CCO Basics: Care Coordination Organizations and You

Download Basic Primer CCOs-2018-04-23 FINAL EDITION

Background

The Federal Agency in charge of Medicaid, CMS (Center for Medicare & Medicaid Services), has mandated that New York State have a “conflict-free” system. CMS believes Medicaid Service Coordinators were sometimes steering families towards programs at the provider agency they worked for, and not the programs that best meet the needs of the individual.

So, NYS has created new Care Coordination Organizations (CCOs). Medicaid Service Coordinators (MSCs) will become Care Managers, working for these new CCOs. Care Managers will not work for an agency, just the CCO so that they will assist families in choosing services that are best for the person. This type of “conflict-free” system has been put in place across the country. New York is one of the last states to do so.

MSCs become Care Managers

The Care Manager’s job will be broader. Their job will include understanding behavioral and medical health in addition to the service system. CCO’s are responsible for training Care Managers and giving them access to a network of specialists in all these areas. Most MSCs have been offered jobs as Care Managers, and most have accepted. CCOs are also hiring additional qualified people to work as Care Managers. Care Managers will continue to work in the same physical space as before, but they will be employees of the CCO and not the agency. They may eventually have separate offices.

Decisions

Which CCO?

Each region is required to have at least two CCOs. There are three in NYC.

The CCO you choose will not change which agencies provide services to you or your loved one.

If your MSC has decided to move to a CCO you can follow them to that CCO. OPWDD says it will be easy to switch CCOs at any point in the future, so you are not locked into your initial decision. Those without MSCs can choose a CCO and the CCO must provide you with a Care Manager. The timeline for being assigned a Care Manager has not been set as of this date.

The CCOs are newly formed companies. None of them have any history of performance or financial stability or customer service. To help make a choice it’s a good idea to attend their presentations and hear about their plans and promises. You can just follow your MSC into the CCO they go to work for. You can change your mind later, after the CCOs start operating.

What Level of Care?

CMS requires that families and self-advocates have a choice of Care Management options. There are two choices:

1. Health Home Care Management. With this choice Care Managers are there for all issues, including getting medical care, finding services, and even signing up for food stamps. The Care Manager is there to help coordinate. They will not be making medical decisions

2. Basic Care. This choice includes only a few meetings a year and only about OPWDD services.

This new system will start July 1st, 2018. If you do not make a choice, the decision will be made for you.

FAQs about Care Coordination Organizations

Who will the MSC be working for, after July 1st?

Medicaid Service Coordinators (MSCs) will no longer work for a Provider Agency, but instead will become Care Managers and work for a Care Coordination Organization (CCO). In some cases, the services of the Care Managers will be “leased” to the CCO for the first year.

Will my services be interrupted?
The promise is that existing services will continue without interruption through the transition to CCOs, with Care Management replacing your “MSC Service”.

Doesn’t the MSC already deal with medical needs?

There is a section about doctors and medications in the Individualized Service Plan (ISP), but the MSC’s role is only to keep track of this information. They do not provide any assistance with dealing with doctors or medical treatment or preventative care.

Since we have private health insurance, why should we use the Health Home?

The Health Home does not duplicate the services of private insurance. Instead, the Care Manager provides assistance with health and wellness, and you are not obligated to use the recommendations or assistance. In addition, the Health Home option for Care Management provides help with other services, such as Food Stamps and housing support.

Where can I find more details about the Care Management Options?

For a list comparing Health Home and Basic, see pages 44 to 46 of the Draft Transition Plan dated February 21, 2018 on the OPWDD website. Yes, someone in New York State mis-spelled “transition” in the name of the posted document:

www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/docs/final_revised_draft_tranisiton_plan_feb_2018_for_publication.pdf

What if I don’t want a stranger coming to my home?

You choose where to meet the Care Manager. There is no need for them to enter your home.

What happens to the ISP (Individualized Service Plan)?

The Individualized Service Plan (ISP) will eventually be replaced by a “Life Plan” for each individual, including information about medical needs.

My MSC doesn’t have formal training in medical issues. What is being done about this?

CCOs are required to have a support network for their Care Managers, of people with expertise in behavioral health, mental health, medical issues, and family assistance.

Why does my MSC seem concerned about this change?

“When something changes, people hunger for information about how the change will effect them. When people lack information, they fill in the gaps with their worst fears.”
-Ken Schwaber

Communication about the changes has been late in coming. Now that details are emerging, MSCs are becoming more enthusiastic. In most cases, the salary packages and working conditions are more attractive than what they have been getting.

Why does my provider agency seem to be opposed to this change?

Some provider agencies might be losing a significant source of income. The providers are non-profits, and that income was used