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Title of Presentation1 Family Forums: Designing the Future.

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1 Title of Presentation1 Family Forums: Designing the Future

2 Agenda Value-based Business Model Care Coordination Model Response to the NYS Transformation Agenda Family Forums2

3 Family Forums3

4 NYIN: Value-based Managed Care NYIN is driven by a simple idea that providers listening to and working with individuals & families can create and design a viable business model that works for everyone. We hold to the ideals of choice, access, and quality of life Family Forums4

5 A picture of the new world NYS Medicaid $$$ NYIN DISCO* with Insurance License Network of Providers (Agencies you know) Medicaid Recipients = Enrollees (Persons Served and Families) Access and Choice of Service 5Family Forums * DISCO - Developmental Disabilities Individual Supports and Care Organization

6 DISCO Benefit Package Family Forums6 OPWDD Auspice Services  OPWDD Comprehensive Waiver Services  Day Treatment  ICF/IID  Art 16 Clinic Svcs: OT, PT, SLP, Clinical Social Work, Psychology, Nutrition, Rehab Counseling, Podiatry, and Dentistry.  Care Coordination provided by the DISCO DOH Auspice Services  Adult Day Health Care  Dentistry  DME and Hearing AIDS  Home Care (offered under any auspice: hospital-based, nursing home-based, and free-standing programs)  Non Emergency Transportation  Optometry/Eyeglasses  OT, PT, SLP  Personal Care  Personal Emergency Response System  Private Duty Nursing  Psychology and Clinical Social Work  Respiratory Therapy  Skilled Nursing Facility  Podiatry OMH/OASAS Auspice Services  OASAS Inpatient  OMH Institutional Program (PC/RTF) & private psychiatric hospitalizations  Personal Recovery Oriented Services (PROS)  Outpatient – OMH, OASAS  Psychology and Clinical Social Work  OMH day treatment

7 Care Coordination Model Current Anticipated Family Forums7 Community Linkages and Referrals Advocacy/ Life Planning Eligibility and Benefits Management/ Assessment Coordination with Providers MSC (Case management) Designated Care Coordinator: Central point of contact

8 What is Care Coordination? Provides a person-centered, integrated system for medical, health and social support services Creates an individual care plan Connects individuals with all their providers Ensures timely communication with providers and community supports Measures, monitors and improves quality informed by individual outcomes Utilizes electronic information to support integrated and coordinated care Family Forums8

9 Responses to NYS Transformation Agenda NYIN will continue to take a leadership role in: Individual Services and Supports (Self-Direction) Employment Opportunities: Cleaning with Meaning a “green” home cleaning business run by people with disabilities. Community Integration: Our Place a new day services model using neighborhood spaces and self- directed activities. Family Forums9

10 What you can do going forward Take advantage of these Family Forums. Ask questions. Stay connected to NYIN – Ensure eligibility for services is formally established through the local DDRO Stick with or get connect to an agency you know - to maintain continuity of services Keep informed Be an advocate Family Forums10

11 Contact the NYIN Agency You Know UCP of NYC 212.683.6700 ext 202 HeartShare 718-422-3204 CBHS 1-888-750-2266 _brochure.pdf YAI LINK 212.273.6182 SUS 212.633.6900 Lifespire 212-741-0100 IAHD 718-741-0100 Family Forums11

12 Agencies You Know Family Forums12 Governing AgencyCommunities Served Coordinated Behavioral Health Services (CBHS)* Westchester, Mid-Hudson Region HeartShare Human Services of New YorkNew York City The Institutes for Applied Human Dynamics (IAHD) New York City, Westchester LifespireNew York City, Lower-Hudson Region Services for the UnderServed (SUS)New York City United Cerebral Palsy of NYC (UCP/NYC)New York City The Young Adult Institute (YAI)New York City, New Jersey, Long Island, Mid-Hudson Region * CBHS is a consortium which includes Abilities First, Crystal Run Village Inc., New Hope Community, Occupations Inc., and Westchester Jewish Community Services

13 Business Council members Ability Beyond Disability Birch Family Services Camp Venture, Inc. CP Associations of New York State Children’s Village Community Based Services, Inc. Edwin Gould Services Epilepsy Foundation of Metro NY F.R.E.E., Inc. Hawthorne Foundation Head Injury Association Opengate, Inc. Richmond Community Servies The Rose F. Kennedy Center St. Vincent’s Services A Very Special Place Family Forums13

14 NYIN UAM Bd. Observer UCP of NYC Heart Share IAHDCBHSYAISUS UAM Loans Reinsurance Agreement Business Plan Administrative / Management Services Agreement 4 Costs of Application split 50/50 by NYIN and UAM OPWDD DISCO Application Business Partnership Owners $ $ Life- spire Business Partnership Family Forums14

15 Acronyms ADA – American with Disabilities Act AT – Assistive technology CASA – Community Alternative Systems Agency CDPAP – Consumer Directed Personal Assistance Program CDS – Consumer Directed Services CMS – Centers for Medicare and Medicaid CR – Community Residence CSS – Consolidated Supports and Services DC – Developmental Center DD – Developmental Disabilities DDRO – Developmental Disabilities Regional Office DISCO - Developmental Disability Individual Support and Care Coordination Organizations DOH – Department of Health DQA – Division of Quality Assurance EI – Early Intervention FIDA – Fully Integrated Dual Advantage Programs FSS – Family Support Services HCBS – Home and Community Based Services HIPAA – Health Insurance Portability and Accountability Act HUD – Housing and Urban Development ICF – Intermediate Care Facility ICS – Individual and Community Supports IEP – Individual Education Plan ILC - Independent Living Center IRA – Individualized Residential Alternative ISE – Individualized Service Environment ISP – Individualized Service Plan ISS – Individualized Support Services IWRP – Individual Work Related Plan LCED – Level of Care Eligibility Determination MA – Medicaid MLTCP – Managed Long Term Care Plan MSC – Medicaid Service Coordination NCI – National Core Indicators OPWDD - Office for People with Developmental Disabilities PCP – Person Centered Planning PCP – Primary Care Physician PCSS – Plan of Care Support Services POM – Personal Outcome Measures SA – Self Advocacy SCAP – Service Coordination Activity Plan SCBA – Service Coordination Basic Agreement SD – Self Determination SE – Supported Employment SSDI - Social Security Disability Insurance SSI – Supplemental Security Income Family Forums15

16 Developmental Disabilities Individual Support and Care Coordination Organization (DISCO) NYIN, as a DISCO, has developed plans to: Enroll individuals who voluntarily opt to enroll in 2014-15 Provide person-centered planning for all individuals enrolled Handle the flows of funds (per member, per month) Promote living and active engagement in the most integrated setting Ensure that each individual who chooses to do so can self- direct his or her services Family Forums16

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