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Presentation on theme: "THE TRANSFORMATIONAL AGENDA FOR NY’S PEOPLE FIRST WAIVER MAY 7 TH 2013."— Presentation transcript:


2 Personal Outcome Measures Pilots People First Waiver RFI Care Coordination ICS Case Studies Front Door DISCO Managed Care InterRAI CQL RFA Coordinated Assessment System (CAS)

3 Today’s Agenda  Why Reform Now  Major Parts of our Transformational Agenda with CMS  Status of DISCO Development  Transformation Agreement  Contract Requirements  Next Steps

4 Why Reform Now? – 3 Factors 1.The sustainability factor - how do we sustain appropriate service provision within fiscal realities? 2.The relevancy factor - are the services we currently offer those that families and individuals coming into our service system are seeking? 3.The compliance factor - in light of Olmstead and recent federal decisions on ADA, will the menu of service options we provide allow us to meet the goals of Olmstead and federal requirements? 4

5 OPWDD Transformation As OPWDD pursued development of the People First Waiver, we worked with CMS to define priority elements of system transformation:  Expanding opportunities and supports for EMPLOYMENT  Expanding COMMUNITY SERVICE OPTIONS – supportive housing, community-based services  Expanding SELF DIRECTION options  OLMSTEAD PLAN- Creating opportunities for people to move from institutions to integrated settings

6 Transformation Documents  “Putting People First: OPWDD’s Road to Reform” – comprehensive review of system reforms recently achieved and underway  “The OPWDD Transformation Agreement” Appendix H of the DRAFT NYS Partnership Plan Amendment (DOH 1115 Waiver)- Articulates clear commitments for achieving ambitious goals for system reform and service delivery

7 Transformation Agreement The Agreement contains commitments for OPWDD related specifically to:  Money Follows the Person (MFP) Demonstration  Balancing Incentives Program (BIP)  1915 b/c Applications  Residential Transitions and Supportive Housing  Supported Employment Services and Competitive Employment  Self-Direction

8 Federal Opportunities Money Follows the Person (MFP) Demonstration An opportunity to receive enhanced federal support for rebalancing the long-term care system by transitioning people with Medicaid from institutions to community settings. Balancing Incentives Program (BIP) Authorizes grants and an enhanced federal Medicaid match to states that make structural changes to increase access to non-institutional long-term supports and services.

9 MANAGED CARE A Means or Road Map to System Reform Components of Managed Care in NY need to include critical elements of CMS guidelines for transformation: – Housing and community integration – Employment goals for all – Opportunities for Self-Direction to those who choose it

10 Waiver Process Update Action ItemTimingStatus Waiver Applications Submission (1915 c amendment & 1915 b application)April 1, 2013 Solicit Letters of Intent & Post Medicaid dataMid-April 2013 Post final Request for Applications for DISCOsSpring 2013 Hold Statewide VC on Medicaid DataMay 2013 Anticipated Approval of Waiver Applications by CMS October 1, 2013  DISCOs begin enrolling volunteer members  DOH Duals Demonstration begins enrolling members into the first DD FIDAs (fully integrated care for Medicare & Medicaid- eligible individuals) January 2014

11 Managed Care Legislation  The NYS legislature recently passed managed care legislation that authorizes delivery of specialized IDD services through a managed care structure.  The People First Waiver, when approved by CMS, will authorize the operation of DISCOs and OPWDD now is focusing on establishing initial DISCOs.  Later, OPWDD will request additional authority from CMS to initiate delivery of specialized IDD services through MLTCPs and HMOs and solicit those applicants through separate actions.

12 Managed Care Legislation  The enacted NYS budget authorizes several options for specialized IDD services within managed care:  DISCOs  Managed Long Term Care Plans (MLTC)  Medicaid Managed Care organizations (HMOs)  Each type is regulated by the same managed care regulations and standards and must possess experience with IDD services.  OPWDD is initiating formation of DISCOs first.

13 DISCOs  Governed by:  Public Health Law Article 44,  Mental Hygiene Law § 13.40,  Social Services Law §364-j  DOH regulations at 10NYCRRSubpart 98-1  federal regulations at 42 CFR Part 438  Will have modified reserve requirements to facilitate start-up.  Must be controlled by one or more non-profit organizations with experience providing or coordinating health and long-term care services to people with IDD.

14 MLTC or Medicaid Managed Care  Same qualification standards for organizations will apply (controlled by nonprofit, exp. with IDD).  Same standards will apply for quality assurance, grievances and appeals, informed choice, person- centered planning and marketing.  Must have ability to provide or coordinate services for people with IDD – either on its own or by affiliation with another entity with experience, and which will oversee or implement the coordination and planning of IDD services.

15 Benefit Package 15 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  Outpatient – OMH, OASAS  Psychology and Clinical Social Work  OMH day treatment

16 DISCO Contract The DISCO Contract will:  Build off NYS DOH’s Contract for Managed Long-term Care Plans.  With amendments to accommodate provisions needed to reflect the specialized developmental disabilities service system.  And amendments to accommodate recommendations of the Targeted Work Teams.

17 DISCO Contract The DISCO Contract will describe:  DISCO authorization requirements  Enrollment responsibilities  Requirements to provide written materials, to communicate in ways that are understood & in needed languages  DISCOs’ obligations to their downstream providers  Care coordination obligations  Records, reporting & certification requirements  DISCO Payment  And more

18 Suggestions for Providers  Understand managed care law and regulation  Network with other regional providers to understand strengths, opportunities to collaborate  Identify and articulate your strength and future role in a service network (DISCOs will need to provide all types of services for all types of individuals.)  If interested in forming a DISCO:  Attend Statewide VC on Medicaid service data  Review Request for Applications  Review DISCO contract

19 OPWDD’s Next Steps  Solicit applications for DISCOs (Post Final RFA, Finalize the DISCO Contract, Hold Medicaid Data VC)  Implementation Planning for launching DISCOs and cross system care management  Program and Policy redesign to meet Transformation Agreement commitments in employment, self-direction, community housing Most Importantly - Continued dialogue with individuals, families & providers


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