantial additional services will be provided to the mentally ill in Orange and Sullivan Counties. OMH has stated that “nobody from PEF should have to transfer to Rockland Psychiatric Center if they don’t want to.” PEF and the Legislature will need to be vigilant to ensure that OMH fully implements the agreement.
· Reduces the nonpersonal service appropriation in the Adult Services program by $1 million
· Adds $400,000 to the Research in Mental Illness Program to fill 4 research scientist positions at Nathan Kline Institute.
Additional information (revised February 14, 2005):
- According to Assembly analysis, staffing allocations pursuant to the Middletown closure on April 1, 2006 would include the continuation of 59 outpatient positions at the Middletown location, 119 FTEs would staff new State-operated community expansion and 178 FTEs would transfer to Rockland. OMH has indicated that they have authorization for 356 positions, but the distribution is dependent on the plan for community based services.
- According to Assembly analysis the budget includes $2 million for a new fingerprinting unit to support 18 FTEs needed to process criminal background checks on new employees of community-based mental health agencies. There is not a separate line item for this appropriation.
- According to Assembly analysis the budget includes $1,850,000 for 22 new children’s inpatient beds: 14 at the Greater Binghamton Health Center and 8 added on a temporary basis to the children’s unit at Hutchings PC in response to the closure of Four Winds Hospital in Syracuse.
The Executive Budget recommends (revised January 20, 2005):
- The increase of 28 FTEs in SFY 2005-06 from the estimated 2004-05 year end FTEs. This includes an increase of 8 FTEs in Administration and Finance and an increase of 20 FTEs in Children and Youth Services. The estimated workforce will be 16,735 FTEs on March 31, 2006.
- Closure of Middletown PC on April 1, 2006 (in compliance with the one year notification law). Remaining patients will be transferred to Rockland PC. One hundred percent of savings from the closure ($7 million) will be reinvested in state-operated community-based programs. The Executive cites avoidance of an “unjustifiable $28 million capital investment” and total patient census of 115 as the reasons for closure.
- Local political support for the closure proposal has been mixed. Senator Bonacic has stated publicly that “it’s going to be hard to justify keeping the psych center open” but that he would fight for local services. Senator Morahan, Assemblywoman Gunther, and Mayor DiStefano have vowed to fight the closure.
- An overall budget of $1.2 billion, an increase of $75.3 million (6.7%) over SFY 2004-05. Personal Service increases in each program range from 5.6% (Research in Mental Illness) to 11.5% (Administration and Finance), reflecting the changes in the new contract. It is unclear how the 7% ($7.4 million) increase in the Children and Youth Program accommodates the increase of 20 FTEs. This should be clarified in Labor/Management.
- A $5 million increase in contractual services in Adult Services. This should be questioned in Labor/Management.
- The budget refers to $23,979,000 in State Operations and Local Assistance efficiencies, including revenue maximization for local programs. The budget specifically cites $3.9 million in Local Assistance savings from reducing or eliminating funding to local mental health providers that are underperforming, delivering less than cost effective services or have higher than average overhead expenses. The budget indicates that OMH will achieve savings by: reducing spending on unnecessary inpatient capacity; eliminating inessential funded vacancies; limiting nonpersonal service expenses through contract reviews and renewals and strict controls on travel, equipment and other purchases, and shifting costs to external grants; eliminating unnecessary spending and reimbursement mechanisms in local funding, including specialty rates for certain hospital-based mental health outpatient programs; and maximizing Federal Medicaid reimbursement. The amount of reduced spending for State Operations related to these “efficiencies” need to be identified by management.
- The budget narrative indicates that there is $7 million in continued funding for expanded mental health treatment capacity and clinical staffing for forensic DOCS inmates with serious and persistent mental illness, continuing the initiative begun with DOCS in 2004-05. The budget also states in the “Summary of Changes” that there is $3.5 million in new funding for annualization of the forensic expansion. In 2004-05 the budget indicated that there was $7.6 million in new appropriations for this purpose, which would appear to suggest a $600,000 reduction in funding for 2005-06. There is not a separate line item for this funding so it is impossible to track through the actual budget bills. We believe this discrepancy reflects the delay in bringing these services online. There are no new positions in the Forensic Services program for this purpose, which probably indicates the 66 positions identified for this purpose in 2004-05 will come online by 3/31/05. This should be clarified with management.
- The potential impact of these Department of Health proposals needs to be explored with management:
· Bi-partisan Commission on Health Care Facilities in the 21st Century. It is unclear if this closure commission includes mental health facilities.
· Modification of Medicaid reimbursement rates by the elimination of “specialty rates” for mental health outpatient programs. The press release accompanying the budget indicates that these payments are to private providers but this needs to be confirmed.
- Aid to Localities increases include:
- $6 million for freestanding Article 31 mental health clinic programs to provide for workforce enhancements,
- $6.5 million to increase the stipends for Supported Housing beds.
- $2.3 million to expand the home and community-based waiver by 245 slots to meet the mental health needs of children in foster care or at risk of institutional placement
Program Details-State Operations
Enacted
Proposed
Enacted
Change in
Percent
Program
2004-05 Budget
2005-06 Budget
2005-06 Budget
Appropriation
Change
All Funds
$1,128,276,000
$1,203,536,000
$1,202,936,000
$74,660,000
6.6%
General Fund
$603,915,000
$587,210,000
$586,610,000
($17,305,000)
-2.9%
Special Revenue-Federal
$1,272,000
$1,272,000
$1,272,000
$0
0.0%
Special Revenue-Other
$512,325,000
$604,196,000
$604,196,000
$91,871,000
17.9%
Enterprise Fund
$8,349,000
$8,349,000
$8,349,000
$0
0.0%
Internal Service
$2,415,000
$2,509,000
$2,509,000
$94,000
3.9%
Administration & Finance
$67,475,000
$72,382,000
$72,382,000
$4,907,000
7.3%
Personal Service
$35,157,000
$39,189,000
$39,189,000
$4,032,000
11.5%
Nonpersonal Service
$18,412,000
$19,193,000
$19,193,000
$781,000
4.2%
Special Revenue-Federal (SRF)
$1,272,000
$1,272,000
$1,272,000
$0
0.0%
Special Revenue-Other (SRO)
$1,870,000
$1,870,000
$1,870,000
$0
0.0%
Internal Service (ISF)
$2,415,000
$2,509,000
$2,509,000
$94,000
3.9%
Enterprise Fund (Ent)
$8,349,000
$8,349,000
$8,349,000
$0
0.0%
Federal Block Grant Fund (SRF)
$1,272,000
$1,272,000
$1,272,000
$0
0.0%
Personal Service
$790,000
$790,000
$790,000
$0
0.0%
Nonpersonal Service
$212,000
$164,000
$164,000
($48,000)
-22.6%
Fringe benefits
$270,000
$318,000
$318,000
$48,000
17.8%
OMH Gifts & Donations - (SRO)
$500,000
$500,000
$500,000
$0
0.0%
OMH Grants & Bequests - (SRO)
$70,000
$70,000
$70,000
$0
0.0%
Cook/Chill Acct (SRO)
$1,300,000
$1,300,000
$1,300,000
$0
0.0%
MH Sheltered Workshop Acct - (Ent)
$5,753,000
$5,753,000
$5,753,000
$0
0.0%
Personal Service
$2,045,000
$2,045,000
$2,045,000
$0
0.0%
Nonpersonal Service
$3,708,000
$3,708,000
$3,708,000
$0
0.0%
MH Community Stores Acct - (Ent)
$2,596,000
$2,596,000
$2,596,000
$0
0.0%
Personal Service
$551,000
$551,000
$551,000
$0
0.0%
Nonpersonal Service
$1,793,000
$1,793,000
$1,793,000
$0
0.0%
Fringe benefites
$252,000
$252,000
$252,000
$0
0.0%
MH Revolving Acct - (ISF)
$2,415,000
$2,509,000
$2,509,000
$94,000
3.9%
Personal service
$942,000
$993,000
$993,000
$51,000
5.4%
Nonpersonal service
$1,042,000
$1,068,000
$1,068,000
$26,000
2.5%
Fringe benefits
$431,000
$448,000
$448,000
$17,000
3.9%
Adult Services
$752,410,000
$805,378,000
$804,378,000
$51,968,000
6.9%
Personal Service
$611,816,000
$654,409,000
$654,409,000
$42,593,000
7.0%
Nonpersonal Service
$137,429,000
$147,804,000