[Enews] PROS is back

[NAMI-NYS Enews]

New York Officials Move Forward with Recovery-oriented Services for Consumers 
Six Counties will Implement Medicaid Initiative
Mental Health Weekly   July 17, 2006
The New York State Office of Mental Health (OMH) this month announced plans to resume efforts for area counties to implement the state's new Medicaid outpatient rehabilitation program, which provides customized recovery-oriented services to consumers with mental illness.

Officials said they plan to work with six 'early adopter' or pilot county directors and providers to issue licenses for the program and provide training and technical assistance.

Although the state Department of Health, as the single state agency for Medicaid in New York, received approval from the Centers for Medicare and Medicaid Services (CMS) to establish the Personalized Recovery Oriented Services (PROS) program in 2004, and seven counties had initially been scheduled to implement PROS, officials only issued the first license for the program in January 2006.

The CMS approval of the state plan amendment to establish the PROS program establishes authority for the programs to receive Medicaid reimbursement, according to OMH.

State officials said they plan to issue detailed guidance regarding these documentation standards and revised regulations which state these standards soon. OMH said it will address issues raised by early adopter counties, including allowing psychiatric nurse practitioners to work collaboratively with PROS staff psychiatrists and to have their work count toward a portion of required psychiatric coverage.

The state's plans have garnered a mixed reaction from advocates and providers who have expressed concerns over pending documentation standards and the finance issues associated with implementing the PROS program initiative.

The PROS program is a licensed outpatient mental health program for adults that offers a customized menu of recovery-oriented services provided in both centralized locations and in community settings. The PROS program model enables recipients to choose specific services in the domains of assessment, treatment, rehabilitation and support.

The Medicaid-reimbursed program licensed under the Federal Rehabilitation Option allows providers to offer a comprehensive array of services that can be customized to relate to an individual's unique recovery needs, said officials.

"I congratulate New York State and the six counties that have resumed PROS implementation," Linda Rosenberg, president and chief executive of the National Council for Community Behavioral Healthcare (NCCBH), told MHW. "PROS is a courageous and thoughtful attempt to align funding with practices that are based upon the best available research."

Rosenberg added, "It's a program that supports consumers and families as full partners in the treatment process. PROS offers a meaningful opportunity for recovery to become a reality for many with serious mental illnesses."

Even though the issue is controversial, it is being recognized as a great step forward in moving services much closer to a vision of recovery, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS).

"We're expecting and hoping [the PROS program] will achieve long-sought service reforms by integrating services and making them more recovery-, wellness- and employment-focused," Rosenthal told MHW. The PROS model is designed with the expectation that evidence-based practices will be offered to individuals and that they will learn to manage their own recovery, said Rosenthal.

To date officials haven't done enough in joining together Medicaid and recovery-oriented services, said Rosenthal. "PROS promises to do that," he added.

Ensuring Compliance
The New York State Council for Community Behavioral Healthcare has been working with its members on federal regulations associated with PROS implementation, said Lauri Cole, LMSW, executive director. "Our organization has assisted our members to enhance their internal compliance activities in order to ensure they comply with all federal and state regulations" particularly those pertaining to medical necessity and documentation, Cole told MHW.

Initially, the seven early adopting counties and the participating providers from those counties spent a significant amount of time and money gearing up for licensure, noted Cole. "During the initial rampup, providers hired and trained staff and re-tooled their agencies in a variety of ways  but then had to shelve their in-house initiative."

Cole added, "During the waiting period, providers have learned a great deal about the strengths and challenges associated with the planned implementation."

Meanwhile, providers are awaiting the PROS documentation requirements from OMH. Until providers have a look at the actual revisions to the documentation standards and finance issues associated with PROS, they won't really know whether this fits their agency mission and objectives, said Cole. The state OMH plans to issue a summary of documentation standards this week, she added. "We're waiting for details. Theres a significant amount of information we just don't have yet."

PROS was initially conceived as an enhancement to the existing continuum of care here in New York State, noted Cole. "It was not created to supplant existing programs and services, some of which are 100 percent state funded, but instead to provide a state of the art treatment option for a subset of consumers who would benefit from PROS," she said.

"Unfortunately, while we have been waiting for the PROS roll out, we have suffered through several years of gradual erosion in state support for a range of safety-net programs and services designed to meet the needs of consumers in local communities across the state," she said. "This withdrawal of state financing has put additional pressure on the service delivery system,
on the state Office of Mental Health and on the consumers who rely on us each day." 
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How is the First Community Mental Health Agency to Implement PROS Faring?

The New York State Office of Mental Health issued the first PROS (Personalized Recovery Oriented Services) license to the Plattsburgh, N.Y.-based Behavioral Health Services North in Clinton County in January 2006. The agency had been one seven counties approved to implement PROS following approval from the Centers for Medicare and Medicaid Services (CMS) in 2004.

Now with less than six months under their belt in offering individuals with mental disorders a menu of recovery-oriented services, agency officials said they are pleased that the other counties have been approved to begin implementing PROS programs.

"Presumably, OMH thought we were ready [for PROS implementation] and that we would be a good beginning role model," Peter Trout, chief of services at Behavioral Health Services North, told MHW. We're a rural county; we're the only PROS provider in the county."

The agency's PROS program is entirely funded by Medicaid, he said. "Another reason we were chosen as an early start-up is we have a history of previously billing Medicaid," he said.

The agency's five programs for consumers with mental illness that have been converted into the PROS initiative include: Intensive Psychiatric Rehabilitation Treatment Program, Continuing Day Treatment Program, supported employment program, the social club, and a business-related program.

The programs are all under one umbrella making them more accessible for consumers with the focus on recovery, said Valerie Ainsworth, PROS program director.

"PROS enabled us to make all five services immediately accessible to everyone," Ainsworth told MHW. "The whole focus of PROS is on a recovery principle, she said. "We've taken the focus off of symptom management and long-term treatment."

Consumers like the program's emphasis on health and well-being, she said. "They like being in the driver's seat and making decisions about where they want their own rehabilitation to go, right from the beginning," noted Ainsworth.

The agency currently has about 150 "active" individuals involved with PROS-related services, said Trout. "It's client-involved and gives clients choices, which increases hope for the future," he said.

All of the PROS services are mandated by regulations, said Trout. Some counties might have a clubhouse model or other different programs than Behavioral Health Services North and may implement PROS differently in their respective counties, he said.

Although their agency has received numerous calls about their PROS initiative, Trout said he looks forward to sharing dialogue with other counties once their programs are up and running. "We don't pretend we have all the answers," notes Trout. "One of the problems with being thus far the only program up and running is being unable to share ideas and experiences," he said. "We can't bounce things off of people. I hope the learning collaborative goes on."







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