Minutes from NYC FAIR Meeting, April 13, 2018
CCO meeting at IAC
Elly welcomed everyone and explained that Tom McAlvanah of IAC would give some background to why these changes are being made. Then a representative from each organization would present. Two moderators would take turns asking questions that were submitted by attendees.
The floor would then open for questions from the audience
Presenters were:
- advancecarealliance.org– Jay Nagy
- caredesignny.org– Ed Matthews Adapt (UCP), Jim Moran CareDesign
- tricountycare.org– Connie Twerski, Bob Manley
- phpcares.org– Annrose Bacani
Tom McAlvanah, CEO of IAC gave the background that led to CCOs -changes had to be made to health care due to rising costs and questionable quality, as well as overuse of the ER and the high cost of drugs
Care Management offers reduction in re-admission to hospitals which leads to cost reduction. This way they will get a “Better handle on costs” and quality.
He explained how this impacts the world of IDD
NYS spends more per person than any other state.
Over $8B total for 130K people. ($4B is state share).
Now there are more people to be served. How are we going to manage this?
This means we are moving to Managed Care on the health side, and managing costs on the Long Term Support Services side.
The plan of Health Homes has been used in Behavioral Health in NYS for several years. For IDD it will be Health Homes Care Management
There will be no changes in current services, unless you request them.
The letters to sign up are coming out soon.
There are two choices in the level of care:
Health Home Care Management is “enhanced care management”
MSC services along with Medical and Behavioral Services. Also help with non-Medicaid services (food stamps for example) with regular visits from the Care Coordinator.
Basic is a few visits and only about Medicaid services
Then the representatives from each organization spoke
Jay – ACA
www.advancecarealliance.org
ACA covers a large area, small amount of specialized agencies
Jim Moran- CareDesign
Care Design is made up of 70 agencies.
They have been hiring the staff right from the start. Sent out 800 offers to MSCs and have gotten 750 yeses.
They plan to keep the staff at the agencies where they work today. They have worked hard on the communications and have had over 70 family forums and are continuing to do so. The focus is on advocacy and accessing supports. No good to have a plan, unless you can access the services.
www.caredesignny.org
Bob Manly from Tri-County
They cover 20 counties, covering regions 3/4/5.
MSC service will become Care Management which is enhanced, with additional resources for you. During the period of transition, member organizations will lease staff to Tri-County. Emphasis is on continuity.
www.tricountycare.org
Voice your concerns about MSC as soon as possible.
You have two choices to make .
Full care management gives you the greatest number of options.
Even if you don’t use all the resources, they will be available to you.
The other choice is basic.
The Second choice for families is to choose which CCO to go to.
Ann Rose Bacani- from PHP
This is managed care for individuals with I/DD who are eligible for both Medicare and Medicaid.
She has been in the field for over 20 years, starting as DSP.
PHP idea is: If Managed Care is coming, then let’s do it properly. This is just for people with IDD
You get a two-person team under PHP. Your Care Manager must be Licensed Social Worker or a Licensed Registered Nurse. LRN. The Care Coordinator is about the same as MSC.
PHP is the payor, and the team approves the services-not OPWDD- all except residential, so there is no need to go through the Front Door.
No cost transportation and home modification is available, along with durable medical equipment i.e. wheelchairs, eyeglasses, hearing aid, etc. You get these things much sooner as Medicaid says 5 years between new wheelchairs.
Their belief: If you are happier & healthier, then that saves money.
There is a network of providers and a network of doctors and hospitals
And they can urge providers to join the network.
PHP has been fully operational over the past 2 years with only 2% dis-enrollment rate.
www.phpcares.org
Questions & Answers
? What if your MSC has left the field?
Jay- The CCO has obligation to provide the service.
? How long do you have to wait?
Jim- We will add you onto a current Care Manager, or a supervisor.
There is no gap.
? MSC brings over higher caseload. Who sorts out who stays?
Jim- Families want continuity.
If they want to keep a caseload at 35. Which 15 will go?
? What is the ratio under Basic?
Jim- They will be paid $60 per month.
Not a lot of service for that amount. They do an Initial plan, and update.
Will not guarantee that you keep your Care Manager if you go with Basic.
Ed- Grew out of PCSS (Person-Centered Support Services). Not popular.
? If not affiliated with any agency ?
Jim- the 20 stragglers have to go to some CCO.
If they don’t decide, then the state, the local DDRO will decide.
? If the person is not competent, who decides?
Jay-Or if they refuse state will do “supported decision making process” and make a choice on their behalf.
? How does Self Direction fit in?
Jim-It should have no direct impact.
The State is not mandating Health Home, but they are strongly urging it.
Ann- PHP, Case load is 35, with a two-person team.
? Self Direction,
The budget stays the same. PHP works with the broker and Fiscal Intermediary.And PHP can expedite the budget approval for Self Direction– as fast as 2 weeks. Average 6 weeks.
? How are MSCs getting trained?
Connie- We are training them already.
All team members will be using MediSked electronic record keeping, with the consent of the person and their family.
? What is the system for replacing a Care Manager?
Jay- It’s similar to the process today. You talk to the supervisor.
they will try to resolve the issue, if not then will give you a selection of new CMs.
Bob- Sometimes, rather than complaining, the family or person will ask for a change in personnel. Often, it can be resolved when you take a look at the problem.
? Will there be enough Care Managers for everyone?
Bob- We need to have CMs for everyone.
We will need to overload cases; we will have managers pitch in.
? What is process for people who are graduating this year?
Jim- We have started regular discussions with Transition Coordinators, Have started that conversation. Already assessing how many staff are needed. Talking to District 75. Easier in the city with a centralized Dept. but
they do still need to go to the Front Door.
Connie- Hiring CMs.
? If you want to make changes?
Jay- About a one month turn-around.
? What goes into the Life plan?
Jay- It is a full assessment of needs, goals, etc.
Life Plans will be created on the renewal schedule for the ISP.
Connie- At the Annual renewal. We have a full year to do the ISP.
There can be up to 1600 questions.
POMs will be the start. It includes Health, wellness, and interests.
? How do you collect the medical info?
Connie- Your ISP remains in effect.
Jim- You can request an earlier Life Plan.
? Who do you go to, to get the letter?
Jim-The MSC agencies. Using the MSC tool-kit.
Ed- Trainings for the MSCs on consent started only last Wednesday so don’t panic yet.
Ann Rose- We have done over 800 Life Plans.
We take the current ISP, contact the person, make the assessment.
We do it through conversation and investigation, getting to know all about the person.1st month is the assessment and then the 2nd month is the Life Plan.
The IM assessment meeting—There are 1600 questions, but fewer questions if they don’t have conditions. If you indicate a condition there is a drop down menu with questions about that. If not then go on to the next section. We include anyone who wants to speak on their behalf.The meeting might be 4 to 6 hours.
? Is the Care Manager the advocate for Housing Placement?
Connie- It is the same as the current situation.
Jim- We have a work force that we do not know yet.
The quality varies. We have high expectations of the CM.
The CCO will say: “This is what the CM will do for you.
We are raising the bar on the CMs. Need to be doing metrics. Not waiting for you to complain. First make sure that they are doing what they are supposed to be doing today. And then expand it.
Connie- Lots of support being put into place, to educate them.
Metrics and measures.
? How are the CMs helping with Mental Health?
Connie- Creating a network of providers, including mental health.
Open to questions from the floor.
Q: How do you start, when the agency has not helped?
Connie- It will be up from there.
Jay- Go to the DDRO.
Q- They said, pick someone from the book.
Q- What about those going through eligibility right now?
Bob- There is a listing of organizations that have MSC.He has been encouraging organizations to continue to hire and provide services?
Jim- CCO cannot enforce anything at this point.
We can try to find an opening for you….
Q- Ralph. There are lots of questions, but they box you out from free-form questions.Will you provide us with the full set of branching questions, so that we can review beforehand? Or if not, then show us the MediSked contract.
Jim-We will take that to MediSked. What you are asking is “not unreasonable.”
Q- You make it sound like things will be getting better.
But if NYS can’t afford it now, how will they deal with this extra?
Jim- This program is funded by Medicaid. Actually, first two years are funded by Federal agencies at 90%. They believe that this will lead to lower costs, long term.
Connie- They are Looking for both better outcomes and efficiencies.
Actually get people what they want and save money by providing good resources, by providing doctors who are sensitive to needs of I/DD. And thus avoid hospitalizations. On-line piece– measure the data on what is going on. On-line, streamlined to figure out where are we spending the money and hoping that there is good news.
Bob-The most expensive part is hospital care. That is what the feds want to reduce– and that is better for the individual.He said that the home attendant program has worked very well in NYS.
Ann Rose- PHP. Because CM is a professional, they can reduce the re-admittance in the hospital.
Tom- In residence, if you have 101 fever, then you will go straight to ER. That will change.
Q- DDP2 today. What will happen in future?
Jim- Assessment must be person-centered.
Not DDP2, but will be some sort of assessment.
Obligated to provide the supports they need, not tied to a DDP2.
Q- Caseloads going down, and salaries going up. Give us the numbers?
Connie-We are decreasing the caseload, and increasing salaries. It’s Different at each CCO.
Q- Current ISP, the family can disagree and there is a protocol and process.
What are the protocols when a family feels that their interests are not protected by Life Plan?
Jay- An escalation within the CCO.
No loss of protections, no new protections.
Ed- Complete independence under this.
Prior, 70% of services were from the same place that you got MSC.
New system, the CM is completely independent.
Ann- PHP follows the same chain of command.
If you did not get what you want, then you go to the ombudsman, thru iCAN.
Q- CAS (Certified Assessment System) versus DDP2?
Jim- DDP2 is used to fund, for Self Direction. The CAS by itself does not drive
resources. It will contribute, but they have not gotten there yet. The summaries coming out of the CAS do not reflect the individual or the discussion that took place. Not clear how this fits in with the IM, the CAS, etc.
Q- For children who are in DOE, where do the CCOs step in?
Jim- OPWDD thought it was only for adults. But there are about 30K children who are eligible. OPW cannot replace DoE services. They can supplement after hours, but not during school hours. It is broken in many places, but NYC does it better than most. CSE in NYC is centralized. CCO will help.
Q- How do I choose among the three of you?
What makes you different?
Jay- The truth is that we are all launching something new.
Over time, we will be differentiating. But not much specializing now.
Main difference is the people, the staff who is coming over.
Connie- Job descriptions are all very, very similar. We are bringing over great ones, and some mediocre ones. And we will try to make them great, and if not then they will be mowing lawns in the cemetery.
? Will share the job description.
I don’t think you can go wrong. And we will differentiate over time.