DMH PROS Stakeholders Implementation Workgroup: Meeting Minutes

February 25, 2004


NYCDMH: Anita Chiu, Melissa Levow, Peter McGarry, Jane Plapinger. SOMH: Susan Friedlander, Christine Madan Joe Maloney. Providers and Consumers: Alison Burke (GNYHA), Doug Cooper (ACL), Gayle DeRienzis (The Coalition), Kenneth Dudek (Fountain House), Rosa Gil (HIRE), Patricia Goldstein (The Coalition), Mary Hanrahan (NY Presbyterian), Ronnie Hochberg (Mt. Sinai), Yvonne Howe (NYCCC), Ernest Lumer (NYCCC), Jim Mutton (ACL, NYC), Alysia Pascaris (The Coalition), Joyce Pilsner (The Coalition), Karen Roth (HHC), Jonas Waizer (FEGS), Bill Witherspoon (UMMHC)

I. Introductions:

Group members introduced themselves and noted their organizational affiliations.

Jane Plapinger and Peter McGarry updated the group on recent activities regarding the PROS planning process.

II. T-2/ P-3 Submissions: Update on plan development:

1. Out of a total of 54 agencies with at least one program that must convert to PROS ("mandatory agencies") and 34 agencies with CDTP's only ("optional agencies"), the Department has received submissions as follows: 35 T-2's from mandatory agencies and 3 from optional agencies).

2. DMH is sorting T-2's into three categories:
  1) Those that appear fiscally viable;
  2) Those that are not viable as submitted;
  3) Those that need technical assistance in using the T-2 planning tool.

3. Based on an initial cursory review, the majority of submissions fall into the first two categories. Those not viable as submitted will be reviewed carefully in collaboration with SOMH. They include both program types for which the PROS model is a questionable fit (e.g., free-standing small employment programs and shelter-based programs), and individual programs whose unique characteristics are such that they might not be viable under PROS (e.g., those with a low Medicaid penetration rate).

4. Providers expressed concerns over the large number of "non-viable" T-2's. DMH assured that a program with a "non-viable" T-2 does not mean that the PROS model will not work. We are at a very initial stage of a process that will address and problem solve around viability concerns. DMH is committed to working with each individual agency and SOMH to enhance viability of programs that will convert and take out of the mix those programs that will be unable to successfully convert.

5. SOMH has acknowledged that client worker programs and affirmative business programs may not fit the PROS model. SOMH has asked localities to set aside these programs for now.

6. Another unresolved issue that SOMH is aware of is the IMD exclusion.

7. DMH is planning to send letters next week to mandatory and optional agencies it has not heard from. Mandatory agencies will be encouraged to submit their T-2 and P-3's; optional agencies will be informed that DMH will assume they have decided not to convert their programs if they haven't submitted the planning documents.

8. As DMH receives viable T-2's, it is inputting data into a database that will generate analyses to assess the impact of the PROS conversion city-wide. DMH will be assessing impact in terms of system capacity, access to services and geographic and cultural diversity, and will work with providers to maximize the aforementioned.

III. Provider agreement and regulations: Update

1. SOMH has not yet issued the provider template, draft regulations, the PAR application, or the PROS handbook. SOMH staff reported that they are currently fine-tuning the PAR, and are in discussion with State DOH regarding the regulations. DMH reported they actively participated in the development of the provider template, and pushed for the county role to include a focus on quality improvement.

2. Providers expressed concern over the hold-harmless provision (repeat concern from last meeting). Is it 70% of net-deficit funding? SOMH did not have any additional comments regarding the hold-harmless provision. Many agencies have had net-deficit funding converted to CSP or COPS. As a result, there is no real safety net (i.e., clubhouses).

3. Providers repeated their hope that the State engage in global budgeting and ensure that any dollars representing shrinkage in the system attributable to PROS be reinvested in the community mental health system.

4. SOMH reported that the federal government has not yet ruled on their amendment submission.

IV. Evaluation: Update

1. DMH reported on the planned evaluation of PROS. SOMH, DMH and Susan Essock of Mt. Sinai and other researchers are designing an evaluation that will commence once the first PROS programs begin to operate in NYC. It will focus on how PROS is impacting utilization of services and the service system, and rely on Medicaid billing and possible Medicaid shadow billing data. Collected data will include: demographics, the number and types of services, diagnosis, impact on non-Medicaid clients, trends in cash flow, etc. The evaluation plan will be shared with stakeholders in a series of forums once it is developed a bit further. Stakeholder input will be encouraged throughout what is anticipated to be an open and transparent evaluation process.

V. Rollout: Discussion

1. DMH invited an open dialogue to help it begin to think about roll-out issues. Providers had expressed a lot of concern at the previous meeting about market share and their inability to project PROS program capacity. DMH is committed to facilitating a roll-out process which does what it can to ensure a level playing field. A few ideas were floated, but the general consensus was that it was difficult to discuss without more data. It was suggested that the "data might speak for itself" (i.e., data around geography and the allocation of PROS slots).

2. Providers were concerned about co-enrollment and consumers' inability to receive duplicative services. DMH referred to the "first bill in" rule and indicated that dual billing is a critical start-up issue.

VI. Future meetings

1. The City reiterated its dedication to a collaborative and transparent planning process. It was suggested that the group continue to meet every 4 to 6 weeks.