1
1 BEFORE THE NEW YORK STATE SENATE FINANCE
AND WAYS AND MEANS COMMITTEES
2 -----------------------------------------------------
JOINT LEGISLATIVE HEARING
3 In the Matter of the
2025-2026 EXECUTIVE BUDGET ON
4 MENTAL HYGIENE
5 -----------------------------------------------------
6
Hearing Room B
7 Legislative Office Building
Albany, New York
8
February 5, 2025
9 9:39 a.m.
10
PRESIDING:
11 Senator Liz Krueger
Chair, Senate Finance Committee
12
Assemblywoman Helene E. Weinstein
13 Chair, Assembly Ways & Means Committee
14 PRESENT:
Senator Thomas F. O'Mara
15 Senate Finance Committee (RM)
16 Assemblyman Edward P. Ra
Assembly Ways & Means Committee (RM)
17
Senator Samra G. Brouk
18 Chair, Senate Committee on Mental Health
19 Assemblywoman Jo Anne Simon
Chair, Assembly Committee on Mental Health
20
Assemblyman Angelo Santabarbara
21 Chair, Assembly Committee on People
with Disabilities
22
23
24
2
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 PRESENT: (Continued)
4 Senator Patricia Fahy
Chair, Senate Disabilities Committee
5
Assemblyman Phil Steck
6 Chair, Assembly Committee on Alcoholism
and Drug Abuse
7
Senator Nathalia Fernandez
8 Chair, Senate Committee on Alcoholism
and Substance Use Disorders
9
Assemblyman Khaleel M. Anderson
10
Assemblyman Chris Eachus
11
Senator Siela A. Bynoe
12
Assemblyman Brian Maher
13
Senator Lea Webb
14
Senator John C. Liu
15
Assemblywoman Jodi A. Giglio
16
Assemblyman Edward C. Braunstein
17
Assemblywoman Yudelka Tapia
18
Senator Roxanne J. Persaud
19
Assemblyman Steven Otis
20
Assemblyman Joe Sempolinski
21
Assemblywoman Chantel Jackson
22
Assemblyman Tony Simone
23
Senator Shelley B. Mayer
24
3
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 PRESENT: (Continued)
4 Senator Pamela Helming
5 Assemblyman Harvey Epstein
6 Assemblywoman Judy A. Griffin
7 Senator Patricia Canzoneri-Fitzpatrick
8 Assemblyman Chris Burdick
9 Senator Peter Oberacker
10 Assemblyman Keith P. Brown
11 Senator Jacob Ashby
12 Assemblywoman Emily Gallagher
13 Assemblyman Sam Berger
14 Senator Rob Rolison
15 Assemblywoman Monique Chandler-Waterman
16 Assemblyman Philip A. Palmesano
17 Senator Bill Weber
18 Assemblywoman Andrea K. Bailey
19
20
21
22
23
24
4
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 LIST OF SPEAKERS
4 STATEMENT QUESTIONS
5 Ann Marie T. Sullivan, M.D.
Commissioner
6 NYS Office of Mental Health (OMH) 14 24
7 Chinazo Cunningham, M.D.
Commissioner
8 NYS Office of Addiction
Services and Supports (OASAS)
9 -and-
Willow Baer
10 Acting Commissioner
NYS Office for People With
11 Disabilities (OPWDD) 171 190
12 Maria Lisi-Murray
Executive Director
13 NYS Justice Center for the
Protection of People With
14 Special Needs 345 352
15 Courtney L. David
Executive Director
16 NYS Conference of Local
Mental Hygiene Directors
17 -and-
Nathan McLaughlin
18 Executive Director
Julie LeClair Neches
19 Board Member
National Alliance on Mental
20 Illness of New York State
(NAMI-NYS)
21 -and-
Glenn Liebman
22 CEO
Mental Health Association
23 in New York State (MHANYS) 396 409
24
5
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Page Pierce
CEO
6 Families Together in
New York State
7 -and-
Kayleigh Zaloga
8 President and CEO
NYS Coalition for Children's
9 Behavioral Health
-and-
10 Ronald E. Richter
CEO
11 JCCA
-and-
12 Joe Tobia
Parent
13 Retired Mental Health Advocate 445 457
14
Jim Karpe
15 Parent, Board Member
Coalition for Self-Direction
16 -and-
Donald Nesbit
17 Executive Vice President
Local 372-New York City
18 Board of Education Employees
-and-
19 Erik Geizer
CEO
20 The Arc New York
-and-
21 Kevin Ryan
Board Member
22 Self-Advocacy Association
of NYS 494 506
23
24
6
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Harvey Rosenthal
CEO
6 Alliance for Rights and
Recovery
7 -and-
Ruth Lowenkron
8 Director
Disability Justice Program
9 New York Lawyers for the
Public Interest
10 -and-
Tom Culkin
11 Member and Advocate
Treatment Not Jail Coalition
12 -and-
Winifred Schiff
13 Interagency Council of
Developmental Disabilities
14 Agencies
-on behalf of-
15 New York Disability Advocates
-and-
16 Doug Cooper
Acting Executive Director
17 Association for Community
Living (ACL)
18 -and-
Michael Seereiter
19 President & CEO
New York Alliance for Inclusion
20 and Innovation 542 562
21
22
23
24
7
1 2025-2026 Executive Budget
Mental Hygiene
2 2-5-25
3 LIST OF SPEAKERS, Continued
4 STATEMENT QUESTIONS
5 Dr. Angelia Smith-Wilson
Executive Director
6 Friends of Recovery-New York
-and-
7 Jihoon Kim
President & CEO
8 InUnity Alliance
-and-
9 Nicole Porter Davis
Licensed Creative Arts
10 Therapist (LCAT)
-for-
11 Licensed Creative Arts
Therapy Advocacy
12 Coalition 598 609
13
14
15
16
17
18
19
20
21
22
23
24
8
1 CHAIRWOMAN KRUEGER: See, it got
2 silent even before I said let's all take our
3 seats, let's have the Commissioner of
4 Mental Health join us at the front table.
5 And I will do one quick text while she's
6 moving.
7 All right. Good morning, everyone.
8 And we still -- we're good on seating. Just
9 quick update and reminder as we get started.
10 Hi, I'm Liz Krueger, Senate Finance
11 chair, joined by my no longer new colleague,
12 the no longer new Ways and Means Chair
13 Gary Pretlow. We've already survived
14 X number of hearings, so just the same old
15 Ways and Means Chair Gary Pretlow.
16 So today is the hearing on
17 Mental Health and Office for People With
18 Developmental Disabilities and Office of
19 Addiction Services and Supports and the
20 Justice Center for the Protection of People
21 with Special Needs.
22 Just some basic rules for people who
23 may not come to all of our hearings. When
24 you are testifying or asking questions, you
9
1 need to speak into the mic. And it only
2 works when you press the "Push" button and it
3 goes from red to green. And there's a little
4 trick with them. You have the sweet spot
5 just above the word "Push." So some people
6 have struggled to get it to work, including
7 me. But just know when it's green, you're
8 on. When it's red, you're not.
9 Also, both for testifiers and for
10 legislators asking questions, there are
11 clocks that all of us can see. And
12 commissioners and other invited government
13 guests get 10 minutes each to testify.
14 Everyone else gets three minutes to testify.
15 We tell everyone you may have 30 pages
16 worth of testimony. You've submitted it, we
17 all have it, and it's up online for the whole
18 public to read. But the best testifiers are
19 people who bullet-point their most important
20 issues, because you're not going to have
21 enough time to get through everything.
22 For people asking you questions, that
23 clock means it's the time for you to ask the
24 question and get the answers. So some of my
10
1 colleagues enjoy doing a very broad opening
2 statement and a very extended question and
3 then are shocked when the bell goes off that
4 they're done. And they assume then
5 somebody's going to answer them. They're
6 not, because your time is up.
7 So just remember if the clock says
8 X amount of time, that's for both of you.
9 And I know it's not enough time, and we
10 haven't just mastered 24-hour hearings -- and
11 I'm not sure any of us want to.
12 Also, if you're a chair, for
13 addressing the commissioners -- and there's
14 four different ones today -- chairs of the
15 relevant committees get 10 minutes, rankers
16 get five minutes, everyone else gets three
17 minutes. Only chairs get a three-minute at
18 the very end follow-up if they have
19 additional questions to ask.
20 Okay, that's I think mostly the rules
21 of the road.
22 So I'm now going to officially do the
23 opening of this actual hearing.
24 So good morning. You already know I'm
11
1 Liz Krueger, chair of Senate Finance. And
2 the Senate is chairing today's hearing. The
3 Assembly and the Senate take turns.
4 Today is the fifth of the 14 hearings
5 to be conducted by the joint fiscal
6 committees of the Legislature regarding the
7 Governor's proposed budget for state fiscal
8 year '24-'25.
9 These hearings are conducted pursuant
10 to the New York State Constitution and
11 Legislative Law.
12 Today the Senate Finance Committee and
13 Assembly Ways and Means Committee will hear
14 testimony regarding the Governor's proposed
15 budget for the following agencies: Office of
16 Mental Health, Office for People With
17 Developmental Disabilities, Office of
18 Addiction Services and Supports, and the
19 Justice Center for the Protection of People
20 with Special Needs.
21 As I've described, following each
22 testimony there will be some time for
23 questions from the chairs of the fiscal
24 committees and other legislative members of
12
1 the committees.
2 I will now introduce members of the
3 Senate. Assemblymember Gary Pretlow, chair
4 of Ways and Means, will introduce members of
5 the Assembly. And then Senator Tom O'Mara,
6 who's actually ably represented by the lovely
7 not Tom O'Mara, and Assemblymember Ra from
8 the Assembly Republicans -- I just wanted to
9 make sure I have the list of all the Senate
10 Democrats so far.
11 Oh, and during the course of the day,
12 because people have session, they have
13 committee meetings, you'll see legislators
14 come and go, and we will introduce them as
15 they show up.
16 And for all of my legislative
17 colleagues, if you want to ask questions then
18 you need to let the four of us, chairs or
19 rankers, let us know so you go on a master
20 list. Because sometimes it's many, many
21 people and they'll be thinking why didn't you
22 know I wanted to ask a question. And the
23 answer will be because you never told us you
24 wanted to ask a question. So please
13
1 remember, colleagues, to do so.
2 So the Senators who are here today so
3 far are Senator Bynoe, our new Senator;
4 Senator Webb; Senator Fernandez; and
5 Senator Brouk.
6 Assemblymember.
7 CHAIRMAN PRETLOW: Thank you, Senator.
8 With us today we have the chair of
9 Mental Health, Assemblywoman Simon. We have
10 the chair of Alcoholism, Assemblyman Steck,
11 and the Disabilities chair, Assemblyman
12 Santabarbara.
13 Also with us we have Assemblypeople
14 Anderson, Braunstein, Burdick, Eachus,
15 Epstein, Otis and Tapia.
16 CHAIRWOMAN KRUEGER: And for the
17 Republican Senate, Senator Canzonerio --
18 Canzoneri-Fitzpatrick. I never mean to
19 disrupt --
20 SENATOR CANZONERI-FITZPATRICK: That's
21 okay.
22 CHAIRWOMAN KRUEGER: And she's also
23 the ranker on the Mental Health Committee.
24 SENATOR CANZONERI-FITZPATRICK: Thank
14
1 you, Chair.
2 I'm honored to introduce my colleagues
3 from the Republican Senate: Senator
4 Oberacker, Senator Rolison and Senator Weber.
5 CHAIRWOMAN KRUEGER: Assembly.
6 CHAIRMAN PRETLOW: Assemblyman Ra.
7 ASSEMBLYMAN RA: Good morning. We are
8 currently joined by Assemblyman Sempolinski,
9 who is our ranker on Mental Health;
10 Assemblyman Keith Brown, our ranker on
11 Alcoholism; and Assemblymember Maher.
12 CHAIRWOMAN KRUEGER: Okay. Well,
13 then, good morning, Commissioner Sullivan.
14 Nice to see you here today. And you have
15 10 minutes to present.
16 OMH COMMISSIONER SULLIVAN: Thank you.
17 Good morning, Chairs Krueger, Pretlow,
18 Brouk, Simon and members of their respective
19 committees. I want to thank you for the
20 invitation to address Governor Hochul's
21 fiscal year '25-'26 Executive Budget as it
22 relates to mental health.
23 I'm happy to report that the
24 Governor's proposed budget continues to
15
1 emphasize the importance of building a
2 comprehensive mental health system that
3 provides New Yorkers with robust prevention
4 services, increased access to treatment, and
5 a vital safety net for those with high needs
6 who have been unable to effectively engage in
7 treatment on their own.
8 Since taking office, Governor Hochul,
9 in partnership with the Legislature, has made
10 historic new investments in the mental health
11 system, and the Office of Mental Health has
12 been diligently working with counties across
13 the state to implement these programs in a
14 manner that meets the needs of local
15 communities. To date, we have generated more
16 than 780 contracts and funded more than
17 690 providers.
18 And to ensure the success of these
19 programs, Governor Hochul provides a targeted
20 inflationary increase of 2.1 percent,
21 building on investments from previous years.
22 The Executive Budget provides for
23 investments across the lifespan, with an
24 emphasis on recovery and community-based
16
1 wellness, as well as additional intensive
2 services for high-need individuals.
3 Providing for early access to care is at the
4 core of mental wellness, and the Office of
5 Mental Health continues to grow services.
6 Across the lifespan, this year's
7 Executive Budget proposes the inclusion of
8 $1.5 million to integrate behavioral health
9 in OB-GYN offices in underserved communities
10 to improve maternal mental health, providing
11 for vital screenings and access to treatment.
12 We know that treating maternal depression is
13 critical to the successful growth of our
14 youngest New Yorkers.
15 Governor Hochul is continuing her
16 commitment to youth mental health by
17 including $1.5 million to expand
18 Teen Mental Health First Aid, which is
19 specifically designed to teach teens in
20 Grades 9 to 12 how to help each other to
21 respond to mental health challenges. During
22 the Governor's Youth Mental Health Listening
23 Tour in 2023, young people repeatedly
24 emphasized that they first talk to their
17
1 friends when they are experiencing mental
2 health concerns, and that they don't always
3 know how to respond.
4 Additionally, funding for Youth Safe
5 Spaces, which are clubhouses where young
6 people can access mental and behavioral
7 health wellness resources, foster positive
8 peer relationships, and engage in positive
9 activities, further strengthens their ability
10 to help each other.
11 For those children and adolescents
12 whose complex needs require specialized
13 assessment and care, the proposed budget
14 includes $1 million to create Comprehensive
15 Clinical Assessment Hubs for evaluation and
16 linkages to the array of services needed.
17 There's also an amendment to the
18 Mental Hygiene Law which would allow runaway
19 and homeless youth, who are already
20 authorized to consent to their own physical
21 health services, to also consent to inpatient
22 and outpatient behavioral health services
23 without parental consent. This change will
24 help avoid delays in accessing essential
18
1 behavioral healthcare, and ensure that
2 vulnerable minors receive timely treatment
3 and support.
4 For adult New Yorkers, this year's
5 proposed budget provides for the development
6 of clubhouses, which are programs designed to
7 assist individuals living with mental illness
8 with the establishment of friendships,
9 recreational activities, and educational and
10 vocational opportunities.
11 The National Alliance on Mental
12 Illness describes the term recovery as
13 "reaching a place where you are able to
14 pursue a safe, dignified and meaningful
15 life." Governor Hochul and the Office of
16 Mental Health are committed to assisting
17 individuals with mental health challenges to
18 reach that place.
19 Additionally, by working with local
20 communities to develop culturally appropriate
21 care, we are more successful in engaging
22 diverse populations in mental wellness
23 activities. The Executive Budget includes
24 $2 million to support community-determined
19
1 wellness in historically marginalized
2 neighborhoods, which can help us towards
3 reaching all New Yorkers with prevention
4 services.
5 Utilizing peers, who have the unique
6 perspective of living with mental health
7 challenges, has proven to be highly effective
8 in engaging high-need individuals with whom
9 traditional services have had little success.
10 Four million dollars is proposed for
11 hospital-based Peer Bridger services and for
12 the expansion of Intensive and Sustained
13 Engagement Teams to work with individuals to
14 secure their success in the community and
15 prevent hospitalizations and emergency room
16 visits.
17 Ensuring that services are available
18 across the lifespan, the recovery journey
19 requires us to make adjustments as people
20 enter different stages of life. This year's
21 budget provides $1.6 million to create a
22 pilot Aging in Place program for OMH licensed
23 residential units, allowing individuals to
24 continue to receive optimum services and
20
1 support in their own homes as they grow
2 older.
3 Our highest-need New Yorkers require
4 specialized intensive and innovative
5 approaches to engage them in services.
6 Governor Hochul launched the Safe Options
7 Support initiative in January of 2022. These
8 teams, initially working with unsheltered
9 individuals in the subways of New York City,
10 have expanded to Long Island and upstate
11 communities. There are currently 27 SOS
12 teams who have conducted more than 67,000
13 encounters, and have successfully housed
14 884 individuals who were previously
15 unsheltered, often for many years, in
16 permanent housing.
17 Additionally, teams have helped to
18 facilitate over 2,600 shelter placements in
19 New York City. They have also initiated
20 875 voluntary referrals to hospital emergency
21 rooms, both for medical and psychiatric
22 services. And this year's budget includes
23 over $12 million to enhance specialty
24 services for these high-need individuals.
21
1 Funding will be available to add street
2 medicine and street psychiatry to the SOS
3 teams, as well as additional funding for
4 OASAS street outreach teams to integrate for
5 substance use services.
6 For mobile outreach teams, proposed
7 funding would also establish welcome centers
8 in five New York City subway stations,
9 allowing for a more private space to speak
10 with outreach workers.
11 Beyond the data, it is an individual's
12 life change that is so important. A woman
13 who was unsheltered and living in the subway
14 for many years, after working with her SOS
15 team not only accessed permanent housing but
16 reconnected with her worried sister, who had
17 been searching for her for years.
18 We will always make every effort to
19 work with and engage individuals in need of
20 services in their communities. Since 2023,
21 with the over $2 billion investment in mental
22 health, we are significantly expanding the
23 availability of outpatient services
24 throughout our system, including ways to
22
1 effectively connect individuals to services
2 upon discharge from the hospital.
3 But sometimes for people living with a
4 mental illness, due to their illness they are
5 unable to engage in community mental health
6 services despite being at extremely great
7 risk for their personal safety. This year,
8 we are proposing a clarifying amendment to
9 the involuntary inpatient commitment criteria
10 to include individuals at substantial risk of
11 harm due to an inability or refusal, as a
12 result of their mental illness, to provide
13 for their essential needs such as food,
14 clothing, medical care, safety or shelter.
15 In addition, the Executive Budget
16 applies a new $16.5 million to the Assisted
17 Outpatient Treatment Program, for counties to
18 increase efforts to work with individuals on
19 a voluntary basis while also providing
20 support for local oversight; and $2 million
21 for additional staff at OMH to better support
22 the counties, enhance state oversight, and
23 enable increased use of voluntary AOT
24 throughout the state.
23
1 There are also proposed changes to the
2 Mental Hygiene Law to clarify AOT criteria
3 and provide petitioners with better guidance
4 on when an AOT petition can be filed within
5 six months of an expired AOT court order.
6 Finally, this budget specifically
7 increases services in two additional key
8 areas. It proposes funding for the
9 much-needed update to the crisis unit of the
10 Capital District Psychiatric Center and
11 expansion of its Mobile Integration Team,
12 providing ready access to crisis services in
13 the Capital area. And the Executive Budget
14 also provides $160 million in capital for an
15 increase of 100 psychiatric forensic
16 inpatient beds on Wards Island in New York
17 City, to address the increasing need for
18 restoration services to ensure that
19 individuals can participate in their court
20 processes in a timely manner.
21 Lastly, the budget also provides
22 $21 million for OMH to increase clinical and
23 direct-care staffing at its four forensic
24 facilities to reduce staff-to-patient ratios,
24
1 improving safety and quality of care.
2 Again, thank you for the opportunity
3 to testify on the Executive Budget, and I am
4 happy to answer any questions you may have.
5 CHAIRWOMAN KRUEGER: Thank you very
6 much.
7 We've also been joined by
8 Senator Persaud.
9 And our first Senator questioning will
10 be Senator Brouk, the chair of the
11 Mental Health Committee.
12 SENATOR BROUK: Thank you.
13 Good morning, Commissioner. Thank you
14 for your testimony, and thank you for
15 everything you do every day for New Yorkers.
16 It's really an honor to be able to work with
17 you.
18 I want to jump right in because I
19 think that there's a lot -- obviously we're
20 very grateful to you and the Governor for
21 putting such a heavy focus on mental health,
22 the entire continuum of care. We know that
23 we can't solve it by just looking at one part
24 of mental health. So from prevention all the
25
1 way to crisis, I think there's still a lot of
2 work we need to do.
3 I want to start with your work on the
4 Daniel's Law Task Force this year. To your
5 knowledge, in this Executive Budget were any
6 of the recommendations that came out of the
7 report -- which came out a year early, so
8 that was December 2024 -- were there any of
9 the recommendations from the Daniel's Law
10 Task Force included in this budget?
11 OMH COMMISSIONER SULLIVAN: The
12 Daniel's Law Task Force, which I think did an
13 excellent job of bringing together
14 stakeholders coming up with recommendations
15 for policymakers to look at what should be
16 emergency response for mental health crisis
17 look like in New York State.
18 So those recommendations are there.
19 They're a tremendous resource for
20 policymakers. And it's up to policymakers to
21 decide which of those recommendations they
22 may want to move forward.
23 SENATOR BROUK: Okay. Just so we all
24 know, there were these two major
26
1 recommendations, establishing a defined
2 response protocol for behavioral health
3 crisis, and then creating a statewide
4 behavioral health crisis technical assistance
5 center, which I thought was -- could be of
6 tremendous value, and I was glad to see it
7 come out of the recommendations.
8 So I guess my question is, if we were
9 to move forward with those recommendations in
10 this year's budget, is OMH in a position, if
11 funding were to come through this budget, to
12 start creating this technical assistance
13 center and actually start the process of
14 these Daniel's Law pilots as it recommends in
15 the report?
16 OMH COMMISSIONER SULLIVAN: We have a
17 pretty robust -- at the current time we have
18 mobile crisis teams in all of our counties.
19 We have a 988 answering center. We have
20 crisis residences. And we have an increase
21 in crisis stabilization centers over the next
22 few years.
23 So we have a crisis system which we
24 have been working with now for many years to
27
1 establish across the state. So I think the
2 issue of a technical assistance center is
3 something that, again, is a recommendation in
4 the report and, again, for policymakers to
5 decide if it's something they would want to
6 enhance. It's up to the policymakers.
7 SENATOR BROUK: Okay. So in other
8 words are you saying you may have the
9 capacity at OMH now to administer some of
10 these recommendations?
11 OMH COMMISSIONER SULLIVAN: It would
12 depend on the other -- it would depend on the
13 other recommendations that are accepted. So
14 what would be available currently, and then
15 what we would need in addition if they were
16 accepted.
17 SENATOR BROUK: Okay. Thank you.
18 I want to move on to some of the
19 changes that were in the Executive's budget
20 that you mentioned around AOT and how those
21 are implemented. So the first thing I was
22 curious about is we know that there's a study
23 I think that's going through OMH, I think
24 it's been contracted out. And that study is
28
1 due in 2026, is that correct?
2 OMH COMMISSIONER SULLIVAN: Yes.
3 SENATOR BROUK: So have we learned
4 anything in the interim while this study is
5 going around, you know, what the efficacy has
6 been like, what the impact has been of AOT
7 orders statewide?
8 OMH COMMISSIONER SULLIVAN: We haven't
9 yet received anything from the group that's
10 doing the study. They have all the data, and
11 they are compiling it at this point. They
12 will be on time to deliver it next year, but
13 we haven't received anything from them yet.
14 What we do know from our outcomes that
15 we look at is that AOT decreases
16 incarcerations, it decreases
17 hospitalizations, it decreases episodes of
18 violence. So that's our determinations as we
19 have looked at AOT. But from the
20 researchers, we're still waiting to hear from
21 them. And they have not yet given us any
22 information on what they're looking at.
23 They're doing a qualitative and a
24 quantitative analysis.
29
1 SENATOR BROUK: So then my next
2 question would be -- I know your -- and I
3 know it was the task force that you were in
4 charge of chairing. And this is different,
5 it's a study that's being done externally.
6 But do you think that there's an opportunity
7 to get any of that information earlier than
8 2026?
9 And I ask because in this executive
10 proposal there are a number of changes to
11 AOT, and it seems somewhat premature to be
12 moving forward with changes to something that
13 we have put a million dollars towards
14 studying. And so maybe there's a way that we
15 can still do the study with integrity but to
16 get some answers of what these researchers
17 are seeing so that we can make more
18 data-driven, evidence-based decisions on how
19 we might make changes.
20 OMH COMMISSIONER SULLIVAN: I think we
21 can ask. However, our conversations so far
22 with the researchers, I don't think that they
23 are able to give us too much of the results
24 of their data analysis yet. But we can
30
1 certainly ask if they have anything that they
2 could share.
3 SENATOR BROUK: Okay, thank you.
4 And then you talked about there's a
5 total of 18.5 million going towards AOT
6 orders. It sounds like 2 million of that is
7 for OMH staff. What do you anticipate the
8 16.5 million going towards exactly?
9 OMH COMMISSIONER SULLIVAN: A good
10 part of that is going to go towards expanding
11 the use of voluntary AOT. One of the
12 difficulties with using as much voluntary AOT
13 has been not having the degree of care
14 coordination, care oversight, making sure
15 that all the services are there, that the
16 individual is getting everything they need.
17 So individuals we think may have -- since
18 that isn't there, we haven't been using the
19 voluntary as much as we could.
20 So those dollars will be going to the
21 county to increase voluntary, but also to
22 help them with some of the ongoing services
23 they are providing for individuals on AOT.
24 SENATOR BROUK: Okay.
31
1 OMH COMMISSIONER SULLIVAN: Voluntary
2 AOT could really provide excellent services
3 as well with the right supervision.
4 SENATOR BROUK: And so just so -- to
5 make it very clear, this could actually go to
6 someone who's voluntarily choosing to enter
7 this program and get services that they may
8 not be able to get right now.
9 OMH COMMISSIONER SULLIVAN: Yes. Yes.
10 And voluntarily with high priority for the
11 services so they can get them, but continue
12 the same degree of support that you would get
13 if you actually had an AOT order.
14 SENATOR BROUK: Wonderful.
15 And then I'll use my last few
16 minutes -- you know, I don't think it was in
17 this testimony but obviously in the
18 Executive Budget there are changes, pretty
19 big changes to the involuntary commitment and
20 how we would do that here in New York State.
21 You know, civil rights lawyers, peers,
22 community members -- a lot of people are
23 talking about how there is fear that, you
24 know, the new standard is essentially saying
32
1 that anyone who may be unhoused, whether or
2 not they may have on and off employment or it
3 might be temporary unhousing, now could be at
4 risk of involuntary commitment.
5 How do you think we avoid this from
6 being a sweeping change so that we are
7 essentially saying homelessness now equals
8 you could be involuntarily committed?
9 OMH COMMISSIONER SULLIVAN: Let me be
10 very clear. In no way does homelessness
11 equal involuntary commitment.
12 And this is a very -- for a very
13 small, select group of individuals who are at
14 very substantial risk of physical harm
15 because they are unable to take care of their
16 daily needs. So we're talking about an
17 individual who, for example, really is out in
18 the freezing cold and is not adequately
19 dressed at all and is in danger of frostbite.
20 We are talking about an individual who has
21 severe cellulitis that could lead to serious
22 medical problems that has no understanding of
23 what it is because of their mental illness.
24 We are talking about individuals with very
33
1 serious physical problems, their inability to
2 take care of themselves. It's a very small
3 percentage.
4 Clearly, making these decisions is
5 very difficult. You have to be extremely
6 careful about ever committing anyone to a
7 psychiatric facility involuntarily.
8 All this does is clarify what has been
9 present in case law before, that individuals
10 with this degree of substantial, substantial
11 risk can also be involuntarily committed. It
12 also exists in case law, but by clarifying
13 you help individuals who make these difficult
14 but important decisions know better how to
15 make those decisions.
16 SENATOR BROUK: Thank you. And so I
17 want to switch quickly to the incident review
18 panels that are -- has any locality ever
19 requested to have a review panel when there
20 are -- we hear about all these instances,
21 right, horrific incidents. You know, and we
22 hear certain things in whatever headline, but
23 rarely do we hear the information really
24 behind it and the investigation that goes
34
1 into it.
2 I know that there is an ability to do
3 incident review panels when there is someone
4 with a mental illness who, you know, has
5 created physical harm to themselves or
6 others, but it has to be locality that is
7 requesting it. For example, has New York
8 City or any locality ever requested that
9 there be a review panel to really dig into
10 what's happening?
11 OMH COMMISSIONER SULLIVAN: We've
12 never had the formal incident review panel
13 that is described in the legislation.
14 However, every time there's an
15 incident there's a tremendous amount of
16 review that goes on, both within the Office
17 of Mental Health and any other agencies that
18 are involved.
19 SENATOR BROUK: Sorry, not to cut you
20 off --
21 OMH COMMISSIONER SULLIVAN: So that's
22 going on. It's not in the formal incident
23 review panel.
24 SENATOR BROUK: Right. So why not do
35
1 the formal one? We have that option to do
2 it.
3 Do you think we could maybe learn more
4 about how to better serve those who are
5 severely mentally ill? And I always have to
6 remind folks, by and large, right, they're
7 actually victims of -- you know, they are
8 victims and they are not the perpetrators of
9 violence. And so we want to be careful --
10 again, this is a very small number of folks.
11 But do you think we might be able to learn
12 more and do better to serve them and create
13 better safety in our subways and beyond if we
14 were to do those?
15 OMH COMMISSIONER SULLIVAN: I think
16 you can always do a good review, and we do do
17 good reviews. And we learn all the time from
18 what we review.
19 I think incident review panels we have
20 not used yet; it's something to look into.
21 SENATOR BROUK: Thank you,
22 Commissioner.
23 OMH COMMISSIONER SULLIVAN: Thank you.
24 CHAIRWOMAN KRUEGER: Thank you.
36
1 Assembly.
2 CHAIRMAN PRETLOW: Assemblywoman
3 Simon, 10 minutes.
4 ASSEMBLYWOMAN SIMON: Thank you.
5 Thank you, Commissioner, for your
6 testimony and for all of your work in this
7 area.
8 I have a few additional questions to
9 follow through on what Senator Brouk asked.
10 A couple of things that strike me is, you
11 know, for example, the incident review teams,
12 right, incident review panels that have not
13 been engaged in a formal way.
14 In your mind, what kind of support
15 from the state or funding from the state
16 would be helpful to really encourage that
17 kind of review in a formal way so that we
18 actually had information from which we could
19 make informed policy decisions?
20 OMH COMMISSIONER SULLIVAN: I think
21 that the ability to do such a review panel is
22 there.
23 I think that the question is when you
24 would call it, what localities would want to
37
1 do. And I really do have to keep emphasizing
2 that none of -- it's not that these reviews
3 have not been seriously looked at. So much
4 of the information behind what has happened
5 is confidential.
6 But then the outcome of looking at
7 those reviews certainly influences the
8 services we put up. The outcome of all the
9 reviews of these incidents have led to
10 developing things like INSET teams for
11 individuals with -- have led to the CTI
12 programs that we're putting forward.
13 So I don't want people to think that
14 the reviews that we've been doing haven't
15 been substantial and haven't been informing
16 the whole array of services that we are
17 putting up to work with individuals with
18 serious mental illness.
19 ASSEMBLYWOMAN SIMON: Okay, thank you.
20 I have another question about a
21 population I think is of concern. One is a
22 question on managed care. As you know, the
23 outpatient behavioral substance abuse
24 services were carved into Medicaid managed
38
1 care about a decade ago, and later on now
2 they're not actually managing the care, that
3 there's no real benefit to that care provided
4 to the patients that comes out of that
5 carve-in to Medicaid managed care.
6 And there are like 16 plans that are
7 for-profit corporations that are profiting
8 off of this but not making -- but not
9 actually contributing to that -- the
10 management of that care.
11 And so the organizations, the
12 providers that are providing this care are at
13 a breaking point because they're spending
14 more time doing the administrative work for
15 something that actually is yielding no
16 savings to the state or any benefit to the
17 people that they're serving.
18 You know, one of the providers had to
19 hire four people just to do the
20 administrative work. Those are dollars that
21 could be used to take care of people.
22 So I want to know if you can work with
23 us to carve these outpatient services out of
24 managed care, which would actually save us
39
1 over $400 million to New York State.
2 OMH COMMISSIONER SULLIVAN: We work
3 very closely with the Department of Health,
4 and the Department of Health ultimately
5 manages the benefits of -- the organization
6 of how payments are made to managed care. We
7 work very closely with them and with the
8 managed-care organizations to ensure that the
9 appropriate amount of dollars is spent on
10 mental health services and that the managed
11 care organizations work cooperatively with
12 our providers.
13 The question of a carveout I think is
14 a big question and really has to be discussed
15 additionally with the Department of Health.
16 ASSEMBLYWOMAN SIMON: Because I'm
17 concerned because they're not processing
18 payments in a timely manner, which is harming
19 the ability for people to keep their
20 organizations going. And these are
21 vulnerable people --
22 OMH COMMISSIONER SULLIVAN: We
23 monitor -- we do monitor the timely payments,
24 and there have been citations to managed care
40
1 organizations for not providing timely
2 payments. Timely payments of many of them
3 have gotten better because of the oversight
4 and the enforcement. And there have also
5 been fines when managed-care companies have
6 not provided appropriate response to parity,
7 and parity includes timely payments.
8 ASSEMBLYWOMAN SIMON: Thank you.
9 I have a couple of other questions.
10 One question has to do with the Governor's
11 proposal to expand support for the
12 Empire State Supported Housing Initiative
13 program. Which is a good program, but in the
14 meantime there is also the community
15 residence SRO providers, who are getting much
16 less money per unit and are still functioning
17 and provide good support. Which doesn't seem
18 to make a lot of sense in the dollars and
19 cents and also provision of care.
20 So, you know, I want to know what
21 plans you or the Governor have to support the
22 CR SROs at a level above or at least
23 consistent with the amount of money that is
24 committed to the ESSHI programs.
41
1 OMH COMMISSIONER SULLIVAN: Over time
2 there has been a significant investment in
3 housing, and those supportive dollars have
4 gone up. But yes, this year in the budget is
5 for new ESSHI housing, the significant -- the
6 increase.
7 But there has been over $350 million
8 invested in housing over the past four years,
9 overall, with lots of increases to housing
10 providers for stipends to do the work they
11 need to do.
12 ASSEMBLYWOMAN SIMON: Yeah, but these
13 other people aren't getting the same amount
14 of money.
15 OMH COMMISSIONER SULLIVAN: No, they
16 are not.
17 ASSEMBLYWOMAN SIMON: And so they're
18 still providing housing, they still have the
19 same costs, they have a population that has
20 significant needs. The question is beefing
21 that up. How can we beef that up, is really
22 the question.
23 And then the other question is what
24 additional funding is going to be provided to
42
1 residential programs so they can serve not
2 just the current residents but the needs of
3 people who are under this AOT.
4 I think one of the confusions people
5 have is the sort of voluntary AOT, which is
6 actually available for many other programs as
7 well, providing the same kinds of supports,
8 which is different than something that is
9 involuntary, which has other ramifications,
10 obviously.
11 OMH COMMISSIONER SULLIVAN: So
12 basically, yes, the funding for individuals,
13 for AOT, for voluntary, will be the same.
14 Yes. I'm unsure of your question --
15 ASSEMBLYWOMAN SIMON: Well, it seems
16 to me that you have residential programs that
17 some of them are based in a residential
18 facility that might help somebody with
19 outpatient. Right?
20 But also we've made a proposal to
21 expand the use of involuntary commitment, for
22 which there are a number of concerns,
23 including importing a definition from
24 retention of people who are currently
43
1 hospitalized to people who are not yet, and
2 not even evaluated.
3 But if that were to occur, you would
4 increase the number of people who were
5 involuntarily hospitalized. And we have a
6 lack of beds. And, you know, where is the
7 money to support the natural consequence of
8 such a proposed expansion?
9 OMH COMMISSIONER SULLIVAN: I --
10 expansion -- involuntary commitment --
11 (Overtalk.)
12 ASSEMBLYWOMAN SIMON: If you have more
13 people --
14 OMH COMMISSIONER SULLIVAN: -- more
15 hospital beds. I'm just trying to --
16 ASSEMBLYWOMAN SIMON: -- involuntarily
17 hospitalized --
18 OMH COMMISSIONER SULLIVAN: Yes.
19 ASSEMBLYWOMAN SIMON: -- where are you
20 going to put them?
21 OMH COMMISSIONER SULLIVAN: Currently
22 in New York State the occupancy of our
23 psychiatric services is about 80 to
24 82 percent adult, not 95 percent. So there
44
1 is room within the community-based hospital
2 system for the small increase in individuals
3 for the change in the involuntary commitment
4 law.
5 After the pandemic the occupancy was
6 95 percent. And that's why additional beds
7 have been added in the community. But at the
8 current time, across the state, the occupancy
9 is between 80 to 83 percent, which means
10 there is sufficient space to expand.
11 However, the involuntary commitment
12 law which we are expanding is for a very
13 small number of individuals. This will not
14 have a tremendously significant impact on
15 hospital occupancy.
16 ASSEMBLYWOMAN SIMON: So a sort of
17 follow-up question to that is we just
18 recently had a report issued in New York City
19 under the mayor's changed sort of standards
20 and it would bring people into the hospitals.
21 Almost 50 percent of them were not retained,
22 which meant that they were probably not a
23 danger to themselves or others. And they
24 were evaluated by competent people who do
45
1 this kind of work.
2 But 52 percent I think of them were
3 retained. And one of the big challenges, and
4 we hear this with the cycling of people out
5 -- Daniel Prude is somebody who wasn't
6 retained -- that there's no place to --
7 there's not enough availability of those
8 beds. And I know the psych beds in the
9 private hospitals have not been restored
10 fully. In some cases yes, but not fully
11 restored from COVID. But there was also a
12 loss of beds previous to that.
13 So this is a very real concern about
14 the feasibility of ever even implementing
15 what it is that is currently being proposed.
16 And so that's why I asked that question. I
17 think that's a very real concern that people
18 have, and there doesn't seem to be any -- any
19 dollars given to actually making that happen.
20 OMH COMMISSIONER SULLIVAN: There were
21 capital dollars last year for expansion of
22 beds, and there will be a hundred additional
23 community-based beds that will open.
24 But the important thing here is
46
1 occupancy is something we track very, very
2 closely. So if you were at an 80 percent
3 occupancy, that means that you have space to
4 be admitting individuals into the services.
5 The other critical points are the
6 services when that 50 percent that you sent
7 kind of into the emergency room are
8 discharged. And that's where the growth of
9 Critical Time Intervention teams and all the
10 other services we're putting up will affect
11 that revolving door of people coming back.
12 ASSEMBLYWOMAN SIMON: Transition, yes.
13 Thank you.
14 CHAIRWOMAN KRUEGER: Next for the
15 Senate, the ranker, Senator
16 Canzoneri-Fitzpatrick.
17 SENATOR CANZONERI-FITZPATRICK: Good
18 morning. Thank you so much for being here
19 today.
20 I have sort of a general overview
21 question. As was stated previously by
22 Senator Brouk, we have an issue with so many
23 people being arrested that are committing
24 crimes that are -- truly have mental health
47
1 issues or addiction issues.
2 Where in this budget are we providing
3 that those people will get services instead
4 of just being thrown into a system where
5 their issue is not properly addressed? I'd
6 like to know where in this budget are we
7 going to do better in the next session for
8 those people that need those services.
9 OMH COMMISSIONER SULLIVAN: You
10 have -- I think it's important to look at the
11 budgets for the past several years, the
12 services that are coming up now. There's a
13 significant increase in teams that will be
14 working with exactly the individuals that
15 you're talking about, Critical Time
16 Intervention teams, Assertive Community
17 Treatment teams. Those were in the 20 -- the
18 billion-dollar budget; they are now hitting
19 the streets. In the next year you will begin
20 to see these teams available.
21 In addition. Last year's budget had
22 something called court navigators, who are
23 going to be distributed across the state to
24 work actually in the courtroom when
48
1 individuals come before the judge to help
2 connect them to services. And so the
3 entire --
4 SENATOR CANZONERI-FITZPATRICK: Is
5 that being increased -- excuse me. Is that
6 budget being increased so those court
7 navigators -- there's more of them, or
8 there's more time for them?
9 Because we have a system that is
10 obviously not addressing everybody's needs.
11 And unless we put more of those people out
12 there, it's not going to help every person
13 that needs it.
14 So my question is, are we increasing
15 those services?
16 OMH COMMISSIONER SULLIVAN: Well,
17 those services, those court navigators will
18 become available as of January of this year.
19 So I think we need a little time to see
20 exactly how effective they are.
21 But there's a significant increase.
22 It was 10 -- it was $8 million to put court
23 navigators across the state.
24 SENATOR CANZONERI-FITZPATRICK: Okay.
49
1 Switching to our COLA increase, I
2 learned through discussions with many people
3 that the COLA increase previously applied in
4 previous budgets did not typically provide
5 for supervisors and other people to also get
6 increases. And I'd like to know if you had
7 questions, push-back, administrative issues
8 with applying that COLA increase equitably
9 over all of the people working in the
10 agencies.
11 OMH COMMISSIONER SULLIVAN: The
12 particular increase which we're doing this
13 year will be dollars going to the agencies,
14 and they will decide how to use them.
15 Last year there was a segregation of
16 some of the dollars that had to go to direct
17 care staff. This year the targeted
18 inflationary increase we are proposing is
19 general.
20 SENATOR CANZONERI-FITZPATRICK: Okay.
21 And as I understand it, the budget
22 includes a 2.1 percent inflationary increase
23 when inflation was actually 2.9 percent.
24 So why are we not at least meeting
50
1 inflation? And are we going to have issues
2 going forward for letting these care -- these
3 vulnerable care workers, making sure that
4 they can make ends meet to continue the care
5 that they do?
6 Because we hear over and over and over
7 again about the fact that they can't afford
8 to stay in these positions, that they can't
9 make their own salary go as far as they want
10 to. And they're taking care of our most
11 vulnerable. Why aren't we doing better for
12 them?
13 OMH COMMISSIONER SULLIVAN: Well, the
14 budget allocates the 2.1 percent. But it is
15 important to remember that over the past
16 three years there's around an additional
17 13 percent that came through other forms of
18 COLA.
19 So this year's allocation is
20 2.1 percent.
21 SENATOR CANZONERI-FITZPATRICK: All
22 right. I mean, from what I could see, a
23 7.8 percent COLA would be more appropriate to
24 get us back on track.
51
1 But I realize that we live within a
2 budget, but we have to take care of these
3 individuals, in my opinion.
4 I'd like to just switch, because I
5 only have another minute left, and ask you
6 about the $10 million for the expansion of
7 clubhouses and Youth Safe Spaces. I think
8 it's great. We have to focus on youth mental
9 health -- very, very critical.
10 Where will these new safe spaces be
11 throughout the state?
12 OMH COMMISSIONER SULLIVAN: We will be
13 putting out an RFP and looking for
14 individuals interested in doing it. It will
15 be a break between upstate and downstate for
16 the Youth Safe Spaces probably -- we're
17 expecting from this budget I think about
18 36 Youth Safe Spaces which we'll be able to
19 put up. And we'll put out an RFP across the
20 state.
21 SENATOR CANZONERI-FITZPATRICK: But
22 you don't have a guide as to where they're
23 going to be throughout the state?
24 OMH COMMISSIONER SULLIVAN: We're
52
1 probably going to try to do one -- which we
2 usually try to do in each of the regions, but
3 it will depend. We're looking at it closely.
4 SENATOR CANZONERI-FITZPATRICK: Okay.
5 And how will these safe spaces coordinate
6 with existing school-based community health
7 programs? Is there going to be a synergy so
8 that we have efficiencies?
9 OMH COMMISSIONER SULLIVAN: Yes,
10 absolutely. And that's so important, as you
11 say.
12 So there will be synergies with the
13 school-based programs and with the providers
14 and the communities.
15 So the safe spaces will be a place for
16 youth to get all those resources.
17 SENATOR CANZONERI-FITZPATRICK: Thank
18 you.
19 CHAIRWOMAN KRUEGER: Thank you.
20 Assembly.
21 CHAIRMAN PRETLOW: Before we go on,
22 we've been joined by Assemblymembers Berger,
23 Chandler-Waterman, Gallagher and Simone.
24 Next for questioning, five minutes for
53
1 Assemblymember Sempolinski.
2 ASSEMBLYMAN SEMPOLINSKI:
3 Commissioner, thank you so much for coming
4 and thank you for your work helping those
5 with mental illness in the State of New York.
6 I've got three things I want to cover,
7 so I'm going to try and move quick in the
8 five minutes that I have.
9 My first would be sort of an expansion
10 of a question my counterpart, the ranking
11 member from the Senate, was asking about the
12 COLA -- or, now, targeted inflationary
13 increase I think is the new nomenclature.
14 If this is designed, as was pointed
15 out, to match inflationary pressures, why
16 every year do we have, from the Executive,
17 either no COLA or no TII or something that's
18 substantially less than what the inflationary
19 rate is? Why don't we start at the inflation
20 rate, where people can at least then say
21 where they're at from the previous year?
22 OMH COMMISSIONER SULLIVAN: Just to
23 reiterate, it's 2.1 percent in the budget.
24 But there have been consistent COLAs with
54
1 this administration which were not there
2 before, which is partly why we're in the
3 place we're in. But there have been
4 consistent COLAs over the past four years.
5 ASSEMBLYMAN SEMPOLINSKI: But
6 oftentimes those COLAs don't -- we get a
7 COLA, but it doesn't match what actual
8 inflation is, so then it's not really a COLA,
9 it's really a practical cut.
10 So what I'm saying is why don't we
11 start with inflation? Especially considering
12 the return on investment that we get
13 investing in all of the mental hygiene
14 agencies. If we're getting folks the
15 salaries and the resources they need to
16 provide these services across all of the
17 agencies we're going to hear from today, we
18 have a substantial savings on the back end in
19 other services that we don't have to provide.
20 So I'm saying why don't we just start
21 with inflation every year.
22 OMH COMMISSIONER SULLIVAN: Mm-hmm.
23 Well, the amount that's allocated in the
24 budget for it is $68 million, I think, and 8
55
1 million for a minimum wage increase. So
2 that's 2.1 percent.
3 ASSEMBLYMAN SEMPOLINSKI: Okay, I
4 appreciate your answer.
5 Second, I want to highlight and
6 actually indicate my support broadly for the
7 changes to involuntary commitment. You know,
8 I understand some of the concerns that we
9 don't want to have this expand into something
10 where somebody who shouldn't be involuntarily
11 committed ends up being involuntarily
12 committed. I think that's a legitimate
13 concern.
14 But I would just highlight, from my
15 position, that allowing somebody who is at a
16 substantial risk of physical harm to
17 themselves to continue to be out on the
18 street fending for themselves is not
19 compassion.
20 So the idea of expanding this to
21 enable more services be provided to people I
22 think is a good thing. Not to mention the
23 benefits in public safety to both themselves
24 and the broader public.
56
1 What would be the particular changes
2 for an individual going through that process
3 as we shift from likelihood to result in
4 serious harm to substantial risk of physical
5 harm? What would be different for the person
6 going through the involuntary commitment
7 process?
8 OMH COMMISSIONER SULLIVAN: Well, the
9 difference I think would -- once the person
10 is committed to the hospital, then all the
11 services become available. And I think
12 that's what's really important.
13 Get a good evaluation -- get physical
14 health as well as mental health. And then
15 when you're discharged you will have
16 significant wraparound services and
17 assistance in getting housing. Because many
18 of these individuals aren't housed. But if
19 they are housed, significant wraparound
20 services.
21 So what you now provide is the real
22 treatment someone needs so they can make
23 decisions more clearly about their own
24 physical health and physical safety. That's
57
1 the addition of the law, that now they could
2 be able to decide and move forward in their
3 lives.
4 ASSEMBLYMAN SEMPOLINSKI: Well, I
5 appreciate it, and I appreciate the change.
6 I think we're going to actually really help
7 some folks and get them the help that they
8 need and truly be compassionate to them.
9 My last thing I want to point out,
10 later on in the day we're going to have a
11 constituent from my friend Mr. Palmesano's
12 district, from Steuben County -- I also live
13 in Steuben County -- Mr. Tobia testify. And
14 he's going to talk about a very tragic
15 situation regarding suicide in his family,
16 and his support -- there was legislation that
17 passed unanimously through the Legislature,
18 reached the Governor's desk, to provide for a
19 Rural Suicide Prevention Council in the
20 previous Legislature, along with a lot of
21 these other councils.
22 The Governor vetoed that bill and
23 indicated in her veto message that she would
24 prefer this sort of thing to happen through
58
1 the budgetary process.
2 So I wanted to indicate certainly my
3 support for that. I represent an
4 extraordinarily rural district, and ofttimes
5 one of the challenges that we have is just
6 making sure that the services that your
7 department provides and the other departments
8 under mental hygiene provide get out into
9 those rural areas.
10 So I just wanted to voice my support
11 for what he's going to testify on. And I
12 think Mr. Palmesano will expand on that in
13 his questioning.
14 But thank you very much.
15 OMH COMMISSIONER SULLIVAN: Thank you.
16 CHAIRWOMAN KRUEGER: Our next is
17 Senator Nathalia Fernandez.
18 But before she starts, we've also been
19 joined by Senator Tom O'Mara, ranker from
20 Finance.
21 And just to clarify, the people who
22 are chairs and rankers on the four different
23 committees that are relevant to the first
24 four government panelists today, they each
59
1 get 10 minutes for each -- or 10 minutes or
2 five minutes for each.
3 So Senator Fernandez will get
4 10 minutes. Her ranker will get five
5 minutes. But that also applies then to the
6 same group getting time with the OASAS and
7 People with Developmental Disabilities and
8 Justice Center. Just because so much of this
9 work overlaps in relationship to each other.
10 So I just wanted to make sure everyone
11 understood.
12 And the clock is at 10 minutes.
13 Senator Fernandez.
14 SENATOR FERNANDEZ: Thank you so
15 much, Commissioner.
16 Thank you for the 10 minutes.
17 The Executive Budget, you mentioned,
18 has 8.5 million for clubhouses. I know how
19 crucial and important they are to helping
20 those mental illness. But will these funds
21 also be equipped to help those with
22 co-occurring disorders and substance use
23 disorder?
24 OMH COMMISSIONER SULLIVAN: Yes. All
60
1 the clubhouses have integrated treatment.
2 They will all have integrated treatment, so
3 they will be available, absolutely, for
4 individuals who have mental illness and
5 substance use problems for sure.
6 SENATOR FERNANDEZ: Great.
7 The Executive Budget also includes
8 1.9 million for historically marginalized
9 communities. What criteria will be used to
10 determine which neighborhoods qualify as
11 marginalized?
12 OMH COMMISSIONER SULLIVAN: Well,
13 we're going to be looking at data across the
14 state which will tell us which areas are
15 particularly underserved in terms of mental
16 health services. So we do that usually when
17 we send out the RFPs.
18 We will also do some talking with
19 communities as to whether or not they feel
20 that they are getting all the services they
21 need.
22 These dollars are particularly for
23 more what we call kind of grassroots
24 organizations so that they can try to provide
61
1 outreach in the community. They're usually
2 made up of community members who provide
3 services, screenings, and also work with
4 communities on wellness activities. So it's
5 very exciting to have these dollars which
6 will really embed in the community with
7 community workers. And this has been being
8 asked for for a long time from some of the
9 grassroots providers across the state, and
10 now this is actually in the budget. So it's
11 very exciting.
12 SENATOR FERNANDEZ: Thank you.
13 It's been mentioned here before,
14 co-occurring disorders, like I just said.
15 But have you been working -- and if so, how
16 have we been working with the office of OASAS
17 and Commissioner Cunningham on the issue of
18 co-occurring disorders and dual licensing?
19 OMH COMMISSIONER SULLIVAN: Yeah, we
20 work all the time on the issue of
21 co-occurring disorders. It's embedded in
22 what we're doing in prevention; it's embedded
23 in all the new services that we're putting
24 up. We've been working closely with OASAS to
62
1 ensure that there's integrated treatment
2 there, especially harm reduction, and making
3 sure that is throughout the system.
4 On the licensing part, we will be
5 having new regs coming out I believe in a
6 month or two to the Behavioral Health
7 Services Council, to look at how we can make
8 it easier to have integrated care throughout
9 the system.
10 And then, finally, there will be in
11 July some regs for the very highest tier to
12 working together of integrated care.
13 So we're trying to make it easier. We
14 know from the providers that it sometimes has
15 been cumbersome the way we had set up the
16 licensing, but we're working very closely
17 with OASAS and I think there's going to be a
18 lot of -- and with the community, to
19 understand how to make that easier. That
20 will be coming out within the next few
21 months.
22 SENATOR FERNANDEZ: Okay. I have a
23 bill to make it a little easier that would
24 remove copays for integrated care. So we
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1 would love the support on that.
2 With the potential increase of
3 patients due to possible changes in
4 involuntary commitment and assisted
5 outpatient treatment, what are plans in place
6 to ensure that these individuals have the
7 resources and supports they need after
8 they're released from confinement?
9 OMH COMMISSIONER SULLIVAN: I think
10 that's the most critical point. One of the
11 things you have to ensure is those
12 individuals get the services they need.
13 So we are going to have a program with
14 all the hospitals where what we call critical
15 time intervention teams will wrap services
16 around those individuals for up to a year or
17 more until they are stable in getting
18 services, stable in their housing, stable in
19 their treatment. So this is very exciting.
20 We're also growing peer programs that
21 will work with individuals when they leave
22 hospitals. And we're going to make sure the
23 hospitals work with us, with the
24 community-based providers, to have really
64
1 comprehensive discharge plans. We have not
2 been as successful at doing that in the past,
3 and the hospital connections program will
4 ensure that. So the critical thing is to get
5 those services to those individuals.
6 SENATOR FERNANDEZ: Okay. In my
7 district in the Northeast Bronx, I have Bronx
8 State Psychiatric Center. There's been a few
9 buildings there that have been vacant for
10 years. Is there any plans to reutilize these
11 buildings now with -- I know that the mayor's
12 office has mentioned $600 million to help
13 with continual mental health care, given
14 involuntary removal changes.
15 Is there any plans to utilize Bronx
16 State Psychiatric and put more beds there,
17 fill up the buildings that we have? Could
18 you speak on that?
19 OMH COMMISSIONER SULLIVAN: The one
20 building that is particularly vacant is
21 something which will be opening, maybe by the
22 fall, a huge wellness center for the
23 individuals with serious mental illness and
24 for the community. And we have contracted
65
1 out to set this up. We would love to have
2 you come see it when we open it, because it's
3 a way to have individuals with mental illness
4 also integrate in with the community.
5 So that one big building that has been
6 sitting there for a long time that doesn't
7 have -- doesn't look like it's being used
8 will be open soon as this integrated wellness
9 center for the Bronx community, inviting the
10 Bronx community in as well as individuals
11 with mental illness.
12 Most of the other buildings are either
13 residential or occupied by inpatient beds.
14 So except for the unused, older buildings
15 which are not ours any longer, which are on
16 the land which now belongs to the development
17 corporation of the state in terms of getting
18 those buildings sent off to developers.
19 So the only building that we have in
20 Bronx which is really open is now going to be
21 this wellness center. But you're right, that
22 has been --
23 SENATOR FERNANDEZ: Are there beds in
24 this wellness center?
66
1 OMH COMMISSIONER SULLIVAN: No. No.
2 This is for the community.
3 The Bronx Psychiatric Center has no
4 other -- just that one building. Otherwise,
5 there's no buildings there that could be used
6 for beds -- additional beds.
7 SENATOR FERNANDEZ: Okay.
8 OMH COMMISSIONER SULLIVAN: We've
9 looked very closely at Bronx because it's a
10 beautiful facility but it's limited now in
11 terms of its inpatient capacity.
12 SENATOR FERNANDEZ: Okay, thank you.
13 The Executive Budget includes
14 1.1 million for maternal mental health. What
15 type of behavioral health expenses will be
16 covered with this additional funding?
17 OMH COMMISSIONER SULLIVAN: This is an
18 expansion of collaborative care where we
19 would have mental health individuals work
20 with OB-GYN in the OB-GYN practice. And also
21 train OB-GYNs on understanding depression,
22 maternal depression, pre- and post-natal so
23 that they feel comfortable treating
24 individuals with depression.
67
1 Very similar to what you do in primary
2 care, where you have screening for mental
3 health and substance use, we would have that
4 kind of screening in OB-GYN practices.
5 That's never really happened in OB-GYN.
6 Also we have a consultation service
7 available so OB-GYNs can call free of charge
8 for consultation to an expert in treating
9 individuals who are pregnant who have mental
10 health issues. So combine that with a
11 collaborative care approach within the
12 practice, right there in the OB-GYN practice.
13 SENATOR FERNANDEZ: Thank you.
14 The Executive Budget also proposes
15 1.5 million for an aging-in-place pilot.
16 Where would this pilot be located?
17 OMH COMMISSIONER SULLIVAN: We're
18 going to have one in each of the six regions
19 across the state. There are capital dollars
20 from last year which will be rolled into
21 helping do some of the physical
22 reconstruction, and then the aging in place
23 will actually provide a nurse and a nurse
24 aide to work with the housing team to provide
68
1 medical services for individuals who are
2 aging.
3 It's a critical issue that our
4 individuals be able to stay in place in their
5 homes. And by doing some retrofitting with
6 some capital dollars and then having nurses
7 and nurse aides available to enhance the
8 housing team, enabling individuals with
9 growing medical concerns to stay in their
10 housing.
11 SENATOR FERNANDEZ: Thank you.
12 No further questions.
13 CHAIRWOMAN KRUEGER: Thank you.
14 Assembly.
15 CHAIRMAN PRETLOW: We've been joined
16 by Assemblywoman Jackson.
17 Our next questioner will be
18 Assemblyman Steck.
19 ASSEMBLYMAN STECK: Thank you,
20 Mr. Chairman.
21 I want to begin by thanking the
22 Governor for her increased attention to this
23 area. If you know me well, you know that I'm
24 sincerely saying that, because when criticism
69
1 is apt, I don't hesitate. But I think it is
2 helpful to have increased attention to this
3 area.
4 I am wondering how much money has been
5 added to the budget not for hospital beds,
6 not from community behavioral health, but for
7 residential beds for we might say
8 intermediate or transitional care. Is there
9 any increase in that area?
10 OMH COMMISSIONER SULLIVAN: In the
11 billion-dollar budget, which was two years
12 ago, there were 900 slots available for
13 transitional beds. Three thousand five
14 hundred total beds were added; 900 of those
15 are transitional.
16 Half of those have been awarded and
17 are out, and the other half are being
18 reprocured because we've looked again at the
19 areas and what might be the best way to use
20 transitional beds, especially for the
21 forensic population.
22 But there will be 900 transitional
23 beds in the budget -- it takes a while for
24 them to come up. The transitional beds are
70
1 not apartments, they are capital, and that's
2 why it takes a bit more time.
3 ASSEMBLYMAN STECK: So when you say
4 transitional, how long of a transition are
5 you talking about?
6 OMH COMMISSIONER SULLIVAN: Probably
7 somewhere between six to 12 months.
8 ASSEMBLYMAN STECK: Okay. And you had
9 indicated that the -- in response to
10 Chair Simon's question you had indicated that
11 82 percent of certain beds were full, so
12 there was some excess capacity. What beds
13 were you referring to there?
14 OMH COMMISSIONER SULLIVAN: Those are
15 the community-based beds. So when you come
16 into an emergency room and you are admitted
17 to a hospital, those are community-based beds
18 across the state.
19 ASSEMBLYMAN STECK: So are they
20 hospital beds?
21 OMH COMMISSIONER SULLIVAN: Yes.
22 Inpatient hospital units licensed by the
23 Office of Mental Health.
24 ASSEMBLYMAN STECK: That percentage of
71
1 course does not tell us anything about how
2 those beds are distributed geographically.
3 There could be some areas with plenty of
4 capacity and others with none, correct?
5 OMH COMMISSIONER SULLIVAN: Yes.
6 Well, most have some capacity. But yes,
7 there is a differential. There's absolutely
8 a differential.
9 ASSEMBLYMAN STECK: So going back to
10 the transitional care for a moment, there --
11 I'm wondering whether you have any
12 regulations concerning nutrition and exercise
13 for the people that are in transitional care.
14 A lot of the medications of today that are
15 frequently prescribed do cause some very
16 adverse health effects like tremendous
17 increases in obesity. And so I think, you
18 know, the food at these type of things is --
19 may contribute to that and so I'm wondering
20 if you've ever taken a look at providing for
21 nutrition and exercise in such circumstances.
22 OMH COMMISSIONER SULLIVAN: Thank you
23 for that. You know, we look -- we certainly
24 look at it, but I think we could do better.
72
1 And just one initiative which we have
2 started with our state hospital residences is
3 working with farm-fresh food to bring it in,
4 to -- healthy, and teaching people how to
5 prepare farm-fresh food.
6 But I think it's something that we
7 should think about very carefully for these
8 transitional beds as well. Thank you.
9 ASSEMBLYMAN STECK: So I want to talk
10 for a second about the MCO tax. And I
11 realize that's a Medicaid thing and it goes,
12 you know, to some extent appropriate to the
13 Health Committee hearing, but Medicaid
14 certainly provides coverage -- in fact,
15 better coverage than private insurance for
16 people with mental health issues.
17 So my question is whether any of the
18 MCO tax is being allocated to the services
19 that are provided in the mental health area.
20 OMH COMMISSIONER SULLIVAN: We're
21 still discussing this with the Department of
22 Health.
23 ASSEMBLYMAN STECK: So the answer is
24 no. Yes?
73
1 OMH COMMISSIONER SULLIVAN: Well,
2 we're discussing it with the Department of
3 Health.
4 ASSEMBLYMAN STECK: The answer is no
5 for now. Okay.
6 OMH COMMISSIONER SULLIVAN: Not yet.
7 ASSEMBLYMAN STECK: So there was also
8 some discussion by my colleague on the Senate
9 side of co-occurring disorders. Last year in
10 the budget the Legislature allocated an
11 additional 1.2 million to not-for-profits
12 that already provide services to people with
13 co-occurring disorders. This is the one
14 really significant problem with our -- and it
15 occurs in both mental health and substance
16 abuse areas, is that our procurement
17 processes are so cumbersome that the funding
18 doesn't get to the places that it needs to go
19 for a very long time. Whereas when the
20 Legislature specifically allocates money, it
21 gets there very rapidly.
22 So I think part of this issue with
23 co-occurring disorders is not just saying,
24 Oh, we're going to have a rate increase for
74
1 that higher level of service sometime in the
2 future -- I think we need to do something
3 now. And I'm wondering what your thoughts
4 are on that.
5 OMH COMMISSIONER SULLIVAN: Well, I
6 think that, you know, the procurement
7 process, while it is cumbersome, it's also
8 there, you know, for a variety of reasons to
9 protect dollars the state spends and ensure
10 that they're spent well.
11 I think harm reduction is a critical
12 part of the work we do. I want you to know
13 that we are doing a lot with the assistance
14 of OASAS and their expertise. Harm reduction
15 throughout our system of care, all these
16 services that we're putting up, we are
17 including trainings on harm reduction. And
18 especially in our residential services, where
19 we accept individuals with dual diagnoses in
20 all our residences, and they are -- harm
21 reduction is critical. It's just critical
22 that we work and do the training.
23 ASSEMBLYMAN STECK: So I think
24 Commissioner Cunningham's commitment to harm
75
1 reduction cannot be questioned. It's been
2 outstanding. I think the areas where we're
3 not as strong has been in the area of
4 recovery rather than harm reduction.
5 And with respect to the co-occurring
6 disorders, I think the point is we need to do
7 something to streamline the access of
8 programs who have already been approved and
9 operating by the state. I don't think we
10 need to babysit them every second of the day.
11 And I think the bureaucracy for many of these
12 programs is just overwhelming.
13 So I would certainly ask that in your
14 efforts in this area of co-occurring
15 disorders that we need just say, Well, we're
16 going to have a program in five years that --
17 or we're going to spend lots of money
18 studying the rate structure for five years
19 before we do anything. I would ask that we
20 get things done in a deliberate fashion,
21 because we do have -- this is an area of
22 crisis in our state.
23 So to the extent you are talking with
24 OASAS, we would appreciate your advocacy for
76
1 immediacy. Thank you.
2 OMH COMMISSIONER SULLIVAN: Thank you.
3 CHAIRWOMAN KRUEGER: Thank you.
4 Our next questioner is Senator Webb.
5 Three minutes, sorry; she's not a
6 ranker or a chair.
7 SENATOR WEBB: Good morning,
8 Commissioner. Can you -- is that better?
9 Kind of. Okay, hold on one second. But
10 there goes my time.
11 Good morning, Commissioner. So I want
12 to go back to Senator Fernandez's question
13 around maternal mental health.
14 As you know or may know, the
15 commissioner from the Department of Health --
16 there was a report last year talking about
17 maternal mortality and the disparaging
18 outcomes when it comes to that. And so one
19 of the pieces I wanted to lift up is the fact
20 that 70 percent of those maternal deaths were
21 preventable. And we know that mental health
22 is a big part of that.
23 So in looking at the Governor's
24 proposal this year, is there any conversation
77
1 around this $1.1 million investment? You
2 said it was going towards training. Is that
3 training also going to include cultural
4 competency for OB-GYNs in that regard?
5 And then I'll ask my second question
6 with respect to the targeted inflationary
7 proposal. Last year and the year before
8 we've asked questions with regards to why
9 those dollars are not going to all workers.
10 And so I was hoping you could speak to that
11 as well.
12 OMH COMMISSIONER SULLIVAN: Yes. The
13 maternal mental health initiative and
14 providing collaborative care will definitely
15 be looking at the cultural -- most of the
16 cultural issues in terms of ensuring that
17 people are able to have the right
18 conversations about mental health with
19 individuals.
20 Also there will be a consultation
21 service available that will also be
22 culturally sensitive, so that OB-GYNs can
23 call and get advice and understand.
24 You know, one of the very tragic --
78
1 you referenced the DOH report. It was very
2 tragic that a number of those deaths seem to
3 be because of some -- the inability to
4 continue -- the fact that antidepressants may
5 not have been continued during a pregnancy.
6 And I think that that is a very serious
7 issue.
8 And one of the things which we will be
9 doing is working culturally with communities
10 to understand why that can happen, why you
11 should continue to take antidepressants
12 sometimes and continue to treat depression,
13 and look very closely for postpartum
14 depression and how you do that.
15 So yes, that's a big piece.
16 On the targeted inflationary increase,
17 this is really for providers to use as --
18 they would get those dollars to use as they
19 see fit. So it could be spread across
20 different workers.
21 SENATOR WEBB: But it just seems that
22 certain agencies continue to be excluded.
23 When we're talking about expanding workforce
24 because of the staffing shortage, it just
79
1 seems counterproductive and also
2 counterintuitive to continue to have a COLA
3 or a targeted inflationary increase that does
4 not get spread to workers across the board in
5 all the agencies.
6 So thank you.
7 CHAIRWOMAN KRUEGER: Thank you.
8 The next Assembly questioner will be
9 Assemblymember Brown, ranker.
10 ASSEMBLYMAN KEITH BROWN: Good
11 morning, Commissioner. How are you today?
12 OMH COMMISSIONER SULLIVAN: Good,
13 thanks.
14 ASSEMBLYMAN KEITH BROWN: So I
15 appreciate my colleagues bringing up the
16 important issue of integrating care on
17 co-occurring disorders.
18 And I appreciate, you know, that we
19 improve the ability for co-licensure, but we
20 still have a lot of work to do when it comes
21 to co-occurring disorder training, the
22 payment mechanisms, and workforce expansion
23 as well as retention.
24 But my first question, I'm going to go
80
1 back to last year the AG published a report
2 on ghost providers, private insurance
3 companies that state that they provide for
4 mental health treatment but in fact don't
5 have any providers.
6 So what has been the office's role in
7 ensuring network adequacy requirements for
8 these plans? And do you believe the current
9 enforcement actions by OMH, DOH and DFS are
10 adequate?
11 OMH COMMISSIONER SULLIVAN: Basically
12 the regulations have been out by DFS for
13 comment, and I think they will be finalized
14 within the next month or so, both for network
15 adequacy and for the 10-day appointment.
16 So the regulations are there. Now the
17 question becomes enforcing and making sure
18 that they actually happen, because actually
19 parity has been around for a long time and
20 these should have been enforced before.
21 There's a million dollars in this
22 year's budget for us to work together with
23 DFS to ensure that the insurance companies
24 are not providing ghost networks, that their
81
1 directories are up to date and that they also
2 have access to that 10-day appointment for
3 mental health appointments. So those are
4 critical things which we will be enforcing
5 and we're keeping a very, very close eye on.
6 ASSEMBLYMAN KEITH BROWN: I appreciate
7 that.
8 When it comes to your talking about --
9 and the Governor's commitment with the
10 $1 billion and then first aid kits in
11 clubhouses that you referred to in your
12 testimony, one of the things that we've been
13 working on a lot is mentorship programs in
14 the high schools. And, you know, the Office
15 of Children and Family Services has something
16 called Mentor NY that was started by
17 Matilda Cuomo many years ago. It has a very
18 small budget.
19 I just wanted to know if you and
20 Dr. Cunningham ever thought of perhaps
21 utilizing that in conjunction with these
22 efforts that you're trying to make to help
23 young people stay away from drugs and
24 alcohol.
82
1 OMH COMMISSIONER SULLIVAN: I think
2 mentorship programs can be very important.
3 And in fact there's a grant on Staten Island
4 which we got from the federal government to
5 do mentorship from college students to high
6 school students to deal with mental health
7 issues.
8 So I think yes, mentorship is
9 important and it's something we're glad to
10 look at further to see how we might even do
11 better with it, yes.
12 ASSEMBLYMAN KEITH BROWN: Great.
13 So one thing we recently sent out a
14 budget request letter on was a very
15 successful program we have at Suffolk County,
16 and we did a tour of the facility. It's
17 called DASH. It's run by Family Service
18 League in Hauppauge. And as you know, DASH
19 is an extremely important crisis intervention
20 center that's run by Family Service League.
21 However, they run a hotline that has handled
22 a tremendous amount of crisis intervention
23 calls, and they work very well in conjunction
24 with the Suffolk County Police Department.
83
1 The problem is they don't have money
2 left in this year's budget. They need
3 $650,000 in order to continue the hotline.
4 So it's just one thing I wanted to bring to
5 your attention. If there's some way that you
6 could address that, we'd appreciate that very
7 much.
8 OMH COMMISSIONER SULLIVAN: I agree
9 DASH does some great work, and we will --
10 we'll talk to DASH.
11 ASSEMBLYMAN KEITH BROWN: Great.
12 Thank you.
13 In terms of -- I'm looking at the
14 comprehensive plan changes that were in last
15 year's budget, and I'm just wondering if
16 there's any way -- I think many people on
17 this dais would like to see an update in
18 terms of the plan that was put in place back
19 in '23 and how far we've come.
20 Because -- and I'm not going to go
21 through it, I only have a minute left. But
22 if we could get an update in terms of the
23 housing and some of the other initiatives
24 that were made, and to see exactly where
84
1 we're at. Because I know it's not enough for
2 you to get it in all of your testimony today.
3 But I think we'd appreciate that very much.
4 OMH COMMISSIONER SULLIVAN: Yes, we'll
5 definitely get that to you. I think it's
6 progressing really well, so we can get you
7 all the numbers where we're at now.
8 I can assure you, all the dollars are
9 there to be awarded. And probably about
10 60 percent is really moving forward, and the
11 other 40 percent is taking a little longer
12 for various reasons. But all the money's
13 been allocated.
14 So we'll get you that report.
15 ASSEMBLYMAN KEITH BROWN: Great, thank
16 you.
17 And the last question: Do you think
18 the state's allocating enough financial
19 resources towards the current opioid fentanyl
20 crisis to provide comprehensive integrated
21 co-occurring disorder care to our counties
22 across all demographics and life stages?
23 OMH COMMISSIONER SULLIVAN: Well,
24 we're working very, very closely with OASAS
85
1 on doing everything that we can for the
2 opioid crisis. And I think there are a lot
3 of dollars that have been allocated, but we
4 want to make sure they're allocated well and
5 we want to make sure that we put in place all
6 the programs which have been put forward.
7 ASSEMBLYMAN KEITH BROWN: Great.
8 Thank you for your advocacy.
9 OMH COMMISSIONER SULLIVAN: Thank you.
10 CHAIRWOMAN KRUEGER: Thank you.
11 Next is Senator Oberacker, five-minute
12 ranker.
13 SENATOR OBERACKER: Thank you,
14 Madam Chair.
15 And Commissioner, thank you for coming
16 into Albany. It's always nice to get into
17 Albany when it's not a snowstorm, right?
18 A couple of quick just statements and
19 then one question.
20 The mental wellness side of the
21 equation -- being the ranker on the
22 Alcoholism and Substance Use Disorder
23 Committee, the mental wellness side of things
24 is an upstream issue that would have
86
1 downstream, if you will, positive effects.
2 And one thing I'd like to be duly
3 noted, I use the term mental wellness. I
4 think it's a term we ought to start using
5 more than mental health. I think it actually
6 better defines not only where we are
7 currently but where we would like to go. And
8 I'd just like to throw that out. I'd like to
9 use that term more often.
10 In the 51st Senate District -- seven
11 counties, extremely large, and we are a
12 desert when it comes to the services side of
13 the equation. There are a couple of
14 decommissioned state entities, is the term
15 I'll use, that are in that district that I
16 think could basically be used to the good of
17 all -- beds, services, the heat's on, the
18 electric's on already.
19 And so I would encourage -- and I'm
20 cordially inviting you to come travel with me
21 in the 51st to actually take a look at this,
22 and I think it's something that would fill a
23 very, very high need as far as just having a
24 place, you know, to go.
87
1 Transportation being the other issue
2 that we see a lot of. I think if you could
3 kind of focus in some of the dollars that are
4 being allocated for transportation to these
5 facilities, it would help immensely with --
6 as we start to work toward that mental
7 wellness.
8 And lastly, as I've said before, I
9 would cordially invite you to come in. I
10 would love an opportunity to show you what we
11 could do.
12 And I also would like it duly noted,
13 Madam Chair, that I'm going to yield back my
14 three minutes. I would just like to say we
15 can be efficient here in Albany.
16 So thank you, Commissioner.
17 (Laughter.)
18 OMH COMMISSIONER SULLIVAN: Well,
19 thank you. Please, I would love to come. So
20 I would definitely -- and also I think your
21 comments on mental wellness is so, so
22 important. I think that we have to begin
23 early to start early to start thinking about
24 mental wellness -- in pediatricians' offices,
88
1 in schools, with our youth, with young
2 people -- that we begin to help them be
3 mentally well so that the next generations to
4 come have a very different approach to mental
5 health.
6 So I absolutely agree with you, and I
7 would love to come visit, definitely.
8 SENATOR OBERACKER: You're preaching
9 to the choir. Thank you.
10 OMH COMMISSIONER SULLIVAN: Thank you.
11 CHAIRMAN PRETLOW: Assemblyman
12 Santabarbara, for 10 minutes.
13 ASSEMBLYMAN SANTABARBARA: Okay,
14 great. Thank you.
15 Good morning. Thank you,
16 Dr. Sullivan, for being here. Thank you for
17 your testimony.
18 CHAIRMAN PRETLOW: Is your microphone
19 on?
20 ASSEMBLYMAN SANTABARBARA: Yeah, I
21 think. Is it on? Can everybody hear me?
22 Okay.
23 CHAIRMAN PRETLOW: Okay.
24 ASSEMBLYMAN SANTABARBARA: I wanted to
89
1 just talk on a couple of different areas. I
2 want to start with the expanding crisis
3 response services. I continue to hear from
4 families in my communities, and advocates,
5 about the wait, the long wait times for care,
6 especially in inpatient and long-term
7 community supports where lines are -- wait
8 times are extremely long.
9 What specific budget allocations are
10 needed, in your opinion, to ensure that
11 mental health beds and community-based
12 supports can meet the demand in our
13 communities?
14 OMH COMMISSIONER SULLIVAN: First of
15 all, you want to have the right number of
16 beds, which I think we have been successful
17 in opening beds across the state.
18 But the other are the supports. Many
19 of the individuals who are in emergency rooms
20 are not necessarily waiting for beds, they're
21 waiting for community-based services. And
22 that's where our Hospital Connections
23 Program, our Critical Time Intervention
24 teams, our ACT teams, our Assertive Community
90
1 treatment teams that had been gone up in the
2 first budget in significant numbers, are
3 going to have a significant impact once
4 they're up and running to help hospitals
5 manage individuals who are in the emergency
6 room but need intensive community services.
7 We have opened up almost 20 Youth ACT
8 teams across -- just as one example -- across
9 the state, and we are hearing from a number
10 of hospitals that there is an improvement in
11 helping youth who come to the emergency room
12 to leave the emergency room and get the
13 services that they need.
14 So those are the kinds of services, as
15 they come up, that will impact hospitals'
16 ability to make good decisions about who
17 needs to be an inpatient and who can go back
18 into the community, and providing those
19 wraparound services.
20 ASSEMBLYMAN SANTABARBARA: And just as
21 a follow-up to a previous question we just
22 discussed, some of the underserved areas,
23 especially in the rural areas of our
24 communities, how can we strengthen the mental
91
1 health workforce in those areas? We've heard
2 concerns about that as well across New York
3 State and I know in my community as well, in
4 some of the rural areas.
5 What are some of the initiatives and
6 the things that we're doing to strengthen
7 that system?
8 OMH COMMISSIONER SULLIVAN: We're
9 working -- in those rural areas we're working
10 a lot with the counties to try to understand
11 what some of the issues are.
12 We've been working with our loan
13 repayment programs to get the word out that
14 individuals can work in those areas and have
15 loan repayment. We're working with schools
16 that are located somewhat close to those
17 areas to make -- to help individuals become
18 interested in loan repayment, and then
19 working within those more rural areas.
20 And we're going to be talking with the
21 high schools in those areas, working with
22 them to help them understand the
23 opportunities that are in the mental health
24 and social services field to kind of join and
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1 begin to become interested and then support
2 them in their education as they move forward.
3 We're having a paraprofessional title
4 that will become available probably within a
5 year or two for high school graduates, and we
6 feel that that could be particularly helpful
7 in some of the rural communities in getting
8 people into working in the mental health
9 field.
10 ASSEMBLYMAN SANTABARBARA: And just in
11 terms of these rural communities, just
12 healthcare in general is lacking. I would
13 like to see more investment in these areas.
14 OMH COMMISSIONER SULLIVAN: Yes, and
15 we are adapting a lot of our RFPs that we're
16 putting out because we learned over time that
17 they were not -- they wouldn't fit into rural
18 areas. So a lot of the RFPs which are coming
19 out now have different requirements for rural
20 areas.
21 So yes, absolutely. We're working
22 very hard to ensure that the services get
23 into the rural areas.
24 ASSEMBLYMAN SANTABARBARA: And in
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1 connection to healthcare, how can we
2 integrate mental health services more
3 effectively in the primary care system?
4 Because those are some of the services that
5 are lacking as well.
6 But if there is going to be doctor's
7 offices and places to go and resources, can
8 we integrate these services right into those
9 primary care --
10 OMH COMMISSIONER SULLIVAN: Yes. And
11 I think we're working on -- there's a
12 collaborative care initiative which we have
13 been doing across the state, and we're going
14 to be expanding significantly something
15 called Healthy Steps, which provides mental
16 health services in pediatricians' offices
17 right there in those offices. And we will be
18 contracting -- that's expanding and
19 eventually will cover probably about 350,000
20 kids across New York State.
21 So we will definitely be targeting
22 some of that for rural areas to assist
23 pediatricians especially, but then also
24 primary care providers, to be able to put
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1 those services right in their office.
2 And telehealth can be very helpful
3 with that too in terms of consultations for
4 the primary care doctor and the pediatrician,
5 and also to provide services in their office
6 via tele -- via video, which can be very
7 helpful.
8 ASSEMBLYMAN SANTABARBARA: Great.
9 Thank you for that answer.
10 I just want to shift to crisis
11 response services in connection with my
12 committee, People with Disabilities. This
13 may be something you can comment on. The
14 budget includes increased funding for crisis
15 intervention teams but many of the teams lack
16 specialist training in developmental
17 disabilities. So additionally, Kendra's Law
18 was expanded to address individuals with
19 serious mental illness; it still does not
20 include people with disabilities, who are
21 often placed in emergency rooms or jails
22 instead of receiving the proper treatment
23 that they need.
24 What specific investments in this
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1 budget can we make to ensure that the crisis
2 response teams are adequately trained to
3 serve individuals with disabilities as well?
4 OMH COMMISSIONER SULLIVAN: Yeah, we
5 have a contract for ongoing training both for
6 the Mobile Crisis Teams across the state in
7 disabilities.
8 We are also training the Certified
9 Community Behavioral Health Centers, which
10 were expanded in last year's budget from 13
11 to 39. Those Certified Community Behavioral
12 Health Centers are getting intensive
13 training. The RFP has just been -- gone out
14 and been approved in developmental
15 disabilities.
16 In addition, the crisis intervention
17 team, Certified Time Intervention teams that
18 we are working with with hospitals,
19 especially the ones for youth, will be
20 focused on working with young people who have
21 dual diagnosis and who are coming to hospital
22 emergency rooms, working with them to keep
23 them out of the hospital emergency rooms.
24 And something called Home-Based Crisis
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1 Intervention for Youth, which we have about
2 1500 slots for now. Three of those teams are
3 specifically designated just to work with
4 individuals who have dual-diagnosis
5 developmental disabilities. They work in the
6 home. And that's going to be expanded as
7 well.
8 So we are definitely integrating those
9 services into our crisis services in the work
10 that we're doing in the emergency rooms,
11 because we realize that's been a tremendous
12 problem for dual-diagnosis individuals who
13 get stuck -- sadly, very sadly -- in
14 emergency rooms.
15 ASSEMBLYMAN SANTABARBARA: And does
16 that include the Mobile Crisis Teams and
17 community-based --
18 OMH COMMISSIONER SULLIVAN: Yes. Yes.
19 ASSEMBLYMAN SANTABARBARA: --
20 interventions as well? Okay.
21 Just want to switch over to talking
22 about the -- I know we talked about this the
23 last time you were here, about the 988
24 hotline. Just if you can give us an update
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1 on that, how that's working and maybe some
2 statistics on that as well.
3 OMH COMMISSIONER SULLIVAN: We're
4 expecting over 400,000 calls to the 988 line
5 this year. It's been steadily going up.
6 Basically all the calls are being
7 answered now -- 92 percent, 93 percent -- in
8 New York State. That was an important
9 ability to make sure that -- the calls used
10 to, when we didn't have our call centers up
11 and there was geo-routing, before that, they
12 were going to Oklahoma or someplace and being
13 sent back. These calls are now being
14 answered in New York State.
15 We are expecting that that 400,000
16 will probably continue to grow. It's still
17 about 10 percent of those calls get referred
18 to a Mobile Crisis Team. So 10 percent of
19 those calls would go to someone to outreach.
20 Another 10 to 15 percent get
21 referrals, but many of those calls are
22 handled on the phone with the individual.
23 The call length is about 20 minutes for many
24 of the calls, so the service is there.
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1 We feel it's working very well. We're
2 very careful. Any complaints that come, we
3 get -- we take care of and we work with the
4 hotlines. But we feel that it's been very
5 effective in offering the immediate
6 counseling.
7 The other thing we're doing is
8 beginning to help 988 talk with 911, so more
9 and more calls maybe over time can be triaged
10 to 988 so that 988 can do the counseling for
11 individuals.
12 So, so far across New York State I
13 believe it's been very successful.
14 ASSEMBLYMAN SANTABARBARA: Okay,
15 great, that's good to hear. And the last
16 question, just in terms of the school-based
17 programs you mentioned, and also the
18 clubhouse-based services, I know there's a
19 few in my district that have been very
20 effective. In your testimony you talked
21 about those two items.
22 Is there -- do you find that these are
23 effective? I think they seem to be effective
24 in my community. Are there plans for more
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1 investments in programs like this?
2 OMH COMMISSIONER SULLIVAN: Yes, I
3 think the school-based clinics have been very
4 effective. I think that they -- when we've
5 talked to the schools that have had these
6 clinics, it's amazing how the kids are really
7 very connected to seeing someone individually
8 seeing them, speaking with them in the
9 schools and how grateful they are to have
10 those services.
11 So they've been very successful.
12 They've also been working with parents and
13 teachers. So the expansion of school-based
14 clinics is something we're going to continue
15 to do. And I think that it's had a
16 significant impact in our educational system.
17 ASSEMBLYMAN SANTABARBARA: Okay, thank
18 you. That's all I have.
19 Thank you, Mr. Chair.
20 (Discussion off the record.)
21 CHAIRWOMAN KRUEGER: Also I know that
22 Senator Bynoe, you also had a question?
23 Okay, thank you.
24 SENATOR BYNOE: Thank you,
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1 Madam Chair.
2 Good morning, Commissioner. I wanted
3 to chat a little bit about the CCBHCs. And
4 Nassau has and Suffolk has a couple of
5 entities that are providing a need, including
6 Family & Children's Associations, CN
7 Guidance, and also Family Service League.
8 There's an opportunity there, because folks
9 are coming in and they're getting the
10 wraparound services, they're able to be
11 treated and provided care 24 hours a day.
12 There's a need there to increase
13 funding and -- so that they can continue to
14 provide that care, because what they're
15 finding is that people who are not insured
16 are using those facilities to be able to get
17 the medical care. Is there an appetite for
18 the state to increase funding in that area?
19 OMH COMMISSIONER SULLIVAN: There is a
20 pool of dollars that -- for uninsured care,
21 specifically to help the CCBHCs. And as far
22 as I know, we have been spending those
23 dollars, giving them out to the CCBHCs. Each
24 year we look at it and take a look and see if
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1 we need more, then we would look for more.
2 But basically those dollars are also
3 going to be increasing because we've
4 increased the number of CCBHCs. So we will
5 be working with the ones on Long Island to
6 see what their numbers are in terms of
7 uninsured -- people who can't get insurance.
8 For those who are insured, it's a
9 cost-based system. So the CCBHCs get
10 reimbursed very well for the services they
11 provide for the individuals who are insured,
12 which is great. Which gives them the kinds
13 of -- the ability to really expand.
14 But for the uninsured, those who can't
15 be insured, there is a pool of dollars which
16 we have, and we will be working with them to
17 make sure that they're accessing that as much
18 as possible.
19 SENATOR BYNOE: What exactly is -- how
20 much is in that pool?
21 OMH COMMISSIONER SULLIVAN: I think
22 there was 10 million. And I think it will be
23 increasing as we expand the CCBHCs, because
24 we went from 13 to 39. So as we increase,
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1 that number goes up. I'm not sure exactly
2 what it goes up to, but it will be
3 increasing.
4 SENATOR BYNOE: Okay, thank you.
5 CHAIRWOMAN KRUEGER: Assembly.
6 CHAIRMAN PRETLOW: Okay,
7 Assemblymember Anderson, three minutes.
8 He left? Okay.
9 Assemblymember Braunstein? Epstein?
10 ASSEMBLYMAN EPSTEIN: Good morning,
11 Commissioner. Thank you for being here.
12 Thank you for all your work.
13 Just a question on the 884 housed
14 individuals. Are all those housed
15 permanently?
16 OMH COMMISSIONER SULLIVAN: I'm sorry,
17 could you --
18 ASSEMBLYMAN EPSTEIN: You mentioned
19 884 housed individuals.
20 OMH COMMISSIONER SULLIVAN: Yes.
21 ASSEMBLYMAN EPSTEIN: Are those all
22 housed -- permanently housed?
23 OMH COMMISSIONER SULLIVAN: Yes.
24 ASSEMBLYMAN EPSTEIN: And those are
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1 all in supportive housing or --
2 OMH COMMISSIONER SULLIVAN: Yes,
3 supported housing.
4 ASSEMBLYMAN EPSTEIN: Supportive
5 housing.
6 OMH COMMISSIONER SULLIVAN: Supportive
7 housing, yes.
8 ASSEMBLYMAN EPSTEIN: And of the
9 67,000 outreach encounters, how many human
10 beings were those outreach encounters to?
11 OMH COMMISSIONER SULLIVAN: That's --
12 those are -- I can get back to you on that,
13 exactly how many -- how it breaks down to
14 individuals.
15 ASSEMBLYMAN EPSTEIN: Yeah.
16 OMH COMMISSIONER SULLIVAN: I can get
17 back to you on that.
18 ASSEMBLYMAN EPSTEIN: I appreciate
19 that.
20 And then you mentioned some
21 875 voluntary referrals to hospitals. Did
22 those referrals resulted in people being
23 hospitalized or were they just released, do
24 you know?
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1 OMH COMMISSIONER SULLIVAN: It was a
2 mixture. I think some of them were able to
3 be -- the teams went with them, and they were
4 pretty satisfied as to whether someone was
5 hospitalized or was discharged.
6 ASSEMBLYMAN EPSTEIN: Can we get a --
7 can we get from you how many of those
8 actually were hospitalized and how many
9 weren't hospitalized? And how many of those
10 got into supportive housing or -- versus that
11 didn't get supportive housing after
12 hospitalization?
13 OMH COMMISSIONER SULLIVAN: We can get
14 you that. We can get you that.
15 ASSEMBLYMAN EPSTEIN: That would be
16 really helpful.
17 I just want to make sure the safe
18 Options Support -- if this is working, then
19 we want to see it be successful. Because
20 obviously we've seen a lot of this work and
21 still seeing a lot of serious mental health
22 issues on the streets in our city and our
23 state. So we just want to see if that's
24 working.
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1 So how many new units of supportive
2 housing do you know that we've put online in
3 the last year?
4 OMH COMMISSIONER SULLIVAN: We
5 put on -- from the 1200 -- out of the 3600
6 that were in the billion dollars, 1200 are
7 online. There's another 2,000 that will be
8 coming online this year from the pipeline.
9 And then the other 1500 or 1600 for the
10 billion dollars actually are capital, so they
11 will take a little bit longer.
12 So last year in total we probably had
13 about 2,000 units, but 1200 of those units
14 came specifically from the billion-dollar
15 budget.
16 ASSEMBLYMAN EPSTEIN: And the -- thank
17 you for that. And the folks who are leaving
18 hospitalization, do you know what percentage
19 of those end up being housed after leaving
20 hospitalization, whether they're there three
21 weeks, three months, or up to a year? Do you
22 know what percentage of those people are
23 reintegrated into supportive housing or go
24 back with family? Or, you know, versus sent
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1 back to the streets?
2 OMH COMMISSIONER SULLIVAN: Well, the
3 individuals who were in the special
4 transition to home units, which we've had in
5 the state system, all of those when they left
6 were in housing.
7 (Inaudible overtalk.)
8 OMH COMMISSIONER SULLIVAN: -- to make
9 sure they had had -- (inaudible).
10 ASSEMBLYMAN EPSTEIN: You know,
11 involuntary hospitalization, hospitalization,
12 how many of those folk who are -- once are
13 better, are those transitioned back to
14 supportive housing units or to the streets?
15 Do you have that data?
16 OMH COMMISSIONER SULLIVAN: Out of all
17 the discharges.
18 ASSEMBLYMAN EPSTEIN: Yeah.
19 OMH COMMISSIONER SULLIVAN: No, I
20 don't have that.
21 ASSEMBLYMAN EPSTEIN: Could you get
22 that for us, please?
23 OMH COMMISSIONER SULLIVAN: I can get
24 you an approximation of that. I think that
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1 might be hard to get specifically across the
2 state because there's like 80,000 discharges.
3 But we can -- we'll get you what we
4 can.
5 ASSEMBLYMAN EPSTEIN: Thank you.
6 OMH COMMISSIONER SULLIVAN: Thank you.
7 CHAIRWOMAN KRUEGER: Next is Senator
8 Rolison.
9 SENATOR ROLISON: Good morning,
10 Commissioner.
11 Since we last spoke last year during
12 the budget hearing, in the 39th District,
13 which has three cities: Beacon,
14 Poughkeepsie, and Newburgh -- Poughkeepsie
15 and Newburgh having challenges throughout the
16 system -- there's an SOS team based out of
17 Newburgh. And I just want to say that I've
18 had interaction with them on three occasions,
19 and it is a great model. And the more SOS
20 teams that can be out there working in
21 conjunction with the partners -- many of
22 which are in the room today -- I think would
23 be helpful.
24 And also since we last spoke there's a
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1 clubhouse in the City of Poughkeepsie, which
2 is doing fantastic work.
3 And as the chair said, Chair Krueger
4 said, there's an overlap today with everyone.
5 And as we see -- and I applaud the state for
6 ramping up funding, ramping up services in
7 the area of mental health, addiction and the
8 underhoused, and many other issues that are
9 interconnected. I'm hearing more often now,
10 and over the time before the session started,
11 from providers in my district -- and we hear
12 it and we've heard this before, of course --
13 that it is complicated, it is cumbersome, and
14 there isn't one point of contact when many of
15 these organizations are using multiple state
16 agencies for resources and for funding.
17 And that slows the system down on a
18 variety of levels. And I know that you know
19 this, because we've heard this before.
20 But what I'm hearing is -- and I just
21 want to get your brief thoughts on do we
22 need, in this state, a cabinet-type-level
23 position that can help coordinate the
24 different agencies that are doing such great
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1 work? Because I'm hearing that more often
2 than not.
3 And that is not a rub on anybody in
4 state government. That is just as we're
5 getting bigger, more coordinated and giving
6 more services, is that something we need to
7 consider?
8 OMH COMMISSIONER SULLIVAN: I don't
9 know if I can actually speak to that.
10 But I would say that one of the
11 critical things I think when working with
12 communities is at the real community level.
13 And one of the things that we are starting
14 are these regional meetings where we pull
15 together, you know, the -- we pull together
16 the sheriff's office, we pull together the
17 healthcare providers, we pull together the
18 schools, and we talk about the needs of that
19 community based on how do we serve the most
20 needy.
21 And that's part of our hospital -- we
22 call it Hospital Connections, but it's not
23 just hospitals. It's hospitals and all the
24 community providers.
110
1 And I think the most effective way to
2 get to what you want is to really have those
3 kinds of connections happening at the
4 community level. Because it's who talks to
5 you and who knows what, and the information
6 that flows within the community.
7 So as we begin to grow those, I think
8 I'd like to see how effective that is in
9 really combining mental health with all the
10 other people.
11 The other thing is the social network
12 work which is going on in the Department of
13 Health under the 1115 waiver, is another area
14 of bringing multiple stakeholders, which I
15 think can be very effective.
16 SENATOR ROLISON: Thank you.
17 CHAIRMAN PRETLOW: Assemblywoman
18 Giglio, for five minutes.
19 ASSEMBLYWOMAN GIGLIO: Good morning.
20 Thank you for being here.
21 So mental health is a big thing within
22 our school districts, within the workplace,
23 actually even people that are trying to get
24 jobs. And I did speak to somebody in your
111
1 office over the summer, especially when it
2 comes to COVID and kids who maybe have lost a
3 parent, a grandparent, they took an
4 anti-anxiety drug -- they're putting that
5 information on a police test, they're putting
6 it on a corrections test that they took an
7 anti-anxiety drug. And it's making it
8 complicated for them in order to get a
9 position with law enforcement or with
10 corrections.
11 I'm just wondering what
12 recommendations you have or if there's any
13 funding that we should have for these types
14 of programs with a referral from a testing
15 agency that may say, you know, you didn't
16 pass the psychological because you took these
17 anti-anxiety drugs during COVID. So do we
18 have any solutions for that?
19 OMH COMMISSIONER SULLIVAN: You know,
20 I think it probably -- I don't think there
21 should be discrimination against people
22 with -- who have a mental health issue if
23 they're taking medications that are
24 prescribed by their physician, any more than
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1 there should be if you're a diabetic and
2 you're taking insulin.
3 And so I think when those things come
4 up, it's -- I think it might be best to -- a
5 combination of either letting us know or
6 understand who we can refer individuals to.
7 Because that shouldn't -- in my book, that
8 shouldn't be happening that that would
9 exclude you from a position, especially if
10 you're being honest and it is prescribed by a
11 doctor for a condition that happened.
12 So I think that's probably
13 discriminatory, but we'd have to check.
14 ASSEMBLYWOMAN GIGLIO: Yeah, I
15 couldn't agree more. And your office was
16 very willing to help and get back to me with
17 solutions to that problem as to whether or
18 not they could go and get a psychological
19 examination from somewhere outside of the
20 agency to clear them and say that they are
21 currently not and they are stable and they're
22 willing and able to take this position.
23 OMH COMMISSIONER SULLIVAN: I think
24 unfortunately the stigma against mental
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1 health issues is still out there. And I
2 think, you know, unfortunately when it comes
3 up like that, especially in job applications,
4 it has to be looked at very carefully.
5 ASSEMBLYWOMAN GIGLIO: Okay. And then
6 in school districts where social workers are
7 in the schools and they're prevalent, they're
8 available if children should need to talk to
9 them, but a lot of those social workers are
10 being sent out to individual houses to find
11 out why a student is truant and not showing
12 up to school, whether or not there's a mental
13 health issue or something else that's going
14 on in their life, why they're not coming to
15 school.
16 And I'm just -- I'm wondering what
17 your thoughts are on that, whether or not
18 social workers should actually be working for
19 the school districts going into homes to find
20 out why students are not there, rather than
21 being in the school for the students that may
22 be needing them at the moment.
23 OMH COMMISSIONER SULLIVAN: I think
24 the Department of Ed probably has to use --
114
1 that's just something that the school social
2 workers are in the Department of Ed.
3 But one of the ways we can help, and
4 we've been trying to do this across the
5 state, is make sure we get these school-based
6 mental health clinics in the schools.
7 Because once we have those clinics in the
8 schools, that's their job, to talk to the
9 students, to be there to talk to the
10 students. And whatever other needs the
11 Department of Ed may have, they now have that
12 available.
13 So we're working very closely with all
14 the school districts saying we have this,
15 please let us know, we can give you startup
16 funds to start a school-based clinic. After
17 that, they really are financially stable
18 because we've increased the rates.
19 So I think part of the solution is to
20 make sure that every school has a robust
21 school-based clinic so that youth have
22 someone that they can approach and speak
23 with.
24 ASSEMBLYWOMAN GIGLIO: And do you
115
1 think that that funding for the social
2 welfare clinic within the schools should be
3 funded by Foundation Aid and the school
4 itself, or should that be funded by DOH or
5 OMH?
6 OMH COMMISSIONER SULLIVAN: The
7 school-based clinics we give, OMH gives the
8 startup funds, and then it is reimbursable by
9 Medicaid and third-party insurers. And we
10 ensured the commercial has to pay for it.
11 So the school-based clinics, when we
12 assist them to make sure this works, can be
13 financially viable on a payer basis by
14 commercial and Medicaid payments.
15 ASSEMBLYWOMAN GIGLIO: Okay, thank
16 you.
17 CHAIRWOMAN KRUEGER: Thank you. Just
18 double-checking, good.
19 Next is Senator Weber, three minutes.
20 SENATOR WEBER: Good morning,
21 Commissioner.
22 So I have some questions regarding the
23 Joseph P. Dwyer Veteran Peer-to-Peer. You
24 know, I think we've all seen the great work
116
1 that they do. And I know it's been expanded
2 through -- to include all counties now, I
3 think.
4 OMH COMMISSIONER SULLIVAN: Mm-hmm,
5 yes.
6 SENATOR WEBER: And some of the
7 questions that I've had locally is, you know,
8 some of the veterans and the calls that we
9 get from constituents about the unmet need
10 for the program -- has there ever been
11 consideration to really expand the program
12 and, you know, ask for additional
13 appropriation for that program?
14 And how was the allocation of the
15 $8 million, with a minimum of each -- I think
16 100,000 for each county -- you know, how did
17 you come to that -- you know, those
18 conclusions?
19 OMH COMMISSIONER SULLIVAN: Well, it's
20 to give each county the ability to at least
21 set up, you know, a Dwyer program. Because
22 it's such a great program. And to have in
23 every -- really throughout every county.
24 And I think as we're getting more
117
1 experience, now that we're getting back the
2 data from the Dwyer programs, I think we'll
3 be looking at the dollars and where we need
4 to kind of consider other services.
5 The Dwyer program I think provides
6 just tremendous -- it's not just mental
7 health services. It provides all kinds of
8 assistance. And I know we are also working
9 with several of the Dwyer programs on mental
10 health assistance for individuals who are
11 transitioning from the service to the
12 communities.
13 So yes, I think -- we will continue to
14 look at the funding, but we did that to get
15 it started everywhere.
16 SENATOR WEBER: Great, thank you.
17 And just switching gears, just going
18 back to mental health services in schools.
19 So, you know, from -- some of the feedback I
20 got is there are very few providers, outside
21 providers. And I know a lot of families and
22 students sometimes have to wait months upon
23 months to get those services.
24 Is there something that could be done
118
1 to increase the number of providers or make
2 it more available to the students?
3 OMH COMMISSIONER SULLIVAN: Yeah,
4 we're working with all the providers to see
5 that they can really establish these
6 satellite clinics. And so depending upon the
7 area, sometimes they need some technical
8 assistance on how to do that. But it is a
9 viable program.
10 So I think when we hear that there are
11 difficulties setting them up, we're very glad
12 to work with those communities because
13 usually with some help we can get those
14 school-based clinics into the schools.
15 SENATOR WEBER: Thank you.
16 And I think I've also heard too that
17 there's a big need for bilingual-type
18 providers as well. So that's something maybe
19 you can at least keep top of mind as well.
20 But thank you.
21 OMH COMMISSIONER SULLIVAN: Thank you.
22 CHAIRWOMAN KRUEGER: Assembly.
23 CHAIRMAN PRETLOW: Assemblyman Ra.
24 ASSEMBLYMAN RA: Thank you, Mr. Chair.
119
1 Commissioner, good morning.
2 I know we're obviously talking about
3 the major proposals I would say in this
4 budget regarding involuntary commitments and
5 AOT. But are there any other proposals or
6 suggestions that you believe would benefit
7 public safety from a mental health
8 perspective?
9 OMH COMMISSIONER SULLIVAN: You know,
10 I think, again, just always to mention that
11 individuals with mental illness are far more
12 the victims of crimes than the perpetrators
13 of crimes. So just to keep that in mind.
14 But I think the biggest issue to make
15 sure that we have the community-based
16 services that we need, and that's this
17 tremendous investment that the Governor has
18 made over the past three years. So that
19 billion dollars that's coming out to help
20 with all the services I've been talking
21 about, about specialized teams to work with
22 our highest-need individuals, to have housing
23 for our highest-need individuals -- all those
24 things are critical in terms of helping
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1 individuals really thrive in the communities
2 and to avoid things like incarceration or
3 getting in trouble with law enforcement.
4 So the big issue here is to have the
5 services available, and I think we're on a
6 road here to providing that in a way we never
7 have before.
8 ASSEMBLYMAN RA: And what are the
9 investments being made right now in terms of
10 to that end, you know, training and
11 supporting mental health professionals,
12 counselors, other service providers to make
13 sure they have the necessary skills to deal
14 with -- you know, you have mental health
15 obviously coinciding with addiction, all
16 these type of things, and training those
17 professionals?
18 OMH COMMISSIONER SULLIVAN: We have a
19 tremendous training that we run through the
20 Office of Mental Health. We have something
21 called the Center for Practice Innovations
22 which is connected to Columbia University,
23 which does tremendous training across the
24 state.
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1 We have specialized training for youth
2 services where we pay for evidence-based
3 practices to be implemented in our clinic
4 services and in our specialized services.
5 We do training on integrated care. We
6 do training on crisis services. We do
7 training on integration of dual diagnosis.
8 So we have training grants throughout the
9 system. It's critical. One of the reasons
10 that people stay, I think, in public sector
11 work is because we offer them learning
12 opportunities. And I think we have to
13 continue to offer more and more learning
14 opportunities to all those who work in the
15 public sector.
16 ASSEMBLYMAN RA: And what about any
17 efforts to recruit people into these fields?
18 OMH COMMISSIONER SULLIVAN: Some of
19 the major efforts, one of the big successes I
20 think we've had is the loan repayment
21 program. The loan repayment program for
22 psychiatrists and nurse practitioners has
23 gotten us about 70 psychiatrists and about
24 140 nurse practitioners who will be working
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1 with us for three years. And for other
2 clinicians, psychologists, social workers --
3 600 individuals -- loan repayment and they
4 will be working with us for three years. So
5 loan repayment has been successful.
6 We're also working with the
7 scholarship program with SUNY and CUNY, and
8 we are working with trying to recruit from
9 colleges across -- and also going to be
10 starting a paraprofessional title that will
11 enable individuals with just a BA or maybe
12 individuals graduated from high school to
13 begin to work in the field and then move up.
14 So there's lots of exciting
15 recruitments going on.
16 ASSEMBLYMAN RA: Thank you,
17 Commissioner.
18 CHAIRWOMAN KRUEGER: Thank you very
19 much.
20 I think it is my turn. Thank you so
21 much, Commissioner. And I know -- I always
22 try to bat cleanup -- many of my colleagues
23 on both sides have already asked many of the
24 questions. And clearly there's serious
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1 discussion about the involuntary issues.
2 And I happen to represent a section of
3 New York City which probably has more of
4 these incidents than anywhere else -- not
5 because I'm lucky but because of being in the
6 Central Manhattan areas where you have
7 Penn Station, Grand Central, Port Authority,
8 just lots of places where homeless, mentally
9 ill, substance-abusing people may for very
10 rational decisions be spending their days.
11 We see much of this.
12 So I know for a fact that the police
13 are picking up large numbers of people
14 involuntarily and taking them to my hospitals
15 on a daily basis. But I also know the
16 statistics show that they go in and then they
17 get let out a few hours later, and nothing
18 has been done. And in fact the data I
19 believe shows, even though there was a
20 question earlier about tracking, that when
21 police take someone into a hospital against
22 their will, the likelihood of their being
23 admitted for care is radically smaller than
24 if a community-based organization or the
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1 outreach teams that you fund actually
2 convinces someone to go in, that they need to
3 go in, and that there's a much higher rate of
4 actually getting them admitted to the
5 hospital.
6 So I think whatever works out within
7 the budget and the Governor's proposal, I
8 think it's really important to keep focused
9 on what is the goal. And the goal is
10 actually get the people help before something
11 tragic happens to themselves or others, and
12 that we should learn from the experience
13 we're having. So this is more an opening to
14 the real question for you, Commissioner.
15 What I see as the problem is once they
16 get into a hospital, whether voluntary or
17 involuntary, they're not getting the care
18 they need and then they're being released.
19 So I wanted to ask you about discharge
20 planning. I believe that the language that
21 we should have in the budget is if you accept
22 someone for mental health care, you don't get
23 to discharge them unless you have a plan for
24 where they're going to go and what kind of
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1 care they're going to get.
2 And so that is what I'm asking you.
3 Do you agree that the requirements of
4 mandatory should actually be focused on the
5 institutional providers to actually have
6 somewhere for people to go? Because if you
7 just have a rotating pick them up here, drive
8 them there, let them out there the same day
9 or let them out there a week later with no
10 plan for any care, all we did is make people
11 rightly more distrustful of working with
12 anyone in the system.
13 So what do you think about that?
14 OMH COMMISSIONER SULLIVAN: Well,
15 first of all, I absolutely agree with you.
16 And we have promulgated regulations which
17 have gone through all of the necessary
18 committees and everything, state regulations
19 about discharges for individuals with mental
20 health issues from inpatient services. And
21 those regulations are doing exactly -- they
22 passed I believe about a couple of weeks ago
23 for the inpatient and then soon it will be
24 also for the emergency services.
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1 Basically these regulations -- which
2 are not regulations, which means hospitals
3 have to follow them -- require the kinds of
4 discharge planning that you're talking about.
5 That you can't -- that we have to look for
6 complex individuals, for individuals who have
7 complex needs, that we have to have careful
8 discharge planning which includes getting --
9 having them a safe place to go, includes
10 working with them to have teams that will
11 work with them when they are discharged,
12 ensuring that they get the kind of care they
13 need after discharge.
14 Now, in fairness to what was happening
15 in the hospitals before, did we have those
16 things set up? So all these new services
17 that we're putting up -- the increased ACT
18 teams, the increased CTI teams -- these are
19 linked to the hospitals so that now the
20 hospitals have to have careful discharge
21 planning and they have to make sure that
22 individuals who need those complex services
23 get them.
24 In addition, we actually put in the
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1 legislation in the Mental Hygiene Law that --
2 it's one of the things which was added --
3 that hospitals have to notify, about
4 admission and discharge, the provider who's
5 been taking care of that patient, and they
6 have to work with them on discharge planning.
7 That's a critical point, because often some
8 of these individuals do have connections to
9 an outreach team or they have connections but
10 the hospitals aren't aware of it or haven't
11 looked. It can be found in the PSYCKES
12 database which we have.
13 So now hospitals will have to pay
14 attention to that and make sure that that's
15 passed, that -- basically it would be in the
16 actual Mental Hygiene Law that hospitals have
17 to do that.
18 So yes, we are working on the
19 discharge planning but we're also giving the
20 hospitals the tools that they need to offer
21 the services. Because it's -- in a way, what
22 the Governor has done is said, Here are the
23 services; now, hospitals, you have to work
24 with us to make sure that these very, very
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1 needy clients get what they need upon
2 discharge.
3 Similarly we're doing some of -- it's
4 a little more complicated to do it from an
5 emergency room, but some of these services
6 will also be available out of emergency rooms
7 for the individuals who, as you say, may be
8 coming in and are discharged from the
9 emergency room, they will also have access to
10 these kinds of services.
11 And while it will take a little while
12 to put up some of the transitional beds,
13 that's what those transitional beds are for.
14 Those transitional beds are so individuals
15 also have a safe place to be when they leave
16 the emergency room or the inpatient service
17 if they don't have a safe place already.
18 CHAIRWOMAN KRUEGER: Thank you.
19 So we also know, at least from
20 New York City data, that the number of people
21 who are picked up through either an
22 involuntary admission or some coordination
23 with outreach teams who are determined to
24 need supportive housing with additional
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1 services, that the city has only been able to
2 place I think in the last year maybe a fourth
3 to a fifth of the number of people who were
4 approved for this kind of housing.
5 And my experience is that we of course
6 don't have adequate supportive housing or
7 adequate intensive services on a residential
8 basis for the number of people who need it,
9 but we also have huge numbers of contractors
10 for supportive housing who are under the old
11 contracts where the amount of money they get
12 for services is so little per year they can't
13 possibly accept people who have severe needs.
14 Because they're getting something like 2500
15 for services on an annual basis compared to
16 some of the OMH newer contracts that I think
17 have 25,000 per year.
18 So I know the Governor's put some
19 money into the human services budget to
20 increase those contracts, but it's not nearly
21 enough. Would you agree that our whole
22 system is not going to work unless we get
23 both adequate numbers of locations for people
24 to go to but also reasonable levels of
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1 funding for the services we know they need?
2 OMH COMMISSIONER SULLIVAN: You know,
3 it's critical -- housing is obviously
4 critical. It's just a critical issue.
5 I think that there's been a tremendous
6 investment by this administration, whether
7 it's 3500 in the billion dollars -- we have
8 over now, in New York State, over 50,000
9 units of housing. Some of the housing -- and
10 we invested, over four years, over
11 $350 million in upgrading housing stipends,
12 some of which were really incredibly low just
13 a few years ago.
14 So the investments are coming. I
15 think there is a significant investment. But
16 yes, housing is one of the most critical
17 issues. And we're continuing to work on
18 making sure that as much as possible we can
19 get people, especially all those with very,
20 very high needs into housing as quickly as
21 possible and get them the services that they
22 need.
23 CHAIRWOMAN KRUEGER: So I've written
24 you a very detailed letter looking for
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1 information.
2 OMH COMMISSIONER SULLIVAN: Yes. Yes.
3 CHAIRWOMAN KRUEGER: And thank you,
4 you did get a response back. When you get a
5 12-page letter back from an agency, they are
6 taking your questions seriously. So thank
7 you.
8 And that was all about who, what,
9 where, why, the different kinds of things
10 we've funded in the budget, beds have come
11 online or almost online or where they are.
12 So thank you. Even though we're still way
13 behind where we need to be.
14 But yesterday in the Local Governments
15 hearing we heard from the City of New York
16 that they believe they have a need for
17 500 forensic beds. That's different than
18 what we've been talking about so far.
19 Forensic beds, in my understanding, is people
20 who are in our local jails who have been
21 determined by a court not to be able to stand
22 trial because they are not competent to stand
23 trial, hence they're required to be under
24 state control in a forensic facility before
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1 ever being possibly brought to trial if they
2 get better.
3 And so the City of New York reports
4 they need 500 of those beds. So -- and I
5 know there is some funding in this
6 Executive Budget for additional I think FTEs
7 for forensic locations. But, one, do you
8 agree with the City of New York? Two, how
9 big is the problem statewide? And three, do
10 we actually have money to meet these targets?
11 OMH COMMISSIONER SULLIVAN: Basically
12 these are individuals who are waiting to
13 be -- felony arrests who are waiting to be
14 restored to competency.
15 By our numbers, we feel that probably
16 eventually we will need probably another 100
17 to 150 beds. So the plan -- not 500. I'm
18 not sure where they came up with that number.
19 CHAIRWOMAN KRUEGER: That's what the
20 City of New York testified yesterday.
21 OMH COMMISSIONER SULLIVAN: But what
22 we have -- two things. One is this year, in
23 this year's budget we will be opening, from
24 last -- 50 beds, 50 forensic beds.
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1 CHAIRWOMAN KRUEGER: I have to cut
2 myself off. I have to be the bad guy.
3 OMH COMMISSIONER SULLIVAN: And
4 there -- but -- just one quick thing. Also
5 in the budget there is 100 beds that will
6 occur --
7 CHAIRMAN PRETLOW: Assemblyman
8 Burdick.
9 (Laughter.)
10 CHAIRWOMAN KRUEGER: You'll follow up
11 with us afterwards. Thank you.
12 OMH COMMISSIONER SULLIVAN: I just
13 wanted to explain --
14 CHAIRWOMAN KRUEGER: Thank you.
15 CHAIRMAN PRETLOW: Assemblyman
16 Burdick.
17 ASSEMBLYMAN BURDICK: Thank you.
18 And thank you, Commissioner, for your
19 good work and your testimony today.
20 I'd appreciate your addressing how
21 your agency and OPWDD handle areas of overlap
22 requiring services from both the agencies,
23 such as dual diagnosis, crisis intervention,
24 and coordinated services, including the
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1 intake process and development of the
2 person-centered plan of care in the life
3 plan.
4 If you could elaborate on that, it
5 would be appreciated.
6 OMH COMMISSIONER SULLIVAN: Yeah,
7 well, we work very closely with OPWDD on the
8 kinds of services that are important for us
9 to work together on. One of the key things
10 is the individuals with dual diagnosis who
11 have -- there's two groups -- who have
12 high needs.
13 And for those who are working on
14 home-based crisis intervention programs,
15 Critical Time Intervention programs, where we
16 together do an assessment, make a diagnosis,
17 and then work together on the mental health
18 needs that an individual has and then the
19 needs that they may need from OPWDD.
20 We also have a specialized unit which
21 is opening up, up at Upstate, which we're
22 very happy about. It's just opened, to work
23 with individuals particularly with autism who
24 have severe autistic -- and that's a dual
135
1 unit we're going to be working with Upstate
2 and with OPWDD. And we have a whole bunch of
3 step-down units.
4 In addition, OPWDD is working with us
5 to educate our Certified Community Behavioral
6 Health Centers to do these kinds of
7 assessments. The assessment hubs which are
8 in this year's budget are also going to be --
9 for youth, are going to be specializing in
10 dual diagnosis with individuals with
11 developmental disabilities and mental health.
12 So together we're trying to come up
13 with this -- not just a good assessment, but
14 also a system that can really work to provide
15 both intensive services and more regular kind
16 of clinic services on either side, either in
17 OPWDD clinics or in mental health clinics.
18 ASSEMBLYMAN BURDICK: And can I ask
19 what kind of feedback you've been getting on
20 that? And whether you are considering any
21 changes or tweaking in how you handled it.
22 OMH COMMISSIONER SULLIVAN: The
23 feedback we've been getting on the Home-Based
24 Crisis Intervention teams, which we've had a
136
1 few up, is very good. People seem to feel
2 that the families are happy. They actually
3 have workers go in and spend four to six
4 weeks with a family, working intensely with
5 the family on how to work with the young
6 person to avoid their going into the
7 hospital, and getting very good feedback on
8 those teams which we have out.
9 We've been also getting good feedback
10 from our Certified Community Behavioral
11 Health Centers that are doing some of this
12 work for families.
13 So we've been getting good feedback so
14 far. I think it's a question of just
15 continuing to push the services out so that
16 they're more available.
17 ASSEMBLYMAN BURDICK: Thank you so
18 much.
19 CHAIRWOMAN KRUEGER: Thank you.
20 And next up -- we have no more
21 Senators until a second round, so we're just
22 going to keep going with the Assemblymembers
23 here. There are always more of them than us.
24 Assemblymember Otis. Are you here?
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1 Okay, maybe he stepped out. Okay, we'll come
2 back to him.
3 Assemblymember Tapia?
4 ASSEMBLYWOMAN TAPIA: Thank you.
5 Thank you, Commissioner, for being
6 here.
7 The budget includes $9.5 million to
8 expand youth clubhouses and safe spaces for
9 at-risk populations. How will these
10 clubhouses be distributed across the state?
11 And what the criteria will be used -- what
12 criteria will be used to ensure they've
13 reached the communities with the greatest
14 need?
15 OMH COMMISSIONER SULLIVAN: The
16 clubhouses are going to -- there is a lot of
17 money in the city budget for clubhouses --
18 these are for adults in the city. So most of
19 these clubhouses will be an expansion to
20 Long Island and upstate, because the city has
21 been funding an expansion of clubhouses in
22 the city.
23 The state dollars for the Safe Spaces
24 for Youth, that's statewide. So that will
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1 include safe spaces in the city as well, and
2 we will be looking at the demographics of
3 areas where youth -- where there are issues.
4 Whether it's, you know, violence with youth,
5 whether it's youth having more incarceration,
6 we're going to be looking at all that data
7 and looking at communities and then talking
8 with communities about whether or not they
9 think this would be helpful in their area.
10 We are going to be targeting as much
11 as possible the marginalized communities
12 across the state, both in the city and the
13 rest of the state.
14 ASSEMBLYWOMAN TAPIA: Okay. Almost
15 exactly two years ago, the Governor allocated
16 one billion dollars to support mental health,
17 which included creating more patient
18 psychiatric beds and thousands of units of
19 housing for supportive services.
20 Can you provide an update on how this
21 funding was allocated, as well as how the
22 Governor's investment in the budget proposal
23 aligned with this funding?
24 OMH COMMISSIONER SULLIVAN: The state
139
1 hospital beds that were in that budget have
2 all -- there were 150 beds in that budget.
3 They've all been opened in the state hospital
4 system, so those 150 beds are active and
5 open.
6 The various other things which were in
7 that billion-dollar budget, which included
8 like our Critical Time Intervention teams,
9 our expansion of ACT, expansion of CCBHCs,
10 et cetera, all those contracts were sent out.
11 Some are being rebid because we didn't get
12 the responses we needed. But we have done
13 800 contracts, and almost 700 providers have
14 been receiving funds.
15 So all those dollars are moving out.
16 And I think that within a year or two, most
17 of those services will be really successfully
18 up and running. It takes a little while to
19 get them out. But we've been really working
20 diligently to make sure that all the services
21 are out there.
22 ASSEMBLYWOMAN TAPIA: Thank you.
23 If you can provide that information to
24 us, I would --
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1 OMH COMMISSIONER SULLIVAN: Yes. Yes,
2 we'll get that to you.
3 CHAIRMAN PRETLOW: Assemblymember
4 Eachus.
5 ASSEMBLYMAN EACHUS: Thank you.
6 As you know, Doctor, we have a very
7 special relationship, myself with OMH and
8 yourself. And the first thing I'd like to do
9 is say thank you. And please thank your
10 administration and all your staff workers.
11 You do a great job. Thank you for taking
12 care of my daughter. I appreciate that
13 greatly.
14 I have more statements than questions
15 because during your entire tenure I had no
16 reason to call your office and say, "Hey, we
17 need" or "We have to." So that's a credit to
18 your office.
19 But the things that I'd like to
20 discuss is first the SOS, or the Mobile
21 Crisis Teams. Certainly there are not enough
22 across New York State. And I would just like
23 to mention that I have a voluntary ambulance
24 corps which covers four of my municipalities,
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1 which now is carrying a certified social
2 worker on every one of their calls.
3 OMH COMMISSIONER SULLIVAN: Great.
4 ASSEMBLYMAN EACHUS: So instead of the
5 thought of building entirely new teams, maybe
6 there is some money which can -- because they
7 have to use money out of their budget to
8 support those social workers and get them
9 social workers. That might be something that
10 we might consider which can happen quicker at
11 lesser cost.
12 In the report, the certified Teen
13 Mental Health First Aid course, I took that.
14 I think I have to update it, though, it's
15 over a year.
16 And I'm a little worried about that.
17 Having worked, been a teacher for 40 years,
18 I'm a little worried about 9th through
19 12th graders thinking or needing that they
20 have to run into a situation when what they
21 should be doing is calling about a situation.
22 So I hope that that is stressed. It wasn't
23 when I was part of it, maybe because we were
24 adults that they were teaching. But when
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1 you're talking about younger kids, I hope the
2 essence of calling for help is one of the
3 first things.
4 OMH COMMISSIONER SULLIVAN: Yes,
5 that's very important. And basically the --
6 it's a different curriculum for kids and
7 they've been taking that very seriously into
8 account. It's really helping kids kind of be
9 supportive of each other, but just as you
10 said, all that get them help, move forward.
11 Youth have asked just to understand how to do
12 that with someone, and that's what the focus
13 of the Teen Mental Health First Aid is.
14 ASSEMBLYMAN EACHUS: Right. Now I did
15 call your office or it was relayed to your
16 office about recycling and deposit bottles
17 and all. Listen, I visit one of your largest
18 facilities on a weekly basis, I'm there. So
19 I know -- and I appreciate you mentioned that
20 your central office does it completely,
21 recycling and doing the deposit. We're
22 considering two Big Better Bottle Bills, and
23 yet we're not showing good behavior in some
24 of your facilities. In other words, they
143
1 need more bins, they need places -- because
2 if I bring recycled materials in, I have to
3 carry them out.
4 And then finally, as my fellow --
5 Chris Burdick mentioned, you know that I
6 mentioned two years ago about the OMH and
7 OPWDD working together, crossing their silos.
8 I know you didn't have time to report it, but
9 if we could those reports on those programs
10 that would be great.
11 OMH COMMISSIONER SULLIVAN: Yeah, I'll
12 be glad to send it to you.
13 ASSEMBLYMAN EACHUS: Thank you.
14 OMH COMMISSIONER SULLIVAN: Thank you.
15 CHAIRMAN PRETLOW: Assemblywoman
16 Gallagher.
17 ASSEMBLYWOMAN GALLAGHER: Thank you so
18 much, Commissioner. It's so nice to be here
19 in this hearing with you.
20 And I have two questions for you.
21 Part of keeping vulnerable people safe
22 and stable is ensuring that they can stay in
23 the community where they are loved and where
24 they have people they trust. In my
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1 community, extreme rents have made this
2 impossible, and displacement exacerbates the
3 instability. 2024 saw a 53 percent increase
4 in homelessness compared with 2023, because
5 of housing costs. And New York has the
6 highest rate of homelessness in the country.
7 What role would you say the housing
8 market is playing in this instability? And
9 wouldn't a Housing First model -- funding
10 deeply affordable housing solutions, securing
11 individuals in a way so that they could be
12 stabilized before they are getting outpatient
13 treatment -- how would that help their mental
14 health conditions?
15 OMH COMMISSIONER SULLIVAN: Yeah, I
16 think yes, absolutely, housing is just one of
17 the most important -- everyone needs a safe
18 place to put their head at night. And I
19 think housing is a critical, critical point.
20 And that's why we're so invested in
21 increasing housing. The billion dollars had
22 3500 units of housing across the state. Now
23 we have 50,000 total supported housing units.
24 But we need more. So we're growing them with
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1 the 3500. We will be growing them through
2 ESSHI. So yes, we have to continue to grow.
3 And I think the other thing you
4 mentioned was Housing First, which I think is
5 a model which we are definitely using,
6 especially with those transitional beds that
7 we are setting up. Which means that you --
8 housing comes first and then at the same time
9 you can do therapy, you can do all the things
10 someone needs. But the first place they need
11 is to be -- a safe place to be housed.
12 And that cuts through some of the red
13 tape of getting into housing. So yes,
14 housing is critical. And I think the
15 expansion of housing is something which is an
16 ongoing issue. Next year I think in the
17 pipeline there are another 2,000 to 3,000
18 units of housing that will come up across for
19 supported housing for individuals with
20 serious mental illness. But it is critical
21 and something we continue to work on to make
22 sure we have more and more housing available.
23 ASSEMBLYWOMAN GALLAGHER: Yeah, and I
24 think doing messaging around how important it
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1 is to have these units in our communities is
2 really important. Because I know that when
3 we do have supportive housing put in our
4 community, sometimes those units face a great
5 deal of discrimination and push-back, even
6 though they are the greatest buoy for our
7 kind of -- our support.
8 OMH COMMISSIONER SULLIVAN: And I
9 truly appreciate your saying that, because
10 one of our difficulties with the capital we
11 have is actually convincing communities that
12 these are good things for communities. These
13 make communities safer. These make
14 communities more prosperous. So thank you so
15 much for saying that.
16 ASSEMBLYWOMAN GALLAGHER: Thank you.
17 CHAIRMAN PRETLOW: Assemblyman Maher?
18 Assemblyman Palmesano.
19 ASSEMBLYMAN PALMESANO: Yes,
20 Commissioner, thank you for being here.
21 Last year at the hearing I mentioned
22 about a constituent who tragically lost his
23 son to suicide, and you sent us a bunch of
24 information at my request of what you're
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1 doing.
2 This individual, Joe Tobia, is
3 testifying later today. Joe also sits --
4 Mr. Tobia also sits on the Governor's Suicide
5 Prevention Council. He and his wife have
6 been fierce advocates for change and reform
7 to the mental health system, because quite
8 frankly it failed his son and their family.
9 So they've been very strong advocates.
10 And one of the issues they've been
11 advocating on is the Rural Suicide Prevention
12 Council that the Governor vetoed last year
13 for financial reasons, saying that it could
14 be duplicative of services, that she's
15 directing -- it was lumped in with a bunch of
16 other bills that could be asking other
17 agencies to do this and implement -- what can
18 be done to implement this.
19 And given the fact that the rural
20 suicide rate is double the rate of urban
21 areas, this must be a priority. So I would
22 ask you, obviously, would you be willing to
23 meet with -- you and your team be willing to
24 meet with Mr. Tobia? Because he's got a lot
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1 of ideas and suggestions.
2 But more importantly, as the Governor
3 is directing you, what actions have you taken
4 or are going to be beginning to take, and
5 would you be able to provide them in writing
6 after the fact to identify some of those
7 issues in that bill, which would identify
8 barriers to mental health, which would
9 identify vulnerable populations' indeterminate
10 or insufficient capacity, would look for
11 strategies to increase utilization and
12 provide recommendations to improve the
13 coordination of care and services?
14 Would you be willing to meet with
15 Mr. Tobia? Would you be willing to reply
16 back in writing what you're doing to address
17 those vetoed -- that bill, the things in that
18 bill to address this issue? And what can you
19 talk about here too as well?
20 OMH COMMISSIONER SULLIVAN: Yes, we'd
21 be very glad to meet with him.
22 And I think, you know, the Suicide
23 Prevention Task Force, which has been
24 reestablished, it has a whole subgroup that's
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1 going to be working intensely on rural
2 suicide. So I would love to speak with him
3 and to speak with him about his
4 recommendations and make sure that those all
5 get incorporated.
6 So yes, absolutely, and we will send
7 you in writing all the work that we're doing,
8 yes.
9 ASSEMBLYMAN PALMESANO: Because I know
10 he has other ideas on how to improve the
11 bill. I mean, I would like to see us advance
12 this bill because I think it lays it out
13 specifically what is -- I just want to make
14 sure that the department is committed to
15 doing this.
16 I mean, the Governor mentioned this in
17 her veto message. If we have to do it
18 in-house, that's one thing. But I, you know,
19 want to make sure that type of communication
20 is going on. So would like to see what
21 you're doing, in writing, to address those
22 issues in the bill that was mentioned and
23 also some suggested improvements that
24 Mr. Tobia had for the bill. He has a lot
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1 of -- a wealth of experience and knowledge,
2 tragically, that he wants to bring to help
3 and make sure other families don't have to go
4 through this. So hopefully that consultation
5 can happen.
6 And again, because the rural suicide
7 rate is double that of urban areas, it
8 definitely needs to be a priority, especially
9 with the mental health crisis we have in this
10 state.
11 OMH COMMISSIONER SULLIVAN:
12 Absolutely. And we definitely thank you so
13 much that -- thank you so much for all the
14 work he's doing and we would be very pleased
15 to meet with him, get his ideas, and be able
16 to help implement some of what he thinks is
17 needed.
18 So yes, thank you very much for
19 offering that. And thank him. Thank you.
20 ASSEMBLYMAN PALMESANO: Thank you,
21 Commissioner.
22 CHAIRMAN PRETLOW: Assemblyman Maher.
23 ASSEMBLYMAN MAHER: Thank you.
24 Good morning, Commissioner.
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1 Appreciate you being here.
2 One of the favorite things I love to
3 do as an Assemblymember is meet with our
4 local students -- could be elementary school
5 age, middle school, high school age. And one
6 thing I try to do is I let them know it is
7 vital to get their feedback. It's not just a
8 nice trip to come up here, but it's their
9 responsibility to advise us and educate us as
10 legislators on what their needs are.
11 And for the most part, that one issue
12 that always comes up, and they're conscious
13 enough to know that it exists and it's a
14 problem, is increased services for mental
15 health support within our school districts.
16 My first question is, how are our
17 schools being supported to address mental
18 health issues among children?
19 OMH COMMISSIONER SULLIVAN: The first
20 thing is that we are able to open up -- for
21 any school that's interested, is to establish
22 a school-based mental health clinic. What
23 that really is is a satellite clinic of a
24 provider in the community. And that means
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1 that services are then provided on-site in
2 the school.
3 And so that's available to schools.
4 We have talked about this with all the school
5 districts, et cetera.
6 The other things are a whole host of
7 other -- that's probably the main thing,
8 because if you can have a school-based mental
9 health clinic, that makes a huge difference.
10 In addition, we have available
11 something called Teen Mental Health First Aid
12 Training, also first aid training for
13 teachers, first aid training for school staff
14 personnel. That helps individuals understand
15 mental health issues and also be able to talk
16 to each other about the critical mental
17 health issues.
18 So those are available for schools.
19 Schools can call us, we can set that up.
20 We also have a whole host of safer --
21 suicide prevention services that we can talk
22 to schools about, trainings that can go
23 forward to schools. So we'd be glad to work
24 with the schools. There's a lot of suicide
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1 prevention services that are available for
2 suicide-safer schools, training teachers,
3 working with students, et cetera.
4 So the school-based mental health
5 clinics had a whole host of trainings which
6 are available for schools as well.
7 ASSEMBLYMAN MAHER: If I could then
8 add on -- and I appreciate you really laying
9 out all of those services that are
10 available -- I know it can be very difficult
11 to quantify the success and the impact of
12 some of these programs. Can you speak to how
13 you do that right now? And when we talk
14 about some of these programs, is there a
15 questionnaire that goes out? What exists
16 right now for us to quantify whether or not
17 these programs are successful?
18 OMH COMMISSIONER SULLIVAN: Yeah,
19 we're gathering data from the school-based
20 mental health clinics as to who they're
21 seeing and the satisfaction of the
22 individuals that they've seen and whether or
23 not the students feel it's been helpful,
24 et cetera.
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1 On the mental health first aid it's a
2 little bit harder to get outcome data, but we
3 do get satisfaction data about whether people
4 felt the training was helpful, whether the
5 impact, the long-term impact -- I don't know
6 that we have data on that specifically for
7 schools. There's national data that this has
8 an impact, but I don't think we have it for
9 schools right now.
10 ASSEMBLYMAN MAHER: Thank you,
11 Commissioner.
12 CHAIRMAN PRETLOW: Assemblywoman
13 Chandler-Waterman.
14 ASSEMBLYWOMAN CHANDLER-WATERMAN:
15 Thank you, Chair. Thank you, Commissioner --
16 and my colleagues, for great questions.
17 I appreciate you and your team for
18 coming out to my district. As you know, I'm
19 in Brooklyn, representing East Flatbush,
20 parts of Canarsie, Brownsville, and Crown
21 Heights.
22 I also appreciate you and your team
23 partnering with our AD 58, my in-district
24 mental health task force, when it comes to
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1 the Black, brown, Caribbean immigrants. We
2 want to ensure peers are at the forefront of
3 the conversations, of course mental health
4 professionals as well, local, cultural,
5 sensitive clubhouses and respite centers --
6 we're up to 30-days stay -- person-centered,
7 non-police response, wraparound services,
8 more investment in school-based mental health
9 clinics, as you mentioned, ensuring families
10 are prioritized as an intentional part of the
11 plan for recovery.
12 I also discuss with anyone who will
13 listen that we have a great example of
14 institutional support of persons experiencing
15 emotional crisis, One Brooklyn Health,
16 Brookdale University Medical Center
17 Behavioral Health Clinic, under the CEO,
18 Dr. Scott, and Chief of Psychiatry
19 Hershberger, Dr. Hershberger.
20 We need more investments like these
21 into these institutions like this in my
22 district.
23 As you know, we have a broken system
24 that has a lot of disparities. Oftentimes
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1 underserved, underresourced, districts like
2 mine experience worse than other communities.
3 They get a cold, we get a flu. It hits us
4 harder.
5 So on paper, involuntary commitment
6 may sound like a good idea, but it feels more
7 like a Band-Aid. Our fear is that it could
8 look like mass incarceration, it could look
9 like the new stop-and-frisk, or it could look
10 like unfortunately Daniel Prude, who was
11 killed and died, unfortunately, at the hands
12 of police during a mental health crisis.
13 However, we need a more sustainable
14 plan. Great news, we have one. It's called
15 the New York State Daniel's Law Task Force
16 Behavioral Health Crisis Response Report,
17 which I know you know about, a million
18 dollars we invested into that. And you
19 include in the community input we had, peers,
20 doctors, professionals.
21 This report, thanks to you and your
22 team, finished last year, a year early. All
23 of what I have mentioned just now is in
24 Daniel's Law. We need Daniel's Law fully
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1 passed, fully funded. And how is this issue
2 that we need with mental health being
3 addressed with using this report, using
4 Daniel's Law instead of the Band-Aid approach
5 that involuntary commitment may pose?
6 And as you know, we got over like
7 3.2 million individuals experiencing a mental
8 health crisis in 2021 and 2022, in the report
9 by New York State Comptroller DiNapoli, in
10 his new report. So how do you envision that
11 this wonderful report that we invested a
12 million dollars in, is used to help?
13 OMH COMMISSIONER SULLIVAN: Well,
14 thank you. I think it is an excellent
15 report. I think that it provides a resource
16 for, as I said earlier, resource for the
17 policymakers to look at that report and to
18 use it in making their decisions about what
19 of those recommendations that are in the
20 report would be implemented.
21 So it's a -- I think its goal was to
22 be a resource, and I think it is a solid
23 resource for people to look at in terms of
24 what a behavioral health response to a
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1 behavioral health emergency can be.
2 CHAIRMAN PRETLOW: Thank you.
3 ASSEMBLYWOMAN CHANDLER-WATERMAN:
4 Thank you.
5 CHAIRMAN PRETLOW: Assemblyman
6 Anderson.
7 ASSEMBLYMAN ANDERSON: Thank you so
8 much, Chair.
9 And thank you, Commissioner, for being
10 here with us this morning into the afternoon.
11 I have two brief questions. Hopefully
12 I can get an answer from you on them. I did
13 see in the Executive proposal an investment
14 in mental health first aid for teenagers, and
15 I think that that's so important. When I was
16 first elected I was able to train over 150
17 constituents and community leaders in mental
18 health first aid, and I know how effective
19 that program was.
20 So I'm just wondering about the
21 mechanism in which that program, as proposed,
22 would get down to groups and organizations.
23 Is it a grant program, is it a direct
24 allocation to cities? I just want to get a
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1 sense of that.
2 OMH COMMISSIONER SULLIVAN: Yeah.
3 It's direct money that will go to schools.
4 And the goal here is to work with schools who
5 are interested in us doing this. We can
6 probably do mental health first aid training
7 for almost 5,000 students. And we will be
8 taking requests from schools, going out,
9 doing the mental health first aid training
10 team to team. It's an evidence -- it's been
11 developed very carefully to work just with
12 kids and how kids can talk to each other.
13 ASSEMBLYMAN ANDERSON: So when you say
14 schools, commissioner, do you mean school
15 districts or do you mean --
16 OMH COMMISSIONER SULLIVAN: Oh, no, I
17 mean individual schools.
18 ASSEMBLYMAN ANDERSON: Individual
19 schools.
20 OMH COMMISSIONER SULLIVAN: Individual
21 high -- yeah, we're hoping -- it's for
22 individuals 9th to 12th grade. So it's
23 mental health first aid for high schools.
24 ASSEMBLYMAN ANDERSON: Thank you so
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1 much.
2 My next question for you,
3 Commissioner, is I just wanted to learn a
4 little bit more about the -- and this is the
5 larger executive pot that deals with mental
6 health from the disparate groups,
7 individuals, groups and organizations. The
8 name of the pot of resources is escaping me
9 now, but I know that there was an investment
10 in the barbershop mental health program that
11 I helped get started two budget cycles ago,
12 and it was supposed to go towards the
13 Arthur Ashe Institute.
14 Can you report out on how that funding
15 has been spent and how successful that
16 program has been in the eyes of your agency?
17 Or if it's a collaboration with you and
18 DOH --
19 OMH COMMISSIONER SULLIVAN: It's been
20 a collaboration. And I think I can get back
21 to you on that. I'm not as up-to-date
22 because I think it's been through DOH. But
23 we can get back to you on that.
24 ASSEMBLYMAN ANDERSON: Okay. Thank
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1 you so much, Commissioner. I hope to also
2 invite you out to my district to see some of
3 the work that we're doing, because you can't
4 stay all the way in the 58th, you've got to
5 come to the 31st too.
6 (Laughter.)
7 OMH COMMISSIONER SULLIVAN: I'd love
8 to. I'll love to. We will definitely do it.
9 ASSEMBLYMAN ANDERSON: Thank you so
10 much, Commissioner.
11 OMH COMMISSIONER SULLIVAN: Thank you.
12 Thank you.
13 CHAIRWOMAN KRUEGER: Chair Brouk for
14 her three-minute follow-up.
15 SENATOR BROUK: (Microphone issue.)
16 There we go. I did it earlier.
17 Thank you, Commissioner. I just
18 wanted to follow up because I think a lot of
19 the discussion that we had throughout this --
20 and thank you for all of your thoughtful
21 answers. I think they were really helpful
22 and will be for all of our budgetary
23 decisions. But it seems like there is a
24 theme, right, that we are -- while we have
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1 invested, including the $1 billion that the
2 Governor announced a couple of years ago
3 around supportive housing, around SOS teams,
4 ACT teams -- all of this community outreach
5 and building up beds and all of these
6 different things, it seems like we still
7 haven't fully built up and even spent some of
8 the funding that has been allocated.
9 And so, you know, my final question to
10 you is, when we look at the efficacy, right,
11 when I hear you talk about 884 individuals
12 that SOS teams have helped find permanent
13 housing -- permanent housing, that means they
14 are not jumping back out, it's not a bad
15 discharge and they're going right back out
16 and not having their, you know, basic needs
17 met and potentially, you know, suffering
18 themselves -- they are permanently housed.
19 They have dignity. They are on a road to
20 find employment, perhaps on a road for rehab.
21 Right?
22 So it tells me that we need to do more
23 with Housing First. We need to do more with
24 getting people the care they need. We need
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1 more community outreach, whether in our
2 New York City subways or in our upstate
3 communities. And so what troubles me is that
4 there's this big change around involuntary
5 commitment, thinking that this is going to
6 somehow solve this, when we haven't even
7 fully implemented some of the things that we
8 have funded.
9 So big question for you. What do you
10 need to act more swiftly to get those -- I
11 think it was 2,000 supportive housing beds
12 online quicker? What do we need to do and
13 what do you need from us to hurry that up and
14 get that done as quickly as possible so we
15 can serve people in the way that we have seen
16 works really well?
17 OMH COMMISSIONER SULLIVAN: I think,
18 first of all, just speaking to housing, those
19 2,000 beds that are not up are capital. And
20 what we do need help with is what was
21 mentioned by Assemblymember Gallagher, is
22 communities accepting these services.
23 You know, one of the biggest delays
24 are siting for mental health housing. And
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1 our providers are really good at this, but
2 especially in urban areas it's been very
3 difficult to site some of this housing. So
4 we really could use the support of
5 legislators and communities to work with us,
6 because housing -- it benefits communities,
7 it can be beautiful housing. So we do need
8 help with that, because that has delayed and
9 in fact sometimes we have housing out there
10 for years waiting to find a site where we can
11 actually provide the housing.
12 And again, once you build the housing,
13 you're not stuck with these rent costs going
14 up or the cost of other things. We subsidize
15 and make sure the housing is successful in an
16 ongoing way. So that's one way that could be
17 incredibly, incredibly helpful.
18 The other is I think again to work
19 with us with communities to --
20 (Time clock sounds.)
21 SENATOR BROUK: Get back to me.
22 (Laughter.)
23 SENATOR BROUK: Thank you. Thank you.
24 CHAIRWOMAN KRUEGER: To be continued.
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1 Assembly Chair Simon for her second
2 round.
3 ASSEMBLYWOMAN SIMON: Thank you.
4 Plus-one to Senator Brouk's question
5 there. And I appreciate your answer, and I
6 think it's obviously -- we're going to
7 continue to have those conversations.
8 I have a question sort of a little bit
9 different, which is also the issue of
10 children in need of outpatient behavioral
11 health services through Medicaid. And a
12 recent study showed that only one out of
13 every four kids who need this service are
14 actually receiving them. So the question is,
15 what kinds of new investments in Medicaid
16 rates and workforce are being advanced in
17 this budget to meet that unmet need?
18 And also, of course, the bigger -- the
19 big issue is also the Medicaid rates not
20 keeping pace with the cost of providing care.
21 So our children, particularly post-COVID,
22 are, you know, suffering greatly. And the
23 number -- the amount of mental health needs
24 for our younger children has increased. I
166
1 mean, we've never dealt with it enough, but
2 we need -- now we have even more need for it.
3 Can you tell me what it is that the
4 state is doing and how it could help get the
5 providers to be able to actually provide
6 these services to children who are in need of
7 them?
8 OMH COMMISSIONER SULLIVAN: Yeah, I
9 think there's been a -- let me begin with one
10 place where we're making a big investment is
11 something called HealthySteps in
12 pediatricians' offices, which has a mental
13 health worker in a pediatric practice of
14 1500 or more families. And we've been able
15 to spread this across the state right now so
16 that 191,000 kids are covered, and ultimately
17 over 300,000.
18 This kind of prevention is really
19 critical because you want to begin early. So
20 first of all there's prevention, there's
21 prevention that happens in pediatricians'
22 offices and then the prevention that happens
23 in schools. And that's where the
24 school-based services come in, in terms of
167
1 having those available. And also working, as
2 we've talked about, with mental health first
3 aid with teens.
4 And then the next level are
5 individuals who need -- so you want to do
6 prevention and then you want to have access
7 to care when it's needed. So by expanding
8 out Certified Community Behavioral Health
9 Centers, we're greatly expanding the access
10 to kids' services. And the good things about
11 Certified Community Behavioral Health
12 Centers, which cover the whole lifespan, do a
13 lot of child work, is they're cost-based. So
14 at the end of the year, if it cost more to
15 serve 2,000 kids than it did the year before,
16 you can be reimbursed for that. So that
17 helps with the reimbursement.
18 In addition, we have increased rates
19 consistently for child services; increased
20 rates, inpatient side; increased clinic rates
21 for kids. Partial hospitalization rates for
22 kids. And in fact in last year's budget we
23 also increased the number of partial hospital
24 startups. Partial hospitals are kind of
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1 community-based intensive services.
2 We've increased rates across the board
3 over the last several years for children's
4 services. So that has helped to make the
5 services more available.
6 And then finally, for the most
7 intensive needs --
8 (Time clock sounds.)
9 CHAIRWOMAN KRUEGER: Thank you.
10 ASSEMBLYWOMAN SIMON: Let me know
11 later.
12 (Laughter.)
13 CHAIRWOMAN KRUEGER: You clearly will
14 have follow-up with all the chairs.
15 One last three minutes for
16 Senator Fernandez.
17 SENATOR FERNANDEZ: Thank you so much.
18 I mentioned before co-occurring
19 disorders and streamlining the three-tiered
20 system. Could you just expand a little more
21 in these next three minutes about how someone
22 can navigate getting all services dealing
23 with a mental health disorder and a substance
24 use disorder?
169
1 OMH COMMISSIONER SULLIVAN: Yeah. So
2 the three-tier system is -- the second tier
3 is critical because it says that basically
4 our mental health clinics and our substance
5 use clinics are really able to provide a lot
6 more integrated care and get paid for it than
7 they have been currently -- even without
8 doing anything to change their licenses.
9 And so that's an educational
10 phenomenon. You can basically bill for
11 opioid treatments, you can bill for alcohol
12 treatment, everything, in a mental health
13 clinic. It's making it clear how you do
14 that, how you can get reimbursed, so the
15 clinics are more open to do it. So that's
16 where the regulations are shifting.
17 The third tier will be individuals
18 who, for example -- clinics, for example,
19 that would provide the most, most intensive
20 mental health services as well as the most
21 intensive substance use services. Under one
22 license, not having to deal with two
23 agencies, just consistent billing, consistent
24 documentation, making it so much easier for
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1 integrated care.
2 What we have now often requires some
3 different documentation, requires different
4 ways to bill. We're getting rid of all that
5 and basically, if you're doing integrated
6 care, it won't be as complicated within the
7 individual clinics.
8 So basically the three-tier system
9 which we're putting forward I think will be
10 really a breath of fresh air for the
11 community.
12 SENATOR FERNANDEZ: Thank you.
13 CHAIRWOMAN KRUEGER: All right. Thank
14 you very much, Commissioner. I think we have
15 used up the time we have with you today.
16 You have more questions to follow up
17 with some of us, so we appreciate it. And we
18 sincerely appreciate the work of your agency.
19 You're hearing frustration from us because
20 it's all not fixed, and mental illness is
21 actually becoming a growing problem in our
22 communities, so we need to keep working
23 together and get the best answers we can.
24 So thank you very much for your time,
171
1 and thank you to all of your agency staff and
2 your contract agencies throughout the state
3 who do amazing work every day. So thank you.
4 OMH COMMISSIONER SULLIVAN: Thank you.
5 CHAIRWOMAN KRUEGER: And any
6 legislators who want to grab the
7 commissioner -- out in the hall, not in this
8 room, so that we can move on to our next
9 panel of patiently waiting commissioners:
10 Dr. Chinazo Cunningham, commissioner of the
11 New York State Office of Addiction Services
12 and Supports, and Acting Commissioner
13 Willow Baer, New York State Office for
14 People With Developmental Disabilities.
15 (Brief pause.)
16 CHAIRWOMAN KRUEGER: Good afternoon,
17 everyone. Hi. And is it all right if we go
18 in the order here, OASAS first? Is that
19 okay, Commissioner? Yes, okay.
20 Just for the tech people behind so
21 they have your name right when they put your
22 screen up, each of you introduce yourselves
23 now.
24 OASAS COMMISSIONER CUNNINGHAM: I'm
172
1 Dr. Chinazo Cunningham, the commissioner of
2 OASAS.
3 And good afternoon, Senator Krueger,
4 Assemblymember Pretlow, Senator Fernandez,
5 Assemblymember Steck, and distinguished
6 members of the Legislature. My name is
7 Dr. Chinazo Cunningham, the commissioner of
8 the New York State Office of Addiction
9 Services and Supports, and I thank you for
10 the opportunity to present Governor Hochul's
11 fiscal year 2026 Executive Budget and how it
12 supports our work at OASAS on behalf of those
13 who are impacted by addiction.
14 This is my fourth year presenting the
15 OASAS budget. Over the past three years,
16 New York State experienced both the COVID-19
17 pandemic and a devastating overdose epidemic.
18 We met these challenges by following our
19 guiding principles of data-driven
20 decision-making, harm reduction, and equity.
21 Through these efforts, we are now seeing
22 positive results. Most importantly, overdose
23 deaths have declined by 17 percent statewide.
24 That's roughly 900 lives saved through our
173
1 combined efforts between 2023 and 2024.
2 We are optimistic about this trend.
3 However, we must remain focused on saving
4 more lives by bringing innovative prevention,
5 treatment, harm reduction, and recovery
6 services to those who need it. Today I'm
7 proud to share some of our 2024
8 accomplishments and detail how this year's
9 Executive Budget helps us build on our
10 foundation of progress.
11 From the start, New York has
12 distributed more opioid settlement funds to
13 localities and community-based organizations
14 faster than any other state in the nation.
15 OASAS is responsible for distributing
16 36 percent of the state's settlement funds --
17 and does so with efficiency and transparency.
18 A recent report noted that our state received
19 and allocated the largest amount of
20 settlement dollars received nationwide. To
21 date, OASAS has made nearly $400 million
22 available to address substance use disorder
23 and overdoses.
24 This year's Executive Budget includes
174
1 roughly $63 million to help support our
2 continuum of care across the state and in
3 alignment with the Opioid Settlement Fund
4 Advisory Board's recommendations. That
5 includes establishing initiatives to increase
6 medication treatment availability, including
7 expanding access to methadone treatment along
8 with low-threshold buprenorphine treatment;
9 scholarships to support the workforce; youth
10 prevention programs; recovery center and
11 transportation supports; enhanced outreach
12 and engagement; and more.
13 I'm extremely proud to report that our
14 online portal continues to make free,
15 lifesaving harm reduction supplies available
16 to the public. Thus far, over 250,000
17 naloxone kits and nearly 22 million fentanyl
18 and xylazine test strips have been
19 distributed from OASAS alone to individuals
20 and organizations across the state.
21 Just recently, a Poughkeepsie high
22 schooler successfully administered naloxone
23 while at his local barber shop. The teen had
24 ordered the naloxone online through the OASAS
175
1 portal after receiving a lesson on how to
2 administer it during his health class.
3 Our outreach and engagement work has
4 served over 90,000 New Yorkers. In addition,
5 the state now has three Mobile Medication
6 Units up and running. These units bring
7 addiction services, including methadone
8 treatment and other medical care, directly to
9 underserved communities. As Governor Hochul
10 has highlighted, additional funds will help
11 us roll out more units in 2025.
12 The fiscal year 2026 Executive Budget
13 will allow OASAS to continue these critical
14 initiatives and enhance support of our
15 provider system and the individuals they
16 serve. In all, the proposed OASAS budget
17 contains nearly $1.3 billion, including
18 roughly $190 million for State Operations,
19 $964 million for Aid to Localities, and
20 $94 million for capital projects. It
21 continues opioid stewardship funds that
22 allows OASAS to support harm-reduction
23 services and medication and treatment
24 affordability.
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1 Workforce recruitment and retention
2 remains a priority across the OASAS continuum
3 of services, especially as we strive to
4 increase capacity in our system. To address
5 this challenge, OASAS has made historic
6 investments into the addiction workforce to
7 support and expand a skilled, compassionate
8 network of professionals. This includes a
9 partnership with SUNY and other colleges,
10 universities and community-based
11 organizations, which has resulted in over
12 1,000 individuals receiving scholarships for
13 addiction training, and more than 80 medical
14 and behavioral health fellows at four medical
15 schools across the state.
16 The Executive Budget includes
17 $12 million in additional support for a
18 2.1 percent targeted inflationary increase to
19 provide fiscal relief for service providers,
20 as well as an additional $6.4 million minimum
21 wage increase. This action builds upon OASAS
22 workforce initiatives, including a new
23 Leadership Institute, enhanced peer supports,
24 scholarships and paid internships, and an
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1 online addiction credentialing portal.
2 Treating individuals with co-occurring
3 substance use and mental health conditions
4 calls for close collaboration between OASAS
5 and the Office of Mental Health. The budget
6 supports ongoing efforts to triple the number
7 of Certified Community Behavioral Health
8 Centers to better address individuals'
9 complex needs -- regardless of their ability
10 to pay. It also includes an additional
11 $3 million to expand support for joint
12 street-outreach activities to connect
13 vulnerable people with needed services.
14 Further, OASAS and OMH continue to
15 roll out Crisis Stabilization Centers, which
16 provide support, assistance, and urgent
17 access to care. We're also jointly seeking
18 to improve access to services for homeless
19 youth.
20 A 2022 state law required medication
21 treatment for all substance use disorders in
22 carceral settings. It is no small
23 achievement that all 42 prisons and all
24 58 jails have implemented all forms of
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1 FDA-approved medication for substance use
2 disorders. We are a national leader in this
3 work, representing the largest such
4 implementation in a state carceral system
5 nationwide.
6 In the first year of implementation,
7 the number of people who received medication
8 treatment for substance use disorder
9 increased more than five times in prisons and
10 more than three times in jails.
11 State revenues from casinos and mobile
12 sports betting help empower OASAS prevention
13 efforts to promote and encourage responsible
14 gambling. Our "Take a Pause" public
15 awareness campaign is airing throughout the
16 NFL playoffs and Super Bowl, asking people to
17 examine their betting habits.
18 Our Problem Gambling Bureau has also
19 worked to eliminate barriers to training;
20 collect and study data on gambling behaviors;
21 and enhance problem gambling prevention,
22 treatment and recovery services.
23 With the legalization of adult-use
24 cannabis, OASAS is raising awareness for its
179
1 responsible use through a new Cannabis
2 Prevention Toolkit that is available in
3 English and Spanish, giving parents and
4 mentors practical tips and guidance on how to
5 talk to teens about the risks of underage
6 cannabis use.
7 In addition, we're gathering important
8 data from youth about their cannabis
9 behaviors and attitudes, while training
10 providers and schools on the prevention and
11 treatment of cannabis use disorders.
12 The OASAS continuum of services
13 include programs and supports to help
14 individuals achieve and maintain their
15 personal health and recovery goals --
16 including new OASAS-certified recovery
17 residence regulations. This represents the
18 first recovery support service to be
19 certified in the state and allows recovery
20 residences to voluntarily apply for OASAS
21 certification.
22 I urge those who are interested to
23 visit our new Recovery Residences webpage to
24 learn more.
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1 Lastly, the proposed budget includes
2 ongoing support for a five-year capital plan
3 to ensure the health and safety of
4 individuals and proper maintenance of
5 facilities.
6 As outlined today, the proposed
7 Executive Budget allows OASAS to build on a
8 proven foundation of progress based on an
9 equitable, person-centered, data-driven
10 approach. OASAS will continue providing a
11 full continuum of prevention, treatment, harm
12 reduction, and recovery programming and
13 services, all towards our goal of further
14 reducing overdose deaths, improving lives,
15 and preventing addiction.
16 We appreciate your ongoing support and
17 look forward to working with you to better
18 serve those in need.
19 With that, I welcome any questions.
20 Thank you.
21 CHAIRWOMAN KRUEGER: Thank you very
22 much.
23 And I'm now going to -- no. Sorry, we
24 don't ask questions until we do both
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1 commissioners. So please, Acting
2 Commissioner, introduce yourself.
3 OPWDD ACTING COMMISSIONER BAER: Thank
4 you.
5 Good morning, Chairs Krueger and
6 Pretlow, Disability Committee Chairs Fahy and
7 Santabarbara, and other distinguished members
8 of the Legislature. I am Willow Baer, acting
9 commissioner of the New York State Office for
10 People With Developmental Disabilities.
11 Thank you for inviting me to be here today to
12 speak about the historic investments included
13 in Governor Hochul's fiscal year 2026
14 Executive Budget that benefit people with
15 developmental disabilities, their families,
16 not-for-profit providers, and our vital
17 direct-care workforce.
18 In my time as acting commissioner, I
19 have had the privilege of traveling around
20 the state to speak with many of our
21 stakeholders, many of you and your
22 constituents. This has allowed me to better
23 understand the needs of people with
24 developmental disabilities and the challenges
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1 that the system faces. I have learned about
2 innovative approaches that many of our
3 providers are working on, and have heard from
4 people with disabilities about what they
5 want, such as improved access to quality
6 healthcare, housing, and employment. I've
7 also seen the importance of prioritizing
8 efforts that enhance our provider network,
9 advance our workforce, and respond to the
10 changing demographics of the state.
11 I'm excited to highlight several of
12 those proposals included in this year's
13 Executive Budget that respond directly to the
14 requests of people and families, challenges
15 providers have shared, and to what I believe
16 our service system truly needs.
17 For the fourth year in a row,
18 Governor Hochul has included funding that
19 recognizes the imperative role that our
20 providers and direct support staff play in
21 the lives of people with developmental
22 disabilities across New York State. The
23 fiscal year 2026 Executive Budget includes an
24 ongoing investment of $850 million in recent
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1 rate increases, allowing our not-for-profit
2 service providers to afford the increased
3 cost of doing business and, most importantly,
4 to increase wages for frontline staff.
5 Additionally, the Executive Budget
6 proposes a 2.1 percent targeted inflationary
7 increase to further address the rising
8 operating costs in our service system.
9 These investments, especially when
10 combined with Governor Hochul's historic
11 $5 billion proposal to make New York State
12 more affordable, provide incredible support
13 towards the stabilization of our provider
14 network and advancement of our workforce.
15 When added to funding that has been provided
16 since 2022 for cost-of-living increases, rate
17 updates, bonuses, and American Rescue Plan
18 projects, these proposals equal almost
19 $4 billion invested in the developmental
20 disabilities service system to improve
21 recruitment and retention of staff for OPWDD
22 not-for-profit service providers.
23 Coupled with initiatives like OPWDD's
24 "More Than Work" recruitment campaign, and
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1 collaborations with the National Alliance for
2 Direct Support Professionals as well as the
3 State University of New York to provide
4 certifications, credentialing and college
5 credits that professionalize our workforce,
6 we have been able to improve retention and
7 recruitment in our field, as well as
8 significantly reduce the state's reliance on
9 mandatory overtime for these workers.
10 While we all understand that increased
11 funding for providers and enhanced wages for
12 our workforce are imperative to this service
13 system's ability to provide quality supports
14 and services, we also recognize that the
15 demographics of our state and the needs of
16 those we serve are continuously changing.
17 Which is why, as an agency, we have
18 prioritized additional efforts to support
19 people by improving access to both certified
20 and non-certified housing, investing in
21 technology advancements for people to live
22 more independently, and reducing the
23 administrative burden on providers, as part
24 of our strategic plan and short-term housing
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1 strategy.
2 It's also why we are prioritizing the
3 changing needs of an aging population, as
4 well as the complexities of serving people
5 with disabilities and co-occurring mental
6 health diagnoses. And as an agency, we
7 remain committed to efforts that ensure we
8 are meeting the needs of all communities in
9 New York State through our diversity, equity,
10 and inclusion efforts, which include staff
11 training, extensive stakeholder engagement,
12 and strengthening the linguistic and cultural
13 competence of our system at all levels.
14 The Executive Budget continues
15 investments in new service opportunities to
16 meet the needs of people coming into our
17 system or whose needs have changed with
18 $30 million in new state resources which,
19 when matched by the federal government, can
20 total up to $120 million on a full annual
21 basis.
22 To further our goal to increase
23 independent housing opportunities for people
24 with developmental disabilities, the proposed
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1 budget also continues the annual $15 million
2 investment for integrated community-based
3 projects for people with I/DD.
4 Around the state, I have repeatedly
5 heard about the challenges that people with
6 disabilities are facing as they try to meet
7 their basic healthcare needs. Some people
8 wait years for dental care, others can't find
9 a doctor to serve them because the offices
10 are not accessible for physical or sensory
11 needs, and some have simply not received care
12 because doctor's offices do not have the
13 right equipment to meet someone's specialized
14 or mobility needs.
15 This year's budget includes funding to
16 reduce these gaps in healthcare for people
17 with developmental disabilities. To increase
18 access to health services, a $25 million
19 capital funding investment is proposed in
20 this year's Executive Budget to support the
21 creation of regional disability health
22 clinics at existing Article 28 and Article 16
23 clinic locations across the state. These
24 grants will be awarded through OPWDD, and
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1 funding will be used to update or expand
2 buildings, equipment, and technology, to
3 increase accessibility and improve the
4 quality of healthcare provided to people with
5 developmental disabilities statewide.
6 The Governor's proposed budget also
7 calls for a $75 million capital investment in
8 OPWDD's Institute for Basic Research in
9 Developmental Disabilities, or IBR. IBR
10 opened in 1968 as the first large-scale
11 institute in the world designed to conduct
12 basic and clinical research into the causes
13 of developmental disabilities. This
14 important funding for IBR will be used to
15 modernize the institute's infrastructure and
16 expand its capacity to conduct cutting-edge
17 research that will help identify a person's
18 medical and behavioral health needs earlier
19 in life.
20 Significantly, it would also include
21 an establishment of a genomics core facility
22 to better understand how genetics influence
23 people's developmental disabilities and
24 underlying medical conditions. This will
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1 situate IBR to become a national organization
2 for rare diseases that delivers top-tier
3 diagnostic testing for people with
4 developmental disabilities, and to serve as a
5 nationwide resource.
6 In addition to increasing access to
7 healthcare, people with developmental
8 disabilities have repeatedly shared with me
9 their interest in meaningful, gainful
10 employment.
11 We are proud that Governor Hochul
12 signed Executive Order 40, making New York an
13 Employment First State, and has continued her
14 commitment in this year's budget with two
15 proposals that increase tax credits for
16 businesses that hire people with disabilities
17 as well as proposing to make changes to
18 New York's Preferred Source Program
19 permanent.
20 We must continue to prioritize making
21 sure that people with developmental
22 disabilities have access to competitive
23 employment throughout our communities. At
24 OPWDD, I have prioritized hiring people with
189
1 developmental disabilities, ensuring that our
2 agency decision-making is informed by those
3 that our decisions impact most -- and I
4 cannot overstate the benefits that hiring
5 someone with a developmental disability can
6 add to your workplace.
7 Finally, I would be remiss if I did
8 not highlight the important investment being
9 proposed to commemorate New York State's
10 disability rights history by establishing a
11 Willowbrook Center for Learning on the former
12 state school property. What happened at
13 Willowbrook forever changed the way we
14 provide services and supports for people with
15 disabilities. In fact, the advocacy of
16 people who lived at Willowbrook, and their
17 family members, sparked a nationwide civil
18 rights movement that continues to this day.
19 The Center for Learning will forever
20 preserve Willowbrook's historic significance
21 by highlighting how far we have come and will
22 serve as a reminder of what we must continue
23 to fight for.
24 I am proud of the progress that OPWDD
190
1 and New York State have made to better meet
2 the needs of those we serve since the closure
3 of Willowbrook. And I also know there is
4 more work to be done, which would not be
5 possible without the incredible support that
6 Governor Hochul and this Legislature have
7 given our service system. Together, in
8 collaboration, as we enact a new state
9 budget, I have no doubt that we can reach our
10 goals of a more person-centered, inclusive,
11 and accessible New York for people with
12 developmental disabilities and their
13 families.
14 So thank you for allowing me to be
15 here today, and I look forward to the
16 conversation.
17 CHAIRWOMAN KRUEGER: Thank you very
18 much, both of you.
19 And our first questioner will be
20 Chair Fernandez.
21 SENATOR FERNANDEZ: Okay, thank you so
22 much.
23 Thank you so much, Commissioner. It
24 is great to work with you, and I thank you
191
1 for your dedication.
2 (Off the record.)
3 SENATOR FERNANDEZ: All right. Well,
4 thank you so much for everything that you do.
5 I wanted to touch about the opioid
6 settlement funds and transparency. There's
7 been some concerns about the transparency
8 into where the money is going. Would it be
9 feasible to require the localities and state
10 share of the opioid funds not housed in the
11 Opioid Settlement Fund and overseen by OASAS
12 to report to OASAS? And what would you need
13 to make that happen?
14 OASAS COMMISSIONER CUNNINGHAM: Yes,
15 we're very proud of our really effort to be
16 transparent with the opioid settlement funds,
17 as you said. Of the 36 percent of the state
18 dollars that come through OASAS, we have a
19 website that shows exactly how every dollar
20 is used, where those dollars are going, which
21 organizations are getting funded, what
22 categories of funding they include -- you
23 know, how much the counties get -- et cetera,
24 et cetera.
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1 I think, you know, of the dollars that
2 don't come through OASAS and really come from
3 the Attorney General's office, we are working
4 with them to figure out in terms of reporting
5 how we can get reports from those dollars
6 outside of us.
7 So we are working with them, and we
8 anticipate, you know, as programs have had
9 time to actually implement those opioid
10 settlement funds, of getting those reports of
11 how those dollars have been used, and then
12 we'd be happy to add that to our website.
13 SENATOR FERNANDEZ: Okay. Do you have
14 any concerns about what information is made
15 publicly available about the opioid
16 settlement funds, given the hostile federal
17 administration, such as funds being used for
18 syringe exchange programs and other
19 harm-reduction initiatives?
20 OASAS COMMISSIONER CUNNINGHAM: So a
21 lot of -- so, you know, harm reduction was
22 certainly the top priority of the Opioid
23 Settlement Fund Advisory Board, and that has
24 been a top priority at OASAS as well. And I
193
1 think a lot of the harm-reduction efforts
2 have significantly contributed to the
3 reduction in overdose deaths that we've seen,
4 so that 17 percent reduction.
5 So certainly, you know, continuing to
6 expand naloxone kits, fentanyl test strips,
7 xylazine test strips, doing outreach and
8 engagement, meeting people where they are I
9 think is really part of the important, you
10 know, sort of secret to the sauce.
11 We also work with our collaborators at
12 the Department of Health. You know, a lot of
13 their work is with the syringe exchange
14 programs, and they do get some of the dollars
15 from the opioid settlement funds to support
16 that work.
17 So I can't speak specifically about
18 the work that they're doing, but certainly,
19 you know, continuing to expand our work with
20 harm reduction -- and the Governor certainly
21 embraces harm reduction -- is a priority both
22 of the board and of us and, you know, it can
23 be seen how those dollars are used on our
24 tracker for the opioid settlement funds.
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1 SENATOR FERNANDEZ: Okay, yeah, we
2 have a xylazine test strip bill too that we
3 should consider.
4 But this budget was pleasant to see.
5 There was an increase overall in a lot of
6 items, particularly for IT and system
7 updates, which very happy to hear, because in
8 some of the locations that I've seen it looks
9 like they were still using Windows 95. So to
10 get this upgrade is very much needed.
11 And very happy to see that the
12 vocational and job placement services, the
13 funding, the 11.4, was kept in. But with the
14 question that comes, when will the
15 procurement be available for organizations
16 concerned about a funding gap?
17 OASAS COMMISSIONER CUNNINGHAM: Yeah,
18 so we've worked very closely with the
19 organizations that provide vocational
20 services to think about how we can better and
21 more equitably ensure that these vocational
22 services are available to all New Yorkers
23 across the geographic regions and across a
24 whole continuum of services -- so, you know,
195
1 with treatment, with recovery services.
2 And so we have worked with them, and
3 through that we're developing a new model so
4 that we can ensure that there's more equity
5 across the state.
6 There will be no gap in services, so
7 we will continue to fund. We have been
8 continuing to fund those programs that are
9 currently providing services, and we will up
10 until the point where we have new contracts
11 executed. So we plan to release a new RFP
12 with this new model in the coming months, but
13 the services will not be interrupted. They
14 will continue to have funding up until the
15 new contracts are executed.
16 SENATOR FERNANDEZ: Very nice.
17 Regarding recovery services, is it
18 true that the only funding source for
19 recovery services is through the opioid
20 settlement funds?
21 OASAS COMMISSIONER CUNNINGHAM: So
22 some of the recovery services are also
23 through the state aid as well.
24 So we enhanced recovery services
196
1 through the opioid settlement funds, so all
2 of our recovery centers -- the 31 of them
3 funded throughout the state -- had increases
4 in their budgets to really equalize across
5 the state to make it again more equitable and
6 to really enhance their services. And so
7 that includes, you know, enhancing the peers,
8 people with lived experiences, enhancing
9 their services and who they're collaborating
10 with across the communities, and some of them
11 enhancing their sites where they have their
12 community centers.
13 So it is a combination of funds from
14 the state as well as the opioid settlement
15 funds.
16 SENATOR FERNANDEZ: Okay. And when
17 the opioid settlement funds dry up, will the
18 state compensate those funds?
19 OASAS COMMISSIONER CUNNINGHAM: So,
20 you know, what I would say is that
21 sustainability definitely is an issue that we
22 are aware of, and we need to ensure that
23 there are sustainable funds. And so for that
24 reason, with our opioid settlement funds we
197
1 have multiyear initiatives, so that's built
2 into the existing funding. So they are
3 funded for several years at this higher
4 level.
5 SENATOR FERNANDEZ: Okay. The
6 Executive Budget language allows EMTs and
7 paramedics to administer buprenorphine for
8 emergency treatment. Will OASAS oversee the
9 training of EMTs?
10 OASAS COMMISSIONER CUNNINGHAM: So the
11 EMTs really don't fall under our purview.
12 They fall under the Department of Health.
13 But we're certainly happy to collaborate with
14 them, as we do in many ways.
15 You know, we think that this is
16 certainly an important part of just expanding
17 access to medication treatment, because we
18 know medication treatment saves lives.
19 SENATOR FERNANDEZ: Thank you.
20 OASAS has street outreach teams that
21 operate, and there is more funding to do more
22 street outreach teams. Is there any concern
23 that these teams will be used to increase the
24 number of people brought in under the
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1 possible proposed involuntary commitment
2 changes?
3 OASAS COMMISSIONER CUNNINGHAM: So our
4 funding for these outreach teams is really
5 focused on the addiction piece of it and
6 making sure that people have the resources,
7 the education and the linkage to services
8 that they need.
9 So, you know, we work closely right
10 now with Office of Mental Health already with
11 some of the outreach and engagement teams,
12 and we will continue to enhance that. But
13 it's really bringing our addiction expertise,
14 you know, for example, to some of the OMH
15 outreach teams so that they can -- so that we
16 can better address people who have the
17 co-morbid conditions or the dual diagnosis of
18 mental health and substance use conditions.
19 But our mental health professionals,
20 you know, are not trained on the specific
21 mental health diagnoses.
22 SENATOR FERNANDEZ: Okay. This budget
23 also, again, lists a lot of new scheduling
24 that would match what the permanent federal
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1 scheduling is. Has scheduling helped curb
2 overdoses in New York State overall?
3 OASAS COMMISSIONER CUNNINGHAM: So
4 that's a very difficult question to answer.
5 I mean, we know that the overdose rates are
6 going down, and I'm sure it's multifactorial
7 as to why.
8 You know, we certainly are, you know,
9 confident that a lot of our harm-reduction
10 efforts and our improved access to treatment
11 has been a big part of that. But in terms
12 of, you know, law enforcement efforts, that's
13 just not something that I can speak to
14 because obviously we're not a law enforcement
15 agency.
16 So, you know, I think again that
17 this -- it's not a hundred percent clear
18 about why the rates are going down, but
19 certainly I know our efforts are, you know,
20 significantly contributing to that.
21 SENATOR FERNANDEZ: Okay. Because I
22 just would wonder if there is stats, proof,
23 that show that scheduling and matching at the
24 state level, if we were to have it at the
200
1 federal level, why would we need it at the
2 state level? Is that something you can
3 answer?
4 OASAS COMMISSIONER CUNNINGHAM: Yeah,
5 so I mean I'm not aware of any specific
6 research looking at different scheduling and
7 how that impacts outcomes.
8 The scheduling, really that issue is
9 under the Department of Health, and so that's
10 actually not under our purview. So I'm
11 just -- I'm just not aware.
12 SENATOR FERNANDEZ: Okay. Last
13 question. So harm reduction -- thank you
14 again for championing this effort and for
15 what we've seen it do in the state.
16 Do you think other forms of care such
17 as prevention, treatment and recovery
18 services receive the funding needed to meet
19 the care's needs?
20 OASAS COMMISSIONER CUNNINGHAM: Yeah,
21 so, you know, certainly we are fully
22 committed to the whole continuum of services.
23 And that's really, you know, a
24 patient-centered, person-centered approach.
201
1 Because people need different kind of
2 services at different points in their lives,
3 right? And different people need different
4 kind of services.
5 And so a lot of our work is really to
6 make sure that the whole continuum is working
7 better together so that prevention services,
8 for example, are incorporated in treatment.
9 Right? Prevention for the children of the
10 parents that are in treatment. Or, you know,
11 that the linkage from treatment to recovery
12 is also there.
13 So we certainly are investing in our
14 whole continuum of services. And, you know,
15 we're continuing to do that knowing that it's
16 not a linear trajectory, right, that people
17 kind of can bounce around in the whole
18 continuum of services and making sure that we
19 continue to do that and enhance that
20 collaboration better.
21 SENATOR FERNANDEZ: Okay, thank you.
22 I probably have to come back, but
23 gambling addiction. I know that there is a
24 stream going to services based on what we
202
1 currently have in the state with our casinos
2 and gaming. It's been told to me that we
3 have some of the best gambling services that
4 have been nationally recognized. And --
5 (Time clock sounds.)
6 SENATOR FERNANDEZ: Never mind.
7 (Laughter.)
8 CHAIRWOMAN KRUEGER: Hold that answer.
9 Assembly.
10 CHAIRMAN PRETLOW: Hold the answer.
11 Assemblywoman Simon.
12 ASSEMBLYWOMAN SIMON: Hi. Thank you
13 so much for your testimony and your hard
14 work.
15 I have a couple of questions about --
16 if you can, Acting Commissioner -- in your
17 testimony you talked about this $75 million
18 investment in the Institute for Basic
19 Research.
20 OPWDD ACTING COMMISSIONER BAER: Yes.
21 ASSEMBLYWOMAN SIMON: And which sounds
22 terrific. I guess one of the questions I
23 have is what kind of reporting out has the
24 institute done with regard to issues such as,
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1 you know, the causes of developmental
2 disabilities? You know, over our history we
3 had the rubella epidemic at one point, and
4 then we had -- we've had other things.
5 What is the current information that
6 you're finding with regard to, you know,
7 causes of developmental disabilities?
8 OPWDD ACTING COMMISSIONER BAER: So we
9 are very excited about the $75 million
10 investment in IBR.
11 ASSEMBLYWOMAN SIMON: It's great.
12 OPWDD ACTING COMMISSIONER BAER: We
13 know that people with developmental
14 disabilities have a very high propensity for
15 co-occurring underlying medical conditions
16 and mental health conditions. And that's
17 really why the Institute on Basic Research
18 was opened in the 1960s, right, to do that
19 in-depth research to provide clinic services
20 and assessments on-site, which they continue
21 to do today, and to really educate the public
22 about developmental disabilities. And all
23 that work has continued.
24 We've not had a significant investment
204
1 in IBR since that time, so this really would
2 be the first significant investment to update
3 our ability to do that research
4 in-laboratory.
5 But to your question about what data,
6 right, we have a number of research
7 scientists employed at IBR that are
8 continually researching and publishing
9 articles in scientific journals and
10 partnering with other states and national
11 organizations. We certainly can make some of
12 those materials available to you.
13 ASSEMBLYWOMAN SIMON: Thank you.
14 OPWDD ACTING COMMISSIONER BAER:
15 There's a lot of really fascinating work
16 going on, particularly with Alzheimer's and
17 how it relates to Down's syndrome -- that's a
18 big focus of their work right now.
19 ASSEMBLYWOMAN SIMON: Okay, great,
20 thank you. That would be very helpful,
21 because I think there are -- I'm not sure
22 where that information is getting -- and of
23 course, you know, there's also always
24 conversation about causes what out there in
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1 the ozone.
2 And, you know, having some more
3 information about that also allows providers
4 to provide better information -- even when
5 you look at our schools, where a child may
6 have X disability and have an IEP and the
7 school may not be aware or recognize or want
8 to believe that there's also a medical
9 condition that tends to go along with that
10 presentation, so that they're able to better
11 provide those services.
12 So I think that could be very helpful
13 to us at various levels.
14 OPWDD ACTING COMMISSIONER BAER: I
15 think that's so important. We've had genetic
16 testing available through IBR on the limited
17 capacity, and the families that are able to
18 participate in that genetic testing have had
19 just life-changing impacts for really
20 understanding the comorbidities and impacts
21 of medication and treatment. And so really
22 excited to make that more available.
23 ASSEMBLYWOMAN SIMON: Great. Thank
24 you very much.
206
1 CHAIRWOMAN KRUEGER: Thank you.
2 Senator Pat Fahy, chair.
3 SENATOR FAHY: Thank you, Chair.
4 Thank you, Commissioners.
5 Just a couple of questions for OASAS
6 and then I'll save mine for OPWDD. And
7 welcome to both of you. Thank you for being
8 here.
9 I think there's been some indication
10 between both agencies that you are looking to
11 address the children who have dual diagnosis,
12 and wondering what the plan is on that and
13 what the timetable is for providing services
14 for children who may have dual diagnosis, as
15 well as adults.
16 If you could take that, commissioner
17 with OASAS, Commissioner Cunningham, please.
18 OASAS COMMISSIONER CUNNINGHAM: Sure.
19 So when we talk about dual diagnoses, a lot
20 of our focus is on those --
21 SENATOR FAHY: If you could speak up;
22 it's really hard to hear in here. Thank you.
23 OASAS COMMISSIONER CUNNINGHAM: When
24 you talk about the dual diagnosis, a lot of
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1 our focus has been on those with co-occurring
2 mental health and substance use disorders.
3 SENATOR FAHY: Yes.
4 OASAS COMMISSIONER CUNNINGHAM: We
5 work very closely with OMH in many ways. In
6 terms of children specifically, so as OMH is
7 increasing their footprint in schools, we're
8 working with them to ensure, for example,
9 that substance use prevention services are
10 also incorporated in that.
11 The youth clubhouses, which
12 Dr. Sullivan also talked about, we have many
13 youth clubhouses across the state. We're
14 collaborating with OMH there too to think
15 about how we can do a better job of
16 addressing -- providing services to those
17 with co-morbid disorders in the youth
18 clubhouses.
19 So those are some examples in which
20 we're working closely with them to address
21 their co-morbid illnesses.
22 SENATOR FAHY: Thank you. And I'll
23 save the switch for another couple -- I just
24 want to share the comments of Drug and
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1 Alcohol Abuse Chair Fernandez with regard to
2 transparency. I welcome more transparency on
3 some of our funding.
4 And as somebody who spent five years
5 trying to advocate for change here on one of
6 our OASAS sites, treatment sites -- I know
7 that wasn't authorized under your leadership
8 but it was a very opaque process, and hope we
9 don't repeat that. I think we have addressed
10 it, but when we have sites right in a
11 commercial corridor, right on a street level
12 with everyone else, it's been a very
13 difficult process.
14 And look forward to continuing to work
15 with you such that we don't have a repeat of
16 that here, which has really harmed the area,
17 let alone I don't think served those in
18 treatment as well as they could have. But
19 thank you for working with us for a better
20 outcome there.
21 I'm going to switch gears now to
22 Commissioner Baer. Just a few questions.
23 Can you start with what is the waitlist of
24 those who have been certified and on a
209
1 waitlist for either a -- one of your-run
2 facilities or one of the nonprofit
3 facilities? We hear a lot about the demand.
4 OPWDD ACTING COMMISSIONER BAER: Sure.
5 We actually don't have a waitlist in New York
6 State for certified residential
7 opportunities. But what we --
8 SENATOR FAHY: If you could speak up.
9 It would really help if you could pull that
10 mic -- I'm sorry, it's very difficult here.
11 OPWDD ACTING COMMISSIONER BAER: No,
12 don't apologize. How's that?
13 SENATOR FAHY: I'm sorry, not a
14 waitlist?
15 OPWDD ACTING COMMISSIONER BAER: We
16 don't operate a waitlist in New York State
17 for those services where there are vacancies
18 in the certified residential opportunity
19 continuum.
20 That usually is because of one of
21 three reasons. Either there's a need for
22 physical plant renovations, there's a lack of
23 staffing -- which is most significant,
24 right -- or we are actively working to match
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1 someone who's seeking residential services
2 with that placement opportunity.
3 It is a very person-centered process.
4 That provider has to be able to meet the
5 physical needs of that person, the behavioral
6 needs of that person, the health needs. And
7 then that person or their family have the
8 right to say they don't want to be served by
9 that provider or in that part of the state.
10 So that is a very person-centered process of
11 matching those two.
12 We took a really hard look this year
13 at our certified residential opportunities
14 list and thought about what are those three
15 main obstacles, and how could we address
16 them. And we included that update in our
17 most recent strategic plan.
18 So on the staffing side, I talked
19 earlier about the seven -- $850 million
20 investment in those providers, which will
21 really go a long way towards helping them
22 staff those vacancies so they can move people
23 in. We've looked at our administrative
24 processes around physical plant reimbursement
211
1 and trying to make that a much more efficient
2 process of getting those dollars to providers
3 to make those capital investments faster.
4 And then on the third side, the
5 investments that this Governor's made in
6 allowing us to update our IT infrastructure,
7 we've started a really robust process of
8 automating our systems, really catching them
9 up to modern day so that we can track who's
10 looking for those opportunities and what all
11 of those opportunities are, so we can do a
12 much more efficient job of matching people to
13 them.
14 SENATOR FAHY: Okay. Thank you. And
15 as you know, we hear from a lot of parents,
16 especially aging parents, very worried about
17 where their children will end up, or how they
18 will be cared for when they may not be able
19 to.
20 Can we talk a moment about the pay
21 differential? When we spoke, Commissioner, I
22 know there was a rebasing that I think was
23 put into the budget last year, and I think
24 that has helped with a number of the
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1 facilities. Can you talk about that pay
2 differential that I know was finalized at the
3 end of 2024, and how -- is that helping? The
4 Governor has proposed a 2.1 percent COLA
5 increase. Is the rebasing, is that helping
6 with pay?
7 And of course the advocates are asking
8 for a 7.8 percent increase. How -- that's
9 quite a difference. Can you address that,
10 please, and let us know if the rebasing has
11 helped with that getting down to the workers
12 and paying especially the DSPs.
13 OPWDD ACTING COMMISSIONER BAER: Sure.
14 I think it's a really important question.
15 This Governor and this Legislature
16 have invested $1.3 billion in COLAs and
17 targeted inflationary increases to the OPWDD
18 service system over the last four years. The
19 rebase that you mentioned was our federally
20 required five-year rebase of those services
21 and really getting them caught up to the
22 modern-day cost of doing business.
23 We know that in the last five years
24 inflation ran pretty rampant. We had a
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1 global pandemic, right, so there were a lot
2 of increased costs that those providers were
3 desperate to have matched in their rates. So
4 that rebase process that we went through,
5 invested $850 million across the state --
6 that's an average of a 13 percent increase
7 for those providers. That has gone so far to
8 get them caught up to the modern-day doing
9 business. Which then of course is compounded
10 by things like the 2.1 percent inflationary
11 increase to keep them whole and to keep them
12 on the right path.
13 I've heard from providers that that
14 increase was immediately -- immediately
15 enabled them to increase direct-line wages by
16 4, 5, 6, 7 dollars an hour in some regions of
17 the state, and has made an immediate impact
18 on their ability to recruit staff, which was
19 exactly what it was intended to do. So we're
20 very excited about that.
21 SENATOR FAHY: Yes, thank you,
22 commissioner. And if there's a way to get a
23 list of those agencies that did receive that.
24 Because while we've heard that from a couple,
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1 it would be good to have a sense of how many
2 of the providers did feel that impact and how
3 many are passing it on to the workers. It
4 would -- that would help tremendously.
5 I also need to commend you on the
6 Willowbrook -- the Center for Learning. I
7 missed the ribbon-cutting, but I think that's
8 a wonderful way to preserve it, remind us of
9 the history there, and make sure we're doing
10 the research to prevent that in the future.
11 Dental care. It is a crisis. You
12 mentioned it. Is there anything that we
13 should be paying attention to here? It is
14 something here in the Capital Region where
15 it's an extraordinary crisis where we've lost
16 four Medicaid dental care providers -- sorry,
17 we had four, we're down to one, which is the
18 Center for Disabled.
19 Can you talk about other ways to
20 address this particularly for those who are a
21 little harder to serve?
22 OPWDD ACTING COMMISSIONER BAER: Yeah,
23 dental care is so, so important. Dental and
24 healthcare were some of the first things I
215
1 heard about when I stepped into this role and
2 started meeting with families and
3 self-advocates about what they really needed.
4 We in state operations, where we have
5 the ability to have a little more control
6 over providing those safety-net services,
7 have really tried to focus the last few years
8 on building out our ability to provide dental
9 services in our Article 16 dental clinics in
10 various parts of the state. We're also
11 working now -- we hear all the time that
12 people with pretty significant disabilities
13 are unable to receive dental care because of
14 their sensory concerns and response to being
15 in a dental chair.
16 So what we're working on finalizing in
17 state operations is a pilot where we could
18 provide mobile anesthesia to dental clinics.
19 So the mobile anesthesia could arrive at the
20 dental clinic and make that patient -- make
21 that patient's appointment that much easier
22 so that they can get that care that they
23 need.
24 So there are certainly ways that we're
216
1 looking at providing expanded access to
2 dental care, and we see that people with
3 disabilities who lack dental care have a lot
4 more behavioral and long-term health
5 outcomes.
6 SENATOR FAHY: Thank you, and I would
7 love to hear more about that, because it is
8 something that comes up repeatedly.
9 In the last few seconds, you mentioned
10 the funding -- a funding request for
11 disability clinics. Again, I know our Center
12 for Disabled has one of those clinics. Can
13 you tell us how many more and where those are
14 being proposed for in the budget?
15 OPWDD ACTING COMMISSIONER BAER: I'm
16 glad you're familiar with the Center for
17 Disability Services. That's exactly the type
18 of clinic that this idea is modeled after,
19 right, is to make that type of really
20 integrated health services available to more
21 people with disabilities throughout the
22 state. We hear that people drive hours to
23 get to places like the Center for Disability
24 Services to receive that healthcare or they
217
1 have to receive their pap smears in the
2 hospital, for example.
3 SENATOR FAHY: We have five seconds.
4 So how many are you proposing?
5 OPWDD ACTING COMMISSIONER BAER: Up to
6 five.
7 (Laughter.)
8 SENATOR FAHY: Thank you. Thank you
9 to both commissioners.
10 Thank you, Chair.
11 CHAIRWOMAN KRUEGER: Thank you.
12 Assembly.
13 CHAIRMAN PRETLOW: Assemblymember
14 Sempolinski.
15 ASSEMBLYMAN SEMPOLINSKI: My questions
16 are for Commissioner Baer. And just before I
17 start, I want to say thank you for everything
18 your department does. We're having this
19 dialogue because I'm an Assemblymember, but
20 before that, I'm a father of a special-needs
21 child. I have a daughter with Down syndrome.
22 Her name is Jojo. And so thank you for
23 everything you do taking care of folks like
24 her.
218
1 I know a lot of the folks that are on
2 this committee have connections to folks that
3 have developmental disabilities. So thank
4 you.
5 I want to inquire about the
6 $850 million investment that was just
7 announced. What's the timeline for that
8 getting out? And what is the sort of
9 assurances it's going to get to all different
10 parts of the state? Because I represent an
11 extraordinarily rural portion of the State of
12 New York.
13 OPWDD ACTING COMMISSIONER BAER:
14 Great. The $850 million rebase that I
15 mentioned goes to all of our certified
16 residential programs and site-based state
17 programs. So it is a massive swath of our
18 providers in every part of the state. And
19 that's part of our federally required
20 five-year rebase.
21 We did send a letter to those
22 providers as well, letting them know that our
23 absolute expectation was that that money be
24 used at least in part to increase wages for
219
1 front-line staff, to increase them to a
2 living wage, which is what we have seen
3 happening. Those funds are available now.
4 It was paid retroactive to 7/1, which was the
5 effective date of those rates. So we're very
6 excited that providers now have that cash in
7 hand.
8 ASSEMBLYMAN SEMPOLINSKI: Awesome.
9 I'm going to ask the same question I
10 asked the commissioner of the Office of
11 Mental Health. We were talking about the
12 2.1 percent proposed COLA. We call it a COLA
13 or a TII or what have you, but it doesn't
14 match the rate of inflation. And we've had
15 smaller COLAs over the past few years, none
16 of which have quite hit the rate of
17 inflation, so they're not quite truly a COLA.
18 It's still effectively a cut.
19 Why don't we, just as a matter of
20 standard operating procedure or budgeting,
21 just start with whatever the rate of
22 inflation is and go from there? Why is it
23 always lower and then we have to sort of try
24 and work to catch up?
220
1 OPWDD ACTING COMMISSIONER BAER: Well,
2 I certainly defer to the Legislature and the
3 Governor's office in negotiating the language
4 of what that statute requires.
5 But what I can say is that the
6 2.1 percent, which is $116 million for my
7 service system, really will help build upon
8 the $850 million investment to make sure that
9 our providers are keeping current and keeping
10 track with inflation at this point.
11 ASSEMBLYMAN SEMPOLINSKI: Well, I
12 respect that. And certainly 2.1 is better
13 than zero. But when inflation is
14 significantly higher than that, it's just
15 less of a hit, as opposed to keeping people
16 even.
17 And I would imagine, since we have to
18 do this sort of negotiation every year, that
19 for providers it provides a situation where
20 there's certainly a lack of certainty as to
21 what they're going to be able to pay folks.
22 And it's herky-jerky for what they have to do
23 to plan.
24 My last question is, as I mentioned, I
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1 represent an extraordinarily rural area of
2 the state. For whatever particular agency
3 we're dealing with, it's always difficult to
4 access systems. For folks in rural areas,
5 how good of a job are we doing in making sure
6 that they're getting their services near
7 where they live as opposed to having to go to
8 other parts of the state?
9 OPWDD ACTING COMMISSIONER BAER: And
10 that's why OPWDD is split into regional
11 offices, right, so we can really make sure
12 that we're keeping track on a regional basis
13 of what the needs are for people that live in
14 those communities, and to develop networks of
15 providers to support them where they live in
16 those regions.
17 I know that the more rural regions we
18 certainly have robust provider networks in
19 places where they are needed. I know that we
20 continue to work on things like enhancing
21 transportation and access to telehealth and,
22 you know, more innovative ways to deliver
23 those services to those communities.
24 ASSEMBLYMAN SEMPOLINSKI: Well, I'd
222
1 ask you to obviously continue to do that.
2 And again, thank you to yourself and your
3 department for the work you do.
4 OPWDD ACTING COMMISSIONER BAER: Thank
5 you.
6 CHAIRWOMAN KRUEGER: Oh, okay. Are
7 you done? I don't want to cut anyone off.
8 You still have a little time.
9 ASSEMBLYMAN SEMPOLINSKI: I'm good,
10 thank you.
11 CHAIRWOMAN KRUEGER: Okay, thank you.
12 Next is Senator Weber, ranker.
13 Oh, okay, Senator Oberacker.
14 SENATOR OBERACKER: There we go.
15 One of my maladies is I am
16 color-blind, and I've been told that with my
17 choice of tie today. So bear with me on
18 that, Commissioner.
19 (Laughter.)
20 SENATOR OBERACKER: Good to see you in
21 Albany. Commissioner Baer, good to see you
22 as well. Thank you.
23 I'll start off where I kind of left
24 off with Commissioner Sullivan. We in
223
1 New York I think have a supply of
2 decommissioned DOT -- DOT? DOC, excuse me --
3 Department of Corrections facilities in a lot
4 of the areas up here, and two of which I'd
5 like to kind of point out here in my
6 district.
7 One is in South Kortright in Delaware,
8 it was the old Allen facility. And in
9 Fallsburg we just had a closing for one of
10 our correctional facilities. I think we are
11 missing the opportunity to utilize those
12 facilities for the needs and wants for
13 longer-term, 90-day-plus, looking at
14 treatments for that.
15 So I would encourage us, as we start
16 to formulate a plan again on how to move
17 forward, that we would really look at
18 considering those areas.
19 The facility in Delhi I think is
20 strategically located. It's within the
21 transportation hub of Delhi, which is the
22 county seat, so it takes that transportation
23 equation out of it. I think we could
24 definitely look at that.
224
1 Commissioner, I had some folks in my
2 office yesterday, and one of the issues they
3 brought up which I thought was not only
4 interesting but I wasn't aware of, is as
5 someone is starting to transition out of
6 treatment, IDs are a big concern and almost a
7 roadblock. They don't -- they can't get any
8 of the other services that they need because
9 they don't have their Social Security card,
10 they don't have their birth certificate.
11 So we maybe should look at some way of
12 having a verification or, more appropriately,
13 something that we could offer that would
14 allow them to get an ID and then, you know,
15 proceed on. It was something I wasn't aware
16 of, and I'm -- you're nodding, so I'm sure
17 you are. But just wanted to bring it up,
18 that in the ruralness of my district, it's a
19 big -- it's a huge issue.
20 School-based health, a huge supporter
21 of school-based health. I think we ought to
22 partner with school-based health and look at
23 seeing where we, from the Office of Addiction
24 Services, how we can partner with them and
225
1 help them facilitate more of them in the
2 schools. I think if we focus in there, we
3 are focusing in on a way of looking at harm
4 reduction in a new way.
5 To dovetail with that, are you
6 familiar with the one-box concept? It's an
7 AED-style box that is for overdose. And what
8 it has, basically it looks like an AED, and
9 it has -- you open it up, it has a flip-down
10 screen, it will actually walk you through the
11 process of administering Narcan.
12 One of my goals in my district where I
13 have over 65 school districts is to put one
14 in every one of those schools. So we're
15 talking, again, I think a plan for harm
16 reduction that we can get behind.
17 You know, we have some really great
18 programs. Sullivan County has Hope, Not
19 Handcuffs. It works. And it is taking a way
20 of changing the paradigm as to those that are
21 suffering from substance use disorder.
22 In there was probably a couple of
23 questions, but I'm just trying to make you
24 aware that we've really got some interesting
226
1 things going on in the 51st Senate District.
2 I would love an opportunity to invite you to
3 tour with me, as Commissioner Sullivan has
4 agreed to as well, and show you that I have a
5 plan, I think, to address the issues and a
6 true partnership I think can be had.
7 So with that, I'll yield back my
8 55 seconds. But thank you both for the work
9 that you do. It does not go unnoticed or
10 unappreciated. Thank you.
11 OASAS COMMISSIONER CUNNINGHAM: Thank
12 you.
13 OPWDD ACTING COMMISSIONER BAER: Thank
14 you.
15 CHAIRWOMAN KRUEGER: Thank you.
16 Assembly.
17 CHAIRMAN PRETLOW: Assemblyman Steck.
18 ASSEMBLYMAN STECK: Thank you,
19 Mr. Chairman.
20 My questions are all for the
21 commissioner of OASAS.
22 The Governor has repeatedly said that
23 all of the opioid settlement funds have been,
24 quote, made available. This budget is
227
1 reappropriating more than 290 million, or
2 more than 60 percent of the 500 million
3 received. Do you have any kind of timetable
4 as to when these -- over what length of time
5 these funds will be made available to
6 providers?
7 OASAS COMMISSIONER CUNNINGHAM: Yeah,
8 thank you for that question.
9 I mean, as I mentioned earlier, we are
10 actually leading the country in terms of the
11 amount of dollars --
12 ASSEMBLYMAN STECK: I'd like to ask
13 for the timetable. I heard that statement
14 before. I have a limited time. We need to
15 stick to the questions. Thank you.
16 OASAS COMMISSIONER CUNNINGHAM: Thank
17 you.
18 So we just announced, just recently in
19 this past week, another initiative, and we
20 continue to announce initiatives as we're
21 moving forward with the opioid settlement
22 funds. So, you know, we are continuing it,
23 and that information is all -- everything is
24 on our website. So the minute that we have a
228
1 new RFP, that is made available there.
2 ASSEMBLYMAN STECK: So in answer to my
3 question, as you sit here now you don't know
4 what the timetable is, over how many years
5 you intend to release those funds to
6 providers, is that correct?
7 OASAS COMMISSIONER CUNNINGHAM: I
8 mean, we are continuing to constantly release
9 money as we move --
10 ASSEMBLYMAN STECK: You've answered my
11 question. Thank you.
12 So you mentioned in your original
13 statement problem gambling. One of the
14 things that we've been approached about is
15 the issue of problems with addiction to
16 sports betting, particularly among young men.
17 Our office contacted OASAS about that. My
18 legislative director represents to me that
19 the response was "We're not doing anything in
20 that area." We'd certainly appreciate to
21 know what if anything is being done in that
22 area.
23 OASAS COMMISSIONER CUNNINGHAM: Yes,
24 we have a robust response to problem
229
1 gambling. In fact, we've developed a problem
2 gambling bureau with staff dedicated to
3 really addressing --
4 ASSEMBLYMAN STECK: Sports betting in
5 particular.
6 OASAS COMMISSIONER CUNNINGHAM:
7 Including sports betting.
8 So we have public awareness
9 announcements that are airing during the NFL
10 playoffs, during the Super Bowl, so people
11 can do self-assessments, so they can look at
12 their own behaviors, so they can be linked
13 then to services. So that's one kind of
14 example.
15 We're working, you know, with schools
16 as well. We are doing -- all of our
17 prevention providers are working in
18 communities and schools and do education
19 around problem gambling. We've increased our
20 treatment capacity in problem gambling and
21 our workforce who gets trained in problem
22 gambling. We're also collecting a lot of
23 data and doing surveys, working with the
24 Gaming Commission and the New York Council on
230
1 Problem Gambling.
2 So there are many, many efforts to
3 really understand exactly what's happening
4 behavior-wise, and to have a targeted
5 approach and increase the capacity in our
6 system.
7 ASSEMBLYMAN STECK: Have you
8 undertaken any initiatives specifically with
9 respect to kratom?
10 OASAS COMMISSIONER CUNNINGHAM: So
11 there is very little evidence about the role
12 of kratom in addiction. As you know, I'm a
13 researcher, and so this is an area that I'm,
14 you know, very familiar with.
15 What we do know is that medications
16 like methadone and buprenorphine have decades
17 of research showing their effectiveness. And
18 we know that we need to really improve access
19 to that treatment that reduces the risk of
20 overdose death by 50 percent. So our focus
21 is on the tried-and-true treatment that we
22 know from decades of research works.
23 ASSEMBLYMAN STECK: So there's been
24 representations made that kratom does some of
231
1 the same, similar things. I know that's
2 unsubstantiated. I was more inquiring about
3 the proliferation of legal sales of various
4 kratom products throughout the state. I'm
5 wondering just if you have any insight into
6 that.
7 OASAS COMMISSIONER CUNNINGHAM: I
8 mean, we hear on occasion anecdotes, but we
9 don't have data that's systematic about the
10 sale of kratom.
11 ASSEMBLYMAN STECK: Okay, thank you.
12 And then it has also been represented
13 to me that alcohol actually causes more
14 deaths than opioids. Has the OASAS
15 undertaken any new initiatives with respect
16 to alcoholism?
17 OASAS COMMISSIONER CUNNINGHAM: So we
18 also are absolutely, you know, concerned
19 about alcohol, and obviously there are
20 policies that increase the possibility of,
21 you know, getting alcohol. And so this is
22 something that we are working on internally
23 about getting a better understanding, working
24 with the State Liquor Authority in terms of
232
1 what's happening across the state and
2 ensuring that we are, you know, doing more
3 prevention with youth and ensuring that our
4 treatment programs are -- you know, have the
5 capacity and are providing the best
6 treatment. Particularly medication treatment
7 is an area that we're also focused on with
8 alcohol use disorder.
9 ASSEMBLYMAN STECK: So in many states,
10 particularly Appalachian states, crystal meth
11 is a giant problem. We were -- of course
12 parts of New York State could be considered
13 Appalachia, and one of those counties reached
14 out to us that they have a very bad problem
15 with crystal meth.
16 I'm wondering if the department has --
17 or the agency has undertaken any new
18 initiatives with respect to that substance.
19 OASAS COMMISSIONER CUNNINGHAM: We
20 recently published actually an addiction data
21 bulletin that takes a deep dive into the role
22 of stimulants in New York State. And as you
23 may know, the role of stimulants is
24 associated with 50 percent of overdose
233
1 deaths. So this is an area that we are
2 closely watching.
3 Unfortunately the treatment options
4 for stimulant use disorder are not great.
5 This is something we're discussing, you know,
6 the possibility of piloting across the state
7 some new initiatives. But unfortunately the
8 treatment options are not great. But we want
9 to make sure that people still know they're
10 at risk for overdose, so making sure that
11 they have naloxone and they know -- you know,
12 they're informed about the role of fentanyl
13 getting in either the methamphetamine or the
14 cocaine.
15 ASSEMBLYMAN STECK: So I think you had
16 a comment in your remarks about marijuana.
17 How do you regard the tremendous increase in
18 the THC content of marijuana that has been
19 occurring in terms of the growers are now
20 able to cross-breed and so forth? Do you
21 feel that that increase in the THC content is
22 especially harmful to our residents?
23 OASAS COMMISSIONER CUNNINGHAM: So,
24 you know, we work with the Office of Cannabis
234
1 Management and certainly talk to them about
2 prevention efforts and our concerns,
3 especially for underage youth.
4 We also, you know, in our prevention
5 work do a lot on cannabis toolkits. Part of
6 that is the discussion about THC and the role
7 for parents and caregivers to talk to teens,
8 and then also working with schools around
9 this.
10 So we are trying to provide education
11 so people can make, you know, educated
12 decisions and taking a harm-reduction
13 approach to reduce the risk of developing
14 problems associated with cannabis.
15 ASSEMBLYMAN STECK: So medically is it
16 fair to say that there is such a thing as
17 cannabis use disorder and cannabis-induced
18 psychosis?
19 OASAS COMMISSIONER CUNNINGHAM: Yes.
20 ASSEMBLYMAN STECK: Okay, thank you.
21 I have trouble convincing some of my
22 colleagues of that.
23 But in any event, the 24-hour
24 stabilization centers, where do the folks go
235
1 after they've been stabilized for 24 hours?
2 As you know, I've been skeptical of this
3 because we passed legislation allowing
4 hospitals to hold for 72 hours. And, okay,
5 they're there for 24 hours, then what
6 happens?
7 OASAS COMMISSIONER CUNNINGHAM: I
8 mean, we have a full continuum of services,
9 as you know, so people can go from the crisis
10 stabilization centers to inpatient centers to
11 stabilization, you know, residential programs
12 and the whole way through.
13 So we do, you know, have availability
14 across the continuum in those settings to be
15 able to make those warm hand-offs. A lot of
16 the crisis stabilization programs are still
17 not yet up and running, but will be in the
18 coming months.
19 ASSEMBLYMAN STECK: So unfortunately
20 of course there's no requirement -- they get
21 stabilized, and they can go out and do
22 whatever they wish. Isn't that correct?
23 OASAS COMMISSIONER CUNNINGHAM: Yes.
24 We have a voluntary treatment system.
236
1 ASSEMBLYMAN STECK: Right. Okay.
2 So then there's 42 million allocated
3 for prisons for treatment, only 177,000 for
4 county jails. What's the explanation of the
5 disparity?
6 OASAS COMMISSIONER CUNNINGHAM: The
7 42 million for prisons, I'm not sure if
8 you're saying that that's through DOCCS or --
9 ASSEMBLYMAN STECK: That is in the
10 budget. It's an addition for prisons for
11 treatment in prisons. But only 177,000 for
12 counties. And we can understand if you're
13 not familiar with that, but --
14 OASAS COMMISSIONER CUNNINGHAM: I
15 mean, if it's in somebody else's budget, you
16 know, I can't really speak to that.
17 But I can tell you we -- I'm proud of
18 the work we're doing in jails and prisons.
19 We are -- you know, they're offering every
20 form of FDA-approved medication in all of the
21 42 prisons and 58 jails. We work very
22 closely with them. And we do provide
23 support, particularly for the medication
24 costs for all of the jails.
237
1 So that is work that we are doing, and
2 that's actually coming out of those opioid
3 settlement funds.
4 ASSEMBLYMAN STECK: So the mobile
5 medication units is a good idea. Are the
6 reports we see that some counties refuse to
7 let them be sited there -- do you have any
8 comment on that?
9 OASAS COMMISSIONER CUNNINGHAM: Yes,
10 stigma is a huge issue in the field of
11 addiction. And we'd love to work with you
12 and communities to get life-saving treatment
13 in those communities.
14 ASSEMBLYMAN STECK: We'd be happy to
15 legislate on the issue so they can be
16 received.
17 CHAIRWOMAN KRUEGER: Thank you.
18 Senator Shelley Mayer.
19 SENATOR MAYER: Good morning. Thank
20 you both.
21 And Commissioner Baer, questions for
22 you.
23 One is you cited the 850 million. I
24 think that is as a result of last year's
238
1 legislative initiative to apply a COLA or
2 some kind of inflationary index to the
3 not-for-profit community. Am I right?
4 OPWDD ACTING COMMISSIONER BAER: There
5 was a COLA in last year's budget. The
6 $850 million rebase is separate from that.
7 There was, I think, $400 million in last
8 year's financial plan to support the rebase,
9 with an additional investment made this year
10 when we really looked at the cost of doing
11 business over that five-year period.
12 SENATOR MAYER: And is that 850
13 directed exclusively at the not-for-profit
14 community that provides these services?
15 OPWDD ACTING COMMISSIONER BAER: Yes,
16 the $850 million is only for our nonprofits.
17 SENATOR MAYER: In your testimony you
18 refer to the development of regional
19 disability clinics. I take it that's
20 different from -- I assume it is -- from your
21 regional field offices?
22 Can you -- what are these regional
23 disability clinics, and where are they going
24 to be located?
239
1 OPWDD ACTING COMMISSIONER BAER: So
2 the idea behind the regional disability
3 health clinic proposal is a capital funding
4 program that would be run through OPWDD. So
5 we would take existing Article 28 and
6 Article 16 clinic providers that specialize
7 in providing healthcare to people with
8 intellectual and developmental disabilities,
9 and we would provide those grant funds on top
10 of their current operating rates. So that
11 they can expand waiting rooms, buy accessible
12 equipment, right? Increase their ability to
13 provide those services, those healthcare
14 services to people with disabilities.
15 SENATOR MAYER: Okay. With respect to
16 the regional field offices, I think you know
17 in my district I've had complaints that
18 there's no one there, no one answers the
19 phone. They're really not of much help to
20 people who are seeking the assistance of the
21 department.
22 Are they fully staffed? Are people in
23 the office every day? And what is the status
24 of these regional field offices?
240
1 OPWDD ACTING COMMISSIONER BAER: We've
2 been very lucky this last year to really be
3 as staffed up I think as we need to be. We
4 have personnel, in-person staff at all of our
5 regional field offices.
6 Certainly if there's an issue that
7 you're experiencing in your region, I'm happy
8 to talk offline with you about that. People
9 really need to be working with their care
10 managers at this point. So those are there
11 through the care coordination organizations.
12 Their care managers are really the ones doing
13 that day-to-day work on developing someone's
14 life plan and connecting them to services.
15 So -- always should start through
16 their care manager. But we absolutely have
17 people working in all of our regional
18 offices, as well as a 24-hour call center.
19 SENATOR MAYER: Okay. Lastly, those
20 that first are in the OPWDD system and then
21 have a mental health episode, we found have
22 less coordination than when they start in the
23 OMH world and then get into yours.
24 That's been a problem in my community
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1 with inpatient psych hospitals that have
2 experienced this. Do you have a plan to sort
3 of improve that?
4 OPWDD ACTING COMMISSIONER BAER: Yeah,
5 we've been working very closely with the
6 Office of Mental Health, particularly over
7 the last year, to really close those gaps and
8 to share our expertise between OMH-licensed
9 facilities --
10 (Time clock sounds.)
11 OPWDD ACTING COMMISSIONER BAER: We
12 can --
13 SENATOR MAYER: Okay, thank you.
14 CHAIRWOMAN KRUEGER: Thank you.
15 Assembly.
16 CHAIRMAN PRETLOW: Assemblymember
17 Brown.
18 ASSEMBLYMAN KEITH BROWN: Thank you,
19 Chair.
20 Good -- I don't know what -- good
21 afternoon, Commissioner. How are you today?
22 I'm going to start off by saying
23 appreciate the statistics of the drop in
24 overdose deaths. We're seeing the same thing
242
1 in Suffolk County. We met with our medical
2 examiner a couple of weeks ago, and she
3 attributed it to the fact of the
4 effectiveness of Narcan administration.
5 So -- we know we still have a lot of
6 work to do, though.
7 So I appreciate in your remarks you
8 mentioned a recognition of cannabis use
9 disorder. And I see, you know, trying to get
10 the word out in connection with the cannabis
11 prevention toolkit, but I'd also ask if you
12 could include CHS, cannabinoid hyperemesis
13 syndrome, which is very prevalent -- I mean,
14 the fact that kids are using high-potency
15 marijuana and causing psychosis, as one of my
16 colleagues alluded to.
17 But also parents, you know, should
18 understand what some of the symptoms are.
19 You know, if the child is vomiting
20 uncontrollably or taking very long hot
21 showers, there's a reason for it, and it's
22 probably because they're dabbing marijuana or
23 smoking high-potency, and the issues that
24 relate to that.
243
1 So I would ask that as something you
2 can include.
3 Just delving right into some of the
4 big issues. We heard Commissioner Sullivan
5 testify earlier about the co-licensure and
6 the three tier levels. From what we're
7 hearing from the providers, it's causing a
8 lot of problems. And the reason being is
9 because as people will need to move hopefully
10 through those tiers, you know, and have less
11 and less treatment, it doesn't allow for that
12 to happen.
13 So we're hearing back that it's very
14 cumbersome and difficult to deal with the
15 three-tiered system. So maybe there's some
16 way to streamline that, if you want to
17 comment.
18 OASAS COMMISSIONER CUNNINGHAM: So the
19 three-tiered system is something we're
20 actually working on. It doesn't exist right
21 now. And part of the reason why we're
22 working on it is to address exactly the
23 problem that you're saying, that the
24 difficulties that providers have now between
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1 the two systems.
2 So I think, you know, the goal is once
3 we have that three-tiered system in place,
4 that will reduce those barriers and
5 challenges.
6 ASSEMBLYMAN KEITH BROWN: Great.
7 Thank you.
8 And then regarding the Opioid
9 Settlement Fund, just wondering what specific
10 plans there are to address and maybe do an
11 RFA to develop competency and access to
12 integrated treatment and support.
13 OASAS COMMISSIONER CUNNINGHAM: Yeah,
14 so certainly in terms of integrated treatment
15 that is an overarching theme that we've heard
16 from the Opioid Settlement Fund Advisory
17 Board is important. And we've changed our
18 procurement process there. We've also worked
19 very closely with OMH to make sure that they
20 also have access to these dollars, their
21 clinics.
22 So that work is ongoing. And, you
23 know, in addition to the licensing there's
24 many other ways in which we're working
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1 together. We're doing training so the
2 scholarships that we have, for example, for
3 addiction providers also can go to the OMH
4 providers and is going to the OMH providers.
5 So, you know, so from top to bottom,
6 really, around the workforce, around the
7 programming, the licensing, prevention in
8 schools -- there is a lot of work with OMH to
9 better integrate our services.
10 ASSEMBLYMAN KEITH BROWN: Okay.
11 So along those lines, we're increasing
12 the funding for the CCBHC uncompensated care
13 pool. Is there a way to increase it
14 commensurate with the increase in CCBHCs and
15 enable providers to help underinsured and
16 uninsured folks?
17 OASAS COMMISSIONER CUNNINGHAM: That
18 is the whole goal, is really to address
19 those -- those dollars for the uncompensated
20 pool are really to focus on those who are
21 uninsured or underinsured. And so, you know,
22 that is still fairly new, but we're working
23 with providers to ensure that those dollars
24 go to cover that population.
246
1 ASSEMBLYMAN KEITH BROWN: Okay.
2 Switching gears, so one of the
3 problems with bail reform was that
4 individuals who have substance use disorder,
5 it takes a longer period of time for them to
6 get treatment because now there's no
7 arraignment, necessarily. Right?
8 So for individuals who are
9 specifically arrested on DWI, there's
10 currently self-reporting screening. But
11 would you support mental health assessment to
12 provide treatment for co-occurring disorders
13 to help people get treatment faster?
14 OASAS COMMISSIONER CUNNINGHAM:
15 Absolutely. And we work, you know, with the
16 criminal justice system in many ways, and the
17 courts, to be able to do a better job of
18 identifying and then getting the services
19 that people need.
20 ASSEMBLYMAN KEITH BROWN: Okay. Real
21 quick, because I only have a few seconds
22 left. Individuals charged with possession of
23 controlled substances, would you support a
24 method of getting desk appearance tickets,
247
1 get them into treatment, and then if they
2 fail out of treatment, then the desk
3 appearance ticket would be turned over to the
4 court system?
5 OASAS COMMISSIONER CUNNINGHAM: We're
6 not a criminal justice organization, but
7 we're happy to partner with them to make sure
8 that people who do touch that system get the
9 best services that they need.
10 ASSEMBLYMAN KEITH BROWN: Excellent.
11 Thank you.
12 CHAIRWOMAN KRUEGER: Thank you.
13 Senator Helming.
14 SENATOR HELMING: Thank you,
15 Senator Krueger.
16 I walked in from session, so I did not
17 hear your testimony. But what I walked into
18 hearing was somebody was questioning about
19 the availability of services in our rural
20 communities. As someone who represents a
21 rural area, I'm concerned, because a part of
22 the response I heard was that we have robust
23 provider systems in place.
24 I'm going to tell you, based on the
248
1 calls I get from my constituents, that is
2 absolutely not the case. Parents will call
3 all the time about the lengthy waits to get
4 their children services, delays because of
5 insurance issues, and so much more.
6 That's my comment. Now I'll go to my
7 question. I also -- just continuing my
8 comment, I believe you will hear testimony
9 later, if you stick around, from a parent who
10 will tell you about the tragedy that occurred
11 in his family because of a lack of
12 availability of services because of delays.
13 But on to my question. The State
14 Prevention Agenda for 2019-2024 prioritizes
15 preventing substance use disorder, yet it
16 seems like our opioid-related deaths continue
17 to increase. Since 2015 it's my
18 understanding that New York State has ranked
19 in the top five in the nation year after
20 year.
21 As you know, and I think we can all
22 agree on, our counties are on the frontline
23 of addressing this public health crisis, and
24 yet I'm hearing from the local departments
249
1 that they don't have access to the realtime
2 data that's reported to the state. And how
3 helpful it would be for them when they're
4 addressing how to prevent this, how to do
5 better, if they had access to this data.
6 So my question is, do local health
7 departments have direct access to realtime
8 state data on opioid-related deaths?
9 OASAS COMMISSIONER CUNNINGHAM: Yes,
10 so I just want to clarify that the overdose
11 death rate has gone down by 17 percent in
12 New York State, and so that's the first time
13 we've seen this decrease in many years.
14 And we may have the largest number of
15 people who have died, but in terms of -- just
16 because of our size, but the rate is about in
17 the middle of the rest of the states.
18 SENATOR HELMING: I appreciate that
19 clarification.
20 Do our local county health departments
21 and others have access to the state's
22 realtime data?
23 OASAS COMMISSIONER CUNNINGHAM: So
24 that's a question for the Department of
250
1 Health. We don't have authority with those
2 county departments of health.
3 SENATOR HELMING: Okay, so you
4 wouldn't know if in this budget there is
5 anything to amend County Law 677 to formally
6 designate local health officials as
7 representatives of the State Commissioner of
8 Health so that they have access to this data?
9 OASAS COMMISSIONER CUNNINGHAM: So
10 that's not in Mental Hygiene Law, and I can't
11 really speak to the Public Health Law.
12 SENATOR HELMING: Would it help if our
13 local health departments had access to
14 realtime data to address --
15 OASAS COMMISSIONER CUNNINGHAM:
16 Absolutely. Absolutely.
17 SENATOR HELMING: Okay, I appreciate
18 that.
19 How about, then -- maybe this is for
20 health as well -- does the budget include an
21 increase in the reimbursement rates for
22 county coroners or medical examiners? DOH?
23 OASAS COMMISSIONER CUNNINGHAM: So
24 that's a question for DOH.
251
1 SENATOR HELMING: Okay. Thank you.
2 CHAIRWOMAN KRUEGER: Thank you.
3 Assembly.
4 CHAIRMAN PRETLOW: Assemblyman
5 Santabarbara, 10 minutes.
6 ASSEMBLYMAN SANTABARBARA: Thank you,
7 Mr. Chair.
8 Thank you both for being here. Thank
9 you for your testimony. Most of my questions
10 will be for Acting Commissioner Baer, in
11 relation to my committee.
12 I do want to talk about -- circle back
13 to the investment being made for nonprofit
14 providers. It's a major investment. But the
15 question for OPWDD, I guess, is how do we
16 ensure this money actually translates into
17 DSP salary increases? Because in the past we
18 have seen it go to other things, in
19 administrative costs and other items.
20 And a follow-up question to that:
21 Should we include budget language mandating
22 that a percentage go directly to DSP wages,
23 and is that something you would support?
24 And would you also support requiring
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1 midyear reporting for nonprofits to track how
2 these funds are actually being used,
3 including salary increases and new hires?
4 OPWDD ACTING COMMISSIONER BAER: Thank
5 you. So the $850 million goes, as we've
6 said, to our certified residential and
7 site-based providers.
8 The majority of the costs of running
9 those nonprofit organizations is their
10 frontline staff, so absolutely the
11 expectation is that the majority of that
12 investment will make its way to those
13 frontline workers. And we made that clear in
14 the letter, as I said, to those providers.
15 And I have already seen that
16 happening. I had no doubt that our providers
17 would do that, and it's been happening
18 immediately as they receive that cash. And
19 I've seen improvements immediately in terms
20 of recruitment for those providers. So we're
21 very excited about that.
22 There was language in the COLA statute
23 last year that directed that a certain
24 percentage of the COLA go to frontline staff.
253
1 That is not in the 2.1 percent targeted
2 inflationary increase this year. But again,
3 our providers use the bulk of all of their
4 funding to pay for staff. It's their single
5 biggest expense.
6 While it's not required, we at OPWDD
7 also do collect information from each of our
8 providers about how they utilize that
9 funding, and we track year over year how that
10 funding in the COLAs and the targeted
11 inflationary increases are used to increase
12 wages and by what percent. So we are able to
13 collect and report out on that information.
14 ASSEMBLYMAN SANTABARBARA: Great. And
15 that information's available to all of us?
16 OPWDD ACTING COMMISSIONER BAER: Yes.
17 We can make that available for you,
18 absolutely.
19 ASSEMBLYMAN SANTABARBARA: I want to
20 move on to self-direction budgets. This has
21 been a topic of discussion I know in my
22 community, and some advocates have been
23 talking about this.
24 I guess the question is, will the
254
1 budgets be adjusted to cover rising provider
2 costs? And I think we discussed a little bit
3 of this earlier. OPWDD actively encourages
4 self-directed individuals to purchase
5 certified services from providers, but these
6 services are costing more and self-direction
7 budgets are not increasing to cover these
8 costs. And the concern is that if it doesn't
9 change, we could -- individuals could lose
10 services while traditional service users see
11 their funding increase.
12 So the question I have today is, is
13 there -- do you have that same concern,
14 seeing increasing provider rates without
15 increasing self-direction budgets to match?
16 And is there a plan to prevent individuals
17 from losing services because of these rising
18 costs? And would you support a policy to
19 ensure that these budgets are adjusted
20 whenever we see these rate increases?
21 OPWDD ACTING COMMISSIONER BAER: So
22 every time that we get a targeted
23 inflationary increase or a cost-of-living
24 adjustment in the budget, those percentage
255
1 increases are also applied to the budgets
2 within the self-directed model.
3 So they absolutely increase each year
4 by the same percent that the other providers
5 get in terms of that inflationary increase.
6 And that definitely is helpful to keep them
7 current with the cost of providing that care.
8 We currently are working with a
9 consultant to look at our self-direction
10 model in totality. That provider -- or that
11 consultant, rather, is looking at how
12 self-direction is working in New York State,
13 how it's working in other states, to make
14 some recommendations about how we might look
15 to redesign self-direction in a future waiver
16 amendment. So we look forward to those
17 recommendations.
18 It is a pretty young service model in
19 New York State, and it's had a massive
20 explosion in terms of enrollment. So we're
21 very excited that so many people have availed
22 themselves to the flexibilities of
23 self-direction and always at ways to improve
24 it, and to make sure that it's really a
256
1 sustainable model of care going forward.
2 ASSEMBLYMAN SANTABARBARA: Okay, thank
3 you for that answer.
4 I do want to move on, with the time I
5 have left, to circle back to the housing
6 shortage that we seem to be experiencing.
7 The first question is, is there still a
8 survey going on as to what the housing crisis
9 is and where we need more services and where
10 we need more inventory?
11 I hear from families, many families in
12 my district that are waiting for housing
13 options for sometimes years.
14 There seems to be a gap between the
15 two main housing options: The group homes,
16 with limited availability, long waitlists,
17 and closures seem to be happening faster than
18 openings; and then housing supplements only
19 for those that are capable of independent
20 living, with minimal financial support. And
21 this is kind of leaving people out of options
22 on what to do when they need housing.
23 What is the timeline on addressing the
24 housing shortage? Is that survey still going
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1 on, and what is the timeline?
2 OPWDD ACTING COMMISSIONER BAER: Yes,
3 so we are always surveying network adequacy,
4 looking at people that are looking for
5 certified residential opportunities within
6 the system and making sure that we're meeting
7 that increasing need.
8 I think the survey that you reference
9 is about our capacity management system. So
10 this is our investment we've been able to
11 make in our IT infrastructure to really
12 capture, in an IT platform, sort of a
13 modern-day platform, where those vacancies
14 are and what types of services are available
15 in those vacancies, as well as whether
16 there's actual staff. Right? You have to
17 have staff to be able to make use of the
18 vacancy.
19 So the process that we're rolling out
20 now, which will take a year, right, to roll
21 out, to upload all of those profiles into our
22 system of what those vacancies look like so
23 that we can more easily match them with
24 people in the community.
258
1 Right now we have a very cumbersome
2 sort of paper matching process, which is very
3 person-centered but can take a lot of time to
4 make sure that somebody's needs are matched
5 in those opportunities.
6 So this really will go a long way
7 towards enhancing and creating a lot of
8 efficiency with some of that customer
9 experience part of the matching process. So
10 hopefully in a year I'll have some really
11 good news about how much faster that process
12 is happening.
13 ASSEMBLYMAN SANTABARBARA: Just as a
14 follow-up to that, are there plans for other
15 housing models? Particularly, there's been
16 discussion of non-certified supportive
17 housing; we talked about this a little bit
18 briefly beforehand as well.
19 Are there any plans to look into that,
20 or is that an option?
21 OPWDD ACTING COMMISSIONER BAER: So
22 this year's budget continues a $15 million
23 investment in those integrated supportive
24 housing projects that we work on. We match
259
1 those funds with HCR to open supportive
2 integrated apartments in the community for
3 people with I/DD.
4 We've opened 900 of those so far
5 through funding that this Legislature has
6 supported over the last several years. So
7 that is one example of non-certified housing.
8 We also spend about $70 million a
9 year, as you reference, on housing subsidies
10 to support people with disabilities to live
11 either in one of those supportive housing or
12 in any other affordable housing that they
13 find in New York State, to support them to
14 live as integrated as possible.
15 Our newest service this year, which I
16 want to make sure I don't forget to mention,
17 is home enabling supports. This is a new
18 waiver service only available for people who
19 live in non-certified housing. And that's
20 adaptive equipment, remote monitoring, other
21 technology -- telehealth capacity -- to help
22 people live more independently instead of
23 needing to move into that certified system.
24 So a lot of work happening on both
260
1 sides, absolutely.
2 ASSEMBLYMAN SANTABARBARA: Okay.
3 Thank you for that answer.
4 With the time I have left, I just want
5 to talk about crisis response -- just as a
6 follow-up to a previous question -- for
7 nonverbal individuals in particular.
8 There's -- current models rely on
9 outlines, verbal deescalation, and
10 traditional interventions, but it doesn't
11 work for nonverbal individuals with
12 developmental disabilities. Has there been
13 discussion on how to address this gap, I
14 guess, in services?
15 OPWDD ACTING COMMISSIONER BAER: Yeah,
16 it's such a good question. Most of our
17 interventions and therapeutic habilitative
18 services work for people who articulate
19 verbally and those who do not. But there
20 certainly is an increasing number of people
21 who don't articulate verbally, and that's
22 certainly a form of communication that we're
23 looking a lot at now, about how to better
24 meet the needs of those people, both the ways
261
1 that you mentioned and creating community and
2 peer supports for that part of the community.
3 ASSEMBLYMAN SANTABARBARA: All right.
4 Just with the time I have left, so you would
5 support the creation of specifically trained
6 people for crisis intervention that are
7 trained specifically for nonverbal?
8 OPWDD ACTING COMMISSIONER BAER:
9 Absolutely support the need to make sure that
10 those folks are trained and meeting the needs
11 of everyone, including our nonverbal.
12 ASSEMBLYMAN SANTABARBARA: Okay. And
13 hopefully we can see something in the budget
14 to reflect that. I certainly would like to
15 see more investment in this area, just to
16 address this issue that is still out there.
17 Okay, thank you.
18 OPWDD ACTING COMMISSIONER BAER: Thank
19 you.
20 Can I use 30 seconds of your time to
21 thank you as a family member, and for all of
22 the rich advocacy that you do for our service
23 system. The family members of people with
24 disabilities are so important to this system,
262
1 to make sure that we understand what the
2 needs are. And I thank you for your
3 advocacy.
4 ASSEMBLYMAN SANTABARBARA: Thank you.
5 Thank you for being here.
6 All set, Mr. Chair.
7 CHAIRWOMAN KRUEGER: Sorry. I'm
8 focused on lunch at the moment. How rude of
9 me.
10 Next is Senator Mayer -- no,
11 Senator Mayer went.
12 Senator Persaud, excuse me.
13 SENATOR PERSAUD: Good afternoon, both
14 commissioners.
15 My question is about OPWDD. You know,
16 I'm sitting here and I just got this letter
17 from C4SD talking, you know -- and their
18 challenges that you were talking about. And
19 so we have to look at that.
20 But I wanted to talk particularly
21 about the mandatory overtime that you were
22 talking about. We're hearing that there's an
23 abuse of mandatory overtime across the
24 system. There are workers who are required
263
1 to work two-and-a-half shifts, which is not
2 what we want. It's a hazard when that
3 happens because they are not able to give the
4 residents the service the way they should.
5 What are we doing to decrease
6 mandatory overtime? What are we doing to get
7 the workforce to the level that it should be?
8 What are we doing?
9 OPWDD ACTING COMMISSIONER BAER: So in
10 our state-operated facilities, which I think
11 is what you're asking about, we've had a lot
12 of luck this year in particular in terms of
13 recruitment. We hired 3,000 new
14 state-operated employees into our facilities,
15 which is more than what we saw pre-pandemic.
16 So we've come a long way in terms of
17 offering competitive wages and recruiting
18 staff to our state-operated facilities.
19 We brought overtime down this year by
20 24 percent, which is monumental, and that is
21 as a result of that recruitment and retention
22 that we've been able to build into state
23 operations, as well as the work that we've
24 really done to partner with our union
264
1 representatives in terms of creating that
2 open communication and relationship in the
3 state-operated workforce.
4 SENATOR PERSAUD: But it's happening
5 in the residences that are under your
6 guidance also -- you know, the voluntary --
7 why is that? Who is overseeing that the
8 workforce there is working, you know,
9 overtime that they should not be? We cannot
10 have people working to take care of our most
11 vulnerable population, working 18 hours.
12 That's not -- that's not -- there's something
13 wrong with that.
14 Who is looking into that so that we
15 curb that? And why are these operators being
16 allowed to get away with it?
17 OPWDD ACTING COMMISSIONER BAER: I
18 agree, it's very important to keep an eye on.
19 We want work/life balance. We want people
20 taking care of people with disabilities and
21 working with people with disabilities who are
22 not working three shifts in a row, are not
23 tired, right, or not at their best.
24 You know, in any human service
265
1 organization when you rely on staff to
2 provide health and safety minimums,
3 unfortunately sometimes there is the need to
4 keep staff for a second shift. I think it
5 was definitely more pervasive in our
6 state-operated programs, and now that is way
7 down. Anecdotally, I'm not sure that on the
8 nonprofit side they have quite the issue that
9 we did in state operations. But certainly
10 something that management's required to keep
11 an eye on and to make sure that staff is fit
12 to serve.
13 SENATOR PERSAUD: We'll contact your
14 office and give you some complaints.
15 OPWDD ACTING COMMISSIONER BAER: Okay.
16 SENATOR PERSAUD: Thank you.
17 OPWDD ACTING COMMISSIONER BAER: Thank
18 you.
19 CHAIRWOMAN KRUEGER: Thank you.
20 Assembly.
21 CHAIRMAN PRETLOW: Assemblywoman
22 Giglio.
23 ASSEMBLYWOMAN GIGLIO: Yes, good
24 afternoon. And thank you, both of you, for
266
1 what you do.
2 And, Acting Commissioner, I really
3 appreciate you coming to Long Island and
4 visiting some of our medically fragile homes
5 and seeing what the needs are there, and
6 hopefully going to be working together with
7 DOH in the future to make sure that the needs
8 of those individuals have been met.
9 When people with behavioral needs are
10 transitioning into new homes, it's essential
11 that the staff working with them are properly
12 trained and prepared to handle any behaviors
13 that may arise. This can significantly
14 reduce the need for law enforcement
15 intervention.
16 Properly trained workers can
17 deescalate situations, understand triggers,
18 and provide the right support to individuals
19 during challenging moments. Effective
20 communication, proactive strategies, and a
21 trauma-informed approach can help maintain
22 safety and prevent situations from escalating
23 to the point where law enforcement may need
24 to be called.
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1 Collaboration with mental health
2 professionals, social workers, and the
3 individual's family, including the previous
4 home that the person was in, and that
5 collaboration before they transition into a
6 new home to make sure that everyone's on the
7 same page, is crucial for a smooth transition
8 and minimizing behavior-related issues.
9 Preparing the environment to be calm,
10 structured, and predictable also contributes
11 to preventing behaviors from escalating.
12 What other steps do you think are
13 crucial to ensure these individuals are
14 supported during transitions? And does OPWDD
15 need funding for staffing to ensure a smooth
16 transition with suitable trained employees in
17 the homes that can address these behavioral
18 needs?
19 OPWDD ACTING COMMISSIONER BAER: Thank
20 you. I think you hit so many of the
21 important pieces of maintaining continuity
22 for people, and that collaboration as people
23 look to transition from one service setting
24 to another. We see this particularly with
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1 our young adults who are aging out of our
2 residential schools.
3 Which is why it takes two to three
4 years of planning on our part, ahead of time,
5 to really match those young people aging out
6 of residential schools to ensure that the
7 provider that is offering them an opportunity
8 in their residence understands who that young
9 person is, is prepared to meet the behavioral
10 needs. Right?
11 It's an age range that is probably the
12 hardest to serve in any system, and it's
13 someone that you're getting at their sort of
14 strongest and most behaviorally challenging,
15 right. So that continuity is so important,
16 and that communication.
17 ASSEMBLYWOMAN GIGLIO: It is, and
18 especially when a new group home is being
19 formed and it doesn't have any residents in
20 the home, that that home needs to be prepared
21 and OPWDD needs that oversight to make sure
22 that they are prepared to take in those
23 people with behavioral needs and to
24 communicate with the home that they're coming
269
1 from to make sure that if there are
2 protocols, they're met.
3 And also if law enforcement is called,
4 if you're not able to deescalate. And law
5 enforcement is called a lot into group homes
6 to come and help or restrain. And that is
7 really very challenging, not only for the
8 resident, the person that has the behavioral
9 need, but also for law enforcement. And I
10 think that, you know, we really need to make
11 sure the people in the homes are trained and
12 that papers are going with them and law
13 enforcement knows what they're walking into
14 if they're expected to go into a situation
15 like that.
16 So I'd love to work with you on that.
17 And then my next question is, you
18 know, the COLA -- and we're not calling it a
19 COLA anymore, I guess. In the Governor's
20 budget we're calling it a 2.1 percent
21 inflationary increase. They're still behind.
22 You know, the rebates were great. The
23 not-for-profits are still behind, eight years
24 behind, in the funding levels that they need
270
1 to be up to in order to maintain and to
2 provide proper care.
3 So I think we really need to push for
4 at least a 5 percent increase in the COLA, or
5 the inflationary cost. Because as the costs
6 go up and the wages go up, so does the
7 capital that they need in order to run the
8 home.
9 So when it comes to the capital
10 funding and the 15 million, will these ones
11 be used for both state-operated and
12 community-based facilities, not-for-profits?
13 OPWDD ACTING COMMISSIONER BAER: So
14 the $15 million I think you're referring to
15 is for our integrated supportive housing
16 projects, so those are independent apartments
17 for people who can live independently with a
18 little bit of additional support in the
19 community.
20 ASSEMBLYWOMAN GIGLIO: Is there any
21 funding for housing for DSPs or affordability
22 of housing for DSPs in rural areas?
23 OPWDD ACTING COMMISSIONER BAER: There
24 is not a particular investment in this year's
271
1 budget for housing for DSPs. But the
2 Governor has made a $25 billion proposal to
3 create affordable housing statewide. It's
4 part of the Pro-Housing Communities
5 initiative, which I think will greatly
6 benefit DSPs as well as people with
7 disabilities looking for affordable housing.
8 ASSEMBLYWOMAN GIGLIO: Can we
9 prioritize DSPs in rural areas for these
10 affordable housing projects? Can we push for
11 that?
12 OPWDD ACTING COMMISSIONER BAER:
13 That's not my program.
14 ASSEMBLYWOMAN GIGLIO: Thank you.
15 CHAIRWOMAN KRUEGER: Thank you very
16 much.
17 We have -- is Senator Weber back? No.
18 Okay. Senator Rolison, did you go
19 yet? No. Senator Rolison.
20 SENATOR ROLISON: Thank you,
21 Madam Chair.
22 This question is for Commissioner
23 Cunningham. I see that in one of the
24 briefing papers that I got there was
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1 additional money for street outreach in this
2 year's proposed Executive Budget. Can you
3 just give me a brief understanding of that
4 and how that money goes out and the process
5 in which it is distributed, and also what the
6 makeup of the teams are, to your knowledge.
7 OASAS COMMISSIONER CUNNINGHAM: Yes.
8 So that $3 million is to continue to enhance
9 and expand our street outreach teams, and
10 particularly focus on those with co-occurring
11 disorders, so mental health and substance use
12 disorders.
13 So we're working with OMH to really
14 think about how to best target that to make
15 sure that, for example, some of their
16 existing teams we add the addiction expertise
17 to that, in addition to expanding.
18 So a lot of this is going to be
19 targeted, you know, based on kind of where
20 the need is in various communities. And that
21 really builds on an extensive, you know,
22 programming that we have on street outreach
23 and engagement, which we're investing over
24 $30 million in.
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1 SENATOR ROLISON: So as a former
2 mayor, I am a huge proponent of street
3 outreach teams and the work that they do --
4 you know, meeting people where they are. Of
5 course, right? And the -- I had mentioned to
6 Dr. Sullivan the SOS team, which is operating
7 now in my district, the 39th, which has been
8 very, very beneficial to many people. I just
9 actually got a text message from the local
10 outreach team coordinator, who said they're
11 getting ready to place six individuals in
12 housing, because that's part of that program,
13 is a housing component.
14 And so when you're looking at that and
15 the group is looking at that, do you have the
16 ability to structure these RFPs, or however
17 they're going to be done, to have that
18 coordinated team with housing, with OASAS'
19 help, with OPWDD -- because I'm seeing, you
20 know, in the communities that I represent,
21 more individuals with certain types of
22 disabilities that are on the street -- may
23 not be homeless, but they're on the street in
24 wheelchairs, in walkers, and they've got, you
274
1 know, different types of challenges.
2 Because to me, when you have that
3 wraparound approach, you're getting the best
4 for your money and so is the individual that
5 could be receiving the outreach.
6 OASAS COMMISSIONER CUNNINGHAM: Yes.
7 I mean, this is exactly the goal. And so,
8 you know, we're working with OMH now to
9 figure out the details there.
10 SENATOR ROLISON: Good. Thank you.
11 OASAS COMMISSIONER CUNNINGHAM: Yes.
12 CHAIRWOMAN KRUEGER: Thank you.
13 Assembly.
14 CHAIRMAN PRETLOW: Assemblyman Ra.
15 ASSEMBLYMAN RA: Good afternoon.
16 Commissioner Cunningham, I want to
17 just follow up on my colleague's questions
18 about kratom. Just in terms of do you know
19 of data within the department or instances
20 where that is an individual's primary
21 substance of use?
22 OASAS COMMISSIONER CUNNINGHAM: We do
23 collect that information. I'd have to go
24 back and look specifically at the details
275
1 about the numbers.
2 I can tell you if -- the number's
3 quite low. You know, the vast majority of
4 people come into our system for either
5 alcohol use disorder or opioid use disorder.
6 ASSEMBLYMAN RA: Okay. And I know I
7 found some of the statistics on the website,
8 so I would assume it would be under the "all
9 others" category if there were instances?
10 OASAS COMMISSIONER CUNNINGHAM: That's
11 correct, yeah.
12 ASSEMBLYMAN RA: Okay. I wanted to
13 move over to Acting Commissioner Baer.
14 Good to see you again. Thank you for
15 the conversation a few weeks ago.
16 An issue that keeps coming up when I
17 talk to both colleagues who deal with this
18 personally and advocacy groups, people trying
19 to get services for their children, is the
20 issue of private-duty care, private-duty
21 nursing. You know, just their inability to
22 find people that can work with their loved
23 ones.
24 You know, they're approved for it,
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1 they're -- you know. If the staffing or the
2 individuals were there, they would be able to
3 get, you know, all these hours, and they just
4 can't find anybody.
5 And I know there's a couple of pieces
6 of legislation with regard to this and trying
7 to -- you know, we're trying to work through
8 how we deal with the federal side, Medicaid,
9 all of these different things. But if you
10 can tell me a little bit about, you know,
11 what the agency is doing to try to address
12 that issue.
13 OPWDD ACTING COMMISSIONER BAER: So I
14 can't really speak to private-duty nursing,
15 which would fall under the Department of
16 Health.
17 What I can say is we've been able to
18 increase rates of pay for nursing staff to
19 support our certified residential facilities
20 both through the nonprofit rate rebase and at
21 the state level, and have had marginal
22 success with recruiting that nursing staff.
23 It certainly is an issue shared across
24 systems and something that I know
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1 Commissioner McDonald is looking at at the
2 Department of Health as well.
3 ASSEMBLYMAN RA: And I know one of the
4 things we spoke about a few weeks ago was
5 housing for individuals with disabilities,
6 and trying to maybe get a little more
7 creative.
8 Down on Long Island, you know, our
9 former colleague Missy Miller, who's now on
10 the town board there, is trying to come up
11 with some innovative ways to address what is
12 one of the largest concerns that parents have
13 if they have an adult with disabilities,
14 which is "What's going to happen when I'm
15 gone?" And they're trying to, you know, be
16 proactive in planning for that.
17 So I want to again thank your staff
18 for engaging with us on this issue to try to
19 address that particular issue. I don't
20 really have a question with regard to that.
21 The last thing I do have a question
22 with regard to: I've had a number of people
23 ask me about trying to take new measures to
24 make sure residents are safe when they're in
278
1 group homes. And, I mean, there are people
2 who want, you know, some type of cameras.
3 And I understand that, you know, there's
4 privacy issues, there's issues with the
5 workforce, all of that.
6 But is that something that the agency
7 is looking at?
8 OPWDD ACTING COMMISSIONER BAER: At
9 cameras specifically?
10 ASSEMBLYMAN RA: Yeah. Yes. Or other
11 measures in terms of safety for the
12 residents.
13 OPWDD ACTING COMMISSIONER BAER: Sure.
14 I mean, we prioritize safety of residents,
15 the folks that live through our residential
16 system first and foremost, right? We've got
17 a 24-hour incident management unit that
18 responds immediately to incidents,
19 allegations of abuse and neglect, to make
20 sure that corrective actions are taken. We
21 make trainings available to providers all
22 year.
23 Just earlier -- late last month we
24 offered a training with two national experts
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1 for all of our providers on the top 5
2 preventable illnesses and causes of death in
3 the population, right?
4 So we -- absolutely, safety is a top
5 priority. The issue of cameras I have heard
6 family members talk about the idea of cameras
7 being installed for surveillance purposes. I
8 mean, as a family member I certainly
9 emphasize with wanting to make sure that your
10 loved one is safe at all times when they're
11 not in your care.
12 Federal guidelines are pretty clear
13 about the right to privacy. These are not
14 transitional settings like a psychiatric
15 hospital. These are people's homes.
16 We'll talk more offline.
17 ASSEMBLYMAN RA: Sure.
18 CHAIRWOMAN KRUEGER: Sorry. Thank you
19 very much.
20 Senator Canzoneri-Fitzpatrick, ranker,
21 five minutes.
22 SENATOR CANZONERI-FITZPATRICK: Thank
23 you, Chair.
24 Thank you both for being here. My
280
1 question first is for Commissioner
2 Cunningham.
3 I understand that the budget supports,
4 you know, a large increase to triple the
5 number of Certified Community Behavioral
6 Health Clinics. And I support that. And
7 that, in addition, crisis stabilization
8 centers are going to be increased and looking
9 forward to the one opening in Nassau County,
10 my hometown.
11 One of my questions, though, which I
12 believe was asked but I'm not sure it was
13 asked with great detail, is that if we are
14 increasing the fund for the uncompensated
15 care pool, if that's going to be increased
16 commensurate with the number of facilities
17 we're opening, or else you're going to have
18 multiple centers competing for the same pool
19 of funds.
20 So is there enough funding there to
21 support the increase in these centers?
22 OASAS COMMISSIONER CUNNINGHAM: So
23 that's a question that we're discussing with
24 OMH. And it's certainly an issue that
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1 continues to come up, and we want to make
2 sure that we are supporting that care for
3 those with -- uninsured, underinsured.
4 SENATOR CANZONERI-FITZPATRICK: Okay,
5 great.
6 And for Commissioner Baer, my
7 question: Nonprofit provider agencies
8 serving the intellectual and developmental
9 disabilities communities have a vacancy rate
10 of almost 17 percent, from what I've been
11 told, with an annual turnover rate of over
12 35 percent of our DSPs. I am concerned about
13 that in the fact of the proposed COLA
14 increase of only 2.1 percent compared to
15 inflation of 2.9. And our advocates are
16 asking for 7.8. And there's a big gap there
17 to fill.
18 So my question is, how should we be
19 better addressing these vacancy rates and is
20 this 2.1 percent COLA increase, do you think
21 that's going to help these rates that I'm
22 mentioning because I really -- as I said
23 earlier, a 7.8 percent increase is probably
24 more appropriate.
282
1 So I'd like to know what your thoughts
2 are on that.
3 OPWDD ACTING COMMISSIONER BAER: So if
4 we're talking about staff vacancy, I think
5 all of the things we talked about with the
6 rate rebase -- I don't want to keep coming
7 back to an $850 million investment. It's a
8 significant investment. It is a huge part of
9 the solution. I understand it doesn't solve
10 all of the problems. Right?
11 OPWDD has also partnered with our
12 providers in a number of other ways to try to
13 facilitate the retention and recruitment of
14 staff. We had a $10 million investment
15 through the National Alliance of Direct
16 Support Professionals to create a
17 credentialing program, and we've partnered
18 with 41 of our nonprofit agencies to make
19 that credential and the stipend that comes
20 with that available to their staff. That's
21 been very successful.
22 We also have a $50 million contract
23 through the State University of New York to
24 provide microcredentialing and college
283
1 credits, which are funded through that grant
2 for DSPs to go back to school and get up to
3 12 hours of college credits along with the
4 microcredential that comes along with that.
5 So things like that to really
6 professionalize the career of being a direct
7 support professional. I go to those
8 graduations and talk to those DSPs and it
9 really has gone a long way to making those
10 DSPs feel valued and professional and
11 supported in those workplaces. So thinking
12 about how to support our providers from all
13 angles. I talked about our strategic plan a
14 little bit and ways that we're coming up with
15 to try to get other capital funding to
16 providers faster and to reduce some of the
17 administrative burdens that we hear
18 complaints about as well.
19 SENATOR CANZONERI-FITZPATRICK: Well,
20 thank you for that. I do think, though, that
21 the COLA increase is certainly an important
22 piece of what you've just said. I agree that
23 those other pieces are part of the package,
24 but if you can't pay your own bills, it's
284
1 very difficult.
2 In addition to those challenges that
3 we've talked about, there are increased costs
4 facing provider agencies in order to be in
5 compliance with the state's environmental and
6 efficiency laws and regulations as part of
7 the CLCPA. Does the Executive Budget include
8 funding that reflects these increased costs
9 to assist these agencies with these costs so
10 that they aren't forced to choose between
11 complying with new mandates versus adequately
12 funding their workforce?
13 OPWDD ACTING COMMISSIONER BAER: So
14 what's included in our budget is the
15 2.1 percent targeted inflationary increase to
16 help with increased costs for things like
17 that, right?
18 We also provide property funding and
19 capital to providers as they look to renovate
20 their physical plant in terms of compliance
21 with the Climate Act. I'm not aware of any
22 specific funding in this year's budget to
23 support the nonprofits.
24 SENATOR CANZONERI-FITZPATRICK: And
285
1 then I know that the capital budget -- the
2 Executive Budget recommends an appropriation
3 for capital funding that's been increased.
4 And my question is, how are we going to use
5 that capital --
6 (Time clock sounds.)
7 SENATOR CANZONERI-FITZPATRICK: All
8 right, thank you.
9 CHAIRWOMAN KRUEGER: Thank you.
10 Assembly.
11 CHAIRMAN PRETLOW: Assemblyman
12 Burdick, three minutes.
13 ASSEMBLYMAN BURDICK: Thank you.
14 And thank you, Commissioner. This is
15 of course to the commissioner of OPWDD.
16 Among the people in the disability
17 community with whom I work is the senior vice
18 president of the New York State Arc. She
19 tells me that there are an estimated 5,000 to
20 7,000 on waiting lists for group homes, and
21 many in the Mid-Hudson region.
22 I would appreciate your getting back
23 to us on how the lists are maintained, the
24 number of vacant group homes, where they are
286
1 located, and your agency's plan for getting
2 them reopened. So not looking for an answer
3 now on that.
4 Another one that I'm not looking for
5 an answer now on, but wanted to get it on the
6 record, is we've been looking at the model
7 for integrated housing that the United Way of
8 Northern New Jersey has been involved in.
9 They've established, over the last decade,
10 44 housing communities supporting adults with
11 autism and other neurodiversities, veterans,
12 seniors, and working families.
13 Senator Harckham and I toured one of
14 the communities in Florham Park two years
15 ago, discussed it with your predecessor and
16 her staff, and I don't believe that anyone
17 from OPWDD has had a chance to visit the
18 site, though they've had plans to do so.
19 We recognize that Jersey has a
20 different waiver than New York, but we think
21 that it appears that the model could be
22 adapted and still be compliant with New York,
23 and we'd appreciate your getting back to us
24 on the status for visiting the site and
287
1 reviewing the model.
2 Now the next question it would be
3 helpful to get an answer to. There are two
4 vacant group homes in Westchester County.
5 One is in my district in North Salem and has
6 been vacant for over five years. Let's
7 assume that there is a responsible provider
8 who meets OPWDD requirements and has the
9 staff to do so to operate them. How can we
10 get these reopened, and who can we work with
11 on your staff to do so?
12 OPWDD ACTING COMMISSIONER BAER: So it
13 sounds like you're asking about a vacant
14 state-operated program. We operate about
15 1300 facilities statewide. And so where
16 those programs are operating out of can
17 change based on the availability of staff.
18 When we identify unused facilities, which is
19 what it sounds like you're asking about,
20 happy to engage about better utilization of
21 that space.
22 Our properties would have to go
23 through a DASNY or OGS process, but certainly
24 happy to look at making better use of
288
1 underutilized state space. A provider
2 looking to open additional capacity would
3 meet with our regional office to see what the
4 need for services are in that area, and
5 there's a process for that.
6 So happy to talk offline about the
7 particular situation.
8 ASSEMBLYMAN BURDICK: Great. Thank
9 you so much.
10 CHAIRWOMAN KRUEGER: Senator Ashby.
11 SENATOR ASHBY: Thank you,
12 Madam Chair.
13 Commissioner Baer, Commissioner
14 Cunningham, thank you for being here. Good
15 to see you both.
16 Commissioner Cunningham, the
17 Times Union has done extensive reporting on
18 lower enrollment in drug courts following
19 changes to bail and discovery laws. How are
20 you responding to that? And would you be
21 supportive of legislation that --
22 CHAIRWOMAN KRUEGER: I'm sorry,
23 Senator Ashby, can you speak up or pull that
24 a little closer to you? We're having trouble
289
1 hearing you.
2 SENATOR ASHBY: Will you put more time
3 on my clock?
4 (Laughter.)
5 CHAIRWOMAN KRUEGER: No, it's okay.
6 SENATOR ASHBY: You heard that.
7 (Laughter.)
8 SENATOR ASHBY: So the Times Union has
9 done extensive reporting on lower enrollment
10 in drug courts following changes to bail and
11 discovery laws. How are you responding to
12 that? And would you be supportive of
13 legislation that allows lower-level
14 defendants to be remanded so they can receive
15 supervised treatment and detox?
16 OASAS COMMISSIONER CUNNINGHAM: So we
17 work very closely with many of the agencies
18 that deal with the criminal justice system,
19 and the courts in particular. So we are
20 working with the overdose intervention
21 courts, making sure that we have peers,
22 people with lived experience in those
23 settings, to help identify substance use and
24 then link those individuals to services.
290
1 So I think, you know, we're of course
2 very happy to continue to build on that
3 partnership, but we have a pretty extensive
4 partnership with many of the jails, the
5 prisons, the court system, to make sure our
6 individuals get the best treatment possible.
7 SENATOR ASHBY: But with the reduction
8 of the enrollment that we've seen in those
9 courts, do you think that we're failing to
10 adequately reach out to those who need the
11 help who may be lower-level offenders?
12 OASAS COMMISSIONER CUNNINGHAM: I
13 mean, we really use the harm-reduction
14 approach by investing in outreach and
15 engagement teams and really trying to make
16 treatment more accessible for individuals.
17 And so there's a -- you know, investing, you
18 know, over $30 million in that work to
19 reach -- to go out and reach those who may
20 not necessarily come to us, but to really
21 reach them where they are, and all throughout
22 the community.
23 SENATOR ASHBY: Thank you.
24 Commissioner Baer, our wheelchair
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1 repair process in New York State is in need
2 of revision, to say the least. Do you --
3 would you or the Executive be open to
4 reforms, including waiving prior
5 authorization for repairs, right to repair
6 laws, and requiring repairs to be completed
7 in a timely manner?
8 OPWDD ACTING COMMISSIONER BAER: I
9 appreciate the focus on the need for
10 wheelchair repair. I know that there's a
11 proposal in this year's budget around durable
12 medical equipment and wheelchair repair.
13 Unfortunately, that's through the Department
14 of Health, so it's not my place to weigh in.
15 SENATOR ASHBY: Given the population
16 that you work with, do you see this as an
17 issue among the population that you're
18 serving?
19 OPWDD ACTING COMMISSIONER BAER: I
20 certainly appreciate the focus in this year's
21 budget in making sure that there's a better
22 process to repair wheelchairs, absolutely.
23 We had a self-advocate that was
24 supposed to be here with us today who was
292
1 unable to join us because of wheelchair
2 issues in her home.
3 SENATOR ASHBY: I will take that as a
4 yes, thank you.
5 CHAIRWOMAN KRUEGER: Thank you.
6 Assembly.
7 CHAIRMAN PRETLOW: Assemblywoman
8 Gallagher.
9 ASSEMBLYWOMAN GALLAGHER: Hi. Thank
10 you so much, Commissioners, for coming out
11 today.
12 I have a question for each of you, so
13 I'm going to talk quickly but loudly so that
14 we can get through both.
15 So for Commissioner Baer, I've been
16 hearing -- I think this is not necessarily
17 your wheelhouse, but I think your opinion's
18 really going to matter on it. I've been
19 hearing a lot about CDPAP from my
20 constituents. I'm deeply concerned about the
21 speed of the proposed transition and the
22 general thrust towards a single financial
23 intermediary.
24 My question for you is whether you
293
1 think seven weeks is enough time for people
2 with serious mental and physical disabilities
3 to make this transition.
4 OPWDD ACTING COMMISSIONER BAER: So I
5 can't opine about the time of the transition.
6 We do have 9,000 people in the OPWDD system
7 who are also receiving healthcare services
8 through the CDPAP, and I know that our care
9 managers who work with those individuals are
10 working to help them make that transition as
11 quickly as possible.
12 ASSEMBLYWOMAN GALLAGHER: Okay.
13 That's good to hear. I still am not sure if
14 you think that that's really enough time,
15 though.
16 OPWDD ACTING COMMISSIONER BAER: I
17 don't oversee that program so I can't speak
18 to how complicated it is to make that
19 transition.
20 ASSEMBLYWOMAN GALLAGHER: Rats. Okay.
21 So for my other question for
22 Commissioner Cunningham, I was heartened to
23 see the 53 million proposed COLA for
24 behavioral health workers in this year's
294
1 Executive Budget. Can you talk about how
2 much this actually translates to individual
3 workers? Because I know there's a crisis of
4 retention in many of the facilities that we
5 rely on.
6 OASAS COMMISSIONER CUNNINGHAM: Yes.
7 So the targeted inflationary increase will --
8 is $12 million in our system, plus the
9 increase in minimum wage is another 6
10 million. And I think, you know, it is
11 important because there are many other things
12 that we're doing to also support the
13 workforce. You know, we have many, many
14 scholarships, over a thousand people have
15 gotten scholarships. Right? We're doing
16 paid internships.
17 So we're really trying to bring more
18 people into the field and to retain them when
19 they come in the field.
20 ASSEMBLYWOMAN GALLAGHER: That's
21 great. And regarding some of the people out
22 in the field, how many inspectors do you have
23 going to different facilities to make sure
24 people are keeping up with the oversight on
295
1 behavioral health facilities? And how many
2 would be ideal for you?
3 OASAS COMMISSIONER CUNNINGHAM: So we
4 work -- so the Justice Center really does a
5 lot of the inspections when there are issues
6 or reports. And we work with them, but they
7 really have oversight over those incidents.
8 And then we have our -- you know, our sort of
9 regional offices that work with our programs
10 if there's any questions or issues that they
11 need to work through.
12 ASSEMBLYWOMAN GALLAGHER: Okay. So
13 there's no one that does kind of like pop-up
14 inspections or anything like that?
15 OASAS COMMISSIONER CUNNINGHAM: I
16 mean, our regional office works with the
17 programs and will go and do site visits. But
18 I think when there are reports of incidents,
19 that's handled by the Justice Center.
20 ASSEMBLYWOMAN GALLAGHER: Okay. Thank
21 you.
22 OASAS COMMISSIONER CUNNINGHAM: Sure.
23 CHAIRWOMAN KRUEGER: Okay.
24 Senator Tom O'Mara. Ranker, five
296
1 minutes.
2 SENATOR O'MARA: Thank you.
3 Good afternoon. Thank you both for
4 being with us today.
5 To Commissioner Baer on the -- just to
6 follow up on a lot of my colleagues' comments
7 on the direct service professionals' increase
8 in the budget being quite woeful. That's not
9 even keeping up with inflation. I know
10 inflation's been cited as being 2.9 percent,
11 but actually the New York area inflation is
12 4.3 percent. New York area core inflation is
13 4.7 percent over the past 12 months.
14 Just the increase to the minimum wage
15 again this year going up, it's 3.3 percent.
16 More than a percent higher than what you're
17 offering to direct service professionals.
18 The minimum wage in New York State just over
19 the past six years has gone up about
20 25 percent. The pace of cost-of-living
21 adjustments for DSPs is nowhere near that.
22 How are our service providers,
23 agencies, supposed to keep up staffing?
24 We're having group homes closed all over the
297
1 place because of the lack of ability to hire
2 people, when they can work minimum wage at a
3 fast-food place with a much more reliable
4 schedule, much less demanding work. Why are
5 we not keeping pace when your own increases
6 for state OPWDD workers have gone up at a
7 much faster rate than DSPs? How can you
8 justify that in this budget?
9 OPWDD ACTING COMMISSIONER BAER: So I
10 think it's important to remember that the
11 2.1 percent targeted inflationary increase
12 this year is compounded on the last three
13 concurrent years of providing an inflationary
14 increase to providers. Along with the
15 $850 million investment, the millions of
16 dollars on bonuses and ARPA-funded projects,
17 it's almost $4 billion across my service
18 system in the last four years, which has
19 really been an incredible investment for this
20 field to get them caught up to modern-day
21 costs.
22 The rate enhancement alone increased
23 our providers by 13 percent statewide. So
24 while it is absolutely important to stay
298
1 current with the cost of inflation so that
2 the cost of doing business is possible for
3 those providers, you have to remember that
4 we're incrementally catching people up to
5 what was years of underinvestment in a prior
6 administration.
7 SENATOR O'MARA: Well, I don't see
8 that we're catching people up. We're losing
9 ground to the minimum wage increase, with the
10 increases that have been given. So how can
11 we continue to lose ground to the annual
12 minimum wage increases and expect our
13 agencies to be able to provide the staffing
14 for these facilities?
15 OPWDD ACTING COMMISSIONER BAER: Our
16 budget also includes a $38 million investment
17 to keep providers caught up to minimum wage
18 increases as well. So that's baked into the
19 overall enhancement for the service system.
20 SENATOR O'MARA: I think we need to do
21 better for our DSPs and these agencies, and
22 hopefully this Legislature will do that in
23 the final budget here.
24 Thank you.
299
1 OPWDD ACTING COMMISSIONER BAER: Thank
2 you.
3 CHAIRWOMAN KRUEGER: Assemblymember.
4 CHAIRMAN PRETLOW: Assemblyman
5 Epstein.
6 ASSEMBLYMAN EPSTEIN: Thank you,
7 Chair, and thank you both for being here.
8 Really I just wanted to --
9 Commissioner Baer, I just wanted to -- you
10 know, I know we talked a lot about the COLA,
11 so I just want to up-one that we really need
12 to talk about the workforce. I just want to
13 focus on that for a second.
14 But could I ask you, there are two
15 bills that I had passed last year on that.
16 In the infinite wisdom of the Governor, she
17 vetoed, I guess with the urging of the agency
18 really one established to look at and
19 evaluate how we can streamline requirements
20 for applications through OPWDD as well as
21 other agencies. Because what we've heard
22 from a lot of constituents is I apply for one
23 agency, I have to reapply for a second
24 agency. It takes me a year for Agency 1, it
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1 takes me another year for Agency 2 and 3.
2 And so there's no streamlining going on, so
3 you have a lot of frustrated New Yorkers who
4 are just trying to get care and support.
5 I'm wondering what the logic is to not
6 having a process that's streamlined and why
7 we are not doing more to help regular
8 New Yorkers who need help.
9 OPWDD ACTING COMMISSIONER BAER: So I
10 think our system is entirely different than
11 OTDA's system, which is entirely different
12 from OASAS's system, right? And that is a
13 historical product of running those siloed
14 agencies.
15 What I can say is we have come a long
16 way towards integrating that data
17 communication talking to one another. Our
18 care coordination organizations which we
19 launched just a few years ago, right, are
20 responsible for not just focusing on
21 someone's I/DD needs, but to also integrate
22 their physical health, behavioral health,
23 specialty health.
24 And so we in New York are growing a
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1 lot in the space of integrating that
2 information. The Governor's new office on
3 innovation and efficiency is certainly
4 focusing on reducing wait times in New York
5 State and enhancing the customer experience
6 for New Yorkers. I think that touches a lot
7 on what you're getting at.
8 ASSEMBLYMAN EPSTEIN: Yeah, so I have
9 to say that, you know, unfortunately -- I
10 appreciate what you're saying. But to the
11 public at large, they don't see it, and
12 they're frustrated.
13 And the idea of just like there's a
14 simple way to do it, just to come together
15 and have an official process with an outcome,
16 with an easy way to resolve that, that we
17 heard directly from a hearing from
18 constituents. And unfortunately, through
19 whatever urging from the agencies, the
20 Governor made her decision to veto.
21 Another issue is on hiring of people
22 with disabilities, employment for people with
23 disabilities. I'm wondering how your agency
24 tracks, you know, how successful we are,
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1 ensuring that our procurement and operations
2 that we're ensuring people with disabilities
3 get those employment jobs that we're talking
4 about.
5 OPWDD ACTING COMMISSIONER BAER: Yeah,
6 it's such a great question.
7 We provide a continuum of employment
8 services all the way through someone who
9 needs just a little bit of vocational
10 training --
11 ASSEMBLYMAN EPSTEIN: I mean, in
12 government jobs, how do we know how we're
13 doing as government to ensure that people
14 with disabilities are getting government
15 jobs?
16 OPWDD ACTING COMMISSIONER BAER:
17 Government jobs.
18 ASSEMBLYMAN EPSTEIN: Government jobs.
19 Like you. Like us. Like all of us.
20 (Laughter.)
21 ASSEMBLYMAN EPSTEIN: How do we ensure
22 we do a better job getting those people with
23 disabilities internship opportunities,
24 supervision -- because we're not doing a good
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1 job. And we're not even tracking it, so we
2 don't even know what's happening.
3 OPWDD ACTING COMMISSIONER BAER: It's
4 so important. We had a pilot in New York
5 City that was very successful --
6 (Time clock sounds.)
7 OPWDD ACTING COMMISSIONER BAER: Oh,
8 happy to talk offline about it.
9 ASSEMBLYMAN EPSTEIN: Thank you.
10 OPWDD ACTING COMMISSIONER BAER: A lot
11 of exciting work there.
12 CHAIRWOMAN KRUEGER: Okay, I think I'm
13 the last Senator except for one quick
14 follow-up afterwards.
15 So you were just -- I'm sorry,
16 Commissioner -- sorry. This is for OPWDD,
17 Commissioner Baer.
18 So my colleague just asked you about
19 group homes closing. We heard in an earlier
20 testimony how difficult it is to site
21 programs. And we know we have demand. So
22 why are we having group homes closing in
23 New York State? And was that an accurate
24 statement that was made?
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1 OPWDD ACTING COMMISSIONER BAER: So I
2 think in a service system this size there's
3 always growth and movement within the system.
4 On the state side, which I think is what the
5 question was about, it was temporarily
6 suspending programs and state operations,
7 which we do when we can't meet a staffing
8 need in a certain area of the state.
9 So we don't close the capacity to
10 serve people, we move that program to a
11 different location and maintain the capacity
12 to serve people in a different space.
13 CHAIRWOMAN KRUEGER: So if I have
14 family members in an OPWDD contracted site or
15 a state site, and you close the site that my
16 family member's in and move it somewhere else
17 in the state because, quote, you didn't have
18 adequate staff, isn't that an enormous
19 problem?
20 OPWDD ACTING COMMISSIONER BAER: Yes,
21 and it almost never happens in the state side
22 that we have programs where people are living
23 that we need to move.
24 When we have programs in the nonprofit
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1 side that the nonprofit can no longer run, we
2 do a lot of work in our regional office and
3 with our teams to match that provider with a
4 new nonprofit provider who has the staffing
5 capacity to take over that program in place,
6 to cause as little disruption as possible to
7 the people that are using those services.
8 CHAIRWOMAN KRUEGER: So would it be
9 more accurate to describe it as one
10 not-for-profit might no longer be running
11 that site, but it continues and remains open
12 under another not-for-profit's umbrella?
13 OPWDD ACTING COMMISSIONER BAER: That
14 is absolutely the goal when one nonprofit can
15 no longer run a program, absolutely.
16 CHAIRWOMAN KRUEGER: And how often
17 doesn't that happen and you actually end up
18 closing a site where people have been?
19 OPWDD ACTING COMMISSIONER BAER: I
20 don't have that information off the top of my
21 head. Absolutely everything goes into
22 avoiding a situation like the one you're
23 describing.
24 CHAIRWOMAN KRUEGER: If you could just
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1 follow up with us on whether there are
2 actual, you know, losses of existing sites.
3 Because I feel like we all would agree that's
4 not what we should be doing at this moment in
5 history --
6 OPWDD ACTING COMMISSIONER BAER: Yeah,
7 absolutely.
8 CHAIRWOMAN KRUEGER: -- losing sites
9 that have been there and have people living
10 there and family members in a geographic area
11 dependent on their family member's continuing
12 to get services, you know, not seven hours
13 from where they live.
14 OPWDD ACTING COMMISSIONER BAER: A
15 hundred percent.
16 CHAIRWOMAN KRUEGER: That's it for me.
17 Back to the Assembly.
18 CHAIRMAN PRETLOW: Assemblyman Eachus.
19 ASSEMBLYMAN EACHUS: Thank you, Chair.
20 Thank you, Commissioners, for being
21 here.
22 First for Commissioner Cunningham, a
23 suggestion. I have a wonderful wife who
24 happens to own an adult-use cannabis license
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1 and shop. She would love to do anything and
2 everything she can to reduce the risk of, you
3 know, the use of -- by, you know, youth. So
4 it just occurred to me right now, produce
5 posters, I will have her put it right on the
6 exit door about the proper storage and the
7 risks of youth using this product. I'll be
8 glad to do that. And if necessary, I will
9 call OCM and make them mandate that those
10 posters go up on those doors.
11 OASAS COMMISSIONER CUNNINGHAM: We'd
12 love to partner with you.
13 ASSEMBLYMAN EACHUS: Okay.
14 For Commissioner Baer, you and your
15 department sailed way up here for me
16 (gesturing above head). Just a couple of
17 days ago I called you and you were in a
18 meeting, but you called me immediately back.
19 And I so appreciated that. And we talked a
20 little bit about what I would make reference
21 to today.
22 But more importantly, you right away
23 said, when we completed our call, "Can I call
24 Commissioner Sullivan for you?" Which means
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1 that you more than have your two departments
2 in the same building, you actually talk with
3 one another, which is a wonderful thing.
4 But as you know and you may have
5 heard, I have a very grave concern with what
6 I call a dual diagnosis, but my dual
7 diagnosis is mental health and OPWDD. It's a
8 smaller perhaps population than what many
9 people refer to. And so what I would like to
10 do -- there's nothing going to be answered
11 today, but what I'd like to do is request a
12 report on the programs where you are
13 integrated with OMH, and a little description
14 of those programs.
15 And then the final thing I would like
16 to do, as my colleague Gallagher referenced,
17 I know that FIs are under the Health
18 Department and CDPAP is under that. But if
19 you have received any comments -- because I'm
20 getting comments from all over the place; I
21 want to collect them all together. If you
22 receive any comments from your particular
23 groups, independents or otherwise, please
24 pass those on to us.
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1 OPWDD ACTING COMMISSIONER BAER: Okay.
2 I'm happy to provide a report on those OMH
3 projects. We have done such exciting work.
4 You're right, that I absolutely talk to
5 Commissioner Cunningham all the time. They
6 have been incredible partners with the
7 funding they've received the last couple of
8 years to create a lot of capacity to serve
9 those dual-diagnosed individuals.
10 ASSEMBLYMAN EACHUS: Commissioner
11 Sullivan, right?
12 OPWDD ACTING COMMISSIONER BAER:
13 Absolutely. What did I say?
14 ASSEMBLYMAN EACHUS: Cunningham.
15 (Laughter.)
16 OPWDD ACTING COMMISSIONER BAER: Thank
17 you for knowing what I meant.
18 (Laughter.)
19 ASSEMBLYMAN EACHUS: Thank you.
20 CHAIRMAN PRETLOW: Assemblyman Maher.
21 ASSEMBLYMAN MAHER: Thank you.
22 This is for Commissioner Cunningham.
23 How are you?
24 OASAS COMMISSIONER CUNNINGHAM: Good.
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1 ASSEMBLYMAN MAHER: So what I love to
2 do when I'm at these public hearings is I
3 talk to individuals from my district that are
4 in recovery, people that have experienced
5 this firsthand but also are now in the field
6 and are serving. And I view that as
7 something that is very common, and I think
8 it's amazing.
9 And I'm not going to continue to talk
10 about some of the pay issues. Obviously I
11 think that's a bipartisan support that we
12 have here today.
13 I do want to talk about some insurance
14 issues. So I have heard from some of these
15 individuals that there are insurance issues
16 that only cover maybe 14, 21 days of care.
17 When it comes to the shortfalls from the
18 insurance side, have you seen that? What has
19 been the reaction? And what has your
20 department been doing to kind of combat that?
21 OASAS COMMISSIONER CUNNINGHAM: Yes.
22 I mean, so definitely a lot of insurance
23 issues are under the Department of Health and
24 not under us. But we certainly know that
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1 there are challenges.
2 So we have an ombudsman program called
3 CHAMP that we definitely get those complaints
4 and, if there are issues, work with
5 individuals to work through what those issues
6 are. And then, you know, certainly work
7 across the state agencies to be able to
8 address them.
9 ASSEMBLYMAN MAHER: I appreciate that.
10 Another issue that comes up from,
11 again, the folks that are on the ground are
12 talking about some of the documentation
13 that's needed within a 24-hour period, and
14 that there are actually issues where some
15 individuals aren't getting the help needed
16 because they need a little more flexibility
17 in getting that paperwork.
18 Can you speak to how those issues come
19 up and what's being done about it?
20 OASAS COMMISSIONER CUNNINGHAM: Yeah,
21 that's an area that we are definitely
22 interested in continuing to work on, because
23 we don't want that to be the barrier. We
24 want to really improve access to services and
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1 reduce those barriers.
2 And so we've actually worked to make
3 sure that people know that a lot of times we
4 don't necessarily need that before people can
5 be admitted, but that can be part of the
6 admitting process. So we are working with
7 our programs to really try and reduce that
8 barrier.
9 ASSEMBLYMAN MAHER: Okay. And is that
10 something that's administrative within your
11 purview, or is that something that also needs
12 legislation?
13 OASAS COMMISSIONER CUNNINGHAM: Most
14 of that I think is regulatory, and I think
15 it's clarifying in terms of the regulations.
16 ASSEMBLYMAN MAHER: Okay. Another
17 issue that I'm hearing on the ground is that
18 there are some handicap accessibility issues
19 with some of the areas that actually provide
20 the services, and that can also be a
21 deterrent in some cases.
22 Have you seen that? And what are some
23 of those things that we're doing about that?
24 OASAS COMMISSIONER CUNNINGHAM: Yeah.
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1 So certainly the people that we serve are now
2 older and living with more chronic illnesses,
3 including physical illnesses. And so this is
4 an area that we are actually trying to
5 understand a little bit more about that
6 change in the population, and then determine
7 really what the -- you know, how prevalent is
8 that issue and then what the needs are.
9 So that is an area we're actively
10 looking into more.
11 ASSEMBLYMAN MAHER: Is it about
12 collecting information? Have you put
13 something out to say, hey, is there anyone
14 that has this issue? We'd like to quantify
15 it so then we can then put the ask to the
16 Legislature?
17 OASAS COMMISSIONER CUNNINGHAM: It is,
18 so we're -- yes.
19 ASSEMBLYMAN MAHER: Okay. Thank you.
20 CHAIRMAN PRETLOW: Assemblyman
21 Palmesano.
22 ASSEMBLYMAN PALMESANO: Yes. My
23 question is for Commissioner Baer.
24 Commissioner, 30 years ago I was a
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1 direct care worker working with our most
2 vulnerable population. So I'm coming at
3 that from -- I saw firsthand how those direct
4 support professionals impact the quality of
5 care and quality of life of our most
6 vulnerable New Yorkers.
7 So I just want to start with -- before
8 I go there, let me say 2.1 is woefully
9 inadequate. I've been through the campaigns
10 for the #bFair2DirectCare -- we go through
11 this, it's like a dog-and-pony show every
12 year. But then the Governor proposes a
13 quarter-trillion-dollar budget, $19 billion
14 more proposed than last year, doesn't blink
15 an eye at providing $700 million for the
16 Hollywood film tax credit to subsidize
17 Hollywood elites, but here we are with our
18 most vulnerable New Yorkers and the direct
19 support professionals who care for them
20 leaving because they can't afford this job.
21 So on that process, this is two years
22 ago, there was a FOIL request that showed
23 there were 4500 individuals on the
24 residential waitlist. The Western New York
315
1 region that I represent, just the Arc
2 chapters alone, from a report six months ago,
3 had closed down 90 residential beds over the
4 past two years.
5 We have a workforce crisis for our
6 direct support professionals, and that's
7 impacting the quality of care and quality of
8 our most vulnerable New Yorkers. Budgeting
9 is about priorities. The Hollywood elite or
10 our most vulnerable New Yorkers? It doesn't
11 make sense to me.
12 So my question to you is, is the
13 differential between the minimum wage and
14 what our nonprofit agencies like our Arcs are
15 currently funded to pay, is that adequate
16 enough, in your opinion and Governor Hochul's
17 opinion, is that adequate enough for them to
18 compete in the local labor market for the
19 talented and dedicated workers that we
20 require to be direct support professionals
21 and provide this care?
22 OPWDD ACTING COMMISSIONER BAER: First
23 of all, thank you so much for your service as
24 a direct support professional. Very
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1 completely agree, lifeblood of what we do.
2 I believe that at this point in time
3 with the 13 percent increase we offered
4 effective July 1st, compounded with the last
5 three years of COLAs and this year's targeted
6 inflationary increase and investments in
7 minimum wage, that our providers largely are
8 at this point situated to provide a
9 competitive wage. I think that that is
10 drastically impacted by the most recent
11 investment, which was the reason we made that
12 investment.
13 And I have certainly heard from
14 providers that they are now offering up to
15 $26 an hour competitively to their region.
16 ASSEMBLYMAN PALMESANO: For
17 non-for-profits.
18 OPWDD ACTING COMMISSIONER BAER: For
19 not-for-profits.
20 ASSEMBLYMAN PALMESANO: On that
21 front -- because as I mentioned, 91 beds over
22 the past two years have closed in my
23 region -- can you provide a list to us, not
24 just for across the state, not just for the
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1 not-for-profits, but also the state beds and
2 others so we could have a list of how many
3 have closed over the past few years?
4 Because this is a workforce issue. So
5 I'd like you to provide that, and I
6 appreciate you answering my question.
7 OPWDD ACTING COMMISSIONER BAER: Sure,
8 we can get you information about vacancies
9 throughout the system.
10 (Time clock sounds.)
11 ASSEMBLYMAN PALMESANO: Thank you.
12 CHAIRMAN PRETLOW: Assemblywoman
13 Griffin.
14 ASSEMBLYWOMAN GRIFFIN: Thank you.
15 Thank you for being here,
16 Commissioners.
17 Most of the questions I think are for
18 Commissioner Cunningham.
19 I was -- I really appreciate the
20 incredible amount of opioid settlement funds
21 Nassau County has received. And I was just
22 wondering, do you track by county how much of
23 their allocation has been used and how it's
24 been used?
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1 OASAS COMMISSIONER CUNNINGHAM: Yes.
2 So our Opioid Settlement Fund tracker website
3 has all of the county information in terms of
4 how much each county has received, what their
5 plan has been. And we are now collecting the
6 reports, their annual reports, and then we'll
7 put that as well in terms of what -- you
8 know, do they spend it on prevention,
9 treatment, recovery, et cetera. All of that
10 information's on our website.
11 ASSEMBLYWOMAN GRIFFIN: Okay. And if
12 a county hasn't spent down their allocation,
13 is there any time frame that -- like if the
14 county hasn't used a great portion or doesn't
15 have a plan for it, is there any timeline
16 that would be problematic, like that it would
17 get clawed back or something?
18 OASAS COMMISSIONER CUNNINGHAM: No.
19 So the opioid settlement funds are for
20 18 years.
21 ASSEMBLYWOMAN GRIFFIN: Oh, good.
22 OASAS COMMISSIONER CUNNINGHAM: But
23 the dollar amount decreases substantially.
24 And so the counties can use -- spend their
319
1 money according to the agreements.
2 ASSEMBLYWOMAN GRIFFIN: Okay. Thank
3 you very much.
4 And another thing I've heard from many
5 families that are -- they have a child or a
6 partner or someone in the family that's
7 struggling with addiction, and I've heard
8 oftentimes through the years that they don't
9 find that there's enough support -- like
10 they -- there's a lot of decisions they have
11 to make. Some families have a family
12 member -- I spoke to someone recently -- that
13 has been involved in some issues legally,
14 and, you know, there's -- a lot of people
15 just don't know where to turn. Should they
16 be paying for it, should they not?
17 Like there's a lot of things that come
18 up, and they -- they're operating under the
19 stress of having a family member, and so
20 they're also suffering. But some of these --
21 a lot of them say they don't have enough
22 support to advise them.
23 And I just wondered, is this anything
24 you hear or would address, or are there any
320
1 programs that really focus in on the family?
2 OASAS COMMISSIONER CUNNINGHAM: Yeah,
3 I think particular for young people, this is
4 an area definitely of focus, is making sure
5 that the family members are part of the
6 whole -- of the services that they receive.
7 And so that is woven into a lot of our
8 services that really focus on adolescents.
9 ASSEMBLYWOMAN GRIFFIN: Okay. And is
10 there any information that you could provide
11 that tells me or tells me in Nassau County
12 what services are available in that area?
13 OASAS COMMISSIONER CUNNINGHAM:
14 Absolutely. We can get you a list.
15 ASSEMBLYWOMAN GRIFFIN: Terrific.
16 Thank you.
17 And the final question, really
18 quickly, is another area of support that has
19 been expressed to me is that someone's in
20 recovery and now they're looking to work,
21 they're looking for housing, they often don't
22 have enough support. They don't have the
23 transportation to get to work, maybe they're
24 having trouble finding a job. Is that
321
1 something you could send me some information
2 on?
3 OASAS COMMISSIONER CUNNINGHAM: Sure.
4 ASSEMBLYWOMAN GRIFFIN: Okay, thank
5 you.
6 CHAIRWOMAN KRUEGER: Okay. To close
7 out the last three minutes, Senator
8 Fernandez.
9 CHAIRMAN PRETLOW: Your last three
10 minutes.
11 CHAIRWOMAN KRUEGER: The last three
12 minutes of the Senate, excuse me.
13 SENATOR FERNANDEZ: Thank you so much.
14 Okay, for Commissioner Cunningham,
15 just to follow back with the gambling
16 addiction services, you mentioned a lot of
17 the outreach being done. Do you see a need
18 for more, given iGaming has started -- or
19 sports betting? Do you see a need for more
20 outreach, more funding, what?
21 OASAS COMMISSIONER CUNNINGHAM: Yes.
22 I mean, I think, you know, we're continuing
23 to expand our services and build the capacity
24 for treatment and prevention in our system.
322
1 Certainly, you know, additional
2 dollars to make sure that we can reach the
3 people and target individuals who are at
4 risk, you know, would be -- yes, would be
5 helpful.
6 SENATOR FERNANDEZ: Okay. And last
7 question for you.
8 Very happy again about the numbers
9 showing that overdoses went down in New York
10 State, but they still remain a little high in
11 Black and brown communities. What are we
12 doing to reach those demographics?
13 OASAS COMMISSIONER CUNNINGHAM: Yes,
14 absolutely. I mean, you know, for this
15 reason we would really use a data-driven
16 approach to make sure that we're reaching
17 those who are at highest risk, and a targeted
18 approach.
19 And so when we put out, you know, our
20 RFPs and our investments, we're ensuring that
21 those communities who are at highest risk,
22 you know, do have the availability to get
23 those investment dollars. And so this is,
24 for example, looking at, you know, expanding
323
1 medication treatment, expanding our outreach
2 and engagement initiatives.
3 So it is absolutely with a data-driven
4 approach for those communities who are at
5 highest risk.
6 SENATOR FERNANDEZ: Okay. I would
7 hope that includes language access too, which
8 I know we do.
9 So thank you so much, Commissioner.
10 For our other commissioner, last year
11 the Legislature included language that
12 required at least 1.7 percent of the COLA go
13 directly to worker wages to address the
14 pattern of agencies redirecting funds for
15 workers to other operating expenses. Why has
16 the agency yet to produce guidance as
17 required in statute?
18 And without this guidance, what are
19 you doing to ensure that agencies are
20 ensuring funds are going to workers?
21 OPWDD ACTING COMMISSIONER BAER: So
22 like I said, we require of our providers an
23 attestation about how they spend those funds,
24 and they specifically tell us each year the
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1 percent of increase to direct support
2 professionals as well as to other title
3 series like their clinicians and their
4 administrative staff.
5 So we do collect that information.
6 Staffing for our providers is by and large
7 the highest -- the majority of their costs.
8 So when you get a cost-of-living increase as
9 a nonprofit, you have to use that, right, for
10 all of your increased costs of doing
11 business, not just direct care salaries. But
12 for us that is the majority of their costs.
13 So we do see that most of that money,
14 with or without that 1.7 percent directed
15 language last year, goes towards wages of
16 direct care staff.
17 SENATOR FERNANDEZ: All right, thank
18 you. Thank you. All done.
19 CHAIRMAN PRETLOW: Assemblyman Steck
20 for a three-minute follow-up.
21 ASSEMBLYMAN STECK: If I can get my
22 mic.
23 So the street outreach teams, could
24 you explain what they are and where they are
325
1 being located?
2 OASAS COMMISSIONER CUNNINGHAM: Sure.
3 So we have street outreach teams
4 really across the entire state, in urban
5 areas and rural areas. We just came out with
6 a new RFP that will fund $31 million more of
7 continuing this work.
8 So they work, you know, in parks, on
9 streets, under bridges. They provide
10 harm-reduction education and materials. They
11 link people to services and some of them
12 start treatment right there in the community.
13 ASSEMBLYMAN STECK: So the 3 million
14 in the budget is an expansion of that
15 program?
16 OASAS COMMISSIONER CUNNINGHAM:
17 Exactly. And really targeting those with
18 co-occurring mental health and substance use
19 disorders.
20 ASSEMBLYMAN STECK: And then another
21 question is you're familiar with the SAPIS,
22 or Substance Abuse Prevention and
23 Intervention Specialists?
24 OASAS COMMISSIONER CUNNINGHAM: Yes.
326
1 ASSEMBLYMAN STECK: So is there any
2 particular reason why that program is
3 currently located only in the City of
4 New York and not in other parts of the state?
5 OASAS COMMISSIONER CUNNINGHAM: I
6 think it's historical, and I think it's also
7 the interests of the school districts.
8 We certainly want to be in as many
9 schools as possible, and I think schools have
10 competing demands. And so, you know, the
11 substance use prevention may or may not be
12 part of their priority.
13 But we would love to partner with
14 schools, more schools, and have more of a
15 footprint in schools.
16 ASSEMBLYMAN STECK: So with respect to
17 SAPIS, it is a program that's funded
18 partially by the state and partially by the
19 city. The idea would be that if a local
20 school district wanted to participate, they'd
21 have to fund 50 or whatever the percent of
22 the program is in order to get one of the
23 SAPIS individuals in the schools.
24 Is that something you could support?
327
1 OASAS COMMISSIONER CUNNINGHAM: I
2 mean, I think -- we support prevention in
3 schools in a lot of different ways. And so I
4 think it would really just depend on the
5 specific school district.
6 But, you know, often our prevention
7 providers go into schools, we work with the
8 communities around the schools. So I think
9 there's really a variety of ways in which
10 this can be done to really partner with the
11 schools.
12 ASSEMBLYMAN STECK: I don't have
13 anything further.
14 CHAIRMAN PRETLOW: Senator Fahy for a
15 follow-up three minutes.
16 SENATOR FAHY: Thank you.
17 Thank you again, Commissioners. And
18 these are just a couple of more questions for
19 Commissioner Baer.
20 The -- you already had a little bit of
21 a discussion about the certified residential
22 homes that have closed. Do you have a list
23 of how many have closed in the last
24 12 months? And is there a breakout between
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1 which ones are state-operated and which are
2 the nonprofits?
3 OPWDD ACTING COMMISSIONER BAER: I
4 don't have a list like that.
5 SENATOR FAHY: How many have there
6 been?
7 OPWDD ACTING COMMISSIONER BAER: I
8 don't have that information with me. Happy
9 to talk offline about the various reasons
10 that some of those transitions happened and
11 what they look like.
12 SENATOR FAHY: Okay. I appreciate
13 that, thank you. I wasn't sure if I'd missed
14 the number or if you had mentioned it.
15 The waiting list that we talked about
16 the last time, I since got a couple of texts
17 saying, Wait, there is a waiting list. So
18 can -- and then of course we hear a lot from
19 the hospitals where there are at times
20 individuals, those with disabilities and
21 other high needs who may be, quote, unquote,
22 stuck in a hospital waiting for a placement.
23 Can you clarify what is defined as a
24 waiting list and what is not, and why have we
329
1 heard of incidences of people who literally
2 can't be placed out of hospitals? And we
3 certainly hear it here, let alone around the
4 state. So I'm not clear on how we define
5 waiting lists, because others have certainly
6 mentioned that they've been waiting and that
7 only those who are coming out of ER rooms, or
8 where a parent may have died, get what's I
9 guess an emergency placement. So can you
10 clarify that for us, please?
11 OPWDD ACTING COMMISSIONER BAER: Yeah,
12 certainly hear the concern about people who
13 end up hospitalized and hospitalized for a
14 lot longer than they should be. We never
15 want anyone to be hospitalized unnecessarily,
16 and we never want to take up capacity in the
17 hospital system.
18 So we regionally have crisis
19 mitigation liaisons that work with regional
20 hospitals to make sure we are aware when
21 there is someone with OPWDD eligibility
22 looking for a certified residential
23 opportunity in our system, and have a lot of
24 communication with hospitals about what the
330
1 needs are that that individual needs so that
2 we can match them with a provider in the
3 community.
4 The list that people refer to is our
5 certified residential opportunity list, so
6 it's not a waitlist. But we do track people
7 who are looking for certified residential
8 opportunities in the system, and that list of
9 people changes every day as people move in,
10 move out, move between the system.
11 SENATOR FAHY: So how many are often
12 on that tracking list that we don't call a
13 waiting list?
14 OPWDD ACTING COMMISSIONER BAER: I
15 don't know that number, what it looks like
16 today, but happy to follow up with you.
17 SENATOR FAHY: Okay. I would
18 appreciate that. Because certainly it is of
19 concern. Certainly we want to do all we can
20 to address it.
21 Thank you so much, Commissioner.
22 Thank you, Chair.
23 CHAIRMAN PRETLOW: Assemblyman
24 Santabarbara for follow-up, three minutes.
331
1 ASSEMBLYMAN SANTABARBARA: Thank you,
2 Mr. Chair.
3 I just had a couple of follow-up
4 questions for Commissioner Baer.
5 I guess I would like to see that list
6 as well, just to follow up on what
7 Senator Fahy just said. In particular,
8 people that are aging out of the system -- my
9 son has been -- it's been a few years to find
10 a place, and we haven't found one just yet.
11 But whatever that is, I'd like to have
12 some idea of how many people are on it and
13 how many people are actually waiting, because
14 I do hear similar concerns as the Senator did
15 as well.
16 But I did also want to address some
17 questions from service providers regarding
18 the OPWDD regulations that are somewhat
19 outdated, requiring MDs to actually sign off
20 on all orders for prescriptions or forms that
21 are needed for medical services.
22 The reality is a lot of people use
23 physician extenders nowadays, and there's a
24 shortage of MDs in this particular field. So
332
1 the question is, is there anything being done
2 to update regulations to closely reflect the
3 medical model used today to treat individuals
4 in the system in clinical settings, and
5 accounting for the fact that most providers
6 use physician's assistants and nursing
7 practitioners, not exactly doctors? It seems
8 that the regulations should reflect the
9 current model. So just maybe your comments
10 on that.
11 OPWDD ACTING COMMISSIONER BAER: Yeah,
12 I can't say that I'm completely familiar with
13 the regulatory issue you raise specifically,
14 but we do have a workgroup that meets
15 regularly with stakeholders like our provider
16 community to talk about where our regulations
17 and our administrative processes might need
18 some updating to provide some relief or just
19 to catch us up to what the modern-day world
20 looks like.
21 So we're always open to hearing from
22 providers about ways that we can implement
23 those changes to make those things easier.
24 ASSEMBLYMAN SANTABARBARA: In this
333
1 particular case it seems like, you know, the
2 Center for Disability Services and
3 organizations like that would just streamline
4 and make their process a little easier to get
5 services quicker.
6 I did want to follow up also on the
7 career pathways for DSPs. We had a little
8 bit of a discussion on that. I know there's
9 been some investments made, and it seems like
10 it's something that's very -- people are very
11 receptive to and like a lot. And the system
12 at Liberty Arc, which is in Amsterdam in my
13 district, they had received some federal
14 funding.
15 But particularly I wanted to ask about
16 supporting some investments in our SUNY
17 schools and creating actual career pathways
18 and things that people could get on a path to
19 get a degree and get advancement
20 opportunities and so on. I think it would be
21 great for retention and recruitment as well.
22 Just your thoughts on supporting maybe
23 additional funding, or is there something in
24 place already that's underway?
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1 OPWDD ACTING COMMISSIONER BAER: Yeah,
2 I think the program that -- the Arc that you
3 mentioned is our NADSP credentialing program
4 that they've partnered with us to make
5 available to their staff.
6 It has been a very successful program.
7 We're sort of the leading state in the nation
8 in terms of having DSPs run through that
9 program. We're really very proud of that.
10 We also have the $50 million
11 investment through SUNY to create
12 microcredentialing and credits. That's also
13 been very successful.
14 ASSEMBLYMAN SANTABARBARA: Okay, thank
15 you.
16 CHAIRWOMAN KRUEGER: Okay. So
17 surprise, more Senators.
18 Senator Weber, three minutes.
19 SENATOR WEBER: Thank you. Thank you,
20 Chairwoman.
21 Hello, Commissioner, it's great to see
22 you again. I know we had a great talk the
23 other day.
24 CHAIRWOMAN KRUEGER: He's a ranker, so
335
1 he gets five minutes. I apologize.
2 SENATOR WEBER: Thank you.
3 Commissioner, for the last couple of
4 years my office has heard from many
5 self-direction families noting difficulties
6 in accessing benefits for community classes.
7 And, you know, it seems like some fiscal
8 intermediaries are not paying for those
9 classes even through many of those classes
10 were covered in the past or covered for other
11 people, and meets all the criteria.
12 I just wanted to, you know, bring that
13 to your attention. And I'm not sure if
14 there's anything your department is working
15 on on that right now.
16 OPWDD ACTING COMMISSIONER BAER: I'm
17 definitely familiar with the issues
18 surrounding community classes. This is one
19 example of something someone can purchase
20 with a self-directed budget. We're very
21 proud of our self-direction program, which
22 provides a lot of flexibilities to
23 individuals and families to purchase their
24 own services.
336
1 One of those things that they can
2 purchase is called a community class, which
3 is something you or I could go and take, like
4 an aerobics class -- if you're into that,
5 Senator -- and then be reimbursed with
6 Medicaid funding for that class. So it
7 really does provide a lot of flexibility for
8 folks who are enrolled in self-direction to
9 explore things that they're interested in and
10 expand their skills.
11 Because it is federally funded, it
12 comes with rules around how to approve that
13 line item. So it can't be a community class
14 that would otherwise need to be -- that
15 duplicates a certified program like a day
16 program. And it also needs to be genuinely
17 integrated and open to the community. So it
18 can't be a class, for example, that's
19 developed just for people with autism.
20 So I know that there's a sense of
21 frustration that that limits what people can
22 spend those funds on, but there are literally
23 endless thousands of classes throughout the
24 state that people could purchase with that
337
1 line item. And again, it's only one type of
2 service available through self-direction.
3 SENATOR WEBER: Okay, thank you.
4 And just one other question. And
5 again, our office has heard from many people
6 in self-direction that they'd like to see a
7 deputy commissioner dedicated to
8 self-direction. I'm sure you've probably
9 heard that as well. Any thoughts to that?
10 And any -- you know, anything that we can
11 expect on that as well?
12 OPWDD ACTING COMMISSIONER BAER: I am
13 familiar with that advocacy. I've talked to
14 a lot of parents about this perceived need
15 that we need a whole deputy commissioner for
16 self-direction.
17 We have tons of full-time staff
18 committed to the self-directed model,
19 reviewing budgets and facilitating
20 self-direction for the 35,000 people
21 statewide that are enrolled in that program.
22 It doesn't, in my mind, add anything to the
23 function of that program to add yet another
24 state administrator.
338
1 SENATOR WEBER: Okay, thank you.
2 And thank you, Chairwoman.
3 CHAIRWOMAN KRUEGER: Thank you.
4 So Senators seem to be multiplying, so
5 now we have Senator John Liu for three
6 minutes, and then closing will be one more
7 Senator after him. Yes.
8 SENATOR LIU: Thank you, Madam Chair.
9 And thank you, Commissioners.
10 I only get three minutes because I
11 don't rank. But I appreciate the both of you
12 being here, and it's been a long time.
13 My question is for Commissioner
14 Cunningham. I know in your testimony you
15 talked about trying to address some of the
16 problem gambling issues. My question for you
17 is it's been several years since we've
18 established new casinos upstate. Has OASAS
19 looked at any potential problems related to
20 gambling addiction that have arisen from the
21 establishment of those casinos?
22 OASAS COMMISSIONER CUNNINGHAM: So, I
23 mean, we -- so we are constantly looking at
24 the data in terms of problem gambling.
339
1 You know, I don't know that we can
2 attribute it to any specific locations. But
3 we have a robust data collection statewide
4 among young people about their gambling
5 behaviors, and we're looking at, you know,
6 the number of calls to the helpline, the
7 number of people who are accessing treatment
8 and asking for help.
9 And so, you know, we're using data to
10 certainly guide our approach that's a
11 targeted approach and to ensure that we have
12 the capacity in our system to address the
13 need.
14 SENATOR LIU: It seems like -- it
15 seems like, based on your testimony, that
16 it's kind of like it's being treated as a
17 potential problem, as opposed to a real
18 problem. And the data collection is not
19 necessarily related to the casinos
20 themselves, but more sports betting, online
21 betting, et cetera.
22 So is there a plan to look at
23 what's -- look at the impact of casinos
24 themselves?
340
1 OASAS COMMISSIONER CUNNINGHAM: I
2 mean, yes, so we're looking at both, the
3 online sports betting and, you know, gambling
4 behaviors in general.
5 So, I mean -- and again, we are
6 monitoring what comes in for the calls, the
7 reasons why, so how much is sports betting,
8 how much is, you know, gambling at tables,
9 how much is lotto, et cetera.
10 So we do -- we do break it down, and
11 we can provide that specific information.
12 SENATOR LIU: And is there any kind
13 of, you know, perhaps for lack of better
14 terminology, culturally and linguistically
15 capable monitoring of this situation, maybe
16 working with community-based organizations to
17 help with that?
18 OASAS COMMISSIONER CUNNINGHAM: We
19 absolutely do. And we do work in different
20 languages and understand there are definitely
21 different cultural issues around gambling and
22 what --
23 (Overtalk.)
24 SENATOR LIU: So has OASAS identified
341
1 cultural disparities with regard to gambling
2 addiction in different communities?
3 OASAS COMMISSIONER CUNNINGHAM: We're
4 looking at that now. And we're working with
5 specific communities to make sure to enhance
6 the services that are culturally relevant,
7 yes.
8 SENATOR LIU: How long does it take to
9 look at this data and come to some kind of
10 conclusion or lack of conclusion?
11 OASAS COMMISSIONER CUNNINGHAM: Yeah,
12 I mean, we're constantly looking at the data.
13 But I think --
14 SENATOR LIU: So no conclusions as of
15 yet.
16 OASAS COMMISSIONER CUNNINGHAM: Off
17 the top of my head, for specific communities,
18 I don't have that. But we can certainly take
19 that back and look in more detail.
20 SENATOR LIU: Thank you.
21 CHAIRWOMAN KRUEGER: Senator Bynoe.
22 SENATOR BYNOE: Thank you,
23 Madam Chair.
24 Good afternoon, Commissioners.
342
1 My question is for
2 Commissioner Cunningham, and it's kind of
3 piggybacking off of Judy Griffin's question
4 regarding the opioid settlements.
5 So how involved is the department in
6 reviewing those plans? Do you have to
7 approve them? Are they accompanied with a
8 spending plan?
9 OASAS COMMISSIONER CUNNINGHAM: Yes.
10 So for the legal requirements, we had to
11 approve all of the planned spending for the
12 opioid settlement funds for every county.
13 That's part of our regional abatement.
14 So some of the counties get money
15 directly from the Attorney General's office;
16 that's not under our purview.
17 So we have that information actually
18 on our website, of the planned spending, and
19 we are collecting the information on the
20 actual spending now. And, you know, once we
21 have that information, we will also include
22 that on our website for each county.
23 SENATOR BYNOE: I appreciate that.
24 Because I'd like to flag -- I'm not sure that
343
1 any of these plans that are on your website
2 or that you have approved are falling into
3 this category, but I'm going to use
4 Nassau County for an example.
5 Nassau County has settlement money --
6 and it might not be your money, but I'm
7 flagging this for you to look at. Nassau
8 County has spent only about 10 to 15 percent
9 of the funds that they received, the
10 $90 million. They are accruing interest on
11 that money, sitting on that money, not
12 utilizing it and putting it out there where
13 people are struggling with addiction.
14 They're -- they're actually making money on
15 it.
16 And so that's a challenge that we find
17 back home in Nassau County, and I'd like to
18 make sure that any of the state-mandated
19 plans are not being utilized in that same
20 fashion.
21 OASAS COMMISSIONER CUNNINGHAM: The
22 plans that we approved were for the counties
23 that we give money to. That does not include
24 the counties on Long Island or New York City.
344
1 But we are talking with the
2 Attorney General's office about the reporting
3 to us for how those dollars are used.
4 But, you know, we are accountable for
5 36 percent of the opioid settlement funds
6 that come to the state. That does not
7 include New York City or Long Island
8 counties.
9 SENATOR BYNOE: No, I'm aware of that.
10 But I'm just trying to flag you to make sure
11 that those that did receive money from your
12 efforts, from the efforts of the AG's office,
13 that they're spending that money according to
14 the plan. Because what we've found is that
15 families are still struggling and Nassau
16 County is benefiting by gaining interest on
17 the money to the tune of over $3 million.
18 Thank you.
19 CHAIRWOMAN KRUEGER: (Mic off;
20 inaudible) -- with staff and continue to go
21 out there and work for us. We need all of
22 you. Thank you.
23 OPWDD ACTING COMMISSIONER BAER: Thank
24 you for your time.
345
1 CHAIRWOMAN KRUEGER: And with that,
2 I'm going to call up the last government
3 panel, the New York State Justice Center for
4 the Protection of People With Special Needs,
5 Maria Lisi-Murray, executive director.
6 Good afternoon.
7 ACTING EX. DIR. LISI-MURRAY: Good
8 afternoon. Are you able to hear me okay?
9 CHAIRWOMAN KRUEGER: Yes.
10 ACTING EX. DIR. LISI-MURRAY:
11 Excellent.
12 Good afternoon, Chairs Fahy, Brouk,
13 Krueger, Santabarbara, Simon, and Pretlow, as
14 well as to your distinguished colleagues of
15 the Senate and Assembly.
16 My name is Maria Lisi-Murray, and I am
17 the acting executive director of the New York
18 State Justice Center for the Protection of
19 People With Special Needs.
20 Thank you for the opportunity to
21 testify regarding Governor Hochul's fiscal
22 year 2026 Executive Budget proposal.
23 I also want to extend my sincere
24 thanks to Governor Hochul for her continued
346
1 commitment to funding the only agency in the
2 country mandated to both protect vulnerable
3 populations and ensure the workforce has the
4 tools to prevent future abuse.
5 When the Justice Center was
6 established over a decade ago, the state
7 ushered in the strongest protections in the
8 nation against abuse, neglect, and
9 mistreatment. With each passing year, our
10 agency continues its vital mission of
11 protecting vulnerable populations receiving
12 services from six state agencies. Our agency
13 is unique in that most of our staff have not
14 only worked in settings under our
15 jurisdiction, but also have a family member
16 in care.
17 Over the last year, the Justice Center
18 substantiated nearly 4,000 cases, holding
19 subjects responsible for egregious conduct.
20 We prevented over 300 violent criminals from
21 reentering the workforce. And over the last
22 decade, we have barred over 1,000 of the
23 worst offenders from working with vulnerable
24 populations.
347
1 In March, I was elevated to acting
2 executive director. With that change, I can
3 draw from my previous experience to improve
4 our operations. This includes my nearly seven
5 years on the City of Binghamton police force,
6 including my time as a patrol officer and
7 investigator on the special investigations
8 unit; more than 2 decades as a litigator, in
9 both the private and public sectors,
10 including three years in the Attorney
11 General's office and more than five years as
12 a chief risk officer with the Department of
13 Motor Vehicles; and, most recently, my time
14 in a similar role here at the Justice Center.
15 During the last year, under my
16 leadership, the agency focused on three main
17 growth areas: Improving the quality and
18 efficiency of service, strengthening current
19 and forging new community partnerships, and
20 expanding our abuse-prevention efforts.
21 To meet our first goal, we have
22 developed ways to close cases faster and get
23 quality staff back to work quicker through
24 process improvements.
348
1 While our primary duty is to serve and
2 protect individuals under our jurisdiction,
3 we understand the tremendous burdens placed
4 on the state's direct care workforce. That
5 is why we have prioritized evidence
6 introduced early in an investigation that
7 exonerates one or more staff members
8 implicated in a Justice Center case.
9 We have also placed increased
10 attention on our ability to find a facility
11 responsible for an act of abuse or neglect,
12 rather than the individual. Known as a
13 "Category 4" finding, this oversight function
14 allows the Justice Center to address systemic
15 issues at a provider, holding them
16 accountable for inadequate care that could be
17 putting individuals at risk.
18 To satisfy our second goal, engaging
19 with new and existing stakeholders, the
20 Justice Center reached beyond its typical
21 audience to connect with first responders, a
22 group that frequently interacts with
23 vulnerable populations in the field.
24 As a former City of Binghamton police
349
1 officer, I know that law enforcement and
2 first responders play an important part in
3 promoting the safety of vulnerable people.
4 However, these interactions present unique
5 challenges for emergency response
6 professionals and require specialized
7 training to improve outcomes.
8 Leveraging more than a decade of
9 experience working with individuals with
10 special needs, the Justice Center developed
11 and launched an expanded portfolio of courses
12 to train attendees on respectful
13 communications, forensic interviewing skills,
14 and investigative best practices.
15 In 2024, we presented to over
16 200 participants, including members of the
17 New York State Park Police Recruit Academy,
18 the Bronx District Attorney's office, and
19 several city and county police and sheriff's
20 departments.
21 Agency staff also continued several
22 initiatives to support our longstanding
23 stakeholders. We participated in nearly
24 70 outreach events, advised hundreds of
350
1 individuals and families throughout the
2 course of investigations, held roundtable
3 discussions with our sister agencies, and
4 shared the Justice Center's story.
5 And to address our third goal,
6 expanding our abuse-prevention efforts, more
7 than a decade of data has afforded us the
8 opportunity to educate our workforce and
9 close critical gaps in care.
10 For example, in response to our data
11 showing an increase in choking incidents at
12 residential facilities, we created a toolkit
13 that outlines best practices for adhering to
14 food safety care plans.
15 My time heading the agency's
16 quality-control efforts underscores the need
17 for a holistic approach to proactively use
18 the information we collect in our
19 investigations to prevent future abuse and
20 neglect.
21 On the regulatory front, the agency
22 engaged in two rulemakings: One to foster
23 inclusivity by adopting gender-neutral
24 terminology in our regulations, and the
351
1 second to codify the use of remote meeting
2 platforms for our Surrogate Decision-Making
3 Committee hearings, which supports the nearly
4 800 hearings conducted last year. These
5 hearings make critical and speedy medical
6 decisions for individuals who lack the
7 ability to make these decisions themselves.
8 As I touched on earlier, this work is
9 very personal to the staff at the Justice
10 Center. Let me tell you why. Approximately
11 40 percent of our nearly 500 employees have a
12 family member receiving services from
13 programs under our jurisdiction. That means
14 our staff, they have a stake in the game.
15 They want justice for victims of abuse or
16 neglect just like the families we serve.
17 At face value, we can summarize our
18 work in just a few words -- investigation,
19 education, and action. But to the more than
20 1 million New Yorkers under our watchful eye,
21 this agency means so much more. To the
22 parent of a child with Down syndrome, the
23 Justice Center provides peace of mind that
24 your child will be protected even after
352
1 you're gone. To the service recipient
2 enrolled in a substance-use program, our
3 agency is a welcomed safety net and a fierce
4 advocate for justice. And to the providers
5 under our jurisdiction, we are a vital
6 resource that offers education and training
7 to create safer programs.
8 This is why we will continue our
9 important work and are grateful to the
10 Governor for once again investing in the
11 protections of our state's most vulnerable
12 populations.
13 Thank you for your time, and I'm happy
14 to answer any questions.
15 CHAIRWOMAN KRUEGER: (Mic off.)
16 SENATOR FERNANDEZ: Hi. Very quickly,
17 is it true that the Justice Center does not
18 have jurisdiction over recovery programs?
19 ACTING EX. DIR. LISI-MURRAY: I'm
20 sorry, it's a little hard to hear.
21 SENATOR FERNANDEZ: Is it true that
22 the Justice Center does not have jurisdiction
23 over recovery programs?
24 ACTING EX. DIR. LISI-MURRAY: With
353
1 respect to Justice Center jurisdiction over
2 recovery programs, are you speaking to the
3 question that was offered up to Dr. Chinazo
4 earlier, Dr. Cunningham?
5 SENATOR FERNANDEZ: I missed it, I'm
6 sorry.
7 ACTING EX. DIR. LISI-MURRAY: Oh,
8 okay. We have -- we do have jurisdiction
9 over certain OASAS-based programs, if that's
10 the question that you're asking.
11 And when individuals report abuse or
12 neglect in those programs, we do have the
13 ability to come in, conduct an investigation.
14 They are conducted to conclusion,
15 substantiated or unsubstantiated. In either
16 case, whether substantiated or
17 unsubstantiated, the Justice Center does have
18 the ability to utilize what we call our CAP
19 program, our Corrective Action Plan program,
20 so the provider provides us with a corrective
21 action plan and we audit against that to
22 ensure that any issues or concerns, gaps, are
23 being appropriately corrected.
24 SENATOR FERNANDEZ: Okay. Because
354
1 it's been my experience that some recovery
2 centers have been denied help from the
3 Justice Center.
4 So I wanted to know if you were aware
5 of that, because I do know that some
6 OASAS-covered programs do have jurisdiction
7 by the Justice Center. But please know that
8 there are recovery centers that do not that
9 could use it.
10 Thank you.
11 CHAIRWOMAN KRUEGER: Thank you.
12 Assembly.
13 CHAIRMAN PRETLOW: Assemblywoman
14 Simon.
15 ASSEMBLYWOMAN SIMON: Thank you very
16 much.
17 And thank you for your testimony and
18 for your work and for meeting with me earlier
19 this session.
20 I have a couple of very quick
21 questions to ask you. And one is, you know,
22 I appreciate this Category 4 investigation
23 that you're doing. I am curious, how many of
24 those investigations have you done? What are
355
1 the kinds of systemic issues that a
2 provider -- and then when it comes to sort of
3 holding them accountable for inadequate care,
4 what are those remedies? What are the
5 penalties, if any, to that provider? And how
6 do we remedy that situation for the people
7 who have been the victims of this inadequate
8 care?
9 ACTING EX. DIR. LISI-MURRAY: Thank
10 you for that question.
11 So we receive approximately 90,000
12 complaints of abuse and neglect through our
13 call center each year. Of those 90,000,
14 approximately 11,000 boil down to abuse and
15 neglect investigations. With respect to
16 Category 4 findings, our statistics are they
17 are at about 5 percent of our abuse and
18 neglect investigation workload.
19 It's a new eye, quite frankly, the
20 Justice Center has taken towards being
21 sensitive to the workforce situation, being
22 sensitive to sometimes individuals are asked
23 to work multiple shifts back-to-back. If I
24 can offer an example of what a Category 4
356
1 might look like, you might have an individual
2 who's worked multiple shifts, is asked to
3 transport an individual receiving services
4 some ways away to a doctor's appointment,
5 they indicate they're tired, they don't want
6 to, told to do it anyway, and ultimately
7 there's some sort of car crash, they fell
8 asleep at the wheel -- that could in fact be
9 a type of Category 4 finding.
10 Because it's looking at the incident
11 holistically, in the totality of the
12 circumstances, beyond the individual, you
13 know, who is being blamed. Because is it
14 really their fault, or are we looking at more
15 systemic issues like lack of workforce, being
16 asked to work repeatedly, not being able to
17 turn down an instruction to drive someone if
18 they're too tired.
19 ASSEMBLYWOMAN SIMON: Thank you.
20 Another question I have, which I use
21 an example in my experience that is not
22 relevant to your agency, but supported
23 housing facilities, right. I must have five
24 within three blocks of my house, right. So
357
1 I'm pretty familiar with the programs. And,
2 you know, it seems to me that one of the key
3 issues is good management. And particularly
4 where you may have an issue with staffing,
5 et cetera, et cetera, good management is even
6 more important.
7 What if anything does your agency do
8 to help with that situation? So in other
9 words if part of this problem is that it's
10 just not good management, how do you address
11 that issue?
12 ACTING EX. DIR. LISI-MURRAY: Well, we
13 don't have a role with respect to supporting
14 housing. That would be outside of --
15 ASSEMBLYWOMAN SIMON: Well, that's
16 what I said, it wasn't really the right
17 example. But it could be in your situation
18 as well.
19 ACTING EX. DIR. LISI-MURRAY:
20 Absolutely. And it would go back to the CAP
21 audits, you know, that I referenced earlier.
22 These are our opportunity for the Justice
23 Center to come in, or the provider will
24 provide us with their plan for making
358
1 improvements. We can identify issues such
2 as, like I said, staffing issues, issues of
3 inadequate training, whatever those issues
4 may be that are systemic to the facility or
5 the provider. We go back in and we ensure
6 that the remedial actions are being taken and
7 that the provider is adhering to the
8 corrective actions that they committed to
9 implementing.
10 ASSEMBLYWOMAN SIMON: Great. Thank
11 you. I appreciate that very much.
12 Thank you. I'm done.
13 CHAIRWOMAN KRUEGER: (Mic off;
14 inaudible.)
15 SENATOR FAHY: Sorry, the mics are
16 still hard to get on. Thank you.
17 Thank you for being with us, Director,
18 and thank you for your testimony.
19 Can I just pick up very briefly on the
20 Category 4? And was there some impetus for
21 this? And is it data-driven in terms of
22 sites where you have seen repeated problems?
23 Can you just explain what the impetus was and
24 what you're hoping to achieve here?
359
1 ACTING EX. DIR. LISI-MURRAY:
2 Absolutely.
3 So under my leadership, one of the
4 things that I felt was really critical to the
5 agency was taking the data that we receive,
6 using that to drive data, you know,
7 data-driven decisions. I think it's really
8 important that we're not relying on anecdotal
9 evidence but in fact the data that we see.
10 You know, it's no secret that there
11 are, you know, concerns with the workforce.
12 We know firsthand people, you know, are
13 working longer hours and being put under more
14 pressure. These individuals are doing a
15 very, very hard job. And, you know, we felt
16 that it was important to take the totality of
17 the circumstances into consideration in this
18 regard and, in essence, identify what are the
19 actual causal factors to this outcome that's
20 problematic.
21 SENATOR FAHY: Okay, thank you.
22 ACTING EX. DIR. LISI-MURRAY: Thank
23 you.
24 SENATOR FAHY: And in terms of your
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1 regular cases -- and obviously, we appreciate
2 what you do. As you can imagine, especially
3 when the Justice Center was first launched,
4 we used to hear about a whole host of
5 concerns. And one of the concerns that I
6 continue to hear about and I think we spoke
7 about this last year, is the timeliness of
8 the investigations. And, you know, how
9 difficult that is. We've heard all afternoon
10 about the pay of many workers in our
11 facilities and how difficult that is.
12 And there are times, because of an
13 allegation that may be a very old one or a
14 long, longstanding employee who is faced with
15 an allegation and they are removed and not
16 paid, they're off the payroll for months and
17 months and months at a time because of an
18 investigation.
19 And again, while we all recognize the
20 importance of being vigilant, there are some
21 dire circumstances to the individual,
22 especially if they are recused from any of
23 those allegations.
24 Can you talk about the timeliness and
361
1 what the procedures are in our facilities.
2 Does somebody actually have to be removed
3 completely from the facility, or at times can
4 they remain on a payroll? Can you just talk
5 about what levels that is and, again, a focus
6 on the timeliness?
7 ACTING EX. DIR. LISI-MURRAY:
8 Certainly. So back to the timeliness issue,
9 one of the things -- you know, when I started
10 in this position I wanted to look at ways
11 that we could expedite, move our
12 investigations through without reducing
13 quality, obviously.
14 So we took a look at our intake. We
15 operate a 24/7 call center where we receive
16 the 90,000 calls each year. And part of that
17 unit has what we call 3BDR, three-business-
18 day review model. These individuals, when
19 there's a call with respect to abuse and
20 neglect, they begin the process immediately
21 of collecting whatever typical documents you
22 might have -- care plans, policies -- and
23 they begin to put the case together and
24 identify the plan moving forward in order to
362
1 help expedite the actual investigation
2 process and weed out those that should not be
3 going through a full investigation process.
4 So that has been step one. Step two,
5 that we implemented what we call "early
6 unsubstantiation of cases," and this operates
7 through our investigations unit.
8 Our investigators will take cases
9 where we have maybe multiple subjects accused
10 of abuse and neglect and if we can look at
11 the evidence that's been collected right in
12 the front of the investigation, oftentimes we
13 find there are individuals who we can quickly
14 exonerate -- they weren't working that day,
15 it's not a question of did they do it or not,
16 but they were -- just in no way, shape, could
17 be responsible for this. And we now sever
18 those people off and drop them from the
19 investigation in order to return them back to
20 work in a more timely fashion.
21 And then again, in terms of moving
22 through investigations in a timely fashion,
23 the Category 4 findings we believe does help
24 do that. We help to get people back to work
363
1 if we're not focused on the individual and
2 we're more focused on the systemic issue
3 within the facility, because that's the thing
4 that needs to be fixed, right?
5 And then with respect to putting
6 people out of work that really falls to the
7 employer, the provider, the employer of that
8 individual. The only time the Justice
9 Center, you know, truly mandates somebody
10 being removed from work completely is if
11 they're put on our staff exclusion list, and
12 then they can't work with any of the
13 vulnerable populations.
14 So, you know, there's always safety to
15 be concerned about, there's always safety
16 care plans can be implemented. There may be
17 other ways around it that I can't speak to
18 that, you know, would need to be addressed by
19 the provider community. But we don't
20 instruct people to be taken out of work
21 unless they fall on our staff exclusion list.
22 SENATOR FAHY: Thank you. And I look
23 forward to hearing more as you roll out the
24 Category 4 to see, you know, whether that
364
1 helps to really target some of the more
2 routinely problematic sites and if it helps
3 to really target some of your work.
4 And I think we still have some
5 implementation work in terms of some of the
6 providers and the homes on this staff
7 exclusion list and whether people are
8 off-payroll or not. It just seems like there
9 still is, given the calls that we receive
10 about individuals who -- in a number of cases
11 where it was not substantiated.
12 So I appreciate your fresh look at
13 this and trying some new ideas. And thank
14 you again for your testimony.
15 Thank you, Chair.
16 CHAIRWOMAN KRUEGER: Thank you.
17 Assembly.
18 CHAIRMAN PRETLOW: Assemblyman
19 Sempolinski.
20 ASSEMBLYMAN SEMPOLINSKI: Thank you,
21 Chairman.
22 So one thing you said in your
23 testimony intrigued me; I want to sort of dig
24 in a little bit on that. You had indicated,
365
1 all right, we've been doing this 10 years and
2 now we sort of see patterns, and you
3 indicated choking incidents were up. I would
4 think 10 years in is sort of a good time to
5 sort of go back and say what's working,
6 what's not working, what are we seeing more
7 of, what are we not seeing more of, what
8 problems did we solve, what are new problems
9 we didn't anticipate.
10 Are there any other patterns that are
11 sort of like that that you could point to as
12 far as the type of incident or the type of
13 victim or a geographic pattern? Anything
14 like that, now that you have 10 years of
15 data?
16 ACTING EX. DIR. LISI-MURRAY:
17 Absolutely. So historically we've looked at
18 this data and then identified areas where we
19 felt training should be improved. Like I
20 talked about the choking and the food, you
21 know, safety care plans.
22 We've had -- we've looked at
23 wheelchair securement, developed toolkits for
24 that. We've looked at issues with respect to
366
1 inappropriate boundaries. We developed
2 toolkits for that. These are on our website
3 so anybody can look at them. But we have
4 always felt, you know, that at the Justice
5 Center that having this data affords us the
6 ability to identify, you know, areas where
7 people may be having -- we may be seeing more
8 reports or people maybe need more training or
9 there should be some clarification. That's
10 where we want to dig in.
11 I really want to focus, in my year
12 ahead, on preventative measures, utilizing
13 our data to instruct us on where prevention
14 can make a difference.
15 ASSEMBLYMAN SEMPOLINSKI: What would
16 be sort of the biggest difference in the type
17 of investigations you're doing today compared
18 to when you started? What would be the
19 biggest change over that time?
20 ACTING EX. DIR. LISI-MURRAY: Well,
21 I've been at the agency for about a year and
22 a half total at this point, so --
23 (Laughter.)
24 ASSEMBLYMAN SEMPOLINSKI: If we go
367
1 over the life of the agency, maybe not your
2 tenure, if you have that --
3 ACTING EX. DIR. LISI-MURRAY: I do
4 think, though, that the big new fresh look,
5 so to speak, is Category 4. The Justice
6 Center, you know, is charged with protecting
7 the health, safety and dignity of vulnerable
8 populations, but we're also charged with, you
9 know, supporting our direct care workforce.
10 And that's where I see, at least in
11 one aspect, we can make a real difference and
12 that we can provide the tools and the
13 training and, you know, give the workforce --
14 you know, at least from our perspective --
15 the things, you know, that they should be
16 thinking about and have front of mind as they
17 care for our state's most vulnerable people.
18 ASSEMBLYMAN SEMPOLINSKI: Well, thank
19 you very much for what your organization
20 does, and as a special-needs parent I really
21 appreciate it.
22 I'm all set.
23 CHAIRWOMAN KRUEGER: Excuse me. We
24 have Senator Canzoneri-Fitzpatrick.
368
1 SENATOR CANZONERI-FITZPATRICK: Thank
2 you, Madam Chair.
3 Thank you so much for being here today
4 and for testifying.
5 In your testimony you mentioned
6 developing and launching best practice
7 training courses which had over 200
8 participants. I was wondering if you could
9 expand on how that is organized. Is this
10 across the state? Do you have interested
11 departments contact you, or do you contact
12 them? And just how that training is going
13 about.
14 ACTING EX. DIR. LISI-MURRAY: Thank
15 you for that question. This is one of the
16 new initiatives that I've implemented as soon
17 as I came into the acting executive director
18 role.
19 Based upon my background in law
20 enforcement investigations, I have always
21 felt there was a gap in terms of this
22 training and understanding. And our first
23 responders -- you know, EMS, fire, police --
24 they need the tools in order to do better,
369
1 and in order to recognize that sometimes
2 approaching a situation with a law
3 enforcement or a criminality lens isn't the
4 right way to go. Right?
5 So we implemented what we call our
6 mandated reporter trainings. Those are done
7 remotely via Webex. Individual agencies or
8 any first responder agency can sign up for
9 it. It's free. And then they get renewed
10 training, renewed understanding of what their
11 responsibilities are as a mandated reporter,
12 because they are a real vital source of
13 reporting and information to the
14 Justice Center.
15 The other area of training that we are
16 building out and we've got additional
17 training scheduled for the upcoming year is
18 in our forensic interviewing training or we
19 call it our FIVP. This is the training when
20 you have an individual who cannot articulate
21 themselves verbally, this is the training
22 that allows first responders or any
23 investigator to engage with that person
24 effectively.
370
1 So it's a unique training. It's
2 something that our -- you know, within our
3 expertise that I think brings something
4 different to the first responder and
5 investigator's world.
6 SENATOR CANZONERI-FITZPATRICK: So
7 what type of feedback are you getting from
8 those who are participating? Do we need to
9 expand this? Should it be mandatory? What
10 other suggestions might you have to improve
11 this?
12 ACTING EX. DIR. LISI-MURRAY: We've
13 had excellent feedback. I mean, it's fairly
14 new in this regard. But as I said, we've had
15 over 200, you know, folks respond to the
16 training, and it literally was only rolled
17 out a few months ago.
18 So I think it's very important to
19 understand that first responders want this
20 information. They want the tools. They want
21 to do better. You know, I have definitely
22 leveraged my experience and relationships in
23 the law enforcement and first responder world
24 to make sure that people understand and have
371
1 awareness of what it is that we can offer.
2 And, you know, crimes against
3 individuals with special needs who can't
4 speak for themselves or can't articulate
5 themselves, they're a much harder case to
6 successfully bring to trial. And we -- you
7 know, we want to ensure that people, you
8 know, who do wrong are brought to justice.
9 And if we can help in that way, we're happy
10 to do so.
11 SENATOR CANZONERI-FITZPATRICK: Well,
12 thank you for your efforts, because hopefully
13 what you're doing is preventing them from --
14 the incidents from ever occurring. And I do
15 know of a couple of families that have dealt
16 with these types of incidents, and it's so
17 traumatic.
18 So thank you for your efforts, and I
19 have nothing further.
20 CHAIRWOMAN KRUEGER: Thank you.
21 Assembly.
22 CHAIRMAN PRETLOW: Assemblyman Steck?
23 ASSEMBLYMAN STECK: None.
24 CHAIRMAN PRETLOW: Assemblyman Ra?
372
1 Assemblyman Santabarbara.
2 ASSEMBLYMAN SANTABARBARA: Okay, thank
3 you, Mr. Chair.
4 Thank you for your testimony. Thank
5 you for being here.
6 I wanted to just ask about a few
7 different areas, mainly with how are we
8 ensuring that individuals with disabilities,
9 particularly nonverbal individuals, have
10 input on things that -- reports and things
11 that happen and some of the policies that the
12 Justice Center has implemented? How are we
13 getting that input, and how are we making an
14 effort to include nonverbal individuals?
15 ACTING EX. DIR. LISI-MURRAY: Sure.
16 So with respect to input to the
17 Justice Center, I'm sure you're aware we have
18 an advisory council that we meet with
19 regularly. These are individuals who work in
20 the provider field. We have self-advocates
21 on our advisory council.
22 And they are -- you know, they are the
23 boots-on-the-ground folks who bring us back
24 the information in terms of what their
373
1 concerns are and what they're seeing day to
2 day.
3 With respect to the nonverbal
4 community, you know, we do have a training,
5 it's a forensic interview training that I was
6 talking about earlier which allows first
7 responders or investigators to be able to,
8 you know, utilize skills in forensic
9 interviewing to communicate effectively with
10 nonverbal individuals.
11 So we do have an expertise in that
12 area that we are bringing to training and,
13 you know, trying to roll out to the broader
14 population of first responders.
15 ASSEMBLYMAN SANTABARBARA: And
16 mentioning first responders, that's a good
17 segue to the next question, I guess.
18 There has been a bill circulating
19 about mandatory 911 reporting when something
20 happens at one of these facilities. And I
21 think that bill was amended and I think it
22 ended up with some informational materials
23 that are now posted or supposed to be posted
24 in certain areas.
374
1 But what's your opinion on that, on
2 mandatory requiring for a 911 call if
3 something happens? Especially if it's a
4 nonverbal situation where you're not exactly
5 sure what happened. Is that something the
6 Justice Center supports?
7 ACTING EX. DIR. LISI-MURRAY: Well,
8 the Justice Center is not an emergency
9 response or a first responder agency.
10 ASSEMBLYMAN SANTABARBARA: I
11 understand.
12 ACTING EX. DIR. LISI-MURRAY: Our call
13 center operators, there's a -- you know, they
14 have a script, and one of the first questions
15 that they ask is does 911 -- has 911 been
16 called? Is this an emergency?
17 There are other ways to submit a
18 report. We have a web report so it doesn't
19 have to be verbal. But to the extent, you
20 know, pending legislation, I -- you know, I
21 really wouldn't want to comment on that. But
22 we would not be -- the Justice Center would
23 not really be positioned as a first responder
24 agency, given what we do. The vast majority
375
1 of our reports are non-emergent, they are
2 after -- you know, after some time has
3 passed.
4 ASSEMBLYMAN SANTABARBARA: And in
5 terms of funding and resources, staffing, do
6 you have the resources and the staffing
7 available to do -- to investigate all the
8 cases that are being reported?
9 ACTING EX. DIR. LISI-MURRAY: At this
10 time we are sufficiently resourced to do, you
11 know, and complete our mission. We thank the
12 Governor once again for supporting
13 protections for vulnerable New Yorkers.
14 ASSEMBLYMAN SANTABARBARA: And are
15 there training programs for DSPs as well to
16 prevent this neglect and abuse? Are they in
17 place? And is there anything else we need to
18 do to bolden those programs?
19 ACTING EX. DIR. LISI-MURRAY:
20 Absolutely. We have an entire unit that's
21 dedicated to prevention efforts. Our
22 prevention efforts and toolkits and guidance,
23 it's on our website, so it's publicly
24 available for anyone to look at. We take it
376
1 very -- we take training very, very
2 seriously. We feel that giving direct
3 service providers the information and the
4 guidance and the best practices is an
5 effective way to prevent abuse and neglect.
6 ASSEMBLYMAN SANTABARBARA: I guess
7 with the system in place, can you just walk
8 me through like if -- once an incident is
9 reported, could you just walk me through the
10 process of what happens next and what are the
11 following steps and what is the follow-up
12 from the Justice Center?
13 ACTING EX. DIR. LISI-MURRAY: Sure,
14 absolutely. So if our office of incident
15 management receives a call and there's an
16 allegation of abuse or neglect, it will go
17 through the process. Typically it will go
18 through this three-business-day review
19 process and the documentation will be
20 requested upfront. So like care plans, you
21 know, what specific diagnoses might be
22 relevant to the individual who is, you know,
23 the victim.
24 And that information is collected
377
1 upfront, and then a plan is prepared in order
2 to move forward. We identify who the
3 witnesses would be, we identify who the
4 subject might -- would be, and we --
5 obviously we go out, our investigations team
6 would go out on-site and talk to these people
7 individually and, you know, begin the process
8 of collecting evidence to determine whether
9 we can substantiate an abuse or neglect
10 finding against, you know, the subject.
11 So once somebody is -- you know, you
12 go through the process, assuming they are
13 substantiated, is the term we use, they do
14 have a right to request an appeal from that.
15 We have an internal team of attorneys that
16 will review the appeal, go through all the
17 evidence, make sure that there is sufficient
18 evidence in order to move the matter forward
19 to a hearing. And ultimately any subject
20 accused of abuse or neglect has the right to
21 an administrative hearing.
22 ASSEMBLYMAN SANTABARBARA: And who has
23 access to those documents? The caregivers
24 and parents, are they able to access the
378
1 reports?
2 ACTING EX. DIR. LISI-MURRAY: Yeah,
3 and it depends. There is an investigative
4 summary report that gets prepared, and yes,
5 parents can access it.
6 We have privacy protections in our
7 statute that prevent certain people from
8 seeing certain things. If there's a specific
9 ask that you want or you think you need to
10 see, we can certainly have a discussion
11 offline on that topic. But we're always
12 trying to balance those two competing
13 interests.
14 ASSEMBLYMAN SANTABARBARA: In addition
15 to that, I guess the other question is that
16 process you just described, how long does
17 that typically take? How long does it take
18 to get information back on what happened?
19 ACTING EX. DIR. LISI-MURRAY: You
20 know, it depends --
21 ASSEMBLYMAN SANTABARBARA: Or to get
22 an answer either, the determination of
23 what -- what the situation actually was.
24 ACTING EX. DIR. LISI-MURRAY: Sure. I
379
1 mean, it can depend wildly. Like if we have
2 an incident where there's criminal conduct
3 and we're in contact with the district
4 attorney's office, it would not be unusual to
5 be asked to hold our administrative case
6 while they complete the criminal case.
7 That being said, we work in parallel,
8 it's not like we don't -- we continue working
9 our administrative side. But we collaborate,
10 we help ensure that whatever evidence is
11 useful to a district attorney to obtain a
12 criminal conviction, that we're helping to
13 sort of package the case for them in order to
14 ensure their success on the criminal side
15 also.
16 ASSEMBLYMAN SANTABARBARA: And you
17 mentioned substantiated versus
18 nonsubstantiated. How many cases -- do you
19 have an estimate of how many cases come your
20 way, either month or year, and how many of
21 them do end up being substantiated versus
22 not?
23 ACTING EX. DIR. LISI-MURRAY: Sure.
24 So each year we have approximately 11,000
380
1 abuse and neglect cases that we investigate.
2 We substantiate approximately 40 percent of
3 those each year.
4 ASSEMBLYMAN SANTABARBARA: And most of
5 the ones I've heard of have been reported by
6 someone else in the facility. In your
7 opinion, are there barriers to that, people
8 reporting the cases actually having the
9 mechanism or the opportunity to report
10 something if they see something?
11 ACTING EX. DIR. LISI-MURRAY: Yeah,
12 barriers to reporting are completely
13 unacceptable. That is something we make
14 very, very clear. There can be no
15 retaliation. There has to be a clear
16 reporting line. People are mandated
17 reporters and we expect them to, you know,
18 make the reports if they see something that
19 they believe is an abuse or neglect
20 situation.
21 ASSEMBLYMAN SANTABARBARA: Okay, thank
22 you for your answers and your testimony
23 today.
24 ACTING EX. DIR. LISI-MURRAY: Thank
381
1 you.
2 ASSEMBLYMAN SANTABARBARA: That's all
3 I have, Mr. Chair.
4 CHAIRWOMAN KRUEGER: I'm just
5 double-checking. I don't have any more
6 Senators on my list. Am I missing any of
7 you? No.
8 Assembly, it's yours.
9 CHAIRMAN PRETLOW: Assemblywoman
10 Giglio.
11 ASSEMBLYWOMAN GIGLIO: Thank you.
12 So as a follow-up to what my -- the
13 chair on the committee said, so out of all
14 the complaints that the Justice Center gets,
15 how many of those actually rise to the
16 Justice Center doing an internal
17 investigation instead of the agency?
18 ACTING EX. DIR. LISI-MURRAY: Yes,
19 thank you for that question.
20 ASSEMBLYWOMAN GIGLIO: What
21 percentage.
22 ACTING EX. DIR. LISI-MURRAY: Yup.
23 So the Justice Center retains
24 approximately 40 percent of the cases of
382
1 alleged abuse and neglect that come through.
2 These are typically the most egregious, most
3 troublesome cases. And we have about
4 60 percent that get sent back to the
5 oversight agencies in order to do their own
6 investigation.
7 That being said, please understand
8 that when we send those back to them to do an
9 investigation, we have a guidance document in
10 terms of what we expect, what our agency
11 requirements and controls would be. And then
12 when the investigation is complete, they
13 always come back to the Justice Center at the
14 end, and we do a final review and we -- if
15 we're unhappy with an investigation, we can
16 always send it back.
17 But we have the last say in terms of
18 whether that investigation is properly done
19 and complete.
20 ASSEMBLYWOMAN GIGLIO: Okay. And then
21 you had said that you work in parallel with
22 the district attorney's office. What about
23 cooperation with local police? Do you think
24 that an investigation from the Justice Center
383
1 should be automatic? When there is a police
2 or an ambulance or somebody's hospitalized,
3 do you think that that should just
4 automatically be something that the
5 Justice Center investigates?
6 And how do you track and analyze data
7 on cases involving people with disabilities
8 to identify systemic issues?
9 ACTING EX. DIR. LISI-MURRAY: So, you
10 know, we -- one of the reasons that we've
11 rolled out this first responder initiative
12 and this first responder training, reminding
13 them of their obligations as a mandated
14 reporter, is because they are a critical
15 reporting source for the Justice Center.
16 So yes, these individuals who may
17 respond to a scene or may have -- you know,
18 be taking someone to the hospital and they
19 suspect abuse and neglect in that situation,
20 yes, we would want them to call us. So
21 that's really kind of been the crux of, you
22 know, why we're rolling out this -- why we're
23 rolling out our training and outreach efforts
24 to first responders.
384
1 With respect to -- can you just remind
2 me of your second question?
3 ASSEMBLYWOMAN GIGLIO: Yeah, I mean,
4 back to the first question, because I do have
5 a couple of minutes left.
6 But so when police or when
7 emergency -- because this was a question I
8 asked of the commissioner earlier, is, you
9 know, you're getting a call you have people
10 that are in the house -- these are minimum
11 wage employees that are dealing with people
12 that are disabled that cannot speak for
13 themselves and cannot stand up for
14 themselves. So you're depending on, you
15 know, someone in the house to just say, okay,
16 I'd better call an ambulance or I'd better
17 call the police.
18 And then when they come, don't you
19 think that that should warrant an
20 investigation as to whether or not the people
21 in the house are properly trained?
22 ACTING EX. DIR. LISI-MURRAY: Well, I
23 think that the key to warranting the
24 Justice Center involvement is if that first
385
1 responder believes there's some evidence of
2 abuse or neglect.
3 ASSEMBLYWOMAN GIGLIO: Yeah, but with
4 discovery laws and litigation and everything
5 else, first responders are going to be
6 reluctant to actually follow up on a
7 complaint. I think that it should be
8 automatic.
9 And then the second question was, how
10 does the Justice Center track and analyze
11 data on cases involving people with
12 disabilities to identify systemic issues?
13 So this is happening over and over
14 again in this house -- is it the workers? Is
15 it the -- you know, the behavioral needs of
16 the people that are in the house? Or, you
17 know, what triggers like the Justice Center
18 to say, Hey, we might have a problem here in
19 this house?
20 ACTING EX. DIR. LISI-MURRAY: Sure,
21 absolutely. So we do have the ability to
22 track individuals who may come up in our data
23 as somebody who's a victim, you know, who's
24 shown up repeatedly.
386
1 If we see a situation like that in our
2 data -- and we do track that data -- we have
3 the ability to send out our quality and audit
4 teams. We can do an unannounced site visit.
5 We can -- you know, we have the power to do
6 that. If we feel that there is some
7 situation going on at a provider that's
8 problematic, we will utilize that resource
9 and, you know --
10 ASSEMBLYWOMAN GIGLIO: Thank you. I
11 think you'd get a better picture if all
12 reports of police going to a house and an
13 ambulance going to a house and all
14 hospitalizations -- I think you'd get a
15 better picture if that was automatically
16 reported.
17 ACTING EX. DIR. LISI-MURRAY: Mm-hmm.
18 Fair enough.
19 ASSEMBLYWOMAN GIGLIO: Thank you.
20 CHAIRMAN PRETLOW: Assemblyman Berger.
21 ASSEMBLYMAN BERGER: Hello.
22 ACTING EX. DIR. LISI-MURRAY: Hi.
23 ASSEMBLYMAN BERGER: It's my
24 understanding that a provider employee at an
387
1 OPWDD-funded agency, they often work for
2 multiple agencies. And currently if they
3 work for Provider A, they have to go through
4 fingerprinting and a criminal background
5 check, and if they also want to work for a
6 second agency, which happens often enough,
7 they have to go through the whole -- you
8 know, the cost and the background check, you
9 know, a second, third time. That comes with
10 the additional extra cost, delay in
11 employment and delay in services.
12 Has a registry or central registry or
13 some sort of other modernization effort been
14 considered? And do you believe a registry
15 would alleviate those workforce challenges?
16 ACTING EX. DIR. LISI-MURRAY: Sure.
17 So let me just start with saying our criminal
18 background check and our staff exclusion list
19 checks, those really are our first line of
20 defense in terms of protecting vulnerable
21 persons.
22 You know, it sounds like what you're
23 talking about would have multiple like moving
24 parts and we would need to work with our, you
388
1 know, sister agencies to determine what
2 something like that could ultimately look
3 like. So, you know, I hope I've answered
4 your question. But if I haven't, please let
5 me know.
6 ASSEMBLYMAN BERGER: No, that's good.
7 Thank you. That's it.
8 CHAIRMAN PRETLOW: Assemblywoman
9 Griffin.
10 ASSEMBLYWOMAN GRIFFIN: Thank you for
11 being here today.
12 I just first want to congratulate you
13 on the incredible work you and the
14 Justice Center are doing. I appreciate your
15 approach and the accomplishments made with
16 protecting and serving this very vulnerable
17 population.
18 I wondered when -- I appreciated the
19 focus on the systemic issues that are
20 reoccurring. And what I wondered, when did
21 you -- when did that start, that focus on
22 looking at the facility as more responsible?
23 ACTING EX. DIR. LISI-MURRAY: Well,
24 the impetus for looking at this started
389
1 closer in time to when I started at the
2 Justice Center.
3 This is the first year where I think
4 we've had actual data where we can, you know,
5 talk about having 5 percent over the course
6 of 2024 as, you know, being our Category 4
7 findings.
8 It is an area -- because, you know, I
9 come from a background of quality -- you
10 know, internal audit quality, internal
11 controls background. Like I see this as
12 really an area that is going to help drive
13 improvements in quality, prevention, and
14 ultimately then protection.
15 ASSEMBLYWOMAN GRIFFIN: Yeah, which is
16 really what we need.
17 ACTING EX. DIR. LISI-MURRAY: Yes.
18 ASSEMBLYWOMAN GRIFFIN: Is there --
19 like if you were a family and you were
20 considering different options of where you
21 would be having someone served either daily
22 or a live-in, is there any public listing or
23 anything they can access? Because -- so like
24 they wouldn't choose one of these places that
390
1 has some investigations, serious
2 investigations against it, or serious
3 findings.
4 ACTING EX. DIR. LISI-MURRAY: Thank
5 you for that.
6 Yes, there -- to my knowledge, there
7 is no sort of score card, I think is what
8 you're asking about.
9 ASSEMBLYWOMAN GRIFFIN: Mm-hmm, yes.
10 ACTING EX. DIR. LISI-MURRAY: There's
11 nothing of that type currently that I'm aware
12 of.
13 ASSEMBLYWOMAN GRIFFIN: And do you
14 think there should be?
15 ACTING EX. DIR. LISI-MURRAY: I think
16 that that would require, again, probably
17 legislation and it would certainly require
18 working with sister SOAs. There's a lot
19 of -- a lot of data and maybe some privacy
20 concerns.
21 But, you know, if there's a proposal
22 that will protect vulnerable people, you
23 know, we'd like to be part of that
24 conversation.
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1 ASSEMBLYWOMAN GRIFFIN: Right, thank
2 you.
3 And one final question is, is -- there
4 seems like you have a lot of -- must have a
5 decent budget because you're getting a lot
6 accomplished, and even with the training of
7 first responders. Is your budget adequate
8 for what you're trying to accomplish, and
9 with your new focus on the training of
10 first responders?
11 ACTING EX. DIR. LISI-MURRAY: Yes. So
12 our budget as it stands, you know, is
13 sufficient. We're pleased to be resourced.
14 We're pleased with the Governor's investment
15 in protecting New York's most vulnerable
16 populations.
17 We're very fortunate in that the --
18 you know, the trainings that we are rolling
19 out for law enforcement, the vast majority
20 can be done online, you know, via Webex. And
21 that makes things a lot more cost-effective.
22 ASSEMBLYWOMAN GRIFFIN: Okay. Thank
23 you very much.
24 ACTING EX. DIR. LISI-MURRAY: Yes,
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1 thank you.
2 CHAIRMAN PRETLOW: Assemblyman Maher.
3 ASSEMBLYMAN MAHER: Thank you very
4 much.
5 I have gotten a lot of feedback, and I
6 think you've talked at length about some of
7 the items and some of the practices and
8 training that's involved to really take
9 ownership over the fact that there can be
10 harm potentially done with some of these
11 investigations. I really appreciate that.
12 I will say that some of the feedback
13 that I continue to get -- and it's a work in
14 progress, I'm sure -- is the same phrase:
15 It's as though folks are presumed guilty and
16 not innocent. And that's a sentiment that
17 hopefully, with a lot of the things you
18 discussed, can change over time.
19 One question I wanted to ask you is
20 there's a really interesting model, I want to
21 say in the State of Texas -- I'm going to
22 have it emailed as well -- where they use
23 individuals with different experiences, 30,
24 20 years in the field, to supplement some of
393
1 the initial information that's brought in as
2 more of an evidence-based approach.
3 Would you be open to utilizing that
4 model or something similar to make sure that
5 some of these investigations before they get
6 too far, some of the very easy, low-hanging
7 fruit, folks can come and just make sure that
8 we get to that evidence-based approach
9 instead?
10 ACTING EX. DIR. LISI-MURRAY: You
11 know, it's interesting because, you know, I
12 talked earlier about our 3BDR,
13 three-business-day process. That is part
14 of -- you know, it sounds like it might --
15 I'm not familiar with that report. If you'd
16 like to send it, I would be very happy to
17 read it.
18 ASSEMBLYMAN MAHER: Sure.
19 ACTING EX. DIR. LISI-MURRAY: But, you
20 know, this is the first instance when we get
21 something that comes in through our intake
22 unit, these folks identify, you know, what
23 are the typical documents you're going to
24 need, what are the typical -- you know, what
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1 would we need to support an investigation.
2 There are always documents that are,
3 you know, routine, like care plans, you know,
4 medical orders, that sort of thing. So we
5 know right out of the gate what we need to
6 look at, at least to get a handle on what the
7 investigation may look like.
8 That also allows us to create a plan
9 internally. And when it goes to
10 investigations, it streamlines it. It makes
11 it -- it makes it quicker.
12 And that dovetails on the other item I
13 talked about with respect to this early
14 evidence, you know, review and this process
15 of being able to take an investigation that
16 may have multiple potential subjects. And if
17 we can, you know, basically drop those
18 individuals from the investigation at the
19 front end, we try to do that immediately so
20 they can get right back to work.
21 ASSEMBLYMAN MAHER: I did hear you
22 mention that. And I've been very impressed
23 with some of the things that you've said, and
24 they've been in -- you know, contradicting to
395
1 some of the other items that I've heard.
2 So what I'd love to do is have a close
3 relationship with your office and as I
4 receive some of this information on models
5 that work in other states, would love to pass
6 that along.
7 ACTING EX. DIR. LISI-MURRAY:
8 Excellent. Thank you. Appreciate it.
9 ASSEMBLYMAN MAHER: Thank you.
10 CHAIRWOMAN KRUEGER: Just
11 double-checking. Anyone else for this
12 commissioner? Director, sorry.
13 All right, hearing from no one, I'm
14 going to thank you very much for your
15 participation today. And you're welcome to
16 take your leave and continue your work.
17 And we are going to move on to our
18 first non-governmental invitee panel. We're
19 calling you Panel B. So New York State
20 Conference of Local Mental Hygiene Directors,
21 Mental Health Association of New York State,
22 the National Alliance on Mental Illness-
23 New York State, if you would all like to come
24 and take your seats.
396
1 And now for the remainder of this
2 hearing, everyone should remember the rules
3 have now changed to three minutes for each
4 testifier and three minutes for each
5 legislative questioner. Being a chair or a
6 ranker no longer gets you extra time, or a
7 second bite at the apple, so we will all
8 learn to be very, very concise.
9 And I see three groups on my list, and
10 yet four people. So let's have you each
11 introduce yourself so the communications
12 people upstairs know how to describe you when
13 you do go on camera.
14 Hi. Why don't you just introduce
15 yourself.
16 MS. DAVID: Introduce but not start.
17 CHAIRWOMAN KRUEGER: Yes.
18 MS. DAVID: Courtney David, executive
19 director, New York State Conference of
20 Local Mental Hygiene Directors.
21 CHAIRWOMAN KRUEGER: Thank you.
22 Hi.
23 MR. McLAUGHLIN: Nathan McLaughlin,
24 executive director, NAMI-New York State.
397
1 MS. NECHES: Julie LeClair Neches.
2 I'm a board member of NAMI-New York State,
3 psychologist, and mother of somebody with a
4 mental illness.
5 MR. LIEBMAN: Glenn Liebman --
6 CHAIRWOMAN KRUEGER: Which group are
7 you with, I'm sorry?
8 MS. NECHES: I'm with --
9 MR. McLAUGHLIN: The same
10 organization.
11 MS. NECHES: -- the same organization,
12 the NAMI-New York State group. We're going
13 together.
14 CHAIRWOMAN KRUEGER: Thank you.
15 Okay?
16 MR. LIEBMAN: I'm Glenn Liebman, CEO of
17 Mental Health Association in New York State.
18 CHAIRWOMAN KRUEGER: Okay. So we go
19 back to this side of the table. You have
20 three minutes, the two of you together have
21 three minutes, and then the final, for three
22 minutes. Thank you.
23 MS. DAVID: Thank you.
24 Good afternoon. Again, I'm
398
1 Courtney David. I'm the executive director
2 of the New York State Conference of
3 Local Mental Hygiene Directors. The
4 conference consists of the directors of
5 community services for the 57 counties and
6 City of New York. Thank you for the
7 opportunity to testify today regarding the
8 proposed Executive Budget and our priorities
9 to improve the mental hygiene systems
10 locally.
11 First, we must reform the state's
12 competency restoration process. For the last
13 several years the conference has been
14 advocating to implement these reforms, and it
15 is time to finally overhaul the archaic
16 statute that governs the process for
17 determining a defendant competent to stand
18 trial.
19 In fiscal year '21, the state shifted
20 100 percent of the cost of competency
21 restoration onto the counties. The per diem
22 rate for one individual in a state-operated
23 forensic facility is approximately $1300 per
24 day. Over the last four years, this policy
399
1 action has diverted hundreds of millions of
2 dollars away from counties and their local
3 systems of care.
4 For example, Warren County, with a
5 population of 65,000, has experienced a
6 10,000 percent increase in cost -- 14,000 was
7 2019; 2024 was 1.6 million. In many counties
8 these costs are now exceeding the property
9 tax cap.
10 Restoration services do not replace
11 appropriate treatment and supports, which in
12 many cases has led to repeated cycles of
13 incarceration. More individuals deemed
14 incompetent to stand trial are being sent to
15 state forensic facilities, and many have been
16 in restoration for periods of three, six, or
17 even 10 years. The DCS has also received
18 little to no clinical information or
19 timelines for discharge.
20 I want to thank you, Senator Brouk,
21 for your ongoing support by carrying our
22 bill, which includes the reforms necessary to
23 address this issue.
24 We are also asking your support for a
400
1 20 percent administrative state aid increase
2 to sustain county-based single point of
3 access programs. SPOA programs are vital
4 local supports which link individuals and
5 families to needed services, especially those
6 with histories of homelessness and criminal
7 justice involvement.
8 SPOA coordinators make referrals to
9 treatment and supports, provide care
10 coordination, and work with clients to help
11 navigate complex systems. In many cases they
12 serve as an advocate for individuals and
13 their families.
14 Despite increasing responsibilities,
15 state funding for these programs has remained
16 stagnant and many rural counties struggle to
17 retain full-time coordinator positions.
18 We also request the inclusion of a
19 provision outlined in Addendum 1 of my
20 written testimony to require the sharing of
21 clinical records under AOT orders with the
22 county directors. A 2011 legal case known as
23 the Miguel M decision has at times restricted
24 their ability to obtain these records,
401
1 particularly in New York City.
2 We strongly support the Governor's
3 enhancements to AOT programs and inclusion of
4 16.5 million to assist counties with this
5 process. However, the final budget must
6 include our suggested amendment to ensure the
7 appropriate coordinated care is available to
8 support these individuals.
9 Thank you for your time and
10 consideration. I look forward to working
11 with you and your staff this budget cycle.
12 MR. McLAUGHLIN: Good afternoon.
13 Thank you for the opportunity to provide
14 testimony. Again, my name is Nathan
15 McLaughlin. I'm the executive director for
16 the National Alliance on Mental Illness, the
17 New York State Chapter.
18 The issues we'll be testifying on
19 today have long impacted myself and my family
20 as a parent of a child with mental illness.
21 With me today is NAMI-New York State board
22 member Julie LeClair Neches, who will also
23 share a piece of her story.
24 You know, our message today is really
402
1 about progress and collaboration with both
2 the Executive and the Legislature. As you'll
3 read in our testimony, we're really looking
4 at our three legislative priorities this
5 year, which is fighting for people like Alix
6 and Nicole, some of the most vulnerable
7 New Yorkers living with serious mental
8 illness. Also breaking down barriers,
9 building bridges, and increasing access to
10 mental health services for all New Yorkers
11 who need them. And, of course, addressing
12 the youth mental health crisis.
13 There are two issues that we would
14 like to see improvement on, which is the
15 2.1 percent increase and the
16 prescriber-prevails issue we'd like to have
17 another look at.
18 But I hand my time over to
19 Julie LeClair Neches.
20 MS. NECHES: Okay. So I already said
21 who I am, so I'll just get started.
22 So my daughter Alix was diagnosed with
23 bipolar disorder her freshman year of
24 college. And I was called onto the campus,
403
1 and I actually lived in the infirmary in the
2 parent room while she was in the psychiatric
3 unit. It was a little like the movie
4 Freaky Friday: I was living the campus life,
5 but she wasn't leading my life.
6 And while she was on the psych unit
7 she e-mailed the entire freshman class at
8 Dartmouth and got stigmatized, so she ended
9 up transferring to NYU. And while she was
10 there, she did great, and she advocated for
11 others with a mental illness.
12 And I'm also so honored that Governor
13 Kathy Hochul told my daughter Alix's story at
14 the State of the State so that she could
15 still make a difference. And it's like my
16 daughter, who was advocating for those with a
17 mental illness, was still advocating from up
18 in heaven.
19 And my daughter ended up having an
20 issue when she transferred to NYU when my dad
21 died. And she ended up needing the services
22 that Governor Kathy Hochul is prioritizing,
23 and they really helped her.
24 And even though my daughter did not
404
1 make it and passed away at age 25, some
2 wonderful things happened. NYU posthumously
3 gave her a college degree. And also, at the
4 funeral, all these people I didn't know came
5 up to me and said they were on psych wards
6 with my daughter and she had uplifted them
7 while she was on the psych ward and made a
8 difference even while she was in a manic
9 episode.
10 And one person who couldn't come to
11 the funeral went to the gravesite, read my
12 daughter Alix a seven-page letter, said she
13 wouldn't be in med school if it wasn't for my
14 daughter, and that she was going to name her
15 first child after her.
16 And so I want to thank you for letting
17 me give Alix a voice, and she is still
18 advocating right now. So thank you.
19 MR. LIEBMAN: That was -- that was
20 incredible.
21 My name's Glenn Liebman. I'm the CEO
22 of the Mental Health Association in New York
23 State. I've been CEO for over 20 years now,
24 and I've had the privilege of testifying all
405
1 these past 20 years.
2 So our organization has 26 affiliates
3 in 52 counties throughout New York State. We
4 provide community-based mental health --
5 we're a community-based mental health
6 organization; we provide services on the
7 ground.
8 I just want to welcome
9 Assemblymember Simon as our new chair.
10 Thank you.
11 And I also want to acknowledge
12 Aileen Gunther, who was our former
13 Mental Hygiene chair in the Assembly. Aileen
14 was a really strong advocate and a really
15 good friend. And, you know, we wish her
16 luck.
17 And we also want to recognize -- we're
18 so glad that Senator Brouk is back as the
19 Mental Hygiene chair as well.
20 So we have extensive testimony, which
21 I'm obviously not going to read, but it's
22 largely based on workforce, our response to
23 Kendra's Law -- we have a 10-point plan --
24 behavioral health parity, youth and teen
406
1 mental health first aid, mental health
2 training for teachers -- thank you,
3 Senator Fernandez, for your support for that
4 bill -- mental health in colleges, first
5 responder peer support, prescriber prevails,
6 and equal payments for adult home residents.
7 I'm going to just -- given my brief
8 time, I'm going to talk about workforce. And
9 almost all of you articulated it so well,
10 much better than I could, about the
11 challenges that we have. We have a
12 30 percent turnover rate on a yearly basis.
13 Yesterday a woman spoke at our press
14 conference about how her son had 11 case
15 managers in 10 years. How do you develop a
16 therapeutic relationship if someone leaves
17 after 10 months?
18 Now, Governor Hochul has been the best
19 Governor we've ever had in terms of her
20 commitment to workforce. She's provided more
21 than the last four governors combined. But
22 as we all say, it's still not enough.
23 We are advocating for a 7.8 percent
24 increase, which is based on how funding over
407
1 the past four years did not meet the consumer
2 price index. This year she has proposed
3 adding 2.1 percent. It's a start. But for
4 someone like my son, who is a direct care
5 worker who makes $30,000 a year, that amounts
6 to $12 more a week. That's hardly a
7 recruitment tool.
8 Our people are mission-driven --
9 that's why they take these positions. But
10 mission-driven doesn't put food on the table.
11 We can't keep up with salaries in the
12 for-profit companies like Amazon and Walmart,
13 and fast food. We can't keep up with the
14 state workforce either.
15 For equivalent jobs, they pay higher
16 salaries. And we just found this out a few
17 months ago -- their benefit package is
18 65.5 percent of the state workforce. Ours is
19 capped at 27 percent. When a state worker
20 retires, they receive a nice pension. When a
21 non-for-profit worker retires, they receive a
22 nice handshake.
23 So that's really where we are in terms
24 of the funding for this program. And we
408
1 really urge your continued support to move
2 from a 2.1 percent to a 7.8 percent. These
3 people are doing the most incredible work in
4 our community, and we need to support them.
5 And anything we can do to, you know, respond
6 to that support is really important.
7 And including, Senator Brouk, your
8 bill about capping CPI with COLA is something
9 we would love to see happen. And we're
10 obviously advocating for that.
11 So thank you.
12 CHAIRWOMAN KRUEGER: Thank you.
13 Surprise guest, will you say your name
14 once more for our tech people? Because we
15 don't have it in writing anywhere.
16 MS. NECHES: Me?
17 CHAIRWOMAN KRUEGER: Yes.
18 MS. NECHES: Okay. So I am Julie
19 LeClair Neches, N-E-C-H-E-S. Julie LeClair
20 Neches.
21 CHAIRWOMAN KRUEGER: Thank you very
22 much. It's just so that our tech people know
23 what to put on the screen and in the record.
24 Thank you.
409
1 MS. NECHES: All right. Thank you.
2 CHAIRWOMAN KRUEGER: Thank you.
3 And our first questioner is
4 Senator Samra Brouk, chair.
5 SENATOR BROUK: Thank you so much, and
6 thank you all.
7 Julie, it's really nice to see you
8 again. Now we've become fast friends as
9 you've been here advocating. And your
10 story -- I don't think anyone will forget.
11 And thank you, obviously, to our
12 partners that we do this work with.
13 I do want to talk about two quick
14 things. One is, you know, when you shared
15 that part of your story, Julie, around the
16 power that Alix had on her peers, it really,
17 I think for all of us, shows why we talk so
18 much about peer support, because there's
19 nothing more powerful than someone who can
20 understand what you are going through.
21 And so I just -- it's not a question,
22 but it's more of an urging of folks to think
23 about that and how powerful that is. I mean,
24 I had chills hearing it.
410
1 And these individuals who are doing
2 this work, you know, professionally also
3 deserve, you know, living wages and the
4 support they need, because what they do is
5 powerful and can't be replicated.
6 So I want to thank you for putting
7 such a fine point and just for your courage
8 to stand here and be helping others with your
9 story.
10 And then I want to talk about
11 workforce. You know, it's come up a lot.
12 And there's one thing that I wanted to point
13 to. So obviously the Governor has the
14 2.1 percent inflationary increase. You
15 know -- I guess, Glenn, I'll bring this to
16 you. Do you have thoughts on how you would
17 want -- I think you gave 7.8 percent as --
18 MR. LIEBMAN: Mm-hmm.
19 SENATOR BROUK: Okay. So do you have
20 any thoughts on -- you know, I know we've
21 talked in the past about splitting carveouts.
22 Is there a sense of what you want that
23 percentage to look like? Because this isn't
24 technically a COLA that the Governor has put
411
1 in, right?
2 MR. LIEBMAN: Correct.
3 SENATOR BROUK: The language is
4 different. So I just want to be very clear
5 on what it is you think you need to be
6 successful, keep that 30 percent turnover
7 from getting even higher.
8 MR. LIEBMAN: Sure. And I appreciate
9 that, Senator, and thank you for your
10 support.
11 What we're looking for with the 7.8 is
12 simply what used to be a COLA -- whatever
13 we're calling it now -- but what a COLA did
14 in the past was it provided the flexibility.
15 So when the Governor puts out the
16 2.1 percent, there's flexibility there.
17 So for agencies, yes, the priority is
18 workforce. But for agencies that have
19 concerns and issues about the rising cost of
20 healthcare or oil or gas or whatever they
21 need to run their business, they can use that
22 COLA for that as well.
23 So we envision great flexibility
24 within that 7.8 if we do get there. We
412
1 envision it COLA-like in terms of the
2 flexibility of it.
3 SENATOR BROUK: So if we -- thank you.
4 If we're able to get my bill -- thank you for
5 mentioning it -- to actually tie these things
6 to inflation, what will you do with all your
7 free time when you don't have to do fight for
8 a COLA every year?
9 (Laughter.)
10 SENATOR BROUK: Seventeen seconds to
11 tell us.
12 MR. LIEBMAN: Oh, that's not -- look
13 at those 12 pages. That's not an issue. You
14 know -- you've been chair for several years.
15 You know it's never an issue.
16 SENATOR BROUK: All right. Thank you
17 so much. I appreciate it.
18 MR. LIEBMAN: Sure.
19 CHAIRWOMAN KRUEGER: Sorry.
20 Assembly.
21 CHAIRMAN PRETLOW: Assemblywoman
22 Simon.
23 ASSEMBLYWOMAN SIMON: Thank you.
24 Thank you. You know, I have to
413
1 apologize. I was watching you gesticulate,
2 and it's because I was looking at the closed
3 captions. Because the acoustics aren't great
4 in this room, so I was wondering what you
5 were doing. So anyway, I apologize.
6 So I have a couple of questions for
7 you. And so, you know, one question I have
8 for NAMI is, you know, some of the issues
9 that we face when we look -- are looking at
10 AOTs and involuntary commitment that, of
11 course, there are people who, from time to
12 time, need that, right? But a real concern
13 about expanding some of these notions that --
14 as if that was really the problem, right?
15 Sometimes the problem is that there's
16 a determination to release somebody before
17 they're quite ready, or there's no place for
18 them to go to transition. And so they end up
19 then getting off their meds or they end up
20 back in a very difficult set of
21 circumstances.
22 And so I was glad to see that you're
23 advocating for, you know, holistic care, and
24 in that I would also include families,
414
1 support for families and helping families
2 figure out how to help and how not to further
3 engender some of the issues with --
4 inter-families that could just exacerbate
5 things, for example, without knowing.
6 What is your view on that?
7 MR. McLAUGHLIN: So I strongly
8 support, you know, these holistic or what we
9 call natural support systems, right? And I
10 think NAMI is kind of uniquely situated --
11 not uniquely, but we're situated to address
12 that, right?
13 We provide programs such as
14 Family-to-Family that addresses that need
15 directly. We can train families to support
16 one another, which I think really supports
17 what we're calling enhancements of AOT versus
18 expansions.
19 ASSEMBLYWOMAN SIMON: Could you say
20 that again?
21 MR. McLAUGHLIN: Sure. Which we call
22 enhancements of AOT -- versus expansion,
23 right -- which is looking at some very
24 detailed parts of AOT that we talk about in
415
1 our testimony.
2 But I strongly believe that these are
3 all parts of the overall puzzle, you know,
4 and with family support in there that
5 NAMI-New York State can really help provide
6 through our own programming.
7 ASSEMBLYWOMAN SIMON: Yeah. I guess
8 one of the issues that I see with the -- the
9 way there is -- and this is why we have these
10 hearings and a process, is what has been
11 upheld for in-patient circumstances doesn't
12 translate as well to the initial referral.
13 Thank you. I've run out of time.
14 CHAIRWOMAN KRUEGER: Thank you.
15 Any Senators? Just checking. Oh,
16 yes, thank you. Senator Canzoneri-
17 Fitzpatrick, ranker, five minutes. Oh, I'm
18 sorry. I take that back. I forgot my own
19 rules. Everyone only gets three minutes.
20 We're on that stage of the hearing.
21 SENATOR CANZONERI-FITZPATRICK: Thank
22 you, Madam Chair.
23 Thank you all for the work that you're
24 doing. As was stated, I'm the ranking member
416
1 on Mental Health for the Senate, and I'm
2 really very passionate about this.
3 And thank you for sharing your story
4 about your daughter, the most personal of
5 situations that you've gone through. And I
6 appreciate that you're sharing that, because
7 that does help other people out there that
8 are suffering.
9 I wanted to always encourage people to
10 go into this field because of the workforce
11 retention issues that we've talked about.
12 And as we've mentioned, the 7.8 percent
13 increase would be a lot better than where we
14 are right now.
15 But one of the other things that I
16 have advocated for is student loan
17 forgiveness, other programs to encourage
18 people to go into this field, with the idea
19 that if you go in and serve in a
20 community-based center in an underserved
21 area, whatever the criteria are, that we
22 would then help people with the tuition and
23 loan forgiveness. You know, give that
24 incentive for people to go into this field.
417
1 So my question is, are there gaps that
2 you're seeing that a loan forgiveness program
3 would help and specific job titles or other
4 things that you could see where a program
5 like that might offer some help to improve?
6 MR. LIEBMAN: Sure. I'll start, I
7 guess, and then -- thank you.
8 That's a very good question. And by
9 the way, I loved your advocacy on the 7.8,
10 thank you, when we initially spoke of it.
11 SENATOR CANZONERI-FITZPATRICK: Thank
12 you.
13 MR. LIEBMAN: I think where we're
14 missing -- obviously, you know, we have an
15 issue with clinical -- being able to hire
16 clinical staff, we know that.
17 But another issue we have is we have
18 an issue with paraprofessionals and peers as
19 well. And, in the other fields, in OPWDD and
20 OASAS, they have stronger sort of mentoring
21 programs, the beginning of mentoring
22 programs. And I know that the Office of
23 Mental Health is moving forward with their
24 paraprofessional program and their licensure
418
1 around it, but I think that that is an area
2 where we're really lacking.
3 Young people are coming out of
4 high school -- they might not want to get a
5 college degree, but they want to get into the
6 field. My son's a prime example of that. He
7 went into the OASAS field because he was able
8 to become a CASAC. They don't have those
9 kinds of options. They're going to get those
10 options, hopefully, at some point, but they
11 don't have those options now in mental
12 health.
13 SENATOR CANZONERI-FITZPATRICK: Okay.
14 Well, certainly I think it's important for
15 you to tell us how we can help you
16 legislatively to strengthen the workforce,
17 because people are so important to the work
18 that you're doing, and we do recognize that.
19 So thank you all for being here.
20 That's all I have, Madam Chair.
21 CHAIRWOMAN KRUEGER: Thank you.
22 Assembly.
23 CHAIRMAN PRETLOW: Assemblymember
24 Sempolinski.
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1 ASSEMBLYMAN SEMPOLINSKI: Thank you,
2 Chairman.
3 So hi, everybody. I'm Joe
4 Sempolinski. I'm a new Assemblymember. I'm
5 the ranking Republican on the Mental Health
6 Committee, so I'm looking forward to working
7 with all of you.
8 I guess we'll try and do the quick
9 three-minute version here.
10 To Mr. Liebman, I would also want to
11 raise my voice on the COLA situation. I
12 brought that up to both the commissioner of
13 Mental Health and the commissioner of OPWDD
14 earlier today.
15 Why don't we just start with
16 inflation. If you're below inflation, you
17 can call it all sorts of nice terminology,
18 whatever you want to call it, but it's not
19 really a COLA, it's really a cut. It's just
20 how -- it's maybe a little bit less of a cut
21 than we've had from other governors, so.
22 And then to Julie, thank you so much
23 for sharing your daughter's story. And I
24 know she's happy watching you speak on her
420
1 behalf today. So thank you for being here.
2 And then to Ms. David -- I want to dig
3 a little bit in the two minutes I've got --
4 did you say a 10,000 percent increase for
5 Warren County? And the reason I point it out
6 is the places -- I do not represent
7 Warren County, but I represent places that
8 are very similar to Warren County as far as
9 being rural. And where did that number sort
10 of come from?
11 MS. DAVID: So in 2019, there was a
12 cost shift -- I'm sorry, in 2020 there was a
13 cost shift where, because of the way that the
14 statute reads on this competency restoration
15 process, it dates back to 1920 and the way
16 that there's a piece, part of the CPL 30 --
17 that's the reference, we call them 730
18 orders -- there's a section in Mental Hygiene
19 Law that dates back to that old statute that
20 says that the cost for these services would
21 be borne by the county.
22 But again, we're way past 1920, you
23 know. And up until 2020, OMH would share --
24 cost-share those costs with us fifty-fifty.
421
1 Right? And then in 2020 the cost shift
2 happened, went to 100 percent back to the
3 counties, because they could just do that
4 through a financial action because it was
5 already in the statute.
6 And we're seeing more and more the
7 courts using these orders -- you know, I
8 think they believe deep down that this is
9 supposed to put folks into treatment, but
10 these are competency restoration services,
11 which is really just to get folks to
12 understand the charges against them, get them
13 back to the court so that they can, you know,
14 proceed with the legal process.
15 But we're finding that folks are
16 being -- you know, they're languishing in
17 some of these state forensic facilities for
18 years. It's a high cost per day, $1,300 per
19 day per person. So you can imagine, order
20 after order, person after person, and that
21 starts to add up. And that's where you're
22 seeing these increases happening.
23 ASSEMBLYMAN SEMPOLINSKI: Yeah,
24 anytime a rural county has got a
422
1 10,000 percent increase in expenses, it's
2 going to prompt a follow-up question from me.
3 MS. DAVID: Yeah. Sure.
4 ASSEMBLYMAN SEMPOLINSKI: So thank you
5 very much. And thank you to all of you for
6 your time.
7 MS. DAVID: Sure. We have a -- we
8 have a much -- we have a spreadsheet that
9 kind of looks at the whole --
10 ASSEMBLYMAN SEMPOLINSKI: Send it over
11 to me.
12 MS. DAVID: -- whole entire county --
13 ASSEMBLYMAN SEMPOLINSKI: I would love
14 to see that.
15 MS. DAVID: This was just a quick
16 excerpt.
17 ASSEMBLYMAN SEMPOLINSKI: Thank you.
18 CHAIRWOMAN KRUEGER: Thank you.
19 Senators?
20 Then I have a question. Hi.
21 So there has been some national news
22 about health insurance companies refusing
23 mental health payments for people in search
24 of care that they need. And at least under
423
1 federal and previous state law, they have to
2 provide mental health care parity.
3 The articles that I was reading were
4 more of the national scandal. And I'm
5 curious, are we seeing the same problem here
6 in New York? Because there's probably
7 nothing worse than knowing you are desperate
8 for help, going in search of help, actually
9 believing you are entitled to payment for
10 that, and then learning you are not.
11 MR. LIEBMAN: It is -- thank you for
12 that question. I've got to say that we've
13 had Timothy's Law now on the books for almost
14 20 years. It was a comprehensive parity law.
15 And unfortunately, we're still fighting those
16 issues that you referenced. We're still
17 fighting those same issues today. And there
18 is nothing worse.
19 And I think -- you know, the
20 commissioner this morning referenced a
21 million dollars for DFS and Department of
22 Health and OMH to improve enforcement. We
23 need more than a million dollars to improve
24 enforcement. We can't sit there and go case
424
1 by case. We have to have a systemic
2 response, because too many people are falling
3 through the cracks.
4 It's wonderful that the Governor is
5 putting, you know, this program together
6 around parity, around making sure that
7 somebody is engaged with services within
8 seven days. I think that's great.
9 But what's the fail safe with that?
10 What are we going to do to make sure that
11 that happens? We have to have a really
12 comprehensive response. And I think what's
13 going on nationally, sadly, is the same thing
14 in New York State, and it's just -- there's
15 nothing worse. There's absolutely nothing
16 worse.
17 Thank you.
18 CHAIRWOMAN KRUEGER: Thank you, Glenn.
19 I would like us to try to be better than the
20 national problems.
21 MR. LIEBMAN: Yes, well.
22 CHAIRWOMAN KRUEGER: That is my hope.
23 MR. LIEBMAN: Right, agree.
24 CHAIRWOMAN KRUEGER: I don't know if
425
1 anyone else wants to chime in. Okay. I
2 think that's my actually one question.
3 Assembly.
4 CHAIRMAN PRETLOW: Assemblyman
5 Santabarbara.
6 ASSEMBLYMAN SANTABARBARA: Okay, there
7 we go.
8 Thank you all for being here, and
9 thank you for your testimony. Just a couple
10 of questions.
11 Counties are often on the frontlines
12 of mental health services. I just wanted to
13 ask about the state aid formulas and funding
14 structures, how they're meeting local needs,
15 and what changes would you like to see in
16 this state budget?
17 MS. DAVID: Yes. So again, it's when
18 we talk about the 730 issue -- I mean, this
19 is draining millions and millions of dollars
20 every year out of the local system, right?
21 So this is taxpayer dollars that are a county
22 tax levee that's going into the State General
23 Fund. So when you pull those dollars out,
24 then it leaves less for, you know, mental
426
1 health care.
2 So, you know, yes, we -- you know,
3 there are certain programs that I think are
4 sustainable given the local assistance that
5 we get, or I should say state aid assistance.
6 But things like I outlined in my
7 testimony, you know, those SPOA coordinator
8 positions, they're highly valued in the
9 counties. They have them for adults and for
10 children. Sometimes they have to be the same
11 person, and sometimes that person has
12 multiple roles within the county. Those
13 programs have not seen an increase in
14 probably two decades. So programs like that.
15 Again, I was happy to see the
16 16.5 million on the AOT enhancements, because
17 that will help. We also have county AOT
18 coordinators that work on those referrals and
19 those petitions as well. So those are two
20 examples of where we would like to see more
21 state assistance.
22 ASSEMBLYMAN SANTABARBARA: Yeah. No,
23 that's good information. Thank you for your
24 answer.
427
1 MS. DAVID: Sure.
2 ASSEMBLYMAN SANTABARBARA: Just a
3 quick question for Mr. Liebman on the need
4 for parity in mental health funding. I guess
5 I have the same question to you as well.
6 What specific policy would you like to
7 see as far as mental health services to be
8 able to funded at that same level as physical
9 health services?
10 MR. LIEBMAN: You know, and I forgot
11 to reference the other point around this, and
12 you're so right, it's -- there are so many
13 ghost providers. And the Attorney General's
14 report last year I thought was so damning
15 about the lack of a response from, you know,
16 the community, the managed care community on
17 this.
18 And I think, again, where I would go
19 is enforcement. We know that there are these
20 issues that come up from time to time around
21 parity. And I think we have to have a really
22 strong systemic response. And nothing sends
23 a message out like an enforcement and looking
24 at the enforcement and giving a heavy fine if
428
1 necessary. That sends a message out to the
2 entire community that you can't be doing
3 this.
4 And again, with the support of the
5 Governor's office and the Attorney General,
6 the Legislature, I think we can get there.
7 So I'm very hopeful for that.
8 ASSEMBLYMAN SANTABARBARA: Thank you
9 for that.
10 I think I'm just about out of time.
11 Thank you, Mr. Chair. That'll be it.
12 CHAIRWOMAN KRUEGER: Senator
13 Fernandez.
14 SENATOR FERNANDEZ: Thank you so much.
15 Thank you all for being here.
16 Really quick, Glenn, you did mention
17 my bill, thank you. I'm happy to see that
18 continued investing in youth mental health.
19 But could you just explain a little bit --
20 remind me, because this bill I've had for a
21 while and it hasn't moved, unfortunately --
22 why this is necessary to train our teachers
23 and school administrators about mental health
24 awareness.
429
1 MR. LIEBMAN: Sure. And again, thank
2 you again for introducing the bill this year,
3 and for Assemblymember Kelles as well.
4 I think -- we know we have a youth
5 mental health crisis. The Governor's
6 articulated it, we've all articulated it.
7 We've all seen it. About a decade ago now we
8 had mandated -- we were able to pass mandated
9 instruction for mental health for young
10 people in schools, that they were made sure
11 they got trained.
12 But what about teachers? Teachers --
13 there are many teachers out there who are
14 essentially seeing these issues in young
15 people, and they don't know -- is this a
16 mental health issue. We don't want them to
17 be clinicians. The last thing we want them
18 to be are clinicians. They've got enough on
19 their plate. But we want them to look at the
20 individual and say -- clearly, there has to
21 be some concern. And maybe it's referring
22 somebody to a school-based mental health
23 clinic or the ability to at least have an
24 essential understanding.
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1 And your bill really just talks about
2 that. I think it's a very commonsense bill
3 that essentially says, Hey, teachers, you
4 need to have a basic understanding of mental
5 health. Not all of you do. And again, we
6 don't want you to be clinicians, but at least
7 have a basic understanding of mental health.
8 So we hope obviously -- we hope it passes
9 this year. There's not really a fiscal
10 attached to it, so we're very hopeful.
11 Thank you.
12 SENATOR FERNANDEZ: Thank you so much.
13 A reminder that knowledge is power.
14 CHAIRMAN PRETLOW: Assemblyman Maher.
15 ASSEMBLYMAN MAHER: Thank you all for
16 being here today, and thank you for the work
17 that you're doing.
18 I specifically wanted to ask a
19 question of Ms. David. Being in your
20 capacity and working with so many different
21 mental hygiene directors, is there something
22 aside from the labor and the workforce that
23 is a consistent theme that you can talk about
24 that comes up in some of the conversations
431
1 you have?
2 MS. DAVID: Well, our directors are
3 very uniquely situated for what they do in
4 the county. They have oversight of all three
5 mental hygiene systems, so mental health,
6 SUD, and I/DD.
7 So I think one of the consistent --
8 because they have that lens, you know,
9 obviously co-occurring complex needs is a
10 huge priority for them, and making sure that
11 while the agencies are siloed at the state
12 level, they intersect at the local level. So
13 we're really trying to promote more service
14 provision, more service expansion for folks
15 that hit each individual service system.
16 But, you know -- so it's the complex
17 needs, co-occurring issues that they see
18 mostly.
19 ASSEMBLYMAN MAHER: No problem.
20 And this is for anyone at this point.
21 We focused a lot on elementary, middle and
22 high school children and how important the
23 services are especially for some of the
24 high schoolers, especially post-COVID. What
432
1 are some of the challenges that you've seen
2 when it comes to the programs that are being
3 tried, and what can we do better?
4 MR. LIEBMAN: So we have a program --
5 you're talking specifically K-12 or college?
6 ASSEMBLYMAN MAHER: I was actually
7 looking at SEL and how that's being brought
8 into the equation.
9 MR. LIEBMAN: Okay. I would say that
10 I'm not really an expert in that area. But I
11 would say that we have to really kind of
12 figure out how to make sure that young people
13 have a basic understanding of mental health.
14 And whatever the criteria, SEL or
15 whatever criteria is necessary to make that
16 happen, I think that that was sort of -- when
17 we pushed for the, you know, mandated
18 instruction of young people in schools, I
19 think we really wanted to make sure they at
20 least have a basic understanding of
21 mental health.
22 ASSEMBLYMAN MAHER: That's an
23 interesting point. And one comment I got
24 from a youth was they never thought about
433
1 mental health and they never had certain
2 issues, but when it began being discussed so
3 much, that became something that entered
4 their mind.
5 Do you see some of that conversation
6 out there and in the industry?
7 MR. LIEBMAN: Well, I think the
8 pandemic had a lot to do with that. I think
9 that you can't underrate what the pandemic
10 meant to young people and the impact it had,
11 the psychological impact, the mental health
12 impact it had to young people. And the good
13 thing about the pandemic was it sort of ended
14 some of the stigma that was engaged with
15 young people and mental health.
16 But that said, you can't underestimate
17 how important mental health education is.
18 ASSEMBLYMAN MAHER: Thank you all.
19 CHAIRMAN PRETLOW: Assemblywoman
20 Griffin.
21 ASSEMBLYWOMAN GRIFFIN: Okay. Thank
22 you all for being here.
23 Glenn, I wanted to ask you -- well, I
24 wanted to tell you I appreciate the 10-point
434
1 plan in regards to involuntary commitment and
2 especially the importance of implementing the
3 incident review panel, which seems like that
4 would really be helpful in this process.
5 In regards to your recommendation
6 about fully supporting the community service
7 continuum for mental healthcare after a
8 person is discharged, what is the funding
9 like? We know that wasn't -- isn't funded in
10 the budget.
11 What -- what level of funding would
12 you suggest to make that happen?
13 MR. LIEBMAN: That's a very good
14 question.
15 I think that, you know, in terms of
16 the whole Kendra's Law issue, I think we put
17 this 10-point plan together to respond to,
18 you know, what we've seen in the news and
19 certainly from the Governor's office, and
20 some of the legislators too, that we think
21 that we should be going in a different
22 direction. I ran the Kendra's Law program
23 when it first started in the Office of
24 Mental Health. I see that we should be going
435
1 the alternative direction, frankly. I think
2 that.
3 So one of the things we see is the
4 community support piece. Because, you know,
5 it was articulated this morning by
6 Commissioner Sullivan that it sounds
7 wonderful and I think that she's doing a
8 great job and the Governor is doing a really
9 good job of making sure that we have strong
10 discharge plans. But I'm very concerned that
11 from a hospital perspective, from an
12 enforcement perspective, are those discharge
13 plans really going to happen?
14 We had the whole question about
15 mental health parity. How are we going to
16 ensure that we're going to be able to sustain
17 these plans? We have a workforce crisis. We
18 have a community service crisis.
19 I don't know the number. I wish I
20 could give you a solid number. But clearly
21 there needs to be this continuum, and we're
22 very concerned that there isn't that
23 continuum currently in place.
24 And people just -- as we know, it's
436
1 rinse, cycle, repeat. Sadly, it's just like
2 somebody goes into the emergency room, they
3 get, you know, maybe some sort of response,
4 and then they're out the door in 72 hours.
5 And what's going to happen? They're going to
6 end up back in the system. The same with,
7 you know, people coming out of jail. You're
8 going to see this recidivism.
9 If you don't have services right
10 away -- and I like the construct that the
11 commissioner has developed, but if you don't
12 have those services right away and
13 immediately impactful -- and they have to be,
14 you know, something that resonates with the
15 individual -- people will fall through the
16 cracks.
17 ASSEMBLYWOMAN GRIFFIN: Right. Thank
18 you. Thank you very much.
19 And Julie, I just want to share my
20 deepest condolences to you for the loss of
21 your daughter.
22 MS. NECHES: Thank you.
23 ASSEMBLYWOMAN GRIFFIN: And I would --
24 we don't have time now, but I would love to
437
1 learn what you think would be the most
2 important thing, you know, for your daughter,
3 what would have been the most important thing
4 to help her. I would love to hear -- maybe
5 afterwards we can talk.
6 MS. NECHES: Sure.
7 ASSEMBLYWOMAN GRIFFIN: Okay. Thank
8 you.
9 MS. NECHES: Thank you.
10 CHAIRMAN PRETLOW: Assemblywoman
11 Gallagher.
12 ASSEMBLYWOMAN GALLAGHER: Hi,
13 everyone. Thank you so much for your
14 lifesaving work.
15 I know that for some lawmakers -- and
16 forgive me, because I was in conference, I
17 came back, so you might have already answered
18 this. But just humor me. I know that for
19 some lawmakers expanding Kendra's Law
20 eligibility to increase involuntary
21 commitment has been presented as a panacea
22 for improving safety or at least making
23 people feel safer.
24 But I'm wondering -- and it sounds
438
1 like maybe you're on my wavelength -- is
2 involuntary commitment actually the best way
3 to improve public safety? Or would ensuring
4 that people have adequate housing, healthcare
5 and community-based mental health solutions
6 present a more reliable, data-backed way to
7 ensure mental health is protected and
8 communities are kept safe?
9 MR. LIEBMAN: Yup. I would say that
10 absolutely, I think you nailed it.
11 I think we -- we talk about this in
12 the 10-point plan. As I said, I was the
13 first person who ran the program, so I know
14 what the program is like. And tweaking --
15 it's been tweaked for 25 years. And we have
16 not seen the impact of that. We don't know
17 what the impact of that is, frankly.
18 What the real impact is -- what we
19 talk about in this 10-point plan -- it's
20 community services. It's good discharges.
21 It's workforce. It's the idea of having an
22 incident review panel. I know we talked
23 about that this this morning. Those are four
24 basic tenets of why we think that's
439
1 incredibly important.
2 And so I didn't want to -- I know you
3 were about to speak. Do you want to say
4 something?
5 MS. DAVID: Obviously from the county
6 perspective, you know, they oversee these
7 programs. And, you know, while we wouldn't
8 want to promote expanded use of AOT orders,
9 it is a tool that, I think, the counties have
10 felt necessary over the years to utilize. I
11 mean, utilizing every tool in the toolbox,
12 right?
13 So while I agree with Glenn -- you
14 know, obviously we really want to see
15 diversion programs. But, you know, there are
16 opportunities when folks really need, you
17 know, a court-level interaction to help
18 facilitate some pathway into treatment, so.
19 ASSEMBLYWOMAN GALLAGHER: And, you
20 know, the last question that I have for you,
21 particularly top of mind, is that the city
22 was reporting this week that there are
23 currently at least 127 people incarcerated in
24 Rikers who are unfit to stand trial because
440
1 they are so mentally ill that there is no
2 space at state-run facilities.
3 It seems to me like unless we deal
4 with the root cause of mental illness, the
5 way that this society is making people sick
6 by failing to provide essential supports, we
7 will continue to face this issue. So --
8 yeah. I guess that's not a question, that
9 was a statement. Perfect.
10 (Laughter.)
11 MR. LIEBMAN: It's all about stigma.
12 It's a lot about stigma.
13 CHAIRWOMAN KRUEGER: Thank you.
14 Assembly still?
15 CHAIRMAN PRETLOW: We're done.
16 CHAIRWOMAN KRUEGER: Okay. Are there
17 any other Senators who want to ask questions?
18 And we're finished with the Assembly side.
19 Then we're thanking you all very much
20 for your attendance today. Appreciate it --
21 oh, excuse me.
22 CHAIRMAN PRETLOW: A late entry here.
23 CHAIRWOMAN KRUEGER: Well, you have to
24 ask.
441
1 CHAIRMAN PRETLOW: Assemblyman
2 Palmesano.
3 ASSEMBLYMAN PALMESANO: Thank you.
4 And I apologize to my colleagues out there.
5 My question is directed to Courtney.
6 I had talked earlier about a constituent of
7 mine who lost their son to suicide, and
8 they're trying to take action. And I know
9 the mental health system failed them, their
10 entire family. And he's a county legislator
11 too, and I know he's been trying to make
12 inroads at the county level as well in
13 addition to here at the state level.
14 One question is, would you be willing
15 to meet with him to talk to him offline about
16 strategies and ideas on how to work within
17 the county?
18 But also, given the fact that the
19 rural suicide rate in the State of New York
20 is twice that of the urban suicide rate, what
21 other suggestions -- I mean, I know the
22 Governor vetoed that bill, unfortunately.
23 And apparently the Office of Mental Health
24 said that they were going to try and work and
442
1 try to address those things.
2 Do you have suggestions that you would
3 recommend moving forward for Mr. Tobia, who's
4 testifying later, and for him and his family
5 and the work that they're trying to do at the
6 local level but also the state level? And
7 would you be willing to meet with him at some
8 point in time?
9 MS. DAVID: Absolutely. I'm happy to
10 meet with him any time.
11 You know, obviously a big -- we have a
12 portion of the state that is highly rural,
13 right? And we have directors that represent
14 those areas. And I know suicide prevention
15 is close and dear to our directors' hearts.
16 And I know that there was a bill that
17 was going through last year that was vetoed,
18 on the Rural Suicide Prevention Council. We
19 supported that bill. We thought it was
20 important.
21 We have many of our directors in the
22 rural counties also run direct clinic
23 services, which I don't know that most people
24 understand because there aren't a lot of
443
1 services offered in some of the rural areas.
2 So yeah, I mean, the resources are
3 needed, obviously. A lot of them are very
4 innovative with some of their suicide
5 prevention programs. They support, you know,
6 a lot of different national groups or -- you
7 know, they work with national groups. They
8 have other, you know, state-based groups that
9 they work with.
10 And so, yeah, I think we could
11 certainly have a conversation and we can see
12 where we can go from here.
13 ASSEMBLYMAN PALMESANO: Appreciate it.
14 Can I ask one more follow-up question?
15 Are there any barriers or challenges that the
16 State of New York is putting up for local
17 mental hygiene directors at the county level
18 to be able to be more effective in this
19 outreach and providing the services and the
20 coordination of care?
21 Is there anything that you can cite
22 that the State of New York is really kind
23 of -- regulation or whatever, but posing an
24 obstacle for you to address this issue and
444
1 other mental health issues?
2 MS. DAVID: So, you know, we work
3 really closely with the three "O" agencies,
4 right -- the Office of Mental Health, OASAS
5 and OPWDD.
6 ASSEMBLYMAN PALMESANO: Sure.
7 MS. DAVID: Obviously we have an
8 element of Department of Health in there,
9 right, on the Medicaid population.
10 You know, I think we just have to do a
11 little bit more education in reminding folks
12 of what our directors do --
13 (Time clock sounds.)
14 ASSEMBLYMAN PALMESANO: Thank you.
15 MS. DAVID: Thanks.
16 ASSEMBLYMAN PALMESANO: I appreciate
17 it. Thank you.
18 CHAIRWOMAN KRUEGER: Thank you.
19 No more late show-ers up?
20 Now we're going to ask you -- thank
21 you very much for participating today.
22 Appreciate it very much. Thank you for your
23 work.
24 And we're going to call up Panel C,
445
1 which will be Joseph Tobia, Kayleigh Zaloga,
2 Ronald Richter, and Paige Pierce. (Pause.)
3 Okay? Everybody's settled in. Why
4 don't we start with you, Paige, and then
5 we'll just -- each of you introduce
6 yourselves so the tech people know what names
7 to put up on the screen, and then we'll just
8 go in that order. Thank you.
9 MS. PIERCE: Hi. Paige Pierce, CEO of
10 Families Together in New York State.
11 MS. ZALOGA: Kayleigh Zaloga,
12 president and CEO of the New York State
13 Coalition for Children's Behavioral Health.
14 MR. RICHTER: Ron Richter, CEO of
15 JCCA.
16 MR. TOBIA: Joe Tobia, advocate for
17 mental health, and county legislator for
18 Steuben County.
19 CHAIRWOMAN KRUEGER: Great. Okay.
20 Three minutes each.
21 And three minutes for questions,
22 everyone.
23 Okay. Paige, if you don't mind
24 starting us off.
446
1 MS. PIERCE: Thanks, Senator.
2 As I said, I'm Page Pierce, I'm the
3 CEO of Families Together in New York State.
4 We are a statewide family-run,
5 family-governed organization, meaning that we
6 have over 75 percent of our board of
7 directors and more than 80 percent of our
8 staff -- we have 42 staff across the state --
9 who are people with lived experience. Either
10 they're parents or they're young people with
11 lived experience with involvement in the
12 behavioral health systems.
13 I also am a parent myself. My
14 33-year-old son Emmet was diagnosed with
15 autism 30 years ago, so I spent much of his
16 elementary and middle school years being an
17 advocate for him, and then his high school
18 and college years empowering him to be his
19 own advocate.
20 The thing about Families Together is
21 that we say "Nothing about us without us,"
22 because we have some expertise, because of
23 our lived experience, that we want to share
24 with lawmakers and policymakers so that you
447
1 can better do your jobs. Because we have
2 that expertise, we're on the ground, we know
3 what works and what doesn't work, and we're
4 here to help.
5 The other thing that we do is we have
6 a workforce that Families Together trains and
7 credentials, family peer advocates and youth
8 peer advocates across the state. It's a
9 whole workforce where those people, those
10 advocates are able to bill Medicaid or get
11 money from the counties to be able to provide
12 family peer support and youth peer support.
13 Which is really critical, because we
14 know that -- and I heard Senator Brouk and I
15 heard Assemblywoman Simon talking about the
16 importance of peer support. And really
17 what's so important about it is that because
18 of our lived experience we can say to other
19 family members: We have been in your shoes.
20 And that garners a level of trust and
21 credibility that any number of letters after
22 your name doesn't have, or no matter what
23 kind of emblem you have on your car when you
24 pull into their house.
448
1 We have that trust, and we can engage
2 families in a way that other people can't.
3 And that ends up saving money and time and
4 ultimately lives. So we really want to
5 encourage peer support as a way to sort of
6 prevent further involvement and deeper
7 expensive services.
8 These family peer support programs
9 across the state are struggling. As I said,
10 some families can be -- if they're
11 Medicaid-eligible, they can bill Medicaid.
12 If the rates are too low, it makes it so that
13 they're unable to sustain their programs
14 without additional support. And that
15 additional support comes from counties in the
16 form of Aid to Localities, which is woefully
17 underfunded, hasn't been increased in
18 decades. And these programs are bobbing to
19 keep their heads above water.
20 And as I said, it's a cost-saving,
21 effective, efficient program, and it just
22 needs the support. If you look at my
23 testimony, you'll see the rest of our
24 policies.
449
1 MS. ZALOGA: Hi. Kayleigh Zaloga,
2 president and CEO of the New York State
3 Coalition for Children's Behavioral Health.
4 Thank you for the opportunity to testify.
5 We represent young people who need
6 behavioral health services, the families who
7 need help caring for these young people, and
8 the service providers who support all of
9 them.
10 I think we all know that more and more
11 kids than ever are struggling with more and
12 more mental health difficulties than ever
13 before. I hear from providers that they're
14 seeing younger and younger children with more
15 severe and more complex conditions than they
16 ever have before.
17 And in the context where we are
18 hearing increasing concern about mentally ill
19 adults struggling to take care of their
20 needs, I have to drive home that every
21 mentally ill adult was a sick child who
22 didn't get the help that they needed.
23 We're also -- you know, I'm glad to
24 see that youth mental health is a topic of
450
1 conversation, especially in the context of
2 the budget over the last couple of years.
3 And yet there are no meaningful investments
4 in services for kids proposed in this budget.
5 This in a context where we've got tax
6 receipts billions of dollars over
7 projections, a proposal to send a billion
8 dollars per year into a rainy day fund that
9 it will never be raining hard enough to use,
10 and a billion and a half proposed increase to
11 Medicaid from the Medicaid Managed Care
12 Organization tax, none of which is proposed
13 to be invested in behavioral health, let
14 alone children's behavioral health.
15 We continue to starve our system of
16 the resources it would take to eliminate
17 waitlists, to retain skilled and committed
18 staff, and to stop the cycle of young people
19 with unmet needs into adults with more
20 complex and expensive unmet needs.
21 And look, when a child is suspected of
22 having pneumonia we don't say: We're going
23 to put you on a waitlist, maybe you'll get a
24 doctor's appointment in six months and we'll
451
1 go from there. We don't suggest that what
2 they really need is a new peer support club
3 at school -- and I don't mean peer support in
4 terms of the service, I mean the student.
5 Training is important, and it's also not a
6 solution. And I sure hope we aren't saying
7 we need to wait until you can't breathe
8 because your pneumonia has gotten so severe
9 that you need to be treated in the emergency
10 room.
11 But that is what we're doing to
12 children and families if their primary
13 diagnosis is mental health and not, you know,
14 considered physical health.
15 And at the same time, we have
16 providers who are closing their programs and
17 reducing their service capacities because
18 they can't afford six-figure losses for
19 another year in the home- and community-based
20 programs that enable kids to stay in their
21 homes, to communicate better with their
22 families, to connect with their peers and
23 their teachers and to engage in life -- how
24 we all think that kids should be.
452
1 We need to raise reimbursement rates
2 specifically for children's programs. You'll
3 see in our testimony we have a proposal with
4 the Healthy Minds, Health Kids Coalition to
5 invest $195 million into the specific
6 outpatient services that currently three out
7 of four kids who would qualify are unable to
8 access. And we need to raise the cost of
9 living up to 7.8.
10 Thank you.
11 MR. RICHTER: Good afternoon. My name
12 is Ron Richter, and I'm the CEO of JCCA. I
13 have previously served as New York City's ACS
14 commissioner and as a judge of the
15 Family Court.
16 JCCA is a child and family services
17 agency that works with over 17,000 children
18 and families each year. Our services sit at
19 the intersection of child welfare and
20 behavioral health.
21 Governor Hochul's proposed budget
22 provides safe spaces for youth, mental health
23 first aid, and after-school support, which of
24 course we applaud. But it does not address
453
1 the needs of youth with intensive mental
2 health needs. There are treatments for these
3 young people that we know work, kids who have
4 high acuity needs -- but this population
5 remains untouched by the Executive's
6 proposal.
7 An important point for my board of
8 directors is that due to Medicaid eligibility
9 rules, JCCA is losing almost a million
10 dollars each year on young people 21 and
11 older on our residential campus. And I'm
12 afraid to say that while we may not call it a
13 waiting list, at least a dozen of these young
14 people are waiting for OPWDD placements -- in
15 some cases, they are over 21.
16 So for those kids, because of our
17 licensure, we as a provider are not
18 reimbursed for the expenses of providing
19 physical and mental health services to
20 young people over 21. The reason we have
21 them is because OPWDD, which doesn't have a
22 waitlist, has them waiting for placements for
23 which they have been certified. This is an
24 issue of when they get to OPWDD, they'll get
454
1 Medicaid. But in this window we're not
2 approved to take care of 22- and
3 23-year-olds, but we're not going to render
4 them homeless, so we continue doing it at our
5 own cost.
6 With the rise in mental illness among
7 children, we are seeing increased rates of
8 psychosis and severe depression among young
9 people. Many youth in our residential
10 campus, which is licensed by OCFS, qualify
11 for OMH residential treatment facilities, a
12 higher level of care. But despite OMH's
13 recent RFP for RFT beds, capacity has not
14 increased and youth with severe mental
15 illness remain in inappropriate settings --
16 in some jurisdictions, in hotels.
17 We offer an array of mental and
18 behavioral health supports and, like my
19 colleagues, are lamenting the possibility of
20 a 2.1 percent COLA, or whatever we're calling
21 it.
22 Thank you.
23 CHAIRWOMAN KRUEGER: Thank you.
24 MR. TOBIA: Joe Tobia. Good
455
1 afternoon. I failed to mention earlier that
2 I am a suicide survivor.
3 First of all, I would like to thank
4 Commissioner Sullivan and all those who serve
5 on the Mental Health committees for the great
6 job you each do.
7 As a member of the Governor's Task
8 Force on Suicide Prevention, we also have
9 been assigned with strengthening our current
10 suicide prevention services and policies,
11 which we are accomplishing with each and
12 every meeting.
13 However, when looking at methods to
14 better these policies and services toward
15 suicide prevention, we must exhaust every
16 method and explore every avenue to better
17 those policies. New York State Bill 3610,
18 the creation of a Rural Suicide Prevention
19 Council, is a low-cost bill that would
20 investigate suicides by gathering data in
21 regards to individuals who died by suicide.
22 This bill would explore the paths
23 these individuals took in their last year or
24 so of life and investigate such things as
456
1 risk factors, trends, barriers to their
2 well-being, lapses in systemic responses. We
3 must look at where along these paths these
4 individuals lost hope, where our
5 interventions were not effective, and why
6 these interventions weren't effective.
7 I am convinced that by examining our
8 failures and making the needed corrections
9 we'll only reduce the number of lives we lose
10 by suicide each year. Only one other state
11 that I know of in the U.S. actually examines
12 individual suicide deaths, and that is
13 Maryland's Suicide Fatality Review Committee,
14 signed by Governor Hogan in April of 2022.
15 I recently had the opportunity to meet
16 with Senator Helming, who sponsors the bill,
17 3610, and we discussed changes, we discussed
18 revisions to the bill to make it stronger and
19 make it a better bill in aiding suicide
20 prevention.
21 Though this bill finally passed in the
22 Assembly and the Senate last year, it was
23 vetoed by our honorable Governor. With your
24 continued support and with some important
457
1 changes in the bill, I truly believe that
2 Governor Hochul will sign this bill. It's a
3 different approach to gathering data, but I'm
4 convinced the findings will save lives.
5 In August 2021 I lost my boy to
6 suicide. The last year of his life, my wife
7 fought hard to get him the help he needed,
8 only to be denied or told that he did not
9 qualify.
10 My son was a strong, compassionate
11 young man, an excellent athlete. He was a
12 tough kid. Yet he would call me at all hours
13 of the night, crying: "Why won't anybody
14 help me, Dad?" I never had an answer, and
15 I'm just hoping we can find those answers.
16 Thank you.
17 CHAIRWOMAN KRUEGER: Thank you.
18 Sorry the bell went off just at the
19 inappropriate time.
20 Senator Tom O'Mara.
21 SENATOR O'MARA: Thank you. Thank you
22 all for your testimony here today, your
23 advocacy on these very important issues, and
24 your work on these causes.
458
1 Mr. Tobia, you got cut off there at
2 the end, so if there was more you wanted to
3 add, I give you the opportunity to finish
4 what your full thought was there.
5 MR. TOBIA: Finish what I had?
6 SENATOR O'MARA: Yeah.
7 MR. TOBIA: It's just a short
8 paragraph.
9 I was just going to say that question
10 he asked me so many times, "Why won't anyone
11 help me, Dad?" -- and, you know, I never had
12 an answer. But, you know, I feel now it's
13 time to find those answers.
14 So I ask each and every one of you to
15 please support our efforts and do whatever it
16 takes to help create a Rural Suicide
17 Prevention Council. There are so many
18 individuals in New York State who are
19 suffering like my son did. So please, let's
20 not fail them.
21 And I do want to thank you for giving
22 me this time to speak. It's something I feel
23 is very important and very dear to my heart.
24 Thank you.
459
1 SENATOR O'MARA: Well, it's clearly --
2 clearly very dear to your heart, and it's a
3 very important issue for all of us. And we
4 struggle with dealing with mental health in
5 this state year in and year out.
6 I have been pleased to see the
7 attention that the Governor has given this in
8 the last three budgets. Really, it's needed.
9 It hasn't gone far enough; we need to go
10 farther.
11 The legislation that you have with
12 Senator Helming -- and I'm a cosponsor of
13 that -- you know, we'll continue to work to
14 get it through. But with so many of these
15 bills, as I think I've explained to you in
16 the past, Joe, that they get vetoed because
17 they should be done in the budget. And then
18 we get here in this process, and they don't
19 get in the budget.
20 So we're going to continue to push and
21 try to get this type of thing in the budget
22 this year. You know, there's a bunch of
23 bills similar on suicide prevention for --
24 you know, yours is rural, but there's other
460
1 groups' identities for that, so there's a
2 bunch of them.
3 So how does, if you know, your
4 approach on this bill, on the rural suicide,
5 differ from maybe some of the other ones that
6 are these types of commissions? And why do
7 we need one particular to rural as opposed to
8 urban or Black or LGBT? What's the purpose
9 of having it differentiated like that?
10 MR. TOBIA: Well, I think -- you know,
11 first of all, when we look at a rural
12 council, you know, look at suicide
13 fatalities, we know that rurals are twice as
14 high as urbans. We know that. That's a
15 common fact. Rural suicides are twice as
16 high as urban. And we know we're going to be
17 looking at -- they say, what, mental health
18 diagnosis is attached to usually to
19 50 percent of suicides throughout the state.
20 So when you look at the rural, I think
21 you're going to look at a large number of the
22 suicides. And I really think -- you know, I
23 know some of the things we're going to find.
24 We're going to find the telehealth -- that
461
1 telehealth is just not available to some of
2 these people. But I think, you know, you can
3 cover so much looking at those people.
4 SENATOR O'MARA: Thank you.
5 CHAIRWOMAN KRUEGER: Thank you.
6 Assembly?
7 CHAIRMAN PRETLOW: Assemblywoman
8 Simon.
9 ASSEMBLYWOMAN SIMON: Yes. Thank you
10 for your testimony, all of you.
11 And Mr. Tobia, I -- you know, I'm
12 sorry for your loss and your experience. And
13 I think that your proposal for a rural
14 suicide task force makes a lot of sense.
15 I think one of the things that we all
16 struggle with are suggestions that are made
17 for how we can fix things when we haven't
18 really looked at what were the barriers that
19 caused a certain set of circumstances to
20 occur -- the lack of treatment, why there are
21 denials, where are the holes in the system.
22 And also where are those transition points
23 and those points where there's like a cliff,
24 right, which is the age 21 and you fall off a
462
1 cliff. And how can we help families better
2 understand and be part of that recovery,
3 right, and addressing those needs.
4 So I'm very curious about the fact
5 that we haven't really done anything to
6 support families in a demonstrable way, who
7 are very much a part of the picture that can
8 be part of the healthy plan.
9 And so I'm curious to hear from you.
10 I have a minute and a half, go for it.
11 Either -- anybody, actually, but certainly
12 you, Mr. Tobia.
13 MR. TOBIA: Well, first of all, I'm
14 embarrassed to say I have some severe hearing
15 problems.
16 ASSEMBLYWOMAN SIMON: Sorry.
17 MR. TOBIA: I've got two hearing aids
18 in, and I'm hearing a lot of echoes from
19 everybody.
20 ASSEMBLYWOMAN SIMON: We have --
21 MR. TOBIA: So I'm sorry --
22 ASSEMBLYWOMAN SIMON: That's okay. We
23 have lousy acoustics in this room. But we
24 also have assistive listening devices.
463
1 MR. TOBIA: You've got a t-coil?
2 ' ASSEMBLYWOMAN SIMON: Well, we have
3 the --
4 MR. TOBIA: If you've got a t-coil --
5 ASSEMBLYWOMAN SIMON: Yeah.
6 MR. TOBIA: That would be great. I use it
7 in church, so --
8 ASSEMBLYWOMAN SIMON: I don't know who
9 would get it, though, at this juncture. We
10 have an infrared system that works with that.
11 MR. TOBIA: I was going to do
12 something, and whatever -- I didn't want
13 anybody to think I was on my phone texting.
14 ASSEMBLYWOMAN SIMON: No, no, that's
15 fine. Actually, if you look at the
16 captioning -- but it's a little delayed. So
17 why don't you look at the -- can you pull up
18 the captioning on your phone and see what
19 that conversation was?
20 Okay. I'm not sure how to -- so I'll
21 try and talk louder. How's that? You're not
22 going to get it.
23 MR. TOBIA: The t-coil didn't work.
24 ASSEMBLYWOMAN SIMON: Okay, I'm sorry.
464
1 So I was asking about families and the
2 support -- the lack of support that we're
3 giving them. We're not really funding
4 support for families, who can often -- and
5 not only to help them, but they can also help
6 being part of the recovery of their loved one
7 or the path of their loved one to get the
8 right treatment, because they would be able
9 to address those issues better.
10 Does that make sense to you? So
11 maybe -- you want to address that? Maybe,
12 Ron, you want to address it? Maybe you could
13 hear them better.
14 (Laughter; overtalk.)
15 MS. PIERCE: Thanks, Assemblywoman.
16 MR. RICHTER: I know that Paige is
17 really -- this is her thing.
18 MS. PIERCE: That's my thing.
19 ASSEMBLYWOMAN SIMON: Okay.
20 MS. PIERCE: So as I said in my
21 testimony, the family peer support is
22 crucial.
23 And we have hundreds if not thousands
24 of family members across the state that we
465
1 poll, that we survey, that we talk to and ask
2 them, what are the things you need, what are
3 the things you would have liked to have had,
4 what are the things your child needed? And
5 often it's support. It's support for the
6 family and support for the youth.
7 And that's why, you know, we really
8 urge you to look at where we're investing.
9 But, yeah, support, you're absolutely
10 correct.
11 ASSEMBLYWOMAN SIMON: Thank you.
12 thank you. Sorry I ran out of time.
13 CHAIRWOMAN KRUEGER: Thank you.
14 Senator Canzoneri-Fitzpatrick.
15 SENATOR CANZONERI-FITZPATRICK: Thank
16 you, Madam Chair.
17 Mr. Tobia, thank you for sharing your
18 story. And I'm so sorry for your loss. And
19 thank you for turning your family's tragedy
20 into advocacy, because we appreciate your
21 input very much.
22 Mr. Richter, I was very touched by
23 what you said, that even though these kids,
24 these children turn 21, you're not putting
466
1 them out on the street. I'm sure that's a
2 tremendous burden for your facilities and
3 your agency. But as a mom of four, I know
4 that just because they hit 21 it doesn't mean
5 they're really self-sufficient adults, as
6 much as my kids will kill me for saying that.
7 Ms. Zaloga, I wanted to ask you a
8 question because of your testimony about one
9 out of four children on Medicaid are not
10 getting the behavioral health services that
11 they need.
12 MS. ZALOGA: No, one out of four is
13 getting.
14 SENATOR CANZONERI-FITZPATRICK: One
15 out of -- excuse me, one out of four is
16 getting.
17 And as I just said, being a mom of
18 four, I can't imagine telling one of my kids
19 that, You get mental health services, and the
20 other three, Sorry, you got to suffer.
21 So my question to you, though, is what
22 is the biggest barrier? Is it that there
23 aren't enough providers? Is it that the
24 families don't know that these services are
467
1 available? And how does it compare to the
2 non-Medicaid population? What are you
3 seeing, if you know that answer.
4 MS. ZALOGA: Sure. The biggest
5 barrier is the lack of service providers, and
6 that is from decades of underfunding in the
7 system. We have not been able to pay the
8 staff, who are doing really difficult and
9 really meaningful work, enough for them to
10 stay in our workforce.
11 And then there's a different challenge
12 with the non-Medicaid population, is that
13 most services we're talking about are not
14 covered by commercial insurance. Peer
15 support? Not covered. Most of the in-home
16 services that we're talking about that really
17 enable families to better, you know,
18 integrate the care of their children and to
19 improve the whole family system? Not covered
20 by commercial insurance.
21 So there's a whole side of what needs
22 to be done on the commercial side. On the
23 Medicaid side, it's really been about
24 funding. And then for those services that
468
1 are covered by commercial insurance, they've
2 never been paid at a rate that most providers
3 can actually cover their costs with.
4 So last year's legislation, thanks to
5 a lot of you, we do see a rate floor for
6 covered licensed outpatient services for
7 commercial insurers. The problem is that
8 they're not required to cover the majority of
9 the services we're talking about.
10 SENATOR CANZONERI-FITZPATRICK: So
11 during one of the other panels I talked about
12 loan forgiveness programs and incentives to
13 encourage young people to go into this field.
14 And I'm just curious if you think that that
15 would help in your -- you know, fund our, you
16 know -- provide workforce to provide these
17 needed services and trained professionals.
18 You know, create professionals
19 MS. ZALOGA: Yes, loan forgiveness
20 programs are definitely helpful. We've
21 appreciated the OMH Community Mental Health
22 Loan Repayment Program, especially the
23 expansion to more practitioners beyond
24 psychiatrists.
469
1 We also need scholarships for those
2 who can't afford to outlay that cash in the
3 first place.
4 SENATOR CANZONERI-FITZPATRICK: Thank
5 you all.
6 CHAIRWOMAN KRUEGER: Thank you.
7 Assembly.
8 CHAIRMAN PRETLOW: Assemblyman
9 Sempolinski.
10 ASSEMBLYMAN SEMPOLINSKI: Thank you.
11 Thank you to all of you for being
12 here. I'll direct my questions to Mr. Tobia.
13 Mr. Tobia comes from Steuben County,
14 and all four representatives who represent
15 Steuben County are in the room:
16 Mr. Palmesano, Ms. Bailey -- Mr. Tobia is one
17 of Mr. Palmesano's constituents -- Senator
18 O'Mara -- he's one of Senator O'Mara's
19 constituents. And I represent a portion of
20 Steuben County and actually am from the area
21 where -- we're both from the Corning area
22 originally.
23 So as a rural area I really appreciate
24 the work you've done and how you've honored
470
1 your son by doing it. I want to point out
2 sort of one of the beauties of the mental
3 hygiene space -- the bill you're referring to
4 passed unanimously. Mr. Tobia is an elected
5 official. He's a Democrat, I'm a Republican.
6 It doesn't really matter on these issues and
7 a lot of the things that we cover today
8 across all of the mental hygiene areas.
9 And I want to reemphasize
10 Senator O'Mara's excellent point that when
11 the Governor vetoes these type of things, she
12 says we should do it through the budget. So
13 let's -- this is the time to work on it. And
14 I'm glad that you're here for that.
15 The question I want to ask you is
16 given the tragic story that your family went
17 through and the loss of your son, what's the
18 one thing that you would have changed through
19 that process that you think would have
20 improved his access to care?
21 And again, thank you for being here.
22 MR. TOBIA: Well, we -- we knew my son
23 needed long-term care. We knew he needed a
24 bed. We couldn't find one. We couldn't get
471
1 him into Elmira Psychiatric Center, they
2 refused. My son was -- he was bipolar, he
3 was depressed. Schizophrenia came when he
4 was about 26.
5 And my son was very normal. He was a
6 normal kid in high school, a popular kid in
7 high school. I know that, I was his
8 principal.
9 (Laughter.)
10 MR. TOBIA: And, you know, it's just
11 when he hit his mid-20s, we started seeing
12 changes. We just started seeing the
13 paranoia. We started seeing the delusions.
14 And then when the voices came, and they were
15 24/7. And he told us all the time. So we
16 knew he needed long-term care. We couldn't
17 get him in. We were told, No, no, he doesn't
18 qualify for this, he doesn't qualify for
19 that.
20 And, you know, I always remember after
21 my son passed away, it was -- you know, it
22 was -- my wife and I used to say, Boy, they
23 could have learned so much if people just
24 took a little interest in what Matt was --
472
1 you know, went through.
2 And it was two years later when I came
3 across the Maryland bill that I saw, wow,
4 this is what we need. So I Googled and I
5 found the Rural Suicide Prevention Council,
6 which was very similar, and that's when I
7 started my letter writing, voicemails. I
8 became that pest that -- I'm sure a lot of
9 you got my letter, so.
10 ASSEMBLYMAN SEMPOLINSKI: Thank you
11 for your advocacy. I definitely support that
12 legislation.
13 MR. TOBIA: Thank you.
14 ASSEMBLYMAN SEMPOLINSKI: And thank
15 you for honoring your son's memory.
16 MR. TOBIA: Thank you.
17 CHAIRWOMAN KRUEGER: Thank you.
18 Senators?
19 Then I just want to follow through.
20 First off, thank you all for your work. And
21 very, very sorry for your experience with
22 your own son.
23 MR. TOBIA: Thank you.
24 CHAIRWOMAN KRUEGER: And of course we
473
1 know that many of these very serious mental
2 illnesses don't show until someone gets into
3 their early 20s.
4 MR. TOBIA: That's right. That's
5 right.
6 CHAIRWOMAN KRUEGER: So your story is
7 very familiar to me from other people's
8 lives.
9 Ron, I -- so you're not licensed if
10 they're over 21. Can we just get your
11 license expanded?
12 MR. RICHTER: So we have an
13 Article 29-I license on our campus, which was
14 the license that was designed to allow
15 foster-care agencies like -- or residential
16 agencies through OCFS to actually bill for
17 Medicaid services.
18 That license only allows us to cover
19 kids up until they're 21. Even though, as
20 you know, our population on the campus is
21 dual-diagnosed: Serious emotional
22 disturbance, intellectual developmental
23 disabilities. So they're not even
24 chronologically close to 21 or 22. But it's
474
1 because of the 29-I licensure.
2 And we've brought this to the
3 attention of the state, and there's varying
4 levels of interest in trying to solve this.
5 But it is not just my agency. This is a
6 statewide problem.
7 CHAIRWOMAN KRUEGER: No, because I've
8 heard that is a statewide issue also, even
9 just for people who are providing assistance
10 to people who have aged out of foster care,
11 runaway youth, et cetera, et cetera,
12 et cetera.
13 MR. RICHTER: Yes. Yes.
14 CHAIRWOMAN KRUEGER: This concept of
15 you hit 21, you're on your own, seems really
16 poorly thought through.
17 But can we just legally change your
18 license or change the definitions of
19 eligibility so that you can draw down
20 Medicaid?
21 MR. RICHTER: So I believe that -- and
22 by the way, if we took our kids out into the
23 community to get behavioral health services,
24 we would be able to bill Medicaid
475
1 differently. But we're obviously a
2 therapeutic environment where we do this.
3 I -- my -- I don't want to answer yes
4 without saying that some of it is a function
5 of the permissions from CMS in D.C. And so I
6 believe the 29-I licensure had to be approved
7 by the feds in order for us to draw the
8 federal Medicaid money.
9 Certainly if the State of New York
10 wanted to cover it, then the state could do
11 that. But as you probably all know better
12 than I, our state is very determined to
13 capture federal Medicaid revenue and so it
14 sticks very much to the rules in that regard.
15 CHAIRWOMAN KRUEGER: And it's going to
16 get harder and harder to stick to those
17 rules, since it's a moving target every
18 minute of every day.
19 But again, just to follow up with my
20 few seconds, you can't get an additional
21 license status that does meet CMS so that you
22 can serve some over-21-year-olds in your
23 wonderful programs?
24 MR. RICHTER: That's a good -- that's
476
1 an excellent question.
2 CHAIRWOMAN KRUEGER: Okay. Well,
3 please let us know if there's some way we can
4 be helpful. Because that seems to me -- I'm
5 sorry, I'm over time -- like that we ought to
6 be doing that. Thank you.
7 MR. RICHTER: The same to you.
8 CHAIRMAN PRETLOW: Assemblymember
9 Santabarbara.
10 ASSEMBLYMAN SANTABARBARA: Thank you,
11 Mr. Chair.
12 I just wanted to follow up. Kayleigh,
13 back to your testimony about children's
14 mental health services being underfunded.
15 What are some of the budget priorities I
16 guess you would like to see in this budget?
17 And can you talk specifically about the
18 school -- expanding the school-based
19 services?
20 MS. ZALOGA: Sure. So our top
21 priorities are, along with the rest of the
22 behavioral health advocate world, raising the
23 COLA, targeted inflationary increase,
24 whatever you want to call it, to at least
477
1 7.8 percent so that we're actually combating
2 the inflation of the past few years, like
3 you've discussed, Mr. Sempolinski.
4 We also need to invest at least
5 195 million to begin with in children's
6 clinic, children's home- and community-based
7 services or waiver services, child and family
8 treatment and support services, and substance
9 use outpatient services as well. There's a
10 proposal put together about that.
11 Treating children is a lot different
12 from treating adults. They're not just
13 smaller adults, they're a lot more complex.
14 They have whole family systems that we're
15 working within. So rates need to go up in
16 those instances.
17 When it comes to school-based
18 mental health clinics, we're glad to see that
19 there's so much interest in them. They're
20 really beneficial in the schools that they
21 are viable in. They're not viable in every
22 school. Not every school has the population
23 to support keeping a clinician there at all
24 times. The rates are, you know, not high
478
1 enough to support having that clinician there
2 all the time as well.
3 And even with the addition of coverage
4 requirements to commercial insurance, it's
5 still -- most providers are not getting any
6 payment from commercial insurance for those
7 services.
8 But in order to make them more viable,
9 there could be more startup funding, which is
10 one of the things that we included in our
11 proposal. And some providers have been
12 successful in having schools partner with
13 them and contribute to some of the costs
14 because they know how important it is that
15 those services be accessible to all students
16 regardless of their insurance status and
17 other things like that.
18 MR. RICHTER: Can I just give a quick
19 example?
20 ASSEMBLYMAN SANTABARBARA: Yes,
21 please.
22 MR. RICHTER: So in New York, through
23 OMH licensure, you can, if you're designated,
24 provide respite services. Which for a family
479
1 that has a developmentally disabled child or
2 an emotionally challenging child is critical.
3 Most of the providers across the state
4 are de-designating because we cannot afford
5 to provide respite. So we provide it at a
6 loss.
7 I have a colleague who runs a big
8 agency in Rochester. They're de-designating
9 simply because the rate structure makes it
10 impossible for us. Yet respite prevents --
11 you know, it's relief. So it's a problem.
12 ASSEMBLYMAN SANTABARBARA: And going
13 back to your discussion earlier, at age 21 is
14 when the school system stops paying, right --
15 MR. RICHTER: That is -- that is --
16 ASSEMBLYMAN SANTABARBARA: -- is that
17 what you're referring to?
18 MR. RICHTER: Yes.
19 ASSEMBLYMAN SANTABARBARA: But
20 normally the state will pick up after that if
21 they're in a program. But that doesn't
22 happen with your situation?
23 MR. RICHTER: With our kids, the
24 county picks up -- continues providing us
480
1 with a multistate administrative -- maximum
2 state administrative rate, which is the
3 foster-care dollars.
4 ASSEMBLYMAN SANTABARBARA: I see.
5 Okay. Thank you. Thank you for your
6 answers.
7 CHAIRMAN PRETLOW: Assemblyman Maher.
8 ASSEMBLYMAN MAHER: Thank you very
9 much.
10 So I wanted to kind of hit on what you
11 were talking about, Ron. And I think you
12 answered the question that I was going to ask
13 with you're going to look into it. But I was
14 just trying to confirm that there is actually
15 a legislative solution that can be provided
16 to that issue that you brought up.
17 MR. RICHTER: I believe -- I believe
18 so.
19 ASSEMBLYMAN MAHER: Okay.
20 MR. RICHTER: We've actually yesterday
21 spoke to -- I want to say it was Senate
22 counsel or the Governor's counsel -- it was
23 the Governor's counsel. And she seemed as
24 though she was very interested in solving the
481
1 problem because it's a legally interesting
2 problem to solve.
3 ASSEMBLYMAN MAHER: Right.
4 MR. RICHTER: So they've heard it.
5 But I do believe that legislation
6 could certainly resolve it simply, as the
7 chair is saying, you know, figuring out how
8 the license can be modified or perhaps trying
9 to get licensed as an Article 31 on our
10 campus, which is odd.
11 But -- yeah, it's a legal conundrum.
12 ASSEMBLYMAN MAHER: Well, I'm glad
13 you're advocating for it and bringing it up.
14 It looks like it's getting the attention it
15 deserves.
16 And I'm hoping that we can also do
17 that with all the issues that you guys have
18 brought up. You're doing tremendous work.
19 Some of the statistics that you've shown
20 and -- honestly, it's been an education for
21 me to listen. So we look forward to
22 partnering with you.
23 I do want to talk about, with
24 Ms. Zaloga -- is that right? You talked
482
1 about a lack of providers and you talked
2 about the workforce issues and seeing
3 providers shut down. You had some data about
4 one in four don't get the services they need.
5 Do you have any data on how many
6 providers have actually shut down over the
7 last five, 10 years?
8 MS. ZALOGA: I don't have that
9 offhand. And sometimes it's not so much that
10 a whole agency shuts down, it's that they
11 stopped providing a certain service or they
12 stopped providing it in certain areas of the
13 state.
14 So I know one -- the provider who I
15 mentioned yesterday I think is -- there'll be
16 thousands of kids that they can no longer
17 serve. They have to pull the program out of
18 several counties of the state.
19 It's something that we've monitored, I
20 think, kind of the reduction in the number of
21 services available in each county. I can
22 send you some information on that.
23 ASSEMBLYMAN MAHER: I'd love to work
24 with you to quantify even statewide, but
483
1 obviously in my district, where those
2 services have decreased. Because educating
3 myself and more folks on that could really
4 help move the needle in terms of providing
5 solutions.
6 MS. ZALOGA: I will follow up with
7 you.
8 ASSEMBLYMAN MAHER: Thank you. Thank
9 you all.
10 MR. RICHTER: I would ask the state
11 for data on the number of children that were
12 receiving services through Bridges to Health,
13 which I can explain, and how many children
14 are receiving services today.
15 Post the end of B2H, Bridges to
16 Health, and the waiver that allowed us to
17 provide OMH-licensed services, that's been
18 transitioned to Medicaid managed care, and I
19 have been asking for that data. We should be
20 able to get that.
21 ASSEMBLYMAN MAHER: Send me an email.
22 MR. RICHTER: I will.
23 ASSEMBLYMAN MAHER: Let's request it
24 together. And let's work on it, okay?
484
1 MR. RICHTER: Yes.
2 ASSEMBLYMAN MAHER: Thank you.
3 CHAIRMAN PRETLOW: Assemblyman
4 Palmesano.
5 ASSEMBLYMAN PALMESANO: Thank you.
6 Joe, thank you for being here, sharing
7 your story.
8 MR. TOBIA: Thanks for having me.
9 ASSEMBLYMAN PALMESANO: It's a -- you
10 bringing your story, your face, your name,
11 Matt's name, Matt's story to share with us is
12 very powerful and impactful. And I'm hopeful
13 my colleagues here heard your story and it
14 motivates us to act, motivates the Governor
15 to act, motivates the OMH commissioner to
16 act.
17 We talked about -- and when the
18 legislation passed, you were a bulldog
19 pushing that, emails and calls, past the last
20 day of session last year, 5:30 in the morning
21 I remember texting you a picture of the
22 board.
23 MR. TOBIA: Yeah.
24 ASSEMBLYMAN PALMESANO: But since
485
1 then, and obviously when the Governor vetoed
2 it, you've been talking about this. You have
3 thoughts on how to improve the bill, to make
4 it better, make it more efficient.
5 Do you mind just talking a little bit
6 about some of the other things you would add
7 on this? Because this bill was actually
8 introduced by our former Mental Health
9 Chairwoman Aileen Gunther, so it's great that
10 it passed. But do you have any suggestions
11 on what you might recommend, whether it's
12 done through the budget, whether it's done
13 through a bill, whether it's done through
14 OMH, what kind of suggestions you would make
15 to make some positive changes to it?
16 MR. TOBIA: Well, I'm still looking at
17 it as a counsel to go through a bill. So
18 that's the way I'm pursuing it, just like I
19 did last year.
20 So I met with Senator Helming last
21 week, and there were seven changes I felt
22 were needed in the bill. And I've seen a lot
23 of similar legislation throughout the
24 country. Maryland's is excellent, I thought.
486
1 One of the changes I think that's
2 needed in the bill, you have to have an
3 immunity clause. You know, you're going to
4 collect data, you're going to -- people are
5 going to submit data, you know, on some real
6 touchy things coming from social services,
7 medical records, you know. There's got to be
8 an immunity clause where it says anyone
9 receiving or submitting data is immune to
10 liability, or you're not going to get
11 accurate data.
12 I know after, you know, Matt passed
13 away, counselors -- no one would talk to us.
14 No one wanted to talk to us. I think they
15 were a little afraid we were going to sue
16 them or something. We weren't going to. We
17 just wanted to know, you know, what was going
18 on. So an immunity clause.
19 I also thought that the term of the
20 current bill, which is two years -- it's got
21 to be three years. Right now it's two years,
22 you have to meet no less than three times.
23 My recommendation, make it three years, and
24 you've got to meet at least four times a
487
1 year. There's a lot of data to collect, a
2 lot of data to look at.
3 Another one -- I hope it doesn't sound
4 selfish -- to give the bill a name, I think
5 it packs more meaning. Of course the name I
6 thought of was Matt's Bill. I just think
7 when you attach a name like that, people
8 start asking questions.
9 ASSEMBLYMAN PALMESANO: Sure.
10 MR. TOBIA: You know, Who's Matt?
11 It's better than saying well, yeah,
12 Bill 3610. You know? So that was -- that
13 was my third recommendation.
14 I had a couple more, too.
15 ASSEMBLYMAN PALMESANO: Great. Thank
16 you, Joe.
17 CHAIRMAN PRETLOW: Assemblymember
18 Bailey.
19 ASSEMBLYWOMAN BAILEY: Thank you all
20 for being here, very much.
21 My question is actually going to go to
22 Mr. Tobia. And your story is very touching.
23 And a year and a half ago my best friend lost
24 her 16-year-old to suicide.
488
1 MR. TOBIA: I'm sorry. I'm sorry.
2 ASSEMBLYWOMAN BAILEY: As
3 Assemblymember Sempolinski mentioned, I cover
4 part of Steuben County as well, all of
5 Livingston County, part of Wyoming, Rush --
6 in Monroe -- and part of Ontario. So very
7 rural.
8 So your insight in what you -- the
9 energies that you have put into this to
10 remember Matt is very important to me, both
11 from the rural perspective but also
12 disappointing that the Governor did veto the
13 bill.
14 MR. TOBIA: Yeah.
15 ASSEMBLYWOMAN BAILEY: But I do like
16 your outlook that you have that now you look
17 at the veto by the Governor as a good thing
18 to make these changes.
19 So in the next two minutes, you can
20 either continue answering what Mr. Palmesano
21 asked or what Senator O'Mara had as far as
22 the rural area and why this is so desperately
23 needed for our area.
24 MR. TOBIA: Well, it's a different way
489
1 to gather data when it comes to suicides.
2 What you can do is you follow the path,
3 follow the path of the individual who died by
4 suicide. You know, find out where did they
5 lose hope. I mean, what are some of the
6 trends? What services did they have? What
7 services didn't they have? What services
8 should they have had, and why didn't they
9 have these services?
10 And it's not just mental health, even
11 though mental health diagnosis is usually
12 attached to 50 percent of the suicides.
13 You're going to find other services. You
14 know, someone without a mental health
15 diagnosis, you're still looking for certain
16 trends and risk factors, lapses in systemic
17 responses.
18 So it's a different way to gather
19 data. It's just looking intently at that
20 path that individual took. And I think we
21 can just learn a lot of little things there
22 in how to better serve them.
23 OMH does a great job. They do a great
24 job. We've got great policies out there on
490
1 suicide prevention, but some of them aren't
2 reaching these people. Why? What's
3 preventing them? We want to know why. So we
4 can look at some of that.
5 To go back to Assemblyman Palmesano's
6 question, another improvement I thought
7 was -- what was it -- oh, you've got to put a
8 price tag on it. You have to put the cost on
9 the bill, because that -- Governor Hochul
10 didn't see a cost, so she grabbed all these
11 bills, you know, that didn't have a cost on
12 them and kind of vetoed them all. So it's
13 very -- very low cost. I mean, there's not a
14 lot to it. So you put the cost on it, and I
15 think that will help.
16 ASSEMBLYWOMAN BAILEY: Thank you very
17 much for being here.
18 CHAIRWOMAN KRUEGER: Any others?
19 CHAIRMAN PRETLOW: Assemblywoman
20 Griffin.
21 ASSEMBLYWOMAN GRIFFIN: Thank you.
22 Thank you all for being here today.
23 Mr. Tobia, my deepest condolences to
24 you on Matt's loss.
491
1 MR. TOBIA: Thank you.
2 ASSEMBLYWOMAN GRIFFIN: And I really
3 appreciate your meaningful advocacy here.
4 MR. TOBIA: Thank you.
5 ASSEMBLYWOMAN GRIFFIN: Because what
6 you're doing can make such a difference in
7 the lives of other -- other young people. So
8 thank you.
9 In my hometown of Rockville Centre,
10 over the past 10 years there's been a real
11 uptick of suicides in teens and also
12 young adults in their 20s. And so it's a
13 very raw issue where I live. And in response
14 to that, and some of it was along the way,
15 some of our high schools were able to build
16 mental health centers in their school. And
17 that's really helpful, accessible for kids.
18 I was able to allocate funding for one high
19 school to establish one in their high school.
20 But then, in addition to that, there's
21 Northwell Hospital opened up a mental health
22 center in Rockville Centre. But all the
23 local school districts can put money in every
24 year, and whatever that cost is, then their
492
1 students can go to Northwell Health in
2 local -- it's local in Rockville Centre, but
3 it's the neighboring school districts. So
4 that's a good plan.
5 So some of those things, they're
6 making some strides. But one of the problems
7 I've seen, because I know some of the kids --
8 I call them kids, they're in their 20s --
9 that have committed suicide -- even my cousin
10 committed suicide, and he was 30 -- you age
11 out. Like those mental health centers in
12 schools, till 18. Northwell is 18.
13 So I just wondered, I know there's
14 such an issue with we have to increase and
15 upgrade for children, for families, for teens
16 and young adults. But I wondered, do you see
17 a big, big disparity in this young adult age
18 where there's almost, like, a real less than
19 anything for them? Even though it's still
20 bad for children, it seems even worse for
21 this age group of 18 and up -- and over.
22 Anyone can answer.
23 MS. ZALOGA: Yeah, I mean, that's --
24 we call it transition-age youth. Those are
493
1 in the 18 to 26.
2 I can't say whether I think the gap is
3 bigger or smaller, but it's certainly there.
4 Like you said, they're aging out of a lot of
5 the supports that are available to
6 schoolchildren and other certain systems, and
7 it's difficult to get eligibility for the
8 other systems.
9 So I've been glad to see a little bit
10 more attention and work on trying to better
11 serve that population. I know our Youth ACT
12 teams are one of the services that can serve
13 older adolescents. There are some
14 specifically for transition-age youth and,
15 you know, we're seeing more investments in
16 that.
17 ASSEMBLYWOMAN GRIFFIN: Okay.
18 Anyone else want another comment for
19 15 seconds?
20 MS. PIERCE: OMH is really working
21 hard on that, on the transition-age-youth
22 thing, and they're reaching out not just to
23 high schools but also to colleges. Because
24 those are the age where they're sort of
494
1 changing -- their life is changing, you know.
2 ASSEMBLYWOMAN GRIFFIN: Okay, thank
3 you.
4 CHAIRWOMAN KRUEGER: Okay. I believe
5 that is all the questions from all the
6 members up here.
7 I want to thank you all very much for
8 your participation today and for your work on
9 behalf of so many people who don't
10 necessarily have the opportunity to voice
11 their own problems to us, so appreciate it
12 very much.
13 I'm now going to ask you to leave so
14 that I can call up the next panel. We have
15 Donald Nesbit, Jim Karpe, Eric Geizer, and
16 Kevin Ryan, who is a replacement for the
17 Self-Advocacy of New York State coordinator.
18 And then when you get up here, we'll
19 have you each introduce yourself so that the
20 media department -- up at the top -- knows
21 who's who.
22 There aren't better or worse chairs,
23 not to worry. Okay, so starting to my left,
24 your right, why don't you just introduce
495
1 yourself and go down the line.
2 MR. KARPE: Jim Karpe, with the
3 Coalition for Self-Direction.
4 CHAIRWOMAN KRUEGER: Press the "Push"
5 until it turns green. You've got it.
6 MR. NESBIT: Donald Nesbit, executive
7 vice president of Local 372.
8 MR. RYAN: (Mic off.)
9 CHAIRWOMAN KRUEGER: Thank you.
10 MR. GEIZER: Hi, Eric Geizer, CEO with
11 The Arc New York.
12 CHAIRWOMAN KRUEGER: Thank you.
13 So why don't we just go down the line
14 as you present.
15 So why don't you go first. You're
16 going to have to speak up a little bit.
17 MR. KARPE: I was seeking to go last,
18 but that's fine.
19 My name is Jim Karpe. I'm the father
20 of a young adult who's served by OPWDD.
21 You have my written testimony, which
22 is rather wide-ranging. What I'm going to do
23 today is focus on one person, Daryl:
24 Lives in a group home, and he's been
496
1 going to dayhab for years, for decades. He's
2 woken up 6:00 a.m. every morning, showered,
3 dressed, fed, rolled onto the transport van
4 for six hours of dayhab. Until, this last
5 summer, his sister arranged for him to get a
6 taste of retirement. So for eight weeks, in
7 his 70s, Daryl got to choose what to do.
8 Some days he would go with his staff member
9 to a local senior center. Some days he would
10 just stay in the group home with a staff
11 member. And some days he would choose to go
12 to that same dayhab.
13 That eight weeks ended, and with his
14 sister he arranged to get a self-direction
15 budget. And here's the problem. New York
16 State assigned to him a self-direction budget
17 which is half the amount that they're paying
18 for his dayhab. Now, if they gave him
19 88 percent, we would still save thousands of
20 dollars a year and Daryl would finally get to
21 retire.
22 I mean, I'm asking you, just imagine
23 for a moment what it's like in Darrell's
24 shoes, in Darrell's wheelchair. He gets this
497
1 taste of retirement, and now he's learned
2 unless something changes, he's not going to
3 be able to do it.
4 We can give Darrell's story a happy
5 ending. What does he need? He needs a
6 budget that's roughly equitable with what
7 he's getting in the certified system, and he
8 needs a place to appeal, a forum to go to, if
9 that budget is not adequate.
10 And of course we're not just talking
11 about Daryl. There are 10,000 seniors,
12 people 60 and over, who are sitting in
13 group homes. Seven thousand of them are
14 going to dayhabs every weekday. And then
15 there's tens of thousands of others who are
16 not yet seniors who want that freedom, who
17 want that equity so that they can choose
18 whether to be in the certified system or be
19 in the self-direction system.
20 Thank you for your time today.
21 CHAIRWOMAN KRUEGER: Thank you.
22 There you go.
23 MR. NESBIT: Good afternoon, Chairs,
24 distinguished esteemed members of the
498
1 presiding committees.
2 I am Donald Nesbit, executive vice
3 president for Local 372. Thank you for the
4 opportunity to represent Local 372 here and
5 our Substance Abuse Prevention and
6 Intervention Specialists, our SAPIS, in
7 New York City schools.
8 Since 1971, SAPIS have provided a
9 range of mental health services -- mental
10 health and intervention services in the
11 largest school district in our nation,
12 teaching social-emotional strategies and
13 behavioral support to ensure our children are
14 ready to learn.
15 SAPIS use evidence-based programs that
16 are approved by OASAS. SAPIS provides
17 students and their families with tools to
18 navigate the personal peer pressures that may
19 derail from healthy academic development.
20 SAPIS are also responsible for individual
21 work plans each year that's specifically
22 tailored for our children and our schools.
23 It is with willing partners like you
24 that we can ensure that our children's
499
1 concerns will not go unheard. We appreciate
2 the $2 million of funding that you give to
3 the SAPIS program every year, but it is
4 imperative that the State of New York
5 continue to protect our vital programs such
6 as the SAPIS for the mental health and
7 wellness for our children. Middle school and
8 high school students who responded to city
9 schools' annual survey last year said that
10 their classmates are bullied, harassed and
11 work to intimidate each other, which is up
12 44 percent from 2019.
13 New social challenges and family
14 financial losses, cyberbullying, exposure to
15 pressures from social media, and the use of
16 cannabis continues to prove there to be a
17 higher need for SAPIS in our schools.
18 Evidence also suggests that programs
19 implemented at early stages of a child's life
20 may be effective in preventative efforts in
21 providing behavior adjustments, especially in
22 high-risk populations.
23 But there are 236 SAPIS in our schools
24 supporting 912,000 public school children.
500
1 An individual SAPIS can effectively help
2 500 students in need, but this is not enough.
3 Our SAPIS are moved from different campuses
4 based on evaluation of who needs it more.
5 That should not be our system to determine --
6 rather, to pick and choose whether one child
7 should have services and one goes without.
8 This is why Local 372 requests that
9 instead of 2 million this year that the reach
10 is farther, and that we request $6 million
11 into the SAPIS program, as that would equate
12 to 48 full-time SAPIS and could reach 24,000
13 more students.
14 I thank you again for my time.
15 MR. GEIZER: Good late afternoon. My
16 name's Eric Geizer. I'm CEO of The Arc
17 New York. We're the largest provider of
18 supports and services for people with
19 intellectual and developmental disabilities
20 in New York State.
21 This morning you heard Acting
22 Commissioner Baer speak about the significant
23 investments that the Governor and OPWDD has
24 made into our system through the rate
501
1 rebasing process. This increase and recent
2 investments signal a meaningful shift away
3 from the neglect New Yorkers with
4 disabilities have experienced for decades.
5 We are grateful to the Governor and
6 the acting commissioner for leading that
7 charge. But it's dangerously easy to hear
8 about that investment and think that the
9 needs of New Yorkers with disabilities have
10 been met. That is far from the case.
11 Rate rebasing is a federally mandated
12 process to better align the rates providers
13 receive for providing services with the costs
14 of providing those services. The increases
15 we received through the rate-rebasing process
16 were significant, but they were significant
17 because after years without investment, our
18 rates were completely unaligned with costs.
19 The state's investment in our service system
20 over the past two decades still lags
21 inflation by 20 percent.
22 The big investment numbers you've
23 heard today, while great, don't even
24 compensate for that inflation. The
502
1 investments will go primarily to wages, but
2 they will not be enough to bring compensation
3 in line with the skill and responsibility
4 required of our staff. And they only begin
5 to address the inequity between the wages of
6 the nonprofit providers and the
7 state-operated programs.
8 And they do not support our full
9 system of care. Rate rebasing only applies
10 to some of our programs. Critical services,
11 community hab, respite, supported employment,
12 they receive no increases through the
13 rebasing. So people who rely on those
14 services are still struggling to access
15 support.
16 Parents miss work because services are
17 not available. They can't get respite to
18 help them live a life beyond caregiving.
19 Long-time staff are leaving people they've
20 supported for years because they can go to a
21 state-operated home down the road and make
22 30 percent more for the exact same work.
23 These aren't hypotheticals. These are real
24 experiences of real New Yorkers who need your
503
1 help.
2 Our commitment to meeting their needs
3 drives everything we do at my organization,
4 but our ability to meet those needs is
5 limited by your commitment. So we're calling
6 on you to include a 7.8 percent inflationary
7 increase in the budget to support the
8 comprehensive needs of people with
9 disabilities. We're calling on you to
10 convene a wage commission to examine the
11 roles and responsibilities of human service
12 workers and establish fair, sustainable
13 compensation standards. And we're calling on
14 you to move the responsibility for
15 rate-setting back to OPWDD to ensure future
16 rate-setting is timely and appropriate. In
17 short, we're calling on you to help in
18 finally ending the neglect for people with
19 disabilities.
20 Thank you.
21 MR. RYAN: Hi. I am Kevin -- sorry
22 about that. Hi, I am Kevin Ryan. I'm a
23 board member on behalf of SANYS. Thank you
24 for allowing me to testify.
504
1 It is important that you hear from
2 people like me. SANYS is an organization
3 founded by people with developmental
4 disabilities for people with developmental
5 disabilities. We have been speaking up for
6 ourselves and others for over 30 years.
7 I'm not going to read our written
8 testimony today, as you already have that.
9 You will see that we are seeking your support
10 on increases to direct support professional
11 pay, increases to CDPA and HHA staff pay,
12 problems with the transition to a single FI
13 for CDPA, reforming the Nurse Practice Act so
14 people can have the staff support they need
15 to get medications in their own home,
16 increased rate to durable medical equipment
17 vendors, investments in transportation and
18 housing.
19 However, I want to focus on sharing my
20 experience and the experience of my friend
21 and colleague Shameka Andrews, who couldn't
22 be here today due to an ongoing issue with
23 her wheelchair. Shameka has been trying to
24 get her wheelchair repaired since October.
505
1 Since that time, we have had multiple -- she
2 has had multiple breakdowns and had more than
3 a month when she was unable to leave her
4 home. Her chair was to be fixed yesterday,
5 but it's still broken.
6 Believe me, Shameka is not alone with
7 this issue. This happens far too often. So
8 I think it's ironic that she was going to
9 speak about the issue with durable medical
10 equipment today if she could be here.
11 In the State of the State briefing
12 book, Governor Hochul stated that she would
13 increase wheelchair access by increasing
14 rates for clinical specialty evaluation for
15 new wheelchairs, expanding coverage for
16 repairs. We want this promise to be kept.
17 It is not clear that this is represented in
18 the proposed budget, but it is essential.
19 Now, I want to tell you that I rely on
20 my staff and so do others all across New York
21 State. I have seen far too much turnover of
22 the staff I rely on, and too many of us don't
23 have enough staff to meet our needs.
24 In closing, you will see the specific
506
1 requests we are making in our written
2 testimony, but you need to understand how
3 important it is that New York State invest
4 enough in wages to solve our longstanding
5 staffing crisis.
6 Thank you for your time.
7 CHAIRWOMAN KRUEGER: Thank you very
8 much.
9 First Senator? Oh, we have
10 Senator O'Mara. Or we have -- excuse me --
11 Senator Canzoneri-Fitzpatrick.
12 SENATOR CANZONERI-FITZPATRICK: Thank
13 you, Madam Chair.
14 Mr. Geizer, in looking at your
15 statement, I know you could only highlight
16 certain things, but a couple of things that
17 stand out to me that I know are a problem,
18 and I want to acknowledge them.
19 That the starting wage for DSPs
20 employed by nonprofits is only $17.23 per
21 hour statewide. And in contrast, DSPs who
22 work for OPWDD start at $25 an hour outside
23 of New York City and $27 per hour within
24 New York City. And that this disparity is
507
1 terrible because of what you said today on
2 how somebody could go down the street and
3 work for a lot more money. And I don't
4 understand why that is, and that's something
5 that I continue to question.
6 One of the other things that you
7 mentioned in your testimony is about how the
8 Department of Health took six months to
9 approve the adjusted rates for residential,
10 pre-vocational and day programs, and that I
11 believe it was probably close to 10 years ago
12 that OPWDD used to approve those rate
13 increases.
14 And I'm wondering if you could share
15 with us what would the approval process look
16 like when OPWDD had that approval process.
17 MR. GEIZER: Well, it's our hope --
18 and one of the things we're advocating for is
19 switching back the budget authority to OPWDD.
20 You know, nothing in government moves
21 quickly, and anytime you add another state
22 agency into a process that's complicated and
23 difficult, it becomes even slower.
24 So we think by kind of streamlining
508
1 the process, removing the Department of
2 Health from that process, putting the onus
3 back on OPWDD who understands the rates,
4 understands the costs, understands the needs
5 of the providers, that's where that task
6 should lie.
7 SENATOR CANZONERI-FITZPATRICK: And do
8 you have any sense of what that would do to
9 the approval process as far as timeline?
10 MR. GEIZER: My hope would be that it
11 would streamline things. You know, it's our
12 understanding that between the state agencies
13 going back and forth over these rates for
14 some period of time, that was a big part of
15 the delay. So eliminating that piece of it
16 would be very helpful.
17 SENATOR CANZONERI-FITZPATRICK: Okay.
18 Thank you very much.
19 CHAIRWOMAN KRUEGER: Thank you.
20 Assembly.
21 CHAIRMAN PRETLOW: Assemblywoman
22 Simon.
23 ASSEMBLYWOMAN SIMON: Thank you.
24 Thank you all for your testimony.
509
1 I have a couple of quick questions.
2 One is about -- with the consumer-directed
3 program. Are any of your folks using their
4 consumer direction, the CDPAP program? And
5 if so, are you able to -- what's your
6 experience with this transition to a single
7 FI?
8 And then I have another quick question
9 as well. And I just want to acknowledge this
10 issue with durable medical equipment, which
11 has been an issue for the 45 years that I've
12 been in this field. So we really do need to
13 make changes in that and provide, you know,
14 the COLA.
15 MR. KARPE: Eric, maybe you and I can
16 split this.
17 We heard from Commissioner Baer this
18 morning that there's 9,000 people in OPWDD
19 who are using CDPAP. Most of them are people
20 who are either living at home -- I think
21 actually all of them are people who are
22 either living at home with their parents or
23 living on their own with self-direction. And
24 actually SANYS might want to weigh in on this
510
1 as well.
2 There's a lot of confusion about
3 what's going on. There's -- rumors were
4 flying around just yesterday that parents are
5 no longer going to be able to be caregivers
6 for their children under the new FI. There's
7 other rumors that no, no, nothing's going to
8 change. There's other rumors that lots of
9 people are going to be dropped. So it's --
10 there's a lot of confusion and a lot of
11 anticipation of pain.
12 Does SANYS have --
13 ASSEMBLYWOMAN SIMON: Any other
14 experiences? And tell us how we can clarify
15 that so that those rumors and those concerns
16 aren't prevailing.
17 MR. GEIZER: It's not a huge issue for
18 our organization. Our organization
19 primarily -- the majority of our services are
20 in certified settings, residential, dayhab,
21 things like that. So many of our folks do
22 not utilize the CDPAP program.
23 It's more of a self-direction fiscal
24 intermediary process --
511
1 ASSEMBLYWOMAN SIMON: Okay.
2 MR. KARPE: -- so it's not really
3 applicable.
4 ASSEMBLYWOMAN SIMON: And is there a
5 self-direction aspect of folks who are part
6 of the self-advocacy association? I'm sorry,
7 I don't remember the person's name. You're
8 looking at the captions?
9 MR. RYAN: I believe we want New York
10 State to slow down and take time to determine
11 the best path forward regarding improvements
12 to the CDPA FI system, a plan development
13 that will transition to new practices.
14 ASSEMBLYWOMAN SIMON: Okay. Thank
15 you. I think some of us would probably like
16 to follow up with you on that.
17 CHAIRWOMAN KRUEGER: Thank you.
18 Senator Tom O'Mara.
19 SENATOR O'MARA: Thank you all for
20 being here today.
21 And we did hear the acting
22 commissioner's testimony earlier,
23 particularly in regards to your operations,
24 Mr. Geizer, and the Arcs, the differential in
512
1 pay between the state-operated OPWDD facility
2 and an Arc facility or many similar entities
3 providing these services.
4 I represent an area of the
5 Finger Lakes and Southern Tier. The Arcs
6 that I represent, the Franziska Racker
7 Centers, I keep hearing about group homes
8 being closed because of inability to hire
9 enough workers to staff them. Yet I believe
10 we heard some questioning of Chairwoman
11 Krueger of the commissioner that homes were
12 not being closed. I don't know if she meant
13 OPWDD homes were not being closed or Arc
14 homes weren't being closed.
15 Can you -- where do we stand on the
16 staffing issues because of this significant
17 gap in pay?
18 MR. GEIZER: I think the short answer
19 is homes both in the state system and on the
20 not-for-profit side are closing for different
21 reasons.
22 On the not-for-profit side it's
23 primarily staffing. If you're not able to
24 staff a home, you can't afford to keep that
513
1 home open and the costs associated with it.
2 So I don't think it's accurate to say
3 that the homes are not closing. They are.
4 Now, I have to give credit again to
5 the acting commissioner and to the Governor.
6 The massive investment that has recently been
7 made is going to help bring our salaries up.
8 It's not going to be equal with the
9 state-operated workforce, but it's going to
10 bring us closer.
11 But it still begs the question, I
12 think, which I hope many of you have, of why
13 would two sets of people doing the exact same
14 job get different rates of pay. And it's
15 something I have a hard time explaining, too.
16 SENATOR O'MARA: Exactly.
17 Particularly when, on the back hand, when it
18 comes to retirement and other benefits, your
19 operations are much less costly as well, less
20 costly as it is from the state perspective
21 with all the benefits and the retirement
22 contributions going in there as well.
23 So in the long run, I think it could
24 be more cost-effective, more efficient for
514
1 your agencies to be getting -- being able to
2 offer equal or substantially similar pay to
3 these workers to have them in the workforce
4 doing this work.
5 So thank you for your advocacy, all of
6 you for your advocacy on these issues. You
7 know, again, it's frustrating sitting here
8 for the number of years I have, dealing with
9 this issue over and over and over, and there
10 seems to be unanimity among this Legislature
11 of what should be done. Yet every year we're
12 back here talking about the same thing.
13 One of these years, it has to change.
14 Thank you.
15 CHAIRWOMAN KRUEGER: Thank you.
16 Assembly.
17 CHAIRMAN PRETLOW: Assemblyman
18 Sempolinski.
19 ASSEMBLYMAN SEMPOLINSKI: Thank you,
20 Chairman.
21 First of all, thank you, all four of
22 you, for being here.
23 I also want to just point out how
24 important it is to have parents and
515
1 self-advocates who are on the frontlines of
2 dealing with these issues, so especially
3 thank you for being here.
4 Mr. Geizer, I want to first of all
5 give a shout out to my local Arc affiliates
6 in Steuben, Allegheny, and in tandem. I have
7 a great relationship with both -- with the
8 leadership of both of those, and they're in
9 my office all the time. We have a constant
10 communication. So a shout out to the folks
11 back in the Southern Tier.
12 I share Senator O'Mara's concerns on
13 staffing. I've heard the same stories from
14 those local affiliates. It's greatly
15 concerning, especially in a rural area where
16 if a group home closes or some program
17 closes, there's not easily a replacement to
18 that.
19 When we were questioning the
20 commissioners earlier today I made a
21 supposition. I want to see if I was right
22 regarding the concerns where every year we
23 have to deal with the COLA or whatever you
24 want to call it this particular year. I
516
1 would imagine, for yourself and for your
2 local affiliated organizations, it makes it
3 really hard to plan, right?
4 How do you plan long-term for staffing
5 even if staffing's available when we keep
6 having this situation every budget time? How
7 does that affect your operations to have
8 those lack of planning and lack of certainty
9 challenges?
10 MR. GEIZER: It's specifically about
11 COLAS or increases?
12 ASSEMBLYMAN SEMPOLINSKI: Yes, sir.
13 Yeah.
14 MR. GEIZER: Well, I mean, it all
15 comes back to staffing. You know, if we're
16 not able to pay our staff a living wage and a
17 competitive wage, we can't staff our
18 programs. And every year we come back -- and
19 like I said, we're very thankful for the
20 investments that we've gotten over the last
21 four years. They've been significant. The
22 recent significant increase in our rate
23 rebasing is going to be super-helpful for us.
24 But that alone still leaves us, over
517
1 the last two decades, 20 percent behind
2 inflation. So it's going to help us catch
3 up. And now going forward, we need a cost of
4 living, which I think you alluded to earlier
5 today, like 2.1 is still less than 2.9.
6 ASSEMBLYMAN SEMPOLINSKI: It's still a
7 cut. Yeah.
8 MR. GEIZER: So we're actually going
9 to go backwards a bit.
10 MR. KARPE: If I can jump in for a
11 second, from a parent perspective, the entire
12 parent community, it shakes our faith in the
13 system that we have to come up here year
14 after year after year to fight for what
15 should be routine.
16 ASSEMBLYMAN SEMPOLINSKI: Right.
17 Right. And I think -- I hope your takeaway
18 is, at least from this panel, there's really
19 bicameral Assembly and Senate and bipartisan,
20 you know, support for making sure that you're
21 getting a true adjustment that really affects
22 your costs.
23 MR. GEIZER: Thank you.
24 CHAIRWOMAN KRUEGER: Okay. Any other
518
1 Senators?
2 Senator -- I'm sorry. Senator
3 Persaud. That's why I asked everyone.
4 SENATOR FERNANDEZ: You're forgetting
5 me.
6 SENATOR PERSAUD: Thank you all for
7 being here.
8 Donald, I'm going to start with you,
9 quickly. SAPIS. With the increased use of
10 cannabis amongst our youth, what kind of
11 strain has it placed on your SAPIS
12 counselors?
13 You know, every year you come and ask
14 us for money. Every year we fight to get you
15 that money, and it's still not enough. And
16 now we have this added strain of crazy
17 behavioral issues because of the increased
18 use of cannabis in schools.
19 MR. NESBIT: Yeah. Great question,
20 Senator.
21 So if you hear President Francois
22 speak, he says often if you stay ready --
23 SENATOR PERSAUD: You don't have to
24 get ready.
519
1 MR. NESBIT: -- you don't have to get
2 ready.
3 And so what we're pushing for at the
4 very least is for SAPIS to be in every middle
5 school, campus school. If they are there,
6 there's not one issue that they won't be able
7 to sustain or overtake.
8 The issue right now is there's only
9 236 of them servicing over 900,000 students.
10 So where one principal may want -- may have
11 an issue at one school, that SAPIS is now
12 torn from one school to another. In some
13 cases we've had reports of a SAPIS that
14 services four or five schools, just to try to
15 figure it out and make sure that they're
16 servicing all of the students.
17 And in some cases some schools
18 actually have to go without services because
19 the SAPIS -- they're overworked, right? They
20 can't be pulled so many places.
21 That should not be the system that we
22 have where we're picking and choosing which
23 students we're going to service when we
24 should be servicing all.
520
1 SENATOR PERSAUD: Every student.
2 Thank you.
3 And, Kevin, I just want to thank you
4 for your advocacy. You know, I'm listening
5 to you and you're reminding me of someone who
6 calls my house every day, and calls my
7 office. Her name is Debbie Schwartz. And
8 when she speaks she is advocating not only as
9 a self-advocate, but she's always talking
10 only about the needs of the DSPs. The needs
11 of the DSPs.
12 And she always reminds me,
13 "Roxanne" -- this is what she says --
14 "Roxanne, you have to take care of them. If
15 you're not taking care of them, they cannot
16 take care of us."
17 MR. NESBIT: That's correct.
18 SENATOR PERSAUD: And so what you're
19 saying is exactly what she's saying. So it's
20 incumbent upon us to ensure that we take care
21 of the DSPs.
22 You know, I have the bills trying to
23 ensure that they are paid equally across the
24 board.
521
1 MR. NESBIT: Right.
2 SENATOR PERSAUD: You heard the
3 commissioner this morning speak about it. We
4 have to ensure that we're paying them so that
5 we retain the dedicated workforce. Because
6 the people who are DSPs, they are doing it
7 because they love what they are doing.
8 MR. NESBIT: Right.
9 SENATOR PERSAUD: If they didn't,
10 there would be -- every single one of them
11 would walk away because we're not paying
12 them. They could make more somewhere else.
13 So again, I thank you for your
14 advocacy, and we will continue to fight on
15 your behalf.
16 Thank you all.
17 MR. NESBIT: Thank you very much.
18 CHAIRWOMAN KRUEGER: Assembly.
19 CHAIRMAN PRETLOW: Assemblyman
20 Santabarbara.
21 ASSEMBLYMAN SANTABARBARA: Okay, thank
22 you, Mr. Chair.
23 I just wanted to circle back on the
24 discussion on the self-direction, Mr. Karpe.
522
1 Maybe you can just give some comments.
2 On the program itself, obviously, as
3 you said, it has empowered individuals with
4 disabilities to take a different route if
5 they choose to. But we know that there's
6 barriers, administrative barriers, lack of
7 adequate funding, and additional challenges
8 that I talked about earlier, actually, when
9 the commissioner was here.
10 What specific budget changes would you
11 like to see that could enhance the
12 accessibility of self-direction?
13 MR. KARPE: There's a couple of things
14 that would be wonderful.
15 One is if there were funding available
16 to allow every fiscal intermediary to front
17 the money to parents. Right now parents have
18 to reach into their pocket. It's
19 tremendously inequitable. This doesn't have
20 to be that way.
21 New Jersey's self-direction system
22 is -- there's no reimbursement. It's all
23 pre-paid by -- or paid by the state without
24 the family having to reach into their
523
1 pockets. So that's one tremendous change.
2 Another great change would be if there
3 were -- and not just for self-direction, but
4 for the whole system -- if there were some
5 sort of innovation fund that would allow us
6 here in New York State to try things out
7 without having to go through the very lengthy
8 waiver process that's required.
9 I can wait. My son's not yet 30.
10 People like Daryl can't wait. He's in his
11 70s. If he doesn't retire soon, it's all up
12 for him.
13 ASSEMBLYMAN SANTABARBARA: And we also
14 had a discussion earlier today about the
15 rates themselves. When they fluctuate, when
16 they increase, are you finding that the
17 budgets are also matching that, or is there a
18 lag?
19 MR. KARPE: So for the COLAs and now
20 the TII, there is a rate increase and that's
21 great. This 850 million, this 13 percent
22 rate increase, that did not increase the
23 budget for people in self-direction. So
24 somebody in self-direction like my nephew,
524
1 who purchases day services, he's just gotten
2 a cut.
3 ASSEMBLYMAN SANTABARBARA: And that
4 was --
5 MR. KARPE: And his budget now has to
6 stretch to cover this extra 13 percent
7 charge.
8 ASSEMBLYMAN SANTABARBARA: And that
9 was the discussion I was having earlier.
10 Thank you for your responses.
11 I do want to say that I think the wage
12 commission is a good idea. I don't have much
13 time left, but maybe you can give us a little
14 more detail on how that would work. I would
15 appreciate it.
16 MR. GEIZER: Oh, the wage commission?
17 Yeah. So, you know, one of our requests this
18 year is to convene a wage commission that
19 would evaluate and study the human services
20 workforce and determine from an objective
21 body, you know, what's an equitable,
22 competitive wage for our workforce that's
23 sustainable going forward.
24 So I'm super-hopeful that you will all
525
1 support that effort and finally get us to the
2 point we need to with our staffing salaries.
3 CHAIRMAN PRETLOW: Assemblyman Brown.
4 MR. GEIZER: Sorry.
5 ASSEMBLYMAN KEITH BROWN: Thank you,
6 Chair.
7 Thank you all for being here.
8 Mr. Nesbit, I'm intrigued by what I
9 heard. And my colleague who was here earlier
10 asked a question of one of the commissioners
11 about the possibility of expanding SAPIS
12 statewide. What are your thoughts about
13 that?
14 MR. NESBIT: Well, I was listening in
15 to the hearing as well and was also intrigued
16 by that question, right?
17 SAPIS, the vital -- I want to say the
18 most vital thing about most of our SAPIS,
19 they live and work in the community where
20 they live, right?
21 So in order for -- I think it would be
22 great statewide as an initiative to look at
23 what the SAPIS do in New York City. They
24 live in those communities. The students know
526
1 them, the families know them. So whenever
2 there's an opportunity for them to intervene
3 in a situation or they find a student that's
4 actually being bullied, they're able to go to
5 those families and intervene and get things
6 done.
7 So we see substance abuse, and we say
8 it's just a drug issue that they actually do.
9 They do anti-bullying. They do peer-to-peer
10 mentorship, where they teach students how to
11 deal with different issues, not just dealing
12 with drugs. It's a really great program and
13 definitely needed around our state.
14 ASSEMBLYMAN KEITH BROWN: So one thing
15 that's interesting back in my home district,
16 someone I went to high school with, she went
17 to the Board of Ed and she asked them about
18 having all of the people inside the building
19 being trained for crisis identification, for
20 a child who might be in crisis, and she got
21 nowhere. So she actually went to the
22 athletic director, and he was very interested
23 and willing. Her boys had played sports, so
24 she had a personal relationship with him.
527
1 So what they did was they had every
2 coach in the high school, in that particular
3 high school, trained in crisis
4 identification.
5 So as part of the -- what your union
6 does, is that part of your auspices?
7 MR. NESBIT: No. So coaches -- most
8 coaches in New York City are actually
9 teachers, so they're represented by the
10 teachers union.
11 ASSEMBLYMAN KEITH BROWN: But do they
12 get -- my question -- sorry, my question was
13 whether or not they're trained in crisis
14 identification.
15 MR. NESBIT: Oh, yes. So they're able
16 to deal with most situations that a student
17 may go through.
18 And like I said in my testimony, their
19 reach -- so counselors in New York City
20 schools may have one-on-one interaction with
21 a student. SAPIS actually have a whole
22 curriculum where they teach in classrooms.
23 So their reach -- one SAPIS may reach
24 500 students.
528
1 ASSEMBLYMAN KEITH BROWN: And there's
2 a new program -- I only have 22 seconds, so
3 I'm going to talk fast -- where out east, on
4 the East End of Long Island, the school
5 districts are now working with the local
6 police department so that if they're called
7 to a house where there's a child that's
8 exposed to any type of trauma in the
9 household, then they notify the school
10 districts so that the school personnel know
11 at least to keep an eye out for that child.
12 Thank you so much.
13 MR. NESBIT: Thank you.
14 CHAIRMAN PRETLOW: Assemblywoman
15 Chandler-Waterman.
16 ASSEMBLYWOMAN CHANDLER-WATERMAN:
17 Thank you, Chair.
18 Okay. How you doing, Donald? Thank
19 you all, everybody, for your advocacy.
20 But this question is directed to Local
21 372 DC-37.
22 Thank you for the work and advocacy,
23 for you and your President Francois.
24 Regarding SAPIS workers, we know that
529
1 they focus on substance abuse prevention and
2 intervention. But I don't know -- as a
3 former educator running programs as a coach
4 in the New York City public schools, I worked
5 intimately with SAPIS workers. They do way
6 above and beyond the call of duty, from even
7 deejaying sometimes at events, to build that
8 connection.
9 So they become the partner for the
10 community-based organization, they become the
11 partner for the principal and the families in
12 the community to support.
13 So it's kind of disturbing that
14 they're not in every school. For me, I'm --
15 like it's hard to believe that.
16 I want to know are they in all --
17 they're not in all elementary schools,
18 they're not in all junior high schools. So
19 how do we get a plan where we could like --
20 junior high school I'd say has the highest
21 need, because that's that moment, right? How
22 do we get a plan where they're in all junior
23 high schools throughout the city, then work
24 towards, you know, the highest-need high
530
1 schools, and then elementary schools, to
2 build to the plan? Because 6 million doesn't
3 seem like enough to do all of that.
4 I don't -- I'm sorry to give you such
5 a compounded question, but we know this is
6 very important.
7 MR. NESBIT: No. So, Assemblymember,
8 that's actually a great question.
9 We're currently working with the
10 New York City Department of Education to look
11 at the numbers of what it would cost to have
12 a SAPIS in every campus and middle school.
13 Most campuses have multiple schools in it, so
14 we're looking at that model right now. But
15 we know that there's a cost associated to it.
16 I mean, I'd just like to put this out
17 there, to your question. Our teachers do a
18 great job in teaching our students. But we
19 like to say Local 372 members are the support
20 staff in New York City schools, and they're
21 the foundation of the house. And we know
22 when you build a house, if there's no
23 foundation, the house crumbles, right?
24 So just think about the aspect of a
531
1 SAPIS not being there to -- able to reach
2 those students. It gives the teachers also a
3 difficult time in teaching, right, and
4 administration in running the building.
5 And so we're pushing, but we're
6 working to get some numbers now with New York
7 City Public Schools as to how much it would
8 cost to have a SAPIS in every middle school
9 and campus.
10 ASSEMBLYWOMAN CHANDLER-WATERMAN:
11 Yeah. And it definitely takes the load off
12 the administrators and the teachers, who have
13 to do a lot of work. This is something that
14 we definitely want to prioritize and make
15 sure is fully funded. Thank you.
16 MR. NESBIT: Thank you.
17 CHAIRWOMAN KRUEGER: Okay. We have a
18 Senator, Senator Fernandez.
19 SENATOR FERNANDEZ: Thank you so much.
20 And thank you for whoever mentioned
21 SAPIS, because I do have a budget letter to
22 support $3 million.
23 But is that enough? Is that going to
24 be able to address the need that is in our
532
1 schools? Could you speak a little bit as to
2 how much 3 million would do if not do any
3 more?
4 MR. NESBIT: So the ask is for
5 6 million this year.
6 SENATOR FERNANDEZ: Oh, okay, 6
7 million.
8 MR. NESBIT: Six million. And with
9 6 million, as I said during my testimony,
10 6 million we know that that would help with
11 hiring 48 more SAPIS and would reach 24,000
12 more New York City schools.
13 And we know that's not enough. But as
14 I said, we're working to see what the numbers
15 look like for middle schools and campuses.
16 That way, we expand upon the amount of
17 students that we're actually able to reach.
18 SENATOR FERNANDEZ: Thank you very
19 much.
20 CHAIRWOMAN KRUEGER: Thank you.
21 Assembly?
22 CHAIRMAN PRETLOW: Assemblyman
23 Palmesano.
24 ASSEMBLYMAN PALMESANO: Yes. My
533
1 question is for Mr. Geizer.
2 First, I just want to say thank you
3 for what all your dedicated employees do for
4 our most vulnerable citizens here in the
5 State of New York. So please send our thanks
6 and appreciation to them.
7 I want to -- when I talked to the
8 commissioner earlier I mentioned that in the
9 past two years, according to a report of
10 six months ago, 91 residential beds have been
11 closed in the Western New York region. I
12 asked the commissioner to follow up on that
13 about beds across the state.
14 I don't want you to answer that
15 question yet, but I'd like if you had any
16 number on the number of beds that have closed
17 in the Arc homes across the state, if you
18 could share that then.
19 But my question I want to ask you is
20 the same question I asked her. She seemed a
21 little bit more optimistic about it with the
22 funds that have been allocated, but I kind of
23 have my disagreements. So I want to ask you
24 the same question. Is the differential
534
1 between the minimum wage and what nonprofit
2 agencies like Arcs are currently funded to
3 pay, is that adequate enough for them to
4 compete in the local labor market for the
5 talent and dedication required for these very
6 important positions that are tasked with
7 improving the quality of life and care of our
8 most vulnerable citizens?
9 MR. GEIZER: The short answer is no.
10 A decade ago, 15 years ago, our
11 salaries were twice minimum wage. Over that
12 period of time, our salaries now, at $17 and
13 change, are about 10 percent over minimum
14 wage.
15 Now, the investments are going to
16 help. Our salaries are going to raise
17 modestly, and that's a great thing. But I'm
18 not sure that $20 an hour is still enough
19 money for the skill and responsibility we are
20 asking for our staff to accomplish every
21 single day.
22 And that's why we have to continue to
23 fight for a 7.8 percent increase, which will
24 allow us to invest more in our salaries and
535
1 catch up from the inflationary measures over
2 the last two decades, where we're still
3 20 percent behind the eight ball.
4 ASSEMBLYMAN PALMESANO: Well, I've
5 seen in my area people leaving. They want to
6 be there, they care about these individuals,
7 but they just can't take care of their
8 families. They go work at Burger King or
9 Taco Bell or McDonald's. It's just wrong.
10 Truly the work that they do is God's work, so
11 I just wanted to say it.
12 Do you know how many beds -- do you
13 have a tally of how many Arc beds have closed
14 across the state in the past two years?
15 Or --
16 MR. GEIZER: Yeah, I don't have that
17 information --
18 ASSEMBLYMAN PALMESANO: That's okay.
19 MR. GEIZER: -- at the ready right
20 now. I certainly could go back and do some
21 research.
22 But we certainly have had to close
23 programs as well because of staffing
24 shortages, that's for sure.
536
1 ASSEMBLYMAN PALMESANO: Well, we'll
2 keep up the fight.
3 MR. GEIZER: Thank you.
4 ASSEMBLYMAN PALMESANO: And for me, I
5 guess it's hard for me to understand how this
6 Governor, every year she puts in an
7 allocation for $700 million for the
8 Hollywood film tax credit to subsidize the
9 Hollywood elite, but yet our most vulnerable
10 citizens and the direct support professionals
11 who are tasked with their quality care, to
12 improve their quality of life, are left
13 asking over and over again. It's a dog
14 chasing its tail and it's wrong, and it needs
15 to be changed now.
16 Thank you, sir.
17 MR. GEIZER: Thank you.
18 CHAIRWOMAN KRUEGER: Any other
19 legislators? Oh, in the Assembly.
20 CHAIRMAN PRETLOW: Assemblywoman
21 Giglio.
22 ASSEMBLYWOMAN GIGLIO: Yes, so thank
23 you all for being here.
24 And I did visit The Arc at the end of
537
1 2023, and at that time we were talking about
2 the CANS assessments. And I'm just wondering
3 what the CAS and the CANS assessments -- if
4 any of those services have been pulled away
5 and funding to you has been decreased.
6 Have you received any funding cuts, or
7 have you been cut based on these assessments?
8 MR. GEIZER: No, the CAS assessments
9 are -- it's in the works. It's been in the
10 works for a while. I think there are still
11 concerns with the reliability and the
12 validity of the assessment. So at this point
13 they are not being used to determine payment
14 for our supports and services.
15 ASSEMBLYWOMAN GIGLIO: Okay, that's
16 good.
17 Okay. And then my next question is
18 about the dayhabs and sheltered workshops.
19 Because New York State is starting to phase
20 out of the sheltered workshops, which gives
21 organizations an advantage to maybe make some
22 money, let the people that are in their homes
23 go to work and have this rewarding experience
24 of going to a place.
538
1 And I know that I have visited a
2 shelter work spot or workshop in Manorville,
3 New York, and it was very successful and it
4 was funded by the state, partially, and they
5 were working every day. They were scanning
6 in documents for the courts, they were
7 changing batteries on remote controls for the
8 cable companies. And it seems like all of
9 that just went away, and it just went out
10 with the water in the washing machine as the
11 state pulled back funds.
12 So I want to hear your experience on
13 the dayhabs after COVID and getting back to
14 the dayhab programs, and then also about the
15 sheltered workshops.
16 And then, to finish up, if you could
17 just let me know what incentives DSPs are
18 looking for. What are you hearing from them
19 in order to retain them? Because I know
20 housing is a big subject, especially the
21 rates. We've been talking about this for
22 four years, that they need to be paid more,
23 that we need to catch up with the rate of
24 inflation over the last 20 years, and then we
539
1 need to keep it steady based on the CPI. But
2 it doesn't seem to be happening.
3 So are there incentives that we can do
4 for the workforce so that we can retain them?
5 MR. GEIZER: Yeah. So I'll start with
6 the first question, which is the dayhabs and
7 the impact of COVID.
8 Obviously, COVID had a tremendous
9 impact on our dayhab programs. When COVID
10 happened, many of our dayhab programs were
11 required to shut down. They're congregate
12 settings, a lot of people in close quarters.
13 So, you know, obviously a lot of people had
14 to go home or stay in their certified
15 residences. And while they have recovered
16 some, they have not recovered fully.
17 Some people have decided to stay home
18 or seek different service supports. But we
19 have to go back again to staffing. We've had
20 a difficult time reopening our dayhab
21 programs because we can't find sufficient
22 staff to reopen. And that leaves folks,
23 unfortunately, in a tough spot where --
24 Oh. I have to stop.
540
1 CHAIRWOMAN KRUEGER: Thank you.
2 ASSEMBLYWOMAN GIGLIO: No, that's
3 okay. Dayhab's important. Thank you.
4 MR. GEIZER: I can follow up with you.
5 ASSEMBLYWOMAN GIGLIO: We'll talk
6 more, thank you.
7 CHAIRWOMAN KRUEGER: All right. Now I
8 do believe we have taken the questions of all
9 legislators.
10 So I want to thank you all very much
11 for your participation today and for your
12 work every day.
13 MR. GEIZER: Thank you.
14 CHAIRWOMAN KRUEGER: Appreciate it.
15 Thank you.
16 And we are now up to Panel E.
17 CHAIRMAN PRETLOW: The big one.
18 CHAIRWOMAN KRUEGER: Yes, we're going
19 to need some extra chairs, I think, for this
20 one.
21 We have Ruth Lowenkron, New York
22 Lawyers for the Public Interest; Alliance for
23 Rights and Recovery; Association for
24 Community Living; Treatment Not Jail
541
1 Coalition; New York Disability Advocates,
2 with a substitute speaker; and New York
3 Alliance for Inclusion and Innovation.
4 Hi. So let's make sure everybody gets
5 into a seat. And everyone, thank you for
6 being so patient and waiting so long. We're
7 trying to move along.
8 Let's start on this side of the table
9 (gesturing), just to introduce -- well, we're
10 just going to do introductions first so that
11 the people with the cameras and video know
12 who's speaking when you speak. So introduce
13 yourself, please.
14 MR. SEEREITER: Good evening, I'm
15 Michael Seereiter. I'm president and CEO for
16 the New York Alliance for Inclusion and
17 Innovation.
18 CHAIRWOMAN KRUEGER: Next?
19 MR. COOPER: Hard to believe it's
20 evening. But I'm Doug Cooper. I'm the
21 acting executive director at the Association
22 for Community Living.
23 CHAIRWOMAN KRUEGER: Thank you. Next?
24 MS. SCHIFF: Winifred Schiff, from the
542
1 Interagency Council of Developmental
2 Disabilities Agencies.
3 CHAIRWOMAN KRUEGER: Thank you.
4 MR. CULKIN: I'm Thomas Culkin. I'm
5 an advocate with the Treatment Not Jail
6 Coalition.
7 CHAIRWOMAN KRUEGER: Thank you.
8 MS. LOWENKRON: Ruth Lowenkron, with
9 the Disability Justice Program, New York
10 Lawyers for the Public Interest.
11 CHAIRWOMAN KRUEGER: Okay.
12 MR. ROSENTHAL: Harvey Rosenthal,
13 Alliance for Rights and Recovery.
14 CHAIRWOMAN KRUEGER: Great. Why don't
15 we start with Harvey, so we'll just swing
16 back down the table, if that's okay.
17 MR. ROSENTHAL: God bless you. Thank
18 you for that.
19 CHAIRWOMAN KRUEGER: Thank you.
20 MR. ROSENTHAL: So I was hospitalized
21 at Rockville Centre, at Mercy Hospital, for
22 six weeks with a severe depression a long
23 time ago. And so I know of this; this is
24 really my life. And I have been the director
543
1 of this Alliance for Rights and Recovery for
2 about 30 years.
3 The people I serve are the people you
4 read about in the papers, people who have
5 severe issues, you know, with mood, with
6 judgment, who are homeless or hungry. You
7 know, who could come in and out of jail and
8 prison or hospital. Not all of them; lots of
9 people have found recovery.
10 But we're in a terrible climate of
11 fear right now. People are afraid of us, and
12 we're afraid of them. And it doesn't help
13 that the New York Post talks about the
14 deranged and fanatics and lunatics every
15 other day, with an eye towards pushing forced
16 treatment. And I'm here to fight forced
17 treatment.
18 I'll tell you that 4 percent of our
19 community is violent. Eleven percent are
20 victims. We have names for them: Jordan
21 Neely, who was killed -- who was choked to
22 death on the subway, and Daniel Prude, who
23 was killed by the police in Rochester.
24 We know what works, though. Not
544
1 coercion. But we know what works. And we've
2 created some of those programs. We've
3 created the INSET program over here, which is
4 a peer-led program of engagement teams that
5 has engaged 83 percent of people who
6 otherwise would be on a court order. They
7 engage the unengageables.
8 We have -- we're working on Daniel's
9 Law, which would send the police -- not the
10 police, the peers and EMTs out.
11 We created the Peer Bridger Program
12 that helps people leave hospital and not
13 return. Once they leave hospital, you know,
14 they should get into Housing First, which
15 will take people regardless of their taking
16 medicine or drinking or drugging or what have
17 you. We've got to be there for people no
18 matter what.
19 Then the clubhouse movement has not
20 been up in upstate New York for years. The
21 Governor's going to do that. We're grateful
22 for that.
23 In this budget there's $16.5 million.
24 You've heard about it, you know, this
545
1 afternoon. It must go to voluntary services,
2 not AOT. We urge you, please come out in
3 that way.
4 We're against -- like so many groups
5 here, we're against forced treatment. We're
6 against involuntary forced treatment. Do you
7 know when they pick you up on the street,
8 that's called a mental hygiene arrest. If
9 you have trouble with food, shelter and
10 clothing, now you can be picked up and put
11 involuntarily in a hospital. I think we just
12 read for New York City 40 percent of the time
13 they weren't eligible, they didn't have to be
14 admitted. But they were picked up and went
15 through that trauma.
16 Even some of the tragedies you read
17 about in the paper, they were in the hospital
18 a few weeks before. Hospital is not the
19 answer to this thing.
20 Also, assisted outpatient treatment,
21 or Kendra's Law. The Legislature has found
22 this to be controversial. They have not made
23 it permanent since 1999. They review it --
24 (Time clock sounds.)
546
1 MR. ROSENTHAL: Oh, my God. We still
2 have to do the other.
3 It affects people of color. There's a
4 second study that's going -- you ought to
5 wait, please, until the second study comes
6 out.
7 CHAIRWOMAN KRUEGER: Thank you,
8 Harvey. I have to cut you off.
9 MR. ROSENTHAL: Thank you, Senator.
10 CHAIRWOMAN KRUEGER: Thank you.
11 MS. LOWENKRON: Good evening. Ruth
12 Lowenkron, New York Lawyers for the Public
13 Interest.
14 I too, like many of you, am a family
15 member both of a person with physical
16 disabilities, mental disabilities, and I've
17 been an attorney in this space for almost
18 40 years. And our office is counsel for the
19 Willowbrook class, for the Brad H. class, and
20 many more developmental disability and mental
21 health cases.
22 I understand that we're here because
23 we have a goal of improving public safety.
24 But how have we come to the point where we
547
1 think that getting people with mental health
2 diagnoses is going to make us feel safer?
3 They are not the problem. As Harvey
4 Rosenthal said, this is a stereotype that's
5 being peddled at us by newspapers and the
6 media and literature, and people with mental
7 health diagnoses are not the ones causing the
8 harm, they are no more likely to cause the
9 harm than people who do not have diagnosis.
10 And even if this is not the case, do
11 we want to lock people up and make these
12 mental health arrests? Hospitals are not the
13 answer. I too was with my sister in the
14 hospital where she received limited, if any
15 treatment, and then is turned away after a
16 brief amount of time.
17 Forced treatment is not treatment.
18 take a look at the literature. It is very
19 devastating for people with mental health
20 diagnoses. It's a disincentive to seek help.
21 It has increased suicidality.
22 And even if hospitalization, forced,
23 were the answer, as others have said, there's
24 no capacity at the moment for the people who
548
1 need hospitals. How are we all of a sudden
2 going to increase this? Just heard about the
3 people on Rikers staying for days without
4 beds.
5 And even if there were capacity,
6 unless you're thinking about throwing away
7 the key, what are we going to do with these
8 people -- with my sister, with your
9 relatives, upon discharge? We can talk all
10 we want about discharge planning, but where
11 are the services? And that is why we
12 recommend a full list of services.
13 And if you take a look at the tragic
14 incidents where people with mental health
15 incidents were causing harm, you look and you
16 see that every one of them have been in a
17 hospital but they didn't have the
18 coordination of services and they didn't
19 receive what was needed.
20 A real quick thing about forced
21 outpatient treatment. Take a look at the
22 huge racial disparity. Our office is putting
23 out an updated report in days. The disparity
24 is humongous.
549
1 And most critically, even though the
2 commissioner has said that people are being
3 helped by AOT, we don't know that. We know
4 that people who have gone through AOT have
5 had good resolutions, but is it because of
6 the services or is it because they were
7 forced?
8 Please think that through strongly,
9 and thank you so much.
10 MR. CULKIN: Hello. As I said, my
11 name is Tom Culkin, and I would like to thank
12 you for the opportunity to testify here
13 today. I have submitted a comprehensive
14 written testimony. I'd just like to briefly
15 tell you about myself and the coalition that
16 I'm part of.
17 I'm a lifelong Buffalo resident and a
18 recent graduate of the University of Buffalo
19 with a master's degree in social work, and
20 I'm currently a mental health therapy aide at
21 the Buffalo Psychiatric Center. I have a
22 serious mental illness and substance use
23 diagnosis, and like so many of these medical
24 conditions, I'm also a survivor of the
550
1 New York prison system.
2 I'm a member of the Treatment Not Jail
3 Coalition, which is a collective of statewide
4 mental health care professionals, law
5 enforcement personnel, faith leaders and,
6 importantly, people with lived experience.
7 This group advocates for systemic reform at
8 the intersection of mental health, substance
9 use, and criminal justice, by championing
10 expanded access to diversion opportunities.
11 My story is like that of so many other
12 New Yorkers who have dual diagnosis of mental
13 illness and substance use. I have been
14 suffering from drug abuse since my teens,
15 when I first encountered the symptoms of what
16 I would later learn to be mental illness.
17 This included uncontrollable mood swings and
18 obsessive thoughts that I allowed to dictate
19 my behavior.
20 Due to the combination of stigma, a
21 lack of access to medical resources, and my
22 own juvenile brain beliefs, I turned to the
23 only way I knew how to quiet these thoughts,
24 and that was self-medication through illicit
551
1 drugs.
2 By 2012, my addiction had reached
3 crisis levels, which led to multiple arrests
4 for residential burglaries. Recognizing that
5 addiction was at the root of my behavior, my
6 lawyer tried to get me admitted to drug
7 court, which would have allowed me to
8 continue my recovery and avoid incarceration.
9 However, I was deemed ineligible because,
10 despite there being no actual violence in the
11 crimes, some of the charges were classified
12 as violent felonies because of the potential
13 for violence. I was instead sentenced to
14 nine years in state prison.
15 I was suddenly thrust into one of the
16 most hostile and chaotic environments known
17 to man. Drugs, violence, sex, gambling and
18 gang affiliation are pervasive in prison.
19 Most incarcerated people do turn to these in
20 order to survive their time inside. While in
21 prison I lost several friends to death by
22 suicide, and I seriously contemplated ending
23 my life every single day during my first year
24 of incarceration.
552
1 Those of us with underlying addiction
2 and mental health issues were the worst off.
3 Carceral settings naturally enact nearly
4 insurmountable obstacles to obtaining
5 meaningful treatment to those of us in need.
6 The conditions of incarceration exacerbate
7 our underlying issues, and we're more prone
8 to violent abuse by both fellow detainees and
9 corrections staff. We're also more likely to
10 be released mentally gutted and facing acute
11 overdose risks.
12 We reenter our communities
13 disconnected from housing, public assistance,
14 treatment, and struggling to establish
15 livelihoods under the stigma of a criminal
16 conviction. That is why even short periods
17 of incarceration have been proven to increase
18 recidivism.
19 I share my experience here in the
20 hopes that future generations will never
21 suffer the way I did. A good start will be
22 to pass legislation to expand and modernize
23 diversion opportunities, create more
24 treatment courts, open eligibility, make sure
553
1 they're following best practice standards.
2 Expanded access to diversion programs
3 will give people in this state the
4 opportunity for recovery and grace that I did
5 not get. Learn from me and the thousands of
6 others like me who were condemned to dungeons
7 of incarceration for their sickness. Prison
8 did not make me better. It nearly killed me.
9 MS. SCHIFF: Wow. Okay. I'm here on
10 behalf of New York Disability Advocates,
11 which is a coalition of six provider
12 associations representing over 85 percent of
13 New Yorkers with I/DD.
14 And while we thank you for the
15 opportunity to present, the discussions today
16 show that we have some clear support from the
17 Legislature.
18 So we're truly grateful for the past
19 three years of increases and the recent
20 increases associated with our rate rebasing,
21 and those funds will be used and have been
22 used for salaries and other rising expenses.
23 But as shown by our NYDA recent survey
24 results, we still have a 17 percent vacancy
554
1 rate for staff and a 35 percent turnover
2 rate. And those really damage the continuity
3 of care for people who require consistency,
4 including people who are nonverbal and those
5 who have additional physical and behavioral
6 health challenges.
7 So while we're in a much better
8 position now, continuing support is needed to
9 bring us and keep us current with operational
10 expenses and able to pay what would be even
11 approaching a livable wage for our talented
12 and selfless staff who dedicate their lives
13 to helping others.
14 On the inflationary increases, over
15 the past three years we've received
16 12.2 percent, and then led to almost
17 15 percent in staff increases. But inflation
18 during this period exceeded 17 percent. So
19 without continuing to give -- to keep up,
20 we'll be right back where we started before
21 Governor Hochul took office.
22 And now I will give you our asks.
23 There's -- you've heard some of them before.
24 The 2.1 percent targeted inflationary
555
1 increase in her proposal is a great first
2 step, but based on the past three years of
3 inflation, we're asking for a 7.8 percent
4 increase to bring us level with current
5 expenses.
6 And we also ask for the creation of
7 the Human Services Wage Commission to study
8 the wage adequacy for a number of direct care
9 positions. The wage commission would provide
10 recommendations for the creation of a
11 longer-term plan to provide adequate
12 compensation for frontline human social
13 services workers who most of us will
14 eventually depend on.
15 And one more request. We would like
16 to restore the rate-setting authority to
17 OPWDD from DOH. Since the transfer about
18 10 years ago, providers have endured a slow
19 and unpredictable flow of funding which has
20 challenged their financial viability.
21 Thank you.
22 MR. COOPER: Hi. Again, I'm
23 Doug Cooper. I'm with the Association for
24 Community Living. We represent the providers
556
1 that operate about 95 percent of the programs
2 or beds that Commissioner Sullivan mentioned
3 that are housing for people with mental
4 illness. So it's a pretty vast system.
5 And just along with all of our
6 colleagues, we support that 7.8 percent
7 increase and -- you know, recognizing that
8 the 2.1 is just going to put us in a further
9 deficit.
10 You know, but that 7.8 really just
11 maintains the status quo. It doesn't address
12 our built-in deficits that have been years in
13 the making. Our staff -- and there's been a
14 lot of discussion about, you know, the
15 quality of services or the adequacy of
16 services, the capacity that's out there. All
17 of our staff and our programs are
18 paraprofessionals. But the needs of the
19 people coming into our programs require more
20 than that. We don't have any nurses. We
21 don't have any clinical workers. We don't
22 have any health aides. We don't have
23 nutritionists -- I heard someone mentioning
24 that -- that's reimbursed in our system.
557
1 Those services are needed in order for
2 us to provide adequate services to the people
3 that we're serving. The current staff that
4 we have -- you know, we've been hearing about
5 staff vacancy rates and turnover rates. Our
6 staff vacancy rate currently statewide, the
7 average is about 30 percent. Our turnover
8 rate is close to 50 percent. I don't know
9 how our members are keeping their doors open.
10 We need a -- you know, we need the
11 7.8, but we need more of an investment than
12 that. We actually have an ask, which is in
13 my testimony, for an additional $230 million.
14 We don't think that's going to happen all at
15 once, but we need a plan that actually will
16 help us provide the services that are needed
17 by the people who are our residents, who rely
18 on us for their home.
19 You know, and how would we spend that
20 230 million? One example is we have a
21 program that's called the CR-SRO.
22 Assemblywoman Simon, you mentioned that
23 earlier. That's a program that's licensed,
24 provides a high level of services, and the
558
1 funding level for that is anywhere from 8 to
2 10,000 a year less than what is being
3 proposed for ESSHI.
4 ESSHI needs those additional dollars.
5 They need to be funded at a higher rate. But
6 we need that same rate, if not more. We're a
7 licensed program providing a higher level of
8 service.
9 So, you know, our two asks this year
10 are we need to maintain the status quo just
11 to keep our doors open, and that's that
12 7.8 percent. But we also need a plan for a
13 larger investment that will give us the
14 ability to provide the level of services that
15 are needed for the current people that are
16 living in our programs.
17 MR. SEEREITER: Good evening again.
18 Michael Seereiter, with the New York Alliance
19 for Inclusion and Innovation.
20 For the first time in my memory, we
21 are not coming to the Legislature in absolute
22 desperation regarding the staffing crisis
23 that has plagued our OPWDD service system for
24 the past 15 or more years. And that's
559
1 largely thanks to the Governor and the 7/1
2 rates that we were talking about before, that
3 you've been talking about today, that she
4 just released for OPWDD certified residential
5 and day programs that are subject to the
6 rebasing on a five-year basis, including
7 continuation of those resources in this
8 proposed budget.
9 An extra-special thanks to Acting
10 Commissioner Willow Baer for her leadership
11 that she has shown to secure the most
12 significant single investment in OPWDD in my
13 26 budgets that I have been involved with.
14 We very much look forward to working with her
15 as commissioner should she be confirmed.
16 Is it a panacea? Hardly. But it does
17 help to stabilize dangerously unstable parts
18 of the system that I and my colleagues have
19 described to you in previous years.
20 We are appreciative to the Governor
21 for continuing to make investments in our
22 systems and others this year with a
23 2.1 percent targeted inflationary investment,
24 especially after so many years of neglect.
560
1 That's especially important for programs and
2 services that OPWDD operates and funds that
3 are not subject to the rebasing that we have
4 talked about as well today.
5 We join with our colleagues in asking
6 that that targeted inflationary investment be
7 increased to 7.8 percent. As referenced by
8 many of you today, the 2.1 percent doesn't
9 actually help us keep up with the current
10 inflation rates, and we need to avoid losing
11 any further ground with regard to competitive
12 salaries, ability to pay insurance, and
13 remaining compliant with OPWDD's program
14 requirements going forward.
15 There are many other items in the
16 Executive Budget of which we are supportive;
17 it's found in our written testimony.
18 A few places where the Legislature
19 could improve upon the Governor's Executive
20 Budget, including the targeted inflationary
21 increase of 2.1 moving to 7.8 percent: Move
22 the rate-setting authority from DOH back to
23 OPWDD from the 2015 move of 10 years ago.
24 We believe that this would improve
561
1 some of those challenges that Mr. Geizer was
2 speaking about before in relation to all of
3 that administrative effort that goes into
4 actually getting money out the door for
5 things like targeted inflationary investments
6 and COLAs.
7 Include the OPWDD service provider
8 organizations as eligible entities that can
9 access the state's capital resources for
10 targeted climate action. We have nearly 6500
11 physical locations that could benefit from
12 things like solar panels if we had access to
13 capital resources.
14 And lastly, we do recommend and join
15 with others in recommending the creation of a
16 Human Services Wage Commission to study and
17 make recommendations for next year in
18 relation to the wages that would be
19 commensurate with responsibilities that
20 direct support professionals and others in
21 human services provide on a regular basis.
22 Thank you.
23 CHAIRWOMAN KRUEGER: Thank you very
24 much.
562
1 Our first questioner is Senator
2 Fernandez.
3 SENATOR FERNANDEZ: Thank you so much.
4 This question is for Tom Culkin,
5 Treatment Not Jails Coalition. I am familiar
6 with the coalition and its goal to change how
7 we address those that are suffering with
8 substance use disorder. A concern has been
9 put out that the bail reform laws have
10 allowed people to fall through the cracks and
11 lose that touch-point to getting them to
12 substance use disorder treatment.
13 Could you speak about that and how
14 this may be a better idea?
15 MR. CULKIN: Yes. Could you repeat
16 the question, please?
17 SENATOR FERNANDEZ: How can we ensure
18 that we are still reaching these individuals
19 without rolling back progress on bail reform?
20 MR. CULKIN: Well, I mean, I think
21 reaching the individuals is based on making
22 treatment more available and more easier to
23 navigate. I know myself, for years I had the
24 hardest time navigating a treatment system.
563
1 I got kicked out of more rehabs than I care
2 to count.
3 Just applying for treatment is a huge
4 process that a lot of people just are not
5 capable of completing, especially when you're
6 not in your right mind. The system needs to
7 be streamlined and we need to make it easier
8 for people to get into treatment in order to
9 get better rather than just continuing to,
10 you know, incarcerate them, let them out,
11 incarcerate them, let them out.
12 I believe that were treatment courts
13 to be expanded, we would have a lot less
14 crime in a matter of, you know, a relatively
15 short period of time. I hope that answered
16 your question.
17 SENATOR FERNANDEZ: Yeah. Recently at
18 one of the press conferences I believe there
19 was a former sheriff, a law enforcement
20 official who has come out in support of this
21 legislation. Could you speak about how law
22 enforcement has now turned to say that this
23 is the method that we should be utilizing?
24 MR. CULKIN: Yes, I believe that was
564
1 at our advocacy day just a couple of weeks
2 ago. I believe he was an Albany County
3 sheriff as well. He spoke last year.
4 I think that as law enforcement learns
5 about what will actually occur if this law
6 was passed, I think we're getting a lot more
7 support recently. I've been a member of the
8 coalition for almost three years now. There
9 wasn't much law enforcement support when I
10 first joined, but there definitely is more
11 now.
12 I think a lot of law enforcement
13 officials understand that the carceral system
14 we have now does not heal people. It doesn't
15 encourage people to stay out of the system.
16 Prison's a finishing school for criminals.
17 Okay?
18 I could have contacts for drugs, guns,
19 cars, people, if that was the way I decided
20 to spend my time in prison. That's not how I
21 spent my time. But that's the way most
22 people do spend their time when they're
23 incarcerated. Positive things just aren't
24 done. Prison's not rehabilitative.
565
1 (Overtalk.)
2 SENATOR FERNANDEZ: -- programs aren't
3 happening in all prisons and jails as they
4 should be, so --
5 MR. CULKIN: What was that?
6 SENATOR FERNANDEZ: I said MAT
7 programs are not happening in prisons and
8 jails as they should be, from what I've been
9 told. So we could assume that, yes, this
10 is --
11 MR. CULKIN: They do have programs,
12 but they're not run very well. Basically, as
13 far as I'm concerned, what it comes --
14 (Time clock sounds.)
15 MR. CULKIN: Can I finish or no?
16 In prison the priority is always
17 security. With mental illness and addiction
18 the priority has to be recovery or it doesn't
19 work. I know that from painful personal
20 experience.
21 SENATOR FERNANDEZ: Thank you.
22 CHAIRWOMAN KRUEGER: Assembly.
23 CHAIRMAN PRETLOW: Assemblywoman
24 Simon.
566
1 ASSEMBLYWOMAN SIMON: So thank you all
2 for your testimony. I'll get this a little
3 closer here -- sorry.
4 And, you know, I think everybody -- I
5 think you have a lot of support for increased
6 TII, which is the new word for COLA. And I
7 think everybody understands that need, and
8 the fact that we're sort of digging ourselves
9 out of a hole that we've been digging for a
10 long time. And this is a big step, but it's
11 not going to solve every problem.
12 I also want to kind of just explore
13 with you -- because I think this big issue
14 this year is involuntary commitment, expanded
15 AOT, money to help counties pay for things
16 even though we believe it, let's say,
17 shouldn't be coercive. But there's a real
18 challenge here with people feeling that they
19 need to do something to address this issue,
20 which appears to be and what people are
21 thinking is criminality. Right?
22 And yes, we could say we're
23 criminalizing mental illness, but that's been
24 done, and everybody has this association.
567
1 And it's being ginned up by the press for
2 sure, but we've also had some really horrible
3 things happen. And how do we separate those
4 things or achieve a balance that people feel
5 like we have made some progress on this
6 without going to the other extreme, which I
7 think people don't realize that the balance
8 is actually against people with mental
9 illness when people may think it's for them
10 and that's an excuse. Right?
11 MR. ROSENTHAL: Those episodes were
12 horrible. Those episodes were horrible --
13 ASSEMBLYWOMAN SIMON: Yes.
14 MR. ROSENTHAL: -- but they represent
15 such a small minority. And there are other
16 murders like that that happen but if it's a
17 person with mental illness, it's on the front
18 page of the New York Post.
19 ASSEMBLYWOMAN SIMON: Right.
20 MR. ROSENTHAL: And we're being told
21 to force them. So I just want to make a
22 distinction there.
23 The services I mentioned aren't for
24 people who are that troubled, who we worry
568
1 about, who are struggling and suffering. We
2 don't stand by because we're for human
3 rights, we provide the service that actually
4 works. You're just going to force people
5 into the same bad services if you don't
6 create the right services. That's what we
7 need your help for.
8 Don't go to coercion. It really is
9 not going to get it done. I know the public
10 is afraid, but stand tall with us, please.
11 MS. LOWENKRON: If I can just add, we
12 have a whole list in our testimony of
13 positive voluntary community-based programs
14 that are the answer. So we're not just
15 saying "Don't do this," we're saying "Do
16 that, which has an excellent track record."
17 And one of the things that I want to
18 quickly squeeze out is something that
19 Senator Brouk spoke about, and that is the
20 panels of --
21 ASSEMBLYWOMAN SIMON: Mm-hmm, the
22 incident review panels.
23 MS. LOWENKRON: We're talking about
24 the incident review panels. And so many
569
1 people have spoken about the need to look at
2 what are we doing wrong in order to figure
3 out what we're doing right. That is the
4 answer. It's already in statute.
5 CHAIRWOMAN KRUEGER: Thank you.
6 MR. ROSENTHAL: And you can put in the
7 law, it says "may," "shall."
8 CHAIRWOMAN KRUEGER: The time is up on
9 here.
10 MR. ROSENTHAL: Have OMH do that.
11 CHAIRWOMAN KRUEGER: Let someone else
12 ask a question and then you can answer.
13 Whose turn is it?
14 CHAIRMAN PRETLOW: It's your turn.
15 CHAIRWOMAN KRUEGER: Harvey, would you
16 continue to answer the question for me,
17 please.
18 (Laughter.)
19 CHAIRWOMAN KRUEGER: No, I have three
20 minutes. Answer the question.
21 MS. LOWENKRON: Don't answer the
22 question.
23 ASSEMBLYWOMAN SIMON: Finish your
24 answer.
570
1 CHAIRWOMAN KRUEGER: Finish the
2 answer.
3 MR. ROSENTHAL: With more time?
4 CHAIRWOMAN KRUEGER: Yes.
5 MR. ROSENTHAL: Okay, thank you,
6 Senator.
7 So first of all I want to say that
8 people, even the county officials have said
9 to me, I only put them on an order because
10 the line -- waiting list for services is so
11 long, and if you put them on AOT, you know,
12 then they'll get front. So you're dragging
13 people in front of a judge and criminalizing
14 them only to get them to the front of the
15 line. We've got to pay attention to that as
16 well.
17 The incident review panel is really
18 critical. It was recommended in 2008 by a
19 panel in New York City. You put it in
20 statute in 2014. OMH -- the commissioner's
21 great -- she didn't want to do it. We have a
22 right to know what happens each time.
23 otherwise these tragedies happen and, you
24 know, you don't hear what happened.
571
1 And they don't have to break some kind
2 of confidentiality. "We've reviewed these
3 things and what we find is the services are
4 not coordinated." That's a big one.
5 So the way to -- the incident review
6 panel will probably get us services that are
7 better coordinated, more effective, more
8 engaging, and like that -- I forget the
9 fourth word, but ...
10 CHAIRWOMAN KRUEGER: Thank you.
11 Assembly.
12 MR. ROSENTHAL: Thank you, Senator.
13 Thank you so much.
14 CHAIRMAN PRETLOW: Assemblymember
15 Giglio.
16 ASSEMBLYWOMAN GIGLIO: Okay. So I
17 agree, OPWDD needs to take back the rates.
18 you know, the 7/1 rates, we just got them
19 when, two weeks ago? Yup. And organizations
20 such as yourselves are owed millions and
21 millions and millions of dollars that you've
22 been operating on a tight budget since 7/1
23 because these rates just came out. But
24 hopefully you'll be getting those checks
572
1 within the next couple of weeks and it will
2 be retroactive.
3 So yes, I agree with you, OPWDD needs
4 to take that back. DOH has a lot on their
5 plate right now with Early Intervention and
6 with the CDPAP program, and OPWDD should be
7 taking care of your agencies. So I one
8 hundred percent support that.
9 I also support the rate increase, and
10 I also hope that my colleagues and I can get
11 together and make it that you will get your
12 increases every year based on the rate of
13 CPI. We're seeing a lot of inflationary
14 increase in the budget this year for state
15 agencies, but we are not seeing it for our
16 not-for-profits. And a lot of our state
17 agencies are closing down, and those people
18 are coming to you.
19 So I'm just -- I love the idea of a
20 wage commission. I love the access to
21 capital resources for energy. I think these
22 are all really important things because not
23 only are you dealing with not getting the
24 funding that was promised to you in the
573
1 budget -- because the rates weren't set --
2 but you're also dealing with high utility
3 costs and other inflationary items that could
4 reduce your expenses so that more of this
5 money could go to the DSPs.
6 So if you could just tell me any other
7 ideas that any of you have so that we can all
8 work together on this to make sure that we
9 fully fund our most vulnerable population.
10 MR. SEEREITER: If we started with
11 those, we'd make a huge dent in trying to
12 address some of the challenges that have been
13 pervasive in this system for an awfully long
14 time. The things you just rattled off would
15 make a gigantic, gigantic improvement in our
16 service delivery system.
17 MS. SCHIFF: Just thank you very much
18 for your support, and we'll continue to work
19 with you this legislative session.
20 ASSEMBLYWOMAN GIGLIO: (Mic off.)
21 Thank you.
22 Unless anybody wants to add anything?
23 MR. ROSENTHAL: You mean anything
24 or --
574
1 (Laughter.)
2 UNIDENTIFIED SPEAKER: It has to be
3 about this.
4 CHAIRMAN PRETLOW: You're done?
5 Senator Fitzpatrick.
6 We have more time, or no? Oh, I'm
7 sorry, I'm looking at the clock.
8 SENATOR CANZONERI-FITZPATRICK: Thank
9 you. I just wanted to follow up on a
10 question that Senator Fernandez asked to
11 Mr. Culkin.
12 With cashless bail, criminals are, you
13 know, arrested, we release them. How do we
14 motivate them to voluntarily enroll in a
15 program to help them with their addiction
16 issues or their mental health issues? How do
17 we reach those people and motivate them to
18 get the help that they need?
19 MR. CULKIN: I think that -- that's a
20 great question. I think that one of the ways
21 is to make recovery more attractive. And the
22 increased use of peer specialists I think is
23 a great way to do that.
24 The word has to get out that you can
575
1 live a good life without drugs, without
2 alcohol. You can still be okay taking mental
3 health medications on a daily basis.
4 How we do that, I don't know. I'm not
5 a public relations person. But I think that
6 would really help the situation quite a bit.
7 And also streamlining -- streamlining the
8 system like I spoke about earlier. I mean,
9 people with master's degrees have a hard time
10 navigating the treatment system today.
11 SENATOR CANZONERI-FITZPATRICK: Thank
12 you very much.
13 CHAIRMAN PRETLOW: Assemblyman
14 Santabarbara.
15 ASSEMBLYMAN SANTABARBARA: Thank you,
16 Mr. Chair.
17 Thank you all for being here. It's a
18 big panel, so thank you for all your
19 testimony. It's a lot to take in, but it's
20 all good information.
21 I also want to echo what I said for
22 the last panel. The wage commission I think
23 is a very good idea, and I saw it on some of
24 your websites and social media, along with
576
1 some other things as well.
2 The wages are one piece of it, I find,
3 in my agencies, particularly Liberty Arc in
4 Amsterdam. They have really embraced a
5 credentialing program that has several
6 graduating classes, so the recruitment and
7 retention is a whole 'nother piece of it.
8 So I'd love to hear your thoughts
9 on -- besides the wages, we also -- I think
10 we also need more career pathways, and I
11 suggested investing more in the SUNY system
12 and those type of career pathways.
13 Maybe just comments and maybe some
14 things we can do in the budget to improve
15 these pathways to professionalize and
16 credentialize.
17 MR. SEEREITER: Sustaining the things
18 that have been piloted by OPWDD that have
19 proven good outcomes would be remarkably
20 valuable, whether that's professional
21 development in our direct support
22 professionals themselves, the credentials,
23 the SUNY/CUNY microcredential, building a
24 pipeline through the BOCES programs and other
577
1 things like that. We'll pay gigantic
2 dividends if we are able to reflect the
3 complexity of these jobs in the wages that
4 are paid for them.
5 Quite frankly, this sector of OPWDD
6 service providers would be in a more
7 competitive position with regard to other
8 positions in any other sector -- including,
9 quite frankly, human services as well --
10 because of some of these types of
11 investments, if we get to wages that are
12 indeed more competitive. Because it becomes
13 more attractive. It's not just that I have
14 to leave the job to go to get something
15 different, I can make this part of a career,
16 especially if I'm passionate about that and I
17 want to remain as part of someone's life and
18 supporting them to become the most -- you
19 know, supporting them to pursue their dreams
20 and achieve their dreams as best as possible.
21 These are remarkably great things. We
22 just need to kind of follow that through with
23 making sure that the compensation reflects
24 the complexity of the job.
578
1 MS. SCHIFF: Agree with everything
2 Michael just said. And I'd like to also add
3 that the wage commission is so, so important
4 because in order to get us from where we're
5 at now to where we actually need to be in
6 order to really professionalize the position
7 and pay people what -- you know, commensurate
8 with what we request them to do 24/7, it's a
9 multiyear plan. Because it's going to be
10 quite expensive to raise salaries in the ways
11 that we need to.
12 ASSEMBLYMAN SANTABARBARA: Thank you.
13 Thank you for being here. Thank you for your
14 answers.
15 CHAIRMAN PRETLOW: Assemblyman Brown.
16 ASSEMBLYMAN KEITH BROWN: Thank you,
17 Chair.
18 Mr. Culkin, I had some follow-up
19 questions for you. Senator
20 Canzoneri-Fitzpatrick asked you a question
21 that related to -- with violent individuals.
22 You said yourself that you were convicted of
23 a violent crime. What crime was that?
24 MR. CULKIN: I pled guilty to three
579
1 counts of attempted burglary in the second
2 degree. It's considered a violent crime by
3 statute because of the potential for
4 violence. I entered people's homes while
5 they were there.
6 ASSEMBLYMAN KEITH BROWN: Right. And
7 I think -- so let me just preface this by
8 saying that one of the things that I really
9 think that we should try to shoot for as a
10 society is to get people who are having
11 trouble with substance use disorder into
12 therapy and treatment as soon as possible.
13 But the distinction that I think some
14 of the DAs have said to me when it relates to
15 this piece of legislation is that it lets
16 violent criminals out on the street where
17 they need to get rehabilitation inside and
18 that rehabilitation come in the form of
19 behavioral rehabilitation as well as
20 substance use disorder.
21 So what would you say to the DAs?
22 MR. CULKIN: I would say that's great
23 in theory. I could talk for an hour about
24 how ineffective programs in the prison system
580
1 are.
2 No policy is going to perfectly
3 address every case.
4 ASSEMBLYMAN KEITH BROWN: Sure.
5 MR. CULKIN: We are going to make
6 mistakes. The idea I think is to benefit
7 more than we take away. And I think that
8 treatment -- it's not going to work the first
9 time for everybody. It's that simple. But
10 do we give up --
11 ASSEMBLYMAN KEITH BROWN: I'm sorry to
12 interrupt you. But when were you
13 incarcerated?
14 MR. CULKIN: I was incarcerated from
15 2013 to 2020.
16 ASSEMBLYMAN KEITH BROWN: So in our
17 county our sheriff is very active,
18 probably -- you know, and I know several are.
19 But I just know from personal experience that
20 our sheriff has really been at the forefront
21 of bringing as much treatment for substance
22 use disorder into our jail system, and he
23 actually goes around the country speaking to
24 other systems about how to incorporate that.
581
1 So was there something like that in
2 prison for you that you could benefit from?
3 MR. CULKIN: So I was sent to prison
4 in 2013 with a drug problem. I was put in an
5 alcohol and substance abuse treatment program
6 in 2019. The program was run by inmates
7 while the counselors stayed in the office.
8 I was lucky that there was inmates who
9 actually cared and would try to be effective.
10 But yeah, we had professional counselors,
11 they weren't doing anything. There's no
12 motivation for them to do anything. The --
13 ASSEMBLYMAN KEITH BROWN: So if I may,
14 just two quick questions. So I had asked
15 before -- and I only have 18 seconds so I'm
16 going to run out of time. But I think with
17 bail reform we missed an opportunity to get
18 people to treatment as quickly as possible.
19 And I think with desk appearance tickets
20 there's an opportunity there to switch the
21 system and make it available for people to
22 get treatment, rather than having to go into
23 the court system. And then if they fail,
24 then they go into the court system. So --
582
1 CHAIRMAN PRETLOW: Assemblyman Ra.
2 ASSEMBLYMAN KEITH BROWN: Thank you
3 for being here.
4 MR. CULKIN: Thank you.
5 ASSEMBLYMAN RA: Thank you. Thank you
6 all for being here.
7 And I do want to mention quick with
8 regard to the OPWDD and taking back the rate
9 setting, as we know, you know, the Governor's
10 administratively transferring billions of
11 dollars out of DOH into the mental hygiene
12 budget, so it makes even more sense that for
13 consistency's sake that that be the case.
14 And I would say even transparency's sake.
15 I wanted to ask Winnie in particular
16 if you have any thoughts with regard to this.
17 I know, you know, we had done that call back
18 in December and we were talking about the
19 wage commission and I think it's something we
20 need to do and set ourselves up for, you
21 know, the future so we can finally make the
22 changes we need to make and make sure there's
23 adequate wages to retain and recruit workers.
24 But I think we all know in the
583
1 Legislature we've -- if we do something like
2 this as a standalone bill, it's getting
3 vetoed. Right? It happens on so many
4 important issues. Some of them have come up
5 today. But that's just the nature of where
6 we are.
7 So it's imperative that it get done in
8 the budget. So do you have any sense as to
9 what an appropriate appropriation to go along
10 with that would be, so that it could be
11 conducted?
12 MS. SCHIFF: Well, that would be the
13 job of the wage commission. First they would
14 have to study a variety of direct care
15 positions -- because it's not just DSPs,
16 although --
17 ASSEMBLYMAN RA: I mean for the
18 conducting of the study, actually.
19 MS. SCHIFF: Oh, oh, oh, oh. I don't
20 know the cost of that. Do you, Michael?
21 MR. SEEREITER: No, I do not. But I
22 would venture to guess that that's not --
23 probably not north of a million dollars.
24 Like you're talking a pretty sizable group of
584
1 sectors that you're going to need to look at,
2 bring in -- I'm thinking travel, quite
3 frankly, is going to be one of the most
4 expensive things to cover in that.
5 But you could look at this and get
6 some really good trajectory for where the
7 system needs to go, multiple systems need to
8 go. It seems like a wise investment of
9 resources.
10 ASSEMBLYMAN RA: I'm just trying to
11 avoid the pitfalls that we see all the time
12 with these things.
13 MS. SCHIFF: It would be a group of
14 people who are already engaged in the work,
15 so they -- you know, there are no salaries
16 involved. Travel looks like the thing, yeah.
17 ASSEMBLYMAN RA: All right, do -- you
18 look like you have something you want to say.
19 MR. CULKIN: Yeah, I just -- the topic
20 of money came up. I just want to like say
21 that it costs a lot less to treat people than
22 it does to incarcerate people.
23 The state's paying $150,000 per person
24 a year. Rikers is over half a million
585
1 dollars. I mean, it's just -- the money
2 makes sense.
3 ASSEMBLYMAN RA: Absolutely. I agree
4 completely.
5 Thank you all. Thank you all for your
6 patience and being here and your advocacy.
7 CHAIRMAN PRETLOW: Assemblywoman
8 Gallagher.
9 ASSEMBLYWOMAN GALLAGHER: Hi. Thank
10 you so much for your work and for your words.
11 In my district I've seen firsthand how
12 bureaucratic systems inhibit or prevent folks
13 from getting the treatment and care that they
14 need, and I know it from my own community as
15 well. So I know you can't force or cajole
16 somebody into successful recovery. So what
17 are some other barriers that you all are
18 seeing to good recovery that we aren't
19 addressing right now?
20 And what are the right legislative
21 fixes and budgetary fixes that you need from
22 us that we could propose in our one-house
23 budgets?
24 MR. ROSENTHAL: Well, I think housing.
586
1 A lot of, you know, people -- I think
2 poverty, racism. Sorry. Isolation.
3 So I think there are programs like the
4 clubhouse programs that are going upstate.
5 They provide all of that. They provide food,
6 drop-in services, sort of relapse prevention.
7 We have programs out there -- we don't even
8 know what works. We just have to invest in
9 them.
10 ASSEMBLYWOMAN GALLAGHER: Right.
11 Right.
12 MR. ROSENTHAL: We should get a COLA,
13 but we also just need more and -- more
14 different services. It's much cheaper than
15 $1300 a day in a hospital in New York City.
16 ASSEMBLYWOMAN GALLAGHER: Right. And
17 I know like workforce is really difficult
18 too. I know so many folks who are in
19 recovery who are looking for work but they
20 don't have like recovery-ready workplaces
21 available for them to work at.
22 MR. ROSENTHAL: Right.
23 ASSEMBLYWOMAN GALLAGHER: Do you have
24 any thoughts on that program and what we
587
1 could be putting into that?
2 MR. ROSENTHAL: I don't know that one.
3 But clubhouses, that's the main function of a
4 clubhouse, besides connecting people
5 socially, is employment. I ran the clubhouse
6 in Albany and because I didn't do employment
7 all day long, it wasn't really a clubhouse.
8 That's how serious it is.
9 ASSEMBLYWOMAN GALLAGHER: That's
10 great.
11 MS. LOWENKRON: I was just going to
12 add along with housing and dealing with,
13 poverty, let alone racial issues, I think
14 that you're very much onto something, and
15 it's something that we're looking for too,
16 and that's employment skills training,
17 absolutely. And in the program that you
18 mentioned, vocational rehabilitation
19 programs, that's where -- definitely one of
20 the areas.
21 But I think if you take a look at the
22 list that we have and you want to know what
23 can we do, the programs that we have on that
24 list are tried and true, and that's where the
588
1 money should go. And that will avoid the
2 consequences that you're concerned of, even
3 though we say those are very limited --
4 violent public safety consequences.
5 ASSEMBLYWOMAN GALLAGHER: Right.
6 MR. CULKIN: I just want to add that
7 recovery's holistic. If we get somebody
8 sober but don't help them find a place to
9 live and give them a way to meaningfully pass
10 their time, it's just not going to last. I
11 mean, you know, what is it they say, idle
12 hands are the devil's work? If I didn't have
13 a reason for living, what's the point?
14 I think the clubhouses, the money for
15 the clubhouses is huge.
16 ASSEMBLYWOMAN GALLAGHER: Great.
17 Thank you so much.
18 CHAIRMAN PRETLOW: Assemblywoman
19 Griffin.
20 ASSEMBLYWOMAN GRIFFIN: Okay, thank
21 you. And thank you to all of you for being
22 here. I appreciate your well-thought-out
23 strategies to address treatment for mental
24 health issues.
589
1 And I was just curious, like one -- of
2 course treatment courts seem like a really
3 good way to address a variety of issues. And
4 I wondered, are there statistics that show
5 where there is an adequate amount of
6 treatment courts and where there is none?
7 Like do you have those statistics across the
8 state of where this is succeeding, do we --
9 like can we get those numbers anyways?
10 MR. CULKIN: There are numbers. I'm
11 not really familiar with a ton of them, but I
12 can say that I don't know what year it was,
13 but the most recent year statistics were
14 available there was something like 20,000
15 arrests in the state and 40 people were
16 diverted to mental health court. I mean,
17 that's a statistic for the underuse.
18 There are statistics, I could connect
19 you with the person who would have them. I'm
20 not familiar with all of them.
21 ASSEMBLYWOMAN GRIFFIN: Okay.
22 MR. CULKIN: I can say that making the
23 decision to divert somebody to treatment
24 based on the recommendation of a clinician
590
1 would be a lot more beneficial than the
2 recommendation of a DA.
3 ASSEMBLYWOMAN GRIFFIN: It seems like
4 it could be -- make a big impact.
5 And then I'd really like to learn
6 about the programs, like the Peer Bridge,
7 INSET, clubhouses. And the same question
8 goes, like where are those succeeding and
9 where are they, and where are there like
10 deserts where there's nothing like that
11 available to people? Do we have that? Like
12 do we know with Long Island's underserved?
13 Upstate? What do we know about it?
14 MR. ROSENTHAL: They're really
15 everywhere. The INSET program starts in
16 Westchester; now they have one in Long
17 Island. Now they have two in Suffolk. You
18 know, one in Buffalo. You know, so there are
19 five of them in the state.
20 Bridger programs, we created that out
21 of five state hospitals. And now there are
22 more of them, but, you know, that's the core.
23 And we help people get out and stay out of
24 hospital.
591
1 In the budget we're happy that the
2 Governor's going to fund some Bridger
3 programs in community hospitals, not just the
4 state hospitals. So they're growing slowly.
5 These are the first generation of these new
6 models. So they have five of this kind and,
7 you know, eight of that kind. But -- so
8 there is some money in the budget, but we'd
9 love more, because we really think we need
10 them.
11 ASSEMBLYWOMAN GRIFFIN: Right. And it
12 seems like it would be well -- a wise
13 investment because it really does make an
14 impact.
15 But I would love if we could get any
16 statistics so we could see where we --
17 MR. ROSENTHAL: We will.
18 ASSEMBLYWOMAN GRIFFIN: -- where do we
19 need more of them.
20 MR. ROSENTHAL: Definitely.
21 ASSEMBLYWOMAN GRIFFIN: And I agree
22 with the review panels. It's odd to me that
23 it was adopted in 2014 and still hasn't been
24 implemented. That seems odd.
592
1 And also wage commission study, you
2 know, all of those ideas, you know, are -- to
3 me, I'm on board with all of them.
4 And Harvey, you mentioned you were at
5 Mercy Hospital. Do you live in Nassau
6 County?
7 MR. ROSENTHAL: I grew up in Freeport.
8 ASSEMBLYWOMAN GRIFFIN: Oh, in
9 Freeport. And do you still live over that
10 way?
11 MR. ROSENTHAL: No.
12 ASSEMBLYWOMAN GRIFFIN: Oh, okay. I
13 was going to say you could make an
14 appointment at my office and we could speak
15 about this some more. I thought you were
16 local.
17 Okay, thank you very much.
18 MR. ROSENTHAL: We'll have lunch at
19 Ben's.
20 (Laughter.)
21 CHAIRMAN PRETLOW: Assemblywoman
22 Chandler-Waterman.
23 ASSEMBLYWOMAN CHANDLER-WATERMAN:
24 Thank you so much for all of the work and
593
1 advocacy from everybody here.
2 I just want to do a special thanks to
3 Ruth and Harvey. Thank you for supporting my
4 district, working closely with my mental
5 health task force that we've created. And
6 you know we've got to shout out Christina for
7 making sure we put all that together as a
8 peer.
9 Not only my constituency but my family
10 members as well, you have supported them
11 greatly.
12 So I do agree that we need a
13 sustainable person-centered plan with peers
14 at the front of the conversation like
15 Treatment Not Jail, like Daniel's Law, the
16 $1 million that we fought hard to make sure
17 that that was {unintelligible}, shout out to
18 Bronson and Brouk.
19 On that, I just want to know when it
20 comes to -- we talked about the increased
21 funding for the Peer Bridgers Program,
22 definitely, expanded, local, culturally
23 responsive respite centers and clubhouses,
24 transform the mental health crisis response,
594
1 like that housing. Invest and expand family
2 support. That's something I really want to
3 talk about.
4 Oftentimes families are left out of
5 the process or not in the plan at all, and
6 barriers are created for families to really
7 support -- and we know that's the way to
8 recovery, is with family support.
9 So I used to think about like if you
10 had a brochure, a one-pager: What happens
11 once you enter CPAP, right, for a family when
12 you leave them at that door. Right? What --
13 then go to the MHUs after care? What would
14 you think would be like the first thing that
15 you'd focus on for family support so they can
16 be really intentional about the recovery of
17 individuals in crisis?
18 MS. LOWENKRON: So we work closely,
19 Harvey and I -- actually, we work in a
20 coalition with criminal reform attorneys and
21 civil rights advocates, providers, disability
22 advocates. And one of the major contributors
23 to that coalition is NAMI-NYC. And as you
24 know, they are all about family programs.
595
1 And we have a whole platform that is in my
2 testimony and that I can share more broadly
3 with more details.
4 But NAMI-NYC will be putting in
5 testimony that specifically talks about what
6 kind of money for what kind of specific
7 programs.
8 Unless you have something more
9 specific to say, Harvey.
10 MR. ROSENTHAL: The family support
11 program is 500,000, is what they told us for
12 this year.
13 MS. LOWENKRON: Well, that's what
14 we're getting. But I think we have other
15 recommendations.
16 MR. ROSENTHAL: We're asking for it.
17 MS. LOWENKRON: Oh, I'm sorry. Okay.
18 Good work, team.
19 ASSEMBLYWOMAN CHANDLER-WATERMAN:
20 Well, thank you. Is there anything else that
21 you want to add to that? You're good?
22 All right, thank you so much.
23 (Off the record.)
24 ASSEMBLYWOMAN CHANDLER-WATERMAN: No,
596
1 she could. She could add something. Go
2 ahead.
3 MS. LOWENKRON: Well, I wouldn't mind
4 just saying one more thing in terms of all of
5 the programs that we're talking about. I
6 want to just take one second to talk about
7 the Daniel's Law. Because that is something
8 that takes into account all the issues we
9 have been talking about here, the prominent
10 role of peers in -- oh, I thought that the
11 Assemblymember --
12 ASSEMBLYWOMAN CHANDLER-WATERMAN: You
13 still had time.
14 MS. LOWENKRON: Oh, I'm sorry. I'm
15 sorry if I did the wrong thing.
16 ASSEMBLYWOMAN CHANDLER-WATERMAN: Can
17 she finish?
18 CHAIRWOMAN KRUEGER: Afraid not. You
19 used up your time already. You can talk to
20 her afterwards.
21 MS. LOWENKRON: She hadn't. The clock
22 was running. And there's still, in fact, 8
23 seconds.
24 CHAIRWOMAN KRUEGER: It's your --
597
1 remember, you decide.
2 CHAIRMAN PRETLOW: Oh, talk, sure.
3 CHAIRWOMAN KRUEGER: Keep going.
4 MS. LOWENKRON: I'm sorry, not to
5 offend.
6 But the Daniel's Law, which we are
7 hoping to get everyone here to sign onto,
8 many of you have, is all about the frontline
9 role of peers and to avoid the crises that
10 could potentially lead to untoward events,
11 again which we say are limited in number.
12 CHAIRWOMAN KRUEGER: Okay. All right,
13 everyone now got their time. Then we're
14 going to ask you -- thank you very much for
15 staying with us and for sharing so much
16 important information. And we're going to
17 let you be excused.
18 And we're going to call the last panel
19 of this hearing --
20 MR. CULKIN: Assemblymember Griffin, I
21 received a text on my watch. It was 274,000
22 arrests, 52 diversions. I will get some more
23 statistics and email them to your office.
24 ASSEMBLYWOMAN GRIFFIN: Okay, great.
598
1 Thank you.
2 CHAIRWOMAN KRUEGER: Thank you.
3 Okay, so now we have Panel F, for
4 those of you who are keeping score: Friends
5 of Recovery; InUnity Alliance; and Licensed
6 Creative Arts Therapy Advocacy Coalition.
7 (Pause.)
8 CHAIRWOMAN KRUEGER: Well, I guess
9 it's officially good evening. Oh, good, all
10 three of you are here. Thank you.
11 So first just go down the line and
12 introduce yourself so that the tech people
13 know which of you is which.
14 Hi.
15 MS. DAVIS: (Mic off; inaudible.)
16 CHAIRWOMAN KRUEGER: Press the green.
17 You have to push the button in a special way.
18 MS. DAVIS: Push it haaard.
19 I am a cofounder of the LCAT Advocacy
20 Coalition, president emeritus of the New York
21 Art Therapy Association, and clinical
22 director for the Emerald Sketch, an LCAT.
23 CHAIRWOMAN KRUEGER: Thank you.
24 MR. JIHOON KIM: Good evening.
599
1 CHAIRWOMAN KRUEGER: Good evening.
2 MR. JIHOON KIM: My name is Jihoon
3 Kim, and I am the president and CEO of
4 InUnity Alliance.
5 DR. SMITH-WILSON: Good evening. I'm
6 Dr. Angelia Smith-Wilson, executive director
7 of Friends of Recovery-New York.
8 CHAIRWOMAN KRUEGER: And why don't we
9 start with you, Dr. Smith, and then move down
10 that way. Oh, Dr. Smith-Wilson, excuse me.
11 DR. SMITH-WILSON: Excellent. Thank
12 you. Good evening, everyone, and thank you
13 for hanging in there. Right?
14 So again, thank you for allowing
15 Friends of Recovery-New York the opportunity
16 to bring the voice of over 260,000
17 New Yorkers who self-identify and report as
18 being members of the recovery community.
19 Again, my name is Dr. Angelia Smith-Wilson,
20 and I am the executive director of Friends of
21 Recovery-New York.
22 Friends of Recovery-New York reports
23 individuals and families living in recovery
24 from addiction, those who have lost loved
600
1 ones to addiction, and those otherwise
2 impacted by substance use disorder. FOR-NY
3 is also dedicated to building a strong
4 statewide infrastructure as we stand as
5 New York State's only statewide recovery
6 community organization.
7 And -- and -- oh, I lost my train of
8 thought. And we also support a robust peer
9 workforce that provides vital support for
10 people in recovery and others in need.
11 So the question is not how this
12 proposed budget will impact the over 260,000
13 New Yorkers who are in recovery; the question
14 is how bad will it get and how many more
15 lives will be lost to the opioid epidemic.
16 It was literally said earlier today that
17 budgeting is about priorities -- and I wanted
18 to jump through the screen as I was
19 livestreaming that part for my audience,
20 because budgeting is about priorities. It is
21 the definitive way that we decide as
22 New Yorkers who we will care for and how we
23 will care for them.
24 So while it was also stated by our
601
1 New York State OASAS commissioner that there
2 has been a 17 percent decrease in opioid
3 overdose, while we applaud that, it is a
4 short-lived victory, as it is not being -- it
5 is not equitable in the Black and brown
6 communities. We are not seeing such a sharp
7 decrease and decline in opioid overdose. So
8 I would be remiss if I did not bring that
9 point up.
10 So the New York State Office of
11 Addiction Services and Supports continues to
12 be funded at a significantly lower level
13 compared to other agencies serving similar
14 populations such as OPWDD and OMH. On
15 average, the OASAS budget is only 17 percent
16 of these other budgets.
17 So we are directly advocating for
18 additional investments in OASAS to better
19 support recovery services. What I mean by
20 additional is 1 billion.
21 God, that went so fast. Thank you.
22 CHAIRWOMAN KRUEGER: Thank you.
23 DR. SMITH-WILSON: So much more to
24 say.
602
1 MR. KIM: Good evening, Committee
2 Chairs Krueger and Pretlow and distinguished
3 committee members. My name is Jihoon Kim,
4 and I am the president and CEO of InUnity
5 Alliance, and a social worker by training.
6 It's an honor to be here today
7 representing more than 200 community-based
8 organizations serving New Yorkers at risk of
9 or living with substance use disorder and
10 mental health conditions.
11 Beyond advocacy, our organization
12 provides training and is the exclusive
13 certifying body for peer recovery
14 credentialing in New York State. Thank you,
15 Senator Fernandez, for your continued support
16 and funding of our peer-credentialing
17 program.
18 As we all know, addiction and mental
19 health conditions are not unlike other
20 medical conditions such as diabetes. There
21 are early signs, and without care the
22 symptoms get worse. Yet due to persistent
23 stigma and a lack of understanding, when
24 untreated, these conditions jeopardize close
603
1 relationships, disrupt the ability to earn a
2 living, and even put lives at risk.
3 While hospitals can provide short-term
4 stabilization, for most, true recovery
5 requires ongoing care. Without it, the cycle
6 continues.
7 I know this from personal experience.
8 I was fortunate to receive care early, but
9 not early enough to avoid multiple
10 hospitalizations and long-term
11 rehabilitation. I am a person in long-term
12 recovery from a mental illness and a
13 substance use disorder. I share this because
14 the substance use disorder and mental health
15 care system, despite its many challenges,
16 saved my life -- but now it is crumbling.
17 People like me are missing their second
18 chance. New Yorkers who need care wait
19 months or even over a year for their first
20 appointment, many fearing that symptoms will
21 only get worse, only being prioritized when
22 they are in crisis.
23 While the Governor's historic
24 $1 billion commitment to mental health was a
604
1 step forward, and is appreciated, existing
2 programs are struggling to stay afloat due to
3 years of underinvestment. They are doing
4 everything they can, relying on a patchwork
5 of funding to fill the gaps and scrambling to
6 navigate severe and persistent workforce
7 shortages.
8 Substance use disorder services are
9 particular vulnerable, as they have been
10 largely excluded from major transformation
11 efforts and continue to be overlooked.
12 Multiple mental health service
13 providers have approached us, saying they
14 would like to apply for new initiatives but
15 they do not have enough staff or resources.
16 Organizations delivering core services like
17 Assertive Community Treatment, the ACT
18 teams -- serving the population intended to
19 be reached by the proposed expansion of
20 involuntary admission criteria -- are voicing
21 serious concerns about their financial
22 sustainability.
23 New York must invest in ongoing
24 comprehensive funding strategies to ensure
605
1 that lifesaving substance use disorder and
2 mental health services remain available to
3 all who need them. We are calling for a
4 7.8 percent increase to get caught up with
5 inflation as well as an enhanced Medicaid
6 rate and our fair share of the MCO tax
7 revenue. The proposed 2.1 percent is
8 woefully inadequate.
9 By investing in these services, you
10 are meeting the growing needs of New Yorkers
11 and fostering opportunities to help tear down
12 health inequities.
13 I appreciate the committee's time and
14 consideration of these requests and am
15 available to provide additional information.
16 MS. DAVIS: (Singing to hand puppet.)
17 "You'll sing a song and I'll sing a song,
18 we'll sing a song together. You'll sing a
19 song and I'll sing a song, in warm or wintry
20 weather."
21 I've been a licensed creative arts
22 therapist for 12 years. I focus on training
23 clinicians on the ground, mobilizing art
24 therapy after American terror. I am the
606
1 woman, the licensed creative arts therapist
2 who showed up in Newtown, Connecticut, as a
3 New Yorker and mobilized art therapy for the
4 young children there.
5 I'm here today because New York has a
6 child and adult mental health crisis, and the
7 state budget can help solve the problem by
8 adding language to improve access to
9 psychotherapy. (Singing.) "Creative arts
10 therapy is psychotherapy."
11 (With hand puppet.) For those most
12 vulnerable New Yorkers who rely on Medicaid
13 for healthcare, the Division of Budget has
14 determined giving our more than 2,000 LCATs
15 the opportunity to apply to become Medicaid
16 providers will cost only $2 million this
17 year, ramping up the number of therapists who
18 can immediately fill workplace vacancies and
19 provide already existing psychotherapeutic
20 services --
21 (Singing.) "Creative arts therapy is
22 psychotherapy."
23 -- in many facilities in which we
24 provide care already.
607
1 Our therapy for children under the age
2 of six with Medicaid coverage, in network for
3 LCSWs, is requested countless times.
4 Examples are given all day.
5 You all know this, and I appreciate
6 that. While LCSWs have no availability right
7 now, there are countless creative arts
8 therapists who do have openings. But we can
9 never benefit the children in need because we
10 have an LCAT license, and these coordinators
11 are specifically seeking art therapy services
12 for the littlest children in crisis, not to
13 mention of all ages we benefit.
14 In December of 2021 Governor Hochul
15 signed into law Chapter 819 that passed
16 overwhelmingly by both the Senate and the
17 Assembly. It allowed all mental health
18 practitioners licensed under Article 163 to
19 be eligible for coverage under Medicaid.
20 Then, in 2022, Chapter 97, to specifically
21 exclude LCATs and LPS, a "chapter amendment"
22 was signed.
23 Since these 2022 actions, the need for
24 licensed mental health practitioners in our
608
1 state to provide desperately needed
2 psychotherapy has only grown, especially for
3 children and teens. (Sing-song voice, hand
4 puppet.) If you are unaware, LCATs treat
5 some of the hardest-to-reach patients --
6 children, elderly, mm-mm-mm-mm. Very
7 importantly, creative arts therapists are
8 uniquely qualified to work with refugees,
9 immigrants, non-English-speakers, due to the
10 nonverbal processes.
11 Then came extraordinary things,
12 through the efforts of Senator Samra Brouk,
13 Assemblymember Harry Bronson, and the support
14 of many of you, including Assemblymember
15 Jo Anne Simon, as well as our collaborators
16 1199 and Northern Rivers and many, many
17 others.
18 We want you to know (singing)
19 "Creative arts therapy is psychotherapy."
20 And most importantly, listen, the
21 procedure codes for billing psychotherapy are
22 the same. Thank you.
23 CHAIRWOMAN KRUEGER: Thank you.
24 Senator Fernandez.
609
1 SENATOR FERNANDEZ: Thank you for that
2 testimony. That made me happy.
3 MS. DAVIS: Brighten it up a little in
4 here.
5 SENATOR FERNANDEZ: Art therapy is a
6 great therapy.
7 I wanted to allow Dr. Smith-Wilson to
8 finish your funding ask. You said "we need
9 more money," you never got to a number, if
10 you could say that.
11 DR. SMITH-WILSON: Yes, thank you,
12 Senator Fernandez.
13 We are asking for $1 billion
14 investment in OASAS to better support
15 recovery services and address the growing
16 needs of individuals in recovery.
17 SENATOR FERNANDEZ: Thank you. Can
18 you detail how recovery is getting funded?
19 DR. SMITH-WILSON: Currently recovery
20 is funded -- there's a small percentage of
21 the state Aid to Localities, and then the
22 remaining is from the opioid settlement
23 funds. Which are not -- earlier today the
24 commissioner did talk about how those funds
610
1 are time-limited.
2 So even though the funds are due to
3 arrive to New York State over an 18-year
4 period, currently the recovery community
5 organizations right now were given funds last
6 year to be dispersed for a two-year period,
7 which will be ending in March 2025 of this
8 year. Some of those will be extended to
9 June.
10 But again, sustainability with regards
11 to the recovery community organizations is
12 not there.
13 SENATOR FERNANDEZ: Thank you.
14 Senator Canzoneri-Fitzpatrick did ask
15 like what could be the tool -- and forgive me
16 for not word for word, but what could be the
17 tool to get somebody to want to get
18 treatment. My personal opinion is the peer
19 support advocates. I've heard from many,
20 have visited many organizations that have
21 proven that this is a very strong tool to
22 inspire others to take that first step into
23 recovery.
24 And Assemblywoman Gallagher did
611
1 mention the benefits of having a special
2 supportive workplace. Can you speak on that?
3 DR. SMITH-WILSON: Yes. Well, first
4 let me say that treatment -- while we
5 support, we fully, fully support treatment,
6 all levels and all modalities of treatment,
7 let me be clear that treatment is episodic
8 and recovery is lifelong.
9 And what I mean by that is that
10 individuals can seek treatment, we often --
11 if individuals are looking to enter
12 treatment, we certainly help individuals.
13 They receive that help by going to local
14 recovery community organizations that also
15 help to, you know, get people into treatment
16 that want treatment. But we support multiple
17 pathways of recovery.
18 So to your point with regards to
19 recovery-friendly work spaces and peer
20 support specialists, we have had the
21 opportunity to provide over 75 scholarships
22 last year through funds from the opioid
23 system funds, for individuals seeking
24 certification to become certified peer
612
1 recovery advocates.
2 New York State currently has over
3 3,000 certified peer recovery advocates that
4 do remarkable work. Most of them are
5 connected to treatment, and some of them are
6 embedded in the recovery organizations, local
7 recovery community organizations.
8 SENATOR FERNANDEZ: Thank you so much.
9 CHAIRMAN PRETLOW: Assemblywoman
10 Simon.
11 ASSEMBLYWOMAN SIMON: Thank you.
12 First I want to thank all of the
13 speakers today. Clearly -- and I think so
14 important, and you both have said this, is
15 that treatment is relatively short-term,
16 recovery is a long-term commitment. And I
17 think that one of the things we need to do is
18 find out ways that the state can support
19 that, understanding that it is in fact a
20 long-term recovery.
21 And so -- is it Dr. Davis -- or
22 Ms. Davis, from LCAT, one of the things that
23 I see that you pointed out was trauma
24 recovery with children. And we have more and
613
1 more children who are in trauma because of
2 violence in their community, gun violence.
3 We are very lucky in New York that we haven't
4 had big school shootings in the way that many
5 other states have, but we have certainly had,
6 you know, a lot of violence, gun violence in
7 many, many communities. And in some cases,
8 you know, in Buffalo we had a mass shooting,
9 for example.
10 MS. DAVIS: Yes.
11 ASSEMBLYWOMAN SIMON: So, you know, it
12 strikes me that this is probably a population
13 that most people aren't thinking about and
14 that creative arts therapists can actually --
15 are like the magic key there for kids with
16 disabilities, who are nonverbal, who can't
17 express themselves.
18 So it seems to me that this is the
19 budget season and if the bill last year was
20 vetoed by the Governor, we should be putting
21 it in the budget.
22 Do you have a sense of what the costs
23 are of that operation?
24 MS. DAVIS: The LCAT Advocacy
614
1 Coalition was informed from the Governor's
2 office that it would cost $2 million to
3 on-board the 2,000-plus LCATs that already
4 exist all over New York State.
5 So that sounds fairly inexpensive to
6 the overall budget to on-board us, because
7 we're already licensed and we're here, we're
8 ready to go. We have already deployed and
9 trained.
10 ASSEMBLYWOMAN SIMON: Seems like a
11 drop in the bucket.
12 MS. DAVIS: And then it's -- and then
13 it's -- we're on-boarded. And it's not
14 $2 million the next year.
15 ASSEMBLYWOMAN SIMON: Yeah. Great.
16 Thank you very much. I appreciate it.
17 MS. DAVIS: Thank you.
18 ASSEMBLYWOMAN SIMON: And thank you
19 all for your testimony.
20 CHAIRWOMAN KRUEGER: Are there any
21 other Senators?
22 Okay, so I have just one quick
23 question. The licensed creative arts
24 therapy, is there any kind of peer recognized
615
1 review of this as an effective model of
2 therapy with children?
3 MS. DAVIS: Yes, absolutely.
4 CHAIRWOMAN KRUEGER: So can you get me
5 some materials after tonight?
6 MS. DAVIS: Yes, I'm happy to get you
7 materials --
8 CHAIRWOMAN KRUEGER: Thank you very
9 much.
10 MS. DAVIS: -- that support the work.
11 Thank you.
12 CHAIRWOMAN KRUEGER: Thank you.
13 Assembly.
14 CHAIRMAN PRETLOW: Assemblyman Brown.
15 ASSEMBLYMAN KEITH BROWN: Thank you,
16 Chair.
17 Mr. Kim, how are you today?
18 MR. KIM: I'm well, how are you?
19 ASSEMBLYMAN KEITH BROWN: Good. Good.
20 I'm sorry we haven't connected.
21 You know, I want to ask you -- and I
22 don't think three minutes is going to satisfy
23 it, but you're uniquely positioned that you
24 worked on the second floor and you were
616
1 inside the Governor's office in terms of
2 dealing with this crisis as it really ramped
3 up and then, as we've seen, because of -- to
4 a large degree because of Narcan, it's down
5 17 percent, which is great news.
6 What do you think, being on the other
7 side, sitting at that dais now, that you
8 could tell us that is not in this budget that
9 we really need to do? What's the low-hanging
10 fruit that will help, you know, alleviate
11 this crisis some more?
12 MR. KIM: Thank you for that question,
13 Assemblymember Brown.
14 And I believe we might be -- our
15 schedulers are trying to get us to meet on
16 Monday, so hopefully we can find some time to
17 continue this conversation.
18 I appreciate you bringing that up. I
19 was proud of my work on the second floor; I
20 was the deputy secretary overseeing the
21 entire mental hygiene portfolio. And when
22 Governor Hochul took office, it was one of my
23 charges to find a solution to the mental
24 health crisis.
617
1 And the $1 billion, while it goes a
2 long way, the great majority of that
3 billion dollars is for housing that is going
4 to take years to materialize.
5 So in the years since, the priorities
6 have not been to stabilize the
7 community-based services that actually meet
8 the needs of the individuals that are falling
9 through the cracks.
10 Let me give you one example. We have
11 member providers. These are providers who
12 have a lot of OMH- and OASAS-licensed
13 programming and funding. And there are these
14 ACT teams, and these ACT teams that I
15 mentioned earlier are the teams that end up
16 serving the individuals that are ordered
17 through the Kendra's Law to get services.
18 Right? These are outpatient services, and
19 with Kendra's Law they are ordered by a judge
20 to get these services.
21 Those individuals jump the line to the
22 front of the ACT teams. So what do you think
23 happens when that happens? The individuals
24 that are now on the waitlist for these ACT
618
1 teams, they get bumped down the pecking order
2 because of the expansion of -- you know, the
3 proposed expansion of Kendra's Law and the
4 existing Kendra's Law statute. And that
5 actually leads to a greater need for those
6 providers to have better funding to serve
7 these harder-to-serve, high-acuity clients.
8 And that's just one example. There
9 are some other examples. I mean, it's not
10 sexy, it's not fun, but it's bureaucratic
11 inefficiency. Right? Government takes one
12 year to do something that would take a
13 private company, you know, a month to do.
14 And while -- and, you know, I have a
15 great relationship with Commissioner
16 Sullivan, and I work very closely with her,
17 but these funds really need to prioritize the
18 existing community-based system -- and not
19 new projects, that I know are sexy to
20 announce.
21 ASSEMBLYMAN KEITH BROWN: Well, thank
22 you. And I look forward to talking with you
23 and working with you on trying to make it
24 less efficient.
619
1 MR. KIM: Thank you.
2 ASSEMBLYMAN KEITH BROWN: More
3 efficient, I should say. More efficient.
4 (Laughter.)
5 CHAIRMAN PRETLOW: Assemblyman
6 Santabarbara.
7 ASSEMBLYMAN KEITH BROWN: Less
8 inefficient. Thank you.
9 MR. KIM: I got you.
10 ASSEMBLYMAN SANTABARBARA: Thank you,
11 Mr. Chair.
12 Just circling back on the peer support
13 programs, could you just go through -- where
14 do you think we need additional investment?
15 You know, what programs and what can we do in
16 the budget? Can you just go through some of
17 them with me?
18 DR. SMITH-WILSON: Well, with regards
19 to additional programs, first I would say
20 that we really need to increase and expand
21 the recovery community organizations that are
22 already in the community doing the work.
23 Many of the peers are allocated or kind of
24 designated to work within the recovery
620
1 community organizations.
2 And so programs like that and
3 opportunities like that allow for people to
4 come in and work with individuals who have
5 similar -- you know, similar life experience.
6 A lot of the peers have -- well, many of the
7 peers if not all of the peers have lived
8 experience, which often comes -- you know, is
9 received better than, you know, kind of
10 therapy or therapeutic treatment of some
11 sort.
12 I mean, I myself was a primary
13 therapist for 10 years, and I will say that a
14 lot of the breakthroughs that I had with the
15 individuals that I worked with were because
16 of the peers and their peers having the
17 ability to have individuals see things from
18 their perspective and have that opportunity.
19 So programs like the expansion of
20 recovery community organizations is very much
21 needed. Some four years ago we asked for a
22 recovery community organization to be in
23 every county in New York State. Right now we
24 have about 31 recovery community
621
1 organizations; we have 20 youth recovery
2 clubhouses; we have about four or five
3 collegiate programs. That is it -- to
4 service, again, the growing individuals, the
5 growing New Yorkers of the recovery
6 community.
7 ASSEMBLYMAN SANTABARBARA: So they're
8 not in every county, is that what you're
9 saying?
10 DR. SMITH-WILSON: No, they are not.
11 There is not a recovery community
12 organization in every county.
13 ASSEMBLYMAN SANTABARBARA: Okay,
14 that's helpful. Thank you.
15 Just one question on the creative arts
16 therapy. What is the -- I guess what's the
17 educational piece of it to become licensed?
18 MS. DAVIS: I have a master's degree.
19 And then it's a 60-credit master's course,
20 and then we do -- I think it's 3600 -- I did
21 it so long ago. I think it's 3600 hours of
22 clinical work, supervised. So it's very
23 rigorous. It's very rigorous. We're really
24 well-trained, and we're highly skilled.
622
1 And then most of us have -- like on
2 top of it, I have trauma-focused cognitive
3 behavioral therapy under my belt. So, you
4 know, there's a lot that goes into it
5 post-graduate-degree also, that everyone in
6 the art therapy and music therapy fields
7 continue to study.
8 ASSEMBLYMAN SANTABARBARA: Those are
9 all the minimum, like, educational standards
10 you have to meet to get licensed, is that --
11 MS. DAVIS: Yes.
12 ASSEMBLYMAN SANTABARBARA: Okay,
13 great. Thank you.
14 CHAIRMAN PRETLOW: Assemblywoman
15 Griffin.
16 ASSEMBLYWOMAN GRIFFIN: Thank you to
17 all of you for being here today and being
18 patient enough to be the last group.
19 This is for Dr. Smith-Wilson. I just
20 wondered if right now the only way OASAS is
21 being funded is from the Opioid Settlement
22 Fund, how was it funded or how little was it
23 funded before that was even available?
24 DR. SMITH-WILSON: I'm sorry,
623
1 correction. You said the only way that the
2 OASAS budget, overall budget --
3 ASSEMBLYWOMAN GRIFFIN: Yes, that the
4 only state funding available presently comes
5 from the Opioid Settlement Fund.
6 DR. SMITH-WILSON: Okay. So recovery
7 services in New York State, there is a small
8 percentage that is -- even for New York, is
9 funded by the state Aid to Localities.
10 ASSEMBLYWOMAN GRIFFIN: Right.
11 DR. SMITH-WILSON: And so there's a
12 percentage of that.
13 And then there are the opioid
14 settlement funds, which service a lot of the
15 certified peer recovery advocates as well as
16 some of the recovery centers.
17 So there are additional funds that
18 OASAS have that they also dole out for youth
19 services that are still trickling out of the
20 SRO funds, which are the state opioid
21 response funds. And so there are still some
22 discretionary funds coming through the
23 federal government, circling through OASAS to
24 support additional funding as well.
624
1 So I stand corrected with saying that
2 it is only -- yes.
3 ASSEMBLYWOMAN GRIFFIN: Okay. Okay, I
4 understand.
5 And then I do appreciate you shedding
6 light on the disbursement and allocation of
7 the funds because that was a question I asked
8 earlier. You know, I don't know about all
9 the counties in the state, but I do know --
10 the district I represent is in Nassau County,
11 and unfortunately as many people that are
12 struggling with addiction, recovery --
13 families, organizations in need of that
14 really critical funding, it's just sitting,
15 it's just sitting in the Nassau County
16 executive's -- in his coffers.
17 And so I really -- I appreciate the
18 fact that you addressed this, and I would
19 like to learn more about what we can do about
20 that. Because that money is so needed and so
21 vital, and it's -- to me, I was so glad when
22 I saw that large sum of money come in a
23 couple of years ago, and then I can't believe
24 there's years have gone by and it's still
625
1 sitting there.
2 So I appreciate that. And also --
3 this is just quickly -- I also agree that I
4 don't think enough emphasis is on recovery.
5 A lot is on treatment, but there's so much to
6 recovery. Quickly -- you can't really say
7 much, maybe you can email. But I'd like to
8 know what else you could say about recovery.
9 DR. SMITH-WILSON: Yes, absolutely.
10 Well, first to your point with regards
11 to what else can be done -- and I think that
12 you can do a lot -- one of the things that
13 we're asking for, a lot of folks do not know
14 that recovery funding, it is not permanent.
15 It is not permanent in OASAS' budget, nor is
16 it allocated as such. So ensuring that it is
17 permanent and it is allocated as such would
18 help.
19 ASSEMBLYWOMAN GRIFFIN: Okay. Thank
20 you so much.
21 CHAIRMAN PRETLOW: Assemblywoman
22 Gallagher.
23 ASSEMBLYWOMAN GALLAGHER: Hi. Thank
24 you. I am a huge fan of Friends of Recovery,
626
1 and some of my most impactful lobby visits
2 have been from your members.
3 And I have a really strong memory of
4 an interaction I had when I just said to
5 them, the folks visiting me, What is it that
6 you want and that you need? And they said
7 workforce development. And I know from
8 personal experience with people that
9 I've loved and lost to addiction that one of
10 the things that hurt them the most was coming
11 back into the -- you know, the sober world
12 and seeing that their friends had eclipsed,
13 all these opportunities had happened for
14 their friends that they had gotten left out
15 of because they were in another world at that
16 point.
17 So I'm wondering, with these
18 vocational services that you're building,
19 what are some roadblocks that you're finding
20 to having integrated care so that folks can
21 choose a variety of employment opportunities
22 rather than working in the recovery space
23 alone, which is incredible, critical work but
24 also, you know, limiting?
627
1 DR. SMITH-WILSON: Yes. Yes.
2 Well, while we certainly encourage
3 individuals with lived experience to enter
4 the addiction workforce, we find them to
5 be -- you know, it's not so much about the
6 book knowledge, it is really that kind of
7 lived experience that allows for individuals
8 to be seen and heard in a way that a
9 therapeutic environment may not provide.
10 So I think that, to your point with
11 regards to, you know, not kind of
12 pigeonholing and making individuals, you
13 know, go into the addiction workforce, one of
14 the things that we do is kind of allow for
15 individuals to go into any field that they
16 want to.
17 I mean, we had a small -- a very small
18 kind of initiative with -- we have a recovery
19 fine arts festival where we encourage
20 individuals to express their recovery in
21 different ways. So we encourage individuals
22 to really seek that meaningful life and their
23 purpose, no matter where it is.
24 But with regards to some of the
628
1 barriers, obviously it could be gaps in
2 employment. You know, there are other issues
3 as well. People are -- you know, they have
4 family reunification issues. So many of the
5 barriers that they face I think are not
6 mountains. Certainly there are things that
7 can be overcome. But probably the greatest
8 is stigma. Stigma still exists because
9 individuals that create legislative bodies
10 are not informed as well with regards to how
11 do you provide anti-stigma messages, how do
12 you -- even in your own family -- encourage
13 individuals to come forward about being in
14 recovery.
15 ASSEMBLYWOMAN GALLAGHER: Yeah. Thank
16 you.
17 DR. SMITH-WILSON: Thank you.
18 CHAIRMAN PRETLOW: Assemblyman
19 Anderson.
20 ASSEMBLYMAN ANDERSON: Thank you so
21 much, Chair.
22 And thank you to this final panel for
23 being here tonight and sticking it out with
24 us. I certainly appreciate Ms. Porter
629
1 Davis's testimony and all of you all's
2 insight on this issue.
3 So I have two quick questions.
4 Wondering, of the three of you all, are all
5 your programs voluntary for individuals who
6 are experiencing substance use disorder?
7 That's number one.
8 And the second question I have is,
9 with -- as it relates to pretrial diversion
10 programs, I'm working if you all offer any
11 pretrial diversion to allow individuals that
12 might have been caught up in the criminal
13 legal system to be able to receive services
14 from you all as a part of their pretrial
15 conditions?
16 MR. KIM: Thank you for that question,
17 Assemblyman Anderson.
18 So I represent 200 providers who do
19 serve individuals through their outpatient
20 programming and residential services, who may
21 have actually gotten there through an
22 involuntary order. Right? But they're not
23 -- you know, they're not the hospitals
24 themselves, but these are outpatient
630
1 providers who -- the example I gave earlier
2 in response to Assemblyman Brown's question
3 about, you know, what needs to be fixed, it
4 is that these rates are inadequate and a lot
5 of the ACT teams that the community-based
6 organizations actually run on behalf of OMH,
7 they provide outpatient services but some
8 individuals are referred there through AOT,
9 which would be involuntary.
10 ASSEMBLYMAN ANDERSON: Please,
11 Dr. Wilson.
12 DR. SMITH-WILSON: And I work on
13 behalf of the over 30 recovery community
14 organizations. So we -- and, you know, very
15 much like Jihoon, we work with them to ensure
16 that they have the services that anyone,
17 anyone entering the recovery center can
18 certainly access.
19 So most importantly, we work to make
20 sure that whatever services that that
21 individual recovery community organization
22 needs, that we help them to gather those
23 services.
24 And so a lot of the individuals, you
631
1 know, have justice-related, law
2 enforcement-related that enter those. A lot
3 of them have groups, specific groups at a lot
4 of the recovery centers. So I would say
5 although we don't provide those direct
6 services, we certainly advocate for any
7 individual who is in recovery from substance
8 use, mental health or any other -- we even
9 have, you know, eating disorders, whatever
10 the case may be. Anyone that is seeking
11 recovery from any condition, that they have
12 access to do that.
13 And one of the ways that we've found
14 is that at our recovery community
15 organizations, they address just about any
16 type of issue an individual walks through
17 that door with.
18 ASSEMBLYMAN ANDERSON: Thank you so
19 much.
20 CHAIRWOMAN KRUEGER: Thank you.
21 Just double-checking. Then I would
22 like to thank all of you for staying with us
23 or agreeing to stay on the last panel. I
24 think I'm going to officially close this
632
1 hearing.
2 But for those of us who are just
3 hearing junkies, we'll be back here tomorrow
4 morning, 9:30, for the Transportation
5 hearing.
6 And if anyone is getting into a car
7 and driving anywhere in the State of New York
8 today or tomorrow, please be very careful.
9 Thank you.
10 (Whereupon, the budget hearing
11 concluded at 7:18 p.m.)
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