Category Archives: Managed Care

NYC FAIR Meeting withh OPWDD Leadership on October 25th

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Kerry Delaney, Acting Commissioner, OPWDD
Roger Bearden, Acting Deputy Exec. Commissioner, OPWDD
Greg Roberts, Dir. of Legislative & Governmental Affairs, OPWDD

Will be at our meeting on
Thursday October 25th, 2018
from 6-8 PM

at IAC

150 W. 30TH St., 15th Floor

Topics will include

CAS, CCOs and the road to Managed Care

These changes touch every person with IDD and their families.

In person at:
IAC, 150 West 30th Street, NY, NY
Remote Location Possibilities will be announced

CLICK HERE

OR COPY THIS LINK TO REGISTER
https://goo.gl/forms/DYaHElCoVB6NqpWu2

SUBMIT YOUR QUESTIONS TO INFO@NYCFAIR.ORG
OR ON THE REGISTRATION FORM

Please indicate your location preference

And if you need translation services
We will do our best to accommodate these requests.

 

The link for OPWDD’s proposal for Managed Care for people with disabilities
YOU CAN FIND THE DOCUMENT AT THIS ADDRESS:
sipspl_qual_doc_with_attachments_final_draft_for_public_comment_8_31_18.pdf
OPWDD has recorded a presentation to outline the points made in this document for easier understanding. The presentation is available at https://opwdd.ny.gov/providers_staff/managed_care/providers 
YOU CAN COMMENT ON THIS DIRECTLY TO OPWDD THROUGH OCTOBER 17TH: peoplefirstwaiver@opwdd.ny.gov
WE ARE PUTTING TOGETHER OUR THOUGHTS AND COMMENTS ON THIS DOCUMENT
WE WILL POST THEM WHEN FINISHED
 
ADVOCACY SOURCES 
Sign- Up for NYC FAIR News: www.nycfair.org 
Get OPWDD Updates: https://opwdd.ny.gov/jointheconversation
& More Information Available at:
DEVELOPMENTAL DISABILITIES (DD) COUNCILS IN NYC:
Brooklyn: http://www.brooklynddcouncil.org
Bronx: http://www.bronxddcouncil.org
Manhattan: http://www.manhattanddcouncil.org
Queens: http://www.qcddny.org
Staten Island: http://www.siddc.org

CCO/HH – Memorandum of Concern by SWAN-NY

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SWAN of New York State

Comments from the State-Wide Advocacy Network of New York State, a coalition of independent family groups focused on services for individuals with Intellectual and Developmental Disabilities.
DDAWNY Family Committee       ENYDDA                 GROW           NYC FAIR

CCO/HHs – MEMORANDUM OF CONCERN

Executive Summary

As parents, we are attracted by the vision of an integrated network that improves and coordinates the services that our children receive. We would like this network to be effective and responsive, and it is in this spirit that we lay out our concerns about the ambitious agenda for the creation of care management for the IDD population as set forth in the draft RFA. Our hope is to help New York State create and maintain a person-centered system that helps all individuals with IDD live better lives. We understand that for the system to survive in a world of competing budget priorities, it must be able to point to the data-driven evidence of those better lives. Our belief is that to be successful, the system must have these characteristics:

  • A fundamental focus on appropriate use of services and supports which result in personalized goals, in contrast to medical model focus on reductions in avoidable use.
  • Outcome measurements and Value Based Payments based on that fundamental focus, which therefore
    • recognize the wide range of support needs.
    • do not penalize individuals with high acuity and their service providers.
    • reward CCOs and MCOs for maximizing quality of life, rather than rewarding them for minimizing the overall cost.
  • Ongoing structured family involvement in every step of the governance process, from creation of outcome measurements to policy definition, and all the way through to operational oversight.

Concerns: Family Involvement in CCO/HH’s

We hope you share our belief that parent participation will help the transformation process achieve the best possible results. To begin with, the core principal of Comprehensive Care Management is to coordinate services by assembling an interdisciplinary team to develop an individualized plan of care. Other disciplines recognize family advocacy as part of that team. We encourage OWPDD and DOH to examine how a family advocacy role can be developed for the CCO/HH.

We would like to see a role for family advocacy in the governance of the CCOs and MCOs. We recommend a strong ombudsman role and an appeals panel of family advocates.

Concerns: Measures for Value Based Payments (VBP)

The suggested outcome measures do not sufficiently take into account the wide range of support needs. While we want to support and celebrate those individuals who are capable of independent living and competitive employment, we are deeply concerned about the possibility of neglecting the higher acuity portion of the IDD population. Measurements are based on CQL/POMs, or use an increase in the number of individuals employed, the number who have moved into self-direction or more integrated settings outcomes that do not recognize acuity. The recommendations of the DD Subcommittee of the Clinical Advisory Group recognized the limitations of these measures. Applying this paradigm across the wide spectrum of individuals that comprise the I/DD population is not only inappropriate, it encourages service providers to limit the number of higher need individuals that they serve.

Earlier this year SWAN met with Director Helgerson to introduce ourselves and to share our concerns about the system transition to managed care. At that meeting we discussed the need for the development of better outcome measures. We propose that DOH and OPWDD form a work group with SWAN to create a process for working with families to develop these measures. We think a combination of surveys and workshops could be conducted around the state to identify a more comprehensive way to measure the outcomes for our loved ones. This same effort will also serve to educate families about the system transformation.

Concerns: Healthcare Bias in the RFA

The RFA reflects a healthcare bias, the medical model emphasis on preventing avoidable utilization. We recognize the importance of coordination between healthcare services and long term services and supports, and support the goals of reducing hospitalizations, promoting wellness, communication between providers, etc. However, for individuals with IDD that is just the starting point. The big challenge in IDD is the Long Term Services and Supports (LTSS). It is not clear from this RFA how non-medical LTSS will be affected by CCO’s.

As the creation of the CCO/HH’s is intended to be the first step to transitioning I/DD services into Managed Care, we are concerned there will be an effort to reduce rates for all types of services. For example, the current difficulties CDPAS individuals have with maintaining staff are due to Managed Care imposed rate reductions. Individuals using Self Direction with employer authority may be especially affected, but the impact of rate reductions would be felt everywhere.

Concerns: CCO Requirements

As outlined the MSC workforce will require extensive training as a pre-requisite for the job of Care Manager and it is not clear if there is the time or the resources to make that happen. The qualifications of new Care Managers defines a workforce that is not only has more training, but is a much more costly workforce.

Similarly, the IT requirements are considerable. The RFA mentions start-up grants, but there is no mention of how large they will be. We are concerned about whether these IT expectations are truly achievable.

Message from OPWDD and DOH Regarding the 1115 Waiver Draft Application

Advocacy, CCO, Managed Care

Dear Friends and Colleagues,

As you may know, over the past several years the New York State Office for People With Developmental Disabilities (OPWDD) has worked to offer New Yorkers with developmental disabilities and their families more control, flexibility and opportunities for innovative support customized to their abilities and needs.

This year, OPWDD developed a multi-year housing strategy to ensure that individuals seeking residential supports, including those living at home with family, will have supports available to meet their needs. We have helped more people self-direct their supports, leading to thousands more individuals with developmental disabilities taking greater control of their services. And, we have worked to help New Yorkers with developmental disabilities to find employment, in conjunction with the Governor’s Employment First Commission.

While these actions have led to great progress in OPWDD’s system, there is still much we would like to do to increase flexibility and choice. Individuals, families and service providers agree that individualized services and not one-size-fits-all solutions are the way to the future. While we have increased person-centeredness, taking the next step requires new approaches to transform.

An important step in this transformation is People First Care Coordination, an initiative of OPWDD and the Department of Health, to offer care coordination that integrates healthcare and community services—in addition to OPWDD-funded long-term support services—in a single life plan for each person served. While not impacting the intellectual and developmental disabilities (I/DD) supports a person receives, People First Care Coordination offers new opportunities for person-centered planning and integrated supports for people with complex needs.

To support this initiative, OPWDD is seeking a change to the authority under which Home and Community Based Services are delivered. This change will be effective January 1, 2018 pending approval from the federal government.

This transition is necessary for moving into the next phase of OPWDD’s transformation, allowing for the implementation of Care Coordination Organizations, operating under the federal Health Homes program in a conflict-free environment, and establishing a pathway to managed care.

New York State’s highest priority is to ensure that individuals and families will have continuity of care and existing plans of care will remain in place as this transition occurs. New York State’s draft application for this change, and instructions for submitting comments, can be found at this link:

http://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/draft_idd_1115_waiver.htm

Comments will be accepted until August 21, 2017. OPWDD will be scheduling a stakeholder briefing to review the application in detail and more information regarding date and time will be available shortly.

Sincerely,

 

Jason A. Helgerson                            Kerry A. Delaney

Medicaid Director                               Acting Commissioner

New York State Department              New York State Office for People

Of Health                                            With Developmental Disabilities

People First Care Coordination Webinar for Individuals and Families

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Dear Friends and Colleagues,

As you may have heard, the New York State Office for People With Developmental Disabilities (OPWDD) is moving forward with a new initiative aimed at enhancing care coordination for people with developmental disabilities. Through this initiative, called People First Care Coordination, healthcare, behavioral health, and other community services will be coordinated—in addition to the OPWDD services a person receives—in a single “Life Plan”. People First Care Coordination builds on the current service coordination model to offer greater simplicity, improved follow-up, and a person-centered planning approach that considers the whole person.

As part of our continuing outreach and information-sharing regarding People First Care Coordination, we are pleased to announce a webinar on Monday, August 7 for individuals and families served through the OPWDD system. This online presentation will describe plans for the move to enhanced care coordination, as well as provide the reasons for this shift and a timeline of anticipated next steps.

If you would like to attend this webinar, please note that advance registration is required. You may register by clicking this link. To experience the full webinar, both an Internet-connected computer and telephone are required. If you do not have access to a computer, you can also connect with just a telephone and listen to the presentation. For those who are unable to attend, once the webinar is completed, a recording will be posted to the OPWDD website for viewing.

In the meantime, if you would like more information, please visit the People First Care Coordination section of the OPWDD website and feel free to submit any feedback you have about People First Care Coordination to care.coordination@opwdd.ny.gov. The website also includes links to the draft application that entities seeking designation as Care Coordination Organizations will be required to submit. The application lays out the standards and requirements for Care Coordination Organizations in the OPWDD system. Comments on the draft application can be submitted until August 4.

We are making strides toward enhancing person-centered planning and taking a more holistic approach in our system and your continued involvement assures your participation as we move into the future. I hope you will join us to learn more about the People First Care Coordination initiative by registering at this link.

Sincerely,

Kerry A. Delaney

Acting Commissioner