Presentation on theme: "Thank you for your patience"— Presentation transcript:
1 Thank you for your patience The HCBS Waiver Webinar will begin shortly
2 OMH HCBS Waiver Webinar Thursday, March 19, 20151:00 – 2:00 PMDivision of Integrated Services for Children and FamiliesNYS Office of Mental Health
3 Agenda Welcome and Introductions CANS-NY & CANS-NY Algorithm OMH HCBS Waiver ApplicationNew Rate MethodologyConflict of InterestTransition Age YouthSummary and Timelines
4 CANS-NY & CANS Algorithm OMH held regional calls with LGU/SPOA representatives to discuss the use of the CANS-NY and CANS AlgorithmAt this time, LGU/SPOA and ICC should all be CANS-NY certified and using the CANS-NY toolLGU/SPOA should be using/applying the CANS AlgorithmAny outstanding questions or concerns, LGU/SPOA can contact OMH (Contact: Michelle Wagner)
5 Next StepsOMH will be working on identifying key data elements to be collected by SPOA regarding HCBS eligibility process/outcomesFollow up calls will be taking place with identified counties for ongoing TA and support on Conflict of InterestCommunications will continue with counties related to the current and expanded roles of the LGU/SPOA in Waiver and in ongoing system change efforts
7 OMH HCBS Waiver Application Corrective Action PlanNew Rate MethodologyConflict of InterestTransition Age Youth**CMS will not issue an approval of OMH’s application to renew the OMH HCBS Wavier until all corrective action steps have been implemented
8 New Rate Methodology New Rate Methodology includes two steps: Remove Federal Participation Payment (FPP) share from Flex Funds and out of the ICC bundled rate (by January 2015)Unbundle ICC Rate, creating new separate rates for Care Coordination, Intensive In-Home and Crisis Response (by July 2015)
9 Flex Funds Rate CodeFor dates of service 1/1/2015, ICC rates will no longer include the monthly flex fund paymentProviders will need to bill the new “HCBS Waiver Flex Funds” rate code- 4398Since federal participation is no longer included –the $2500 per year per slot rate is now $1250 per year per slot.Just like ICC rates, “HCBS Waiver Flex Funds” are billed on the first of the month following the service month
10 Flex Funds Billing Procedures Providers can only enter one rate code per claim. You will now need to do two claims each month for each waiver slot.Providers will receive new Fiscal worksheets and will need to revise their budgets based on the new flex funds amount of $1250.You will, if you haven’t already receive a letter from DOH/CSC once the new rate code is available for billing. Any ICC claims already paid for January, 2015 services (2/1/15 service date) or later will be adjusted by DOH on a future claim. You will need to bill the new rate code for the Flex Funds for ICC claims previously paid and adjusted by DOH.
11 Flex Funds – Documentation & Approvals New Guidance was issued to providers on the use/application of Flex funds via – New procedures should be in place effective 1/1/15.ICCs are required to maintain a Flex Funds log of all expenses, related goals, and other necessary documentation (example provided via )Approvals from Waiver supervisors, LGU, and/or OMH Regional Coordinators for use of flex funds at or above certain amounts will still be requiredApprovals for ongoing or expenses in the aggregate at or above certain amounts will also be required.
12 Uses for Flex Funds Be thoughtful and planful regarding flex funds Ensure “emergency” expenses are used sparingly and only when neededExplore other options for financial supports, such as social services, state or federal assistance programs, etc.Ensure funding is “one-time” and options are put into place for long-term supportsFocus on personal growth/youth development efforts (boy scouts dues, art supplies, music lessons) or necessary unfunded services and supports (specialized evaluations or services)
13 Unbundled ICC RateEncounter data was collected from providers in December and submitted to OMH by the end of 2014Data has been compiled and is in the process of being reviewed and analyzedOutliers are being identified for follow up and clarificationCrosswalk of comparable services/rates is underway for comparison
15 Conflict of InterestCMS has not provided any feedback or comments on materials provided by OMH to dateCites the requirement that OMH comply with the HCBS Rule – has expressed concerns with ICC agencies providing direct HCBS Waiver servicesContinues to state that we are not in complianceHas referred OMH to CMS regulation on conflict of interest
16 CMS COI Regulation(vi) Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS. In these cases, the State must devise conflict of interest protections including separation of entity and provider functions within provider entities, which must be approved by CMS. Individuals must be provided with a clear and accessible alternative dispute resolution process.
17 COI Firewalls and Mitigation Strategies Examples of proposed mechanisms to address COI in the OMH HCBS Wavier:ICCs can only provide care management services and not directly provide any HCBS Waiver servicesICCs must provide a choice to families and offer any other willing and qualified service provider for any/all of the other five HCBS Wavier services that are availableOnly when there is no other willing and qualified service providers available OR service needs extend beyond the other provider’s available capacity, can the ICC Agency provide the HCBS Wavier service
18 COI Firewalls and Mitigation Strategies ICC Agencies who provide HCBS Wavier services must have administrative firewalls separating care coordination from direct HCBS Wavier service provisionFamilies must have multiple options to grieve their service plan/ services they receive – agency, fair hearing, county, StateIn addition to State agency oversight and monitoring, the LGU plays a role in ensuring availability of services in the network (subcontractors) for each HCBS Waiver service, wherever possibleAnnual site visits and ISP reviews monitor each ICC agency and HCBS Waiver service
20 Transition Age Youth Resource Website:Webinars: Join us for a series of webinars for NYS Transitional Age Youth Providers!The Mental Health Association in New York State, Inc. in collaboration with the New York State Office of Mental Health will offer 4 webinars in the upcoming months. The webinars will help prepare providers to “gear up” for providing the three new Waiver services (1) Pre-Vocational Services (2) Supported Employment, and (3) Youth Peer Advocacy, which will be integral for being able to the serve TAY population.Please mark your calendars and save the following dates from 2pm – 3pm:Webinar 1 – February 27, 2015 [go to for recorded session)Webinar 2 – April 24, 2015Webinar 3 – June 26, 2015Webinar 4 – September 25, 2015
21 Summary and TimelinesCANS-NY training: All Necessary LGU/SPOA/ICC must complete training in the CANS-NY Tool by the end of December 2014CANS-NY Algorithm: All Necessary LGU/SPOA/ICC must view on-line presentations/webinars on the CANS-NY Algorithm within the first quarter of 2015; Implemented by March 2015Wavier Slot Expansion Reporting: Status of Slots/Waitlists reported Monthly by LGU/SPOA - Due on 15th of each Month thereafter for Prior MonthNew Flex Funds Rate Code/Guidance: Implemented on January 2015New Rate Methodology/Codes for Bundled ICC Rate: Implemented on July 2015Conflict Free Case Management Strategies: Implemented on July 2015