OPWDD’s Transformation Update NYSACRA Leadership Conference December 4, 2014 Kate Bishop Director, Health and Community Support, Division of Person Centered Supports at the NYS Office for People With Developmental Disabilities

OPWDD’s Transformation Agenda Aims to Provide Supports That: Are fully integrated into the individual’s community of choice Focus on the person’s needs and wants Result in outcomes that can be measured

Why Managed Care? Each year, approximately 8,000 people with a variety of needs come to OPWDD seeking services. We need to create new and innovative ways to deliver and fund supports consistent with our vision in a changing landscape.

Where Are We Now: Awaiting approval of the 1915 b/c (People First) waiver. Anticipate DISCOs to begin coordinating care October 2015. We released the Certificate of Authority for DISCOs/Start-up Grant Application. Applications are under review, with announcement on funding expected in January.

OPWDD’s Big Picture Initiatives Three big initiatives are designed to improve the system and ensure individuals and their families get the services they need: 1. The Transformation Agenda 2. The Front Door 3. The HCBS Waiver Renewal

Transformation Agenda Shared goals agreed upon by New York State and the federal Centers for Medicare and Medicaid Services (CMS) to: Close institutions and support individuals living in the community Support individuals to be competitively employed Provide opportunities for individuals to self-direct their own services

Community Living

OPWDD Activities to Support Community Living Enhancing system capacity through partnerships System education on broader array of living environments Reduce reliance on institutional supports Developmental Center closure and reduction plans Community ICF transition plan

OPWDD set the closure timelines based on the date by which individuals are anticipated to successfully move into the community. People who continue to need more intensive treatment will receive necessary services in the setting most appropriate for them, with the goal of a community placement as soon as it is clinically appropriate. This figure illustrates OPWDD’s downsizing efforts since 1975. As of July 2014, only 634 individuals continue to reside in developmental centers or special population units across the state. OPWDD will retain a total institutional capacity of approximately 150. This capacity will be reserved for individuals with developmental disabilities who are court-mandated to reside in an OPWDD campus based setting and those with intensive, short-term behavioral needs that require stabilization in a focused, intensive treatment setting to achieve a successful return to the community.

In fulfillment of the U. S. Supreme Court’s decision in Olmstead v. L In fulfillment of the U.S. Supreme Court’s decision in Olmstead v. L.C. (1999), New York State is offering people who reside in institutional settings the opportunity to live and be supported in the community. Incorporating this mandate into its Transformation Agreement with federal CMS, OPWDD specifically embarked on an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Transition Plan which would shift the developmental disabilities service system’s reliance on the ICF institutional model of care to more integrated, community-based supports. Through the ICF Transition Plan, OPWDD will decrease the number of individuals supported in ICF/IIDs each year through October 1, 2018, at which time the only ICF/IID capacity that will remain is 456 opportunities in the Children’s Residential Programs, and the only campus-based capacity remaining will be 150 opportunities for intensive assessment and treatment for individuals who require those services prior to community placement. This figure trends the annual goals for the ICF Transition Plan.

Employment

OPWDD Activities to Increase Employment Outcomes New service initiated in July 2014—Pathways to Employment—to provide greater assessment and skill building to facilitate improved job matches Changing supported employment model and reimbursement to incentivize job retention; January 2015 implementation

OPWDD Competitive Employment Goal 700 new people engaged in competitive employment (net increase) Employed in an integrated community setting (general workforce) Earning at or above minimum wage

OPWDD Competitive Employment Outcomes DATE NUMBER EMPLOYED* As of April 1, 2013 7,044 As of March 31, 2014 7,369 NET GAIN 325 *Employed in integrated setting at or above minimum wage.

Self Direction

Self-Direction Goals: Provide education to at least 1,500 beneficiaries (with designated representatives as needed) per quarter beginning on April 1, 2013. Increase # of individuals self directing by 1,245 by March 31, 2014. Submit OPWDD self-direction policies for CMS approval, January 2014

Education on Self Direction

Year One -Total Growth of People who Self Direct

Transformation Progress Year Two Update

We declined by -118 individuals since last quarter.

We declined by -175 individuals self-directing their services, or 5%

Transformation Agenda Connection to Federal Initiatives Several federal initiatives have been made available to assist us in the transformation, including the Money Follows the Person (MFP) program and Balancing Incentives Program (BIP) (total $250m) MFP and BIP help OPWDD maximize resources by adding specialized funding focused on accomplishing transformational goals OPWDD Acting Commissioner Delaney will be discussing these initiatives with you tomorrow. Describe some of the creative examples that Allison’s staff provided to you.

The HCBS Waiver Renewal & Managed Care Managed care supports our mission and helps OPWDD meet its goals by: Providing better and more seamless access to services Removing “silos” that create barriers to services across systems Emphasizing outcome-based supports Incentivizing providers who achieve quality outcomes while using funds efficiently Care coordination will be more closely linked to service delivery, allowing greater consistency and continuity The primary goal of managed care is creating a system that builds and improves upon what exists already, and efficiencies will be achieved as a result of better management of services to allow us to serve more people

The HCBS waiver renewal will include two new models for self-direction, allowing individuals to select from an array of services and supports that will allow them to live as independently as possible The new HCBS settings regulations will see OPWDD and its providers offer services to individuals emphasizing choice and autonomy New funding models for supported employment are currently being developed

The Front Door Educate individuals and families about service options that can help meet their needs Assist individuals in seamlessly and quickly accessing services Emphasize integrated supports and how people can gain more control over their services and life plan.

The most significant changes are: Expedited processes for some individuals seeking non-waiver services, including FSS and ISS; also for individuals who are seeking only Supported Employment and/or Pathways to Employment. At initial contact, expedite work on determining eligibility, accessing Medicaid if needed, and securing a referral to service coordination services. Decrease the time needed for the development of a service plan through the Preliminary Individualized Service Plan (PISP) Implementing a streamlined process for individuals who are already receiving services but are seeking changes or additions. Based on feedback from families, providers and stakeholders, OPWDD will be implementing several procedural changes to the Front Door over the coming weeks which are intended to improve the experience for individuals seeking services and to expedite their access to services. In addition to improvements in processes, a procedure manual and standardized forms and templates will be used by OPWDD regional offices across the state to ensure consistency and to provide faster access to services. Additional changes will occur later this year, including the implementation of a new Service Amendment process for individuals seeking changes to their services and the implementation of a Vacancy Management protocol.

The Coordinated Assessment System (CAS) Validity Study is underway with stratified sample of individuals receiving support Upon completion of study, validity of CAS will be determined and any needed adjustments undertaken The data from the study will be used to develop acuity scoring of need levels for people receiving supports OPWDD is working with DOH to determine how the information will inform reimbursement in both FFS and Managed Care environment It is expected that the CAS will be implemented by late summer 2015 interRAI is a consortium of researchers from around the world that have developed standardized assessments for multiple populations. Person-centered administration- Unlike current assessment tools, the administration of the CAS requires that the person must either be interviewed or observed, as well as interviews with someone that knows the person well and records review. Interviews are done at times and locations most convenient to the person. Comprehensive- While a limited data set (e.g. the CAS will not replace specialty assessments (e.g. OT/PT) but is designed to raise the “red flag” as to where a care planner may need to assess further) the scope of the CAS is broader and includes looking at the individual’s strengths, relationships and natural supports as well as needs. The CAS is in draft format until the completion of the validity study.

Systemic Therapeutic Assessment Resources and Treatment (START) Launched in Western New York and Finger Lakes. Next roll-out is for Capital District, Hudson Valley, and Taconic. The program’s goal is to provide response and prevention services to individuals with intellectual or developmental disabilities and behavioral health needs, as well as their families and those who provide support within the community. START is a crisis prevention and response model that is comprehensively defined and evidence informed OPWDD has been working with the Center for START services out of the University of New Hampshire UCEDD to implement START statewide. START is a pilot program that will provide community-based crisis response and prevention services to individuals with developmental disabilities and behavioral health needs. START teams are operational in Regions 1 and 3 and are taking referrals Planning is underway in regions 4 and 5 (NYC and LI).A comprehensive gap analysis with stakeholder involvement is taking place currently. Additionally, clinical consultation and system education has been initiated in those regions. Teams are planned for implementation in early 2016 in those two regions. Region 2 will be the last region for implementation.

NY START is not a separate system and does not replace existing services. The NY START program will provide training, consultation, therapeutic services and technical assistance to enhance the ability of the community to support individuals with intellectual and developmental disabilities and complex behavioral health needs, and focuses on establishing integrated services with agency providers. Providing supports that help individuals to remain in their home or community placement is NY START’s first priority.

What Comes Next? Continuing process improvements to the Front Door, including an informational video for individuals, are in development Building upon our excellent success with the transformation agenda - OPWDD will continue to set and meet goals in its key focus areas Now that our rate issues have largely been resolved, OPWDD has proposed a timeline to CMS that will allow for managed care start-up on a voluntary basis