March 12, 2021
Attached is a draft outline prepared by OMH that describes the intent and particulars of an executive budget proposal that would authorize the creation and implementation of Crisis Stabilization Centers in the Mental Hygiene Law. This is a proposal that involves OMH, OASAS and DOH (primary care) services under one roof, to provide emergency walk-in services in local communities. Remember: There is also a proposal in the executive budget that would create a new Integrated Certified Outpatient Services license that would permit providers who obtain the license to offer services without a concern as to whether you could hit a ‘cap’ on how much of a type of service (primary care services, mental health services, substance use disorder services) you can provide.
Last week I participated in a conversation between leads at OMH and OASAS and association advocates who wanted more information about the proposal than what has been provided to this point. Bob Myers, Chris Tavella, Chris Smith and David Wollner were on the call for OMH. Trisha Schell-Guy, Pat Lincourt and others were on for OASAS. The following information is a summary/paraphrase of what I heard from the state agency leads on the call – from their perspective:
OMH began by stating that the Office views the proposed model as providing an integrated hub of a community’s behavioral health acute care system (akin to urgent care centers for physical health). For OASAS, Trisha Schell Guy stated that the Centers will be a place where community members can go when in crisis, to talk to a peer, to access crisis services after a overdose where Narcan was administered but the individual does not want to go to the hospital, where care recipients can get same day access, etc. Both state agencies acknowledged the importance of this new initiative for its’ unique status as the first joint envisioned by OASAS and OMH together.
OMH wants system stakeholders to know that there is nothing about these crisis stabilization centers that will allow them to involuntarily hold community members. They are for people who are seeking immediate crisis intervention, and those who use these services can leave when they want to. These are places where community members can go to receive immediate MH, SUD and primary care services without worrying about being held against their will, etc. Peers will have a very significant role in the program model. The Centers will serve children/youth and adults.
OMH and OASAS are currently working on regs and a SPA to drive reimbursement for services to be offered. They are looking at several different models that may already be in existence across the state and/or across the country. In terms of licensing the new Centers, these facilities will be tiered based on the acuity of care to be provided. Three tiers are envisioned, the most intense of which stops short of CPEP level of care. Local communities will determine what level of care is needed in their community.
1st Tier – Living Room Model. Not a 23 hour model of care. Example: Human Development Services of Westchester
2nd Tier – Crisis Stab Services that can serve someone for up to 23 hours and 59 minutes: This model includes physicians, NPs and would offer services including (but not restricted to) withdrawal monitoring services, medication admin services. Would permit police referrals and drop offs.
3rd Tier – Includes the above services plus a connection to residential services.
OMH and OASAS intend to create a document briefing stakeholders on the proposed model this month and collect feedback from stakeholders. But stakeholders should note that this is a proposal included in the executive budget proposal. The budget will be enacted on / around April 1.
State agencies are viewing these new Centers as a point on the existing continuum of community-based care that will help to keep people out of the hospital. In other states, these programs show good outcomes, reductions in unnecessary hospitalizations. Again, heavy reliance on peer recovery services.
Also true that in 2022, (federal) 988 Crisis Lines are going to be required in every state and likely to do more to help our folks in crisis than anything else that we have on the ground right now. But 988 is only as good as the referral sources. If we don’t establish these Centers, 988 will just lead to more hospitalizations.
OMH and OASAS need the authority and regs to add to this level of care to existing array of services. Plan is for services to be reimbursed via Medicaid.
Note from Lauri: More than a few association advocates are concerned that neither state agency engaged with system stakeholders before including a proposal for this new model in the executive budget proposal. When OMH and OASAS requested support from the coalition of advocates I meet with each week, some pushed back during the call with state leaders and spoke of the need for transparency and dialogue before these major proposals are moved forward by our state agencies. Other advocates feel that it’s an important model and so let’s just move forward.
During the call I raised my voice regarding the lack of transparency to this point AND the fact that there are many serious ‘fires burning’ across our system of care, more than a few of which are driven by a failure to adequately fund existing programs and services and so I have to wonder whether we should be creating a new level of care that may/may not be adequately funded and that could conceivably draw resources from other areas of core programming in a climate of very scarce resources. I also wondered aloud whether we need a new service with new buildings, etc., or whether existing programs and services could meet the need for these services. In summary, I believe we do not have enough information to vigorously support or oppose the proposal.
How do you feel about this? Please let me know at your earliest convenience? I’m at 518 461-8200 or firstname.lastname@example.org
If you would like to hit ‘reply all’ so your fellow member agencies can see what others are thinking please feel free to do so.
Hope to hear from you!