Tag Archives: CCOs

CCO Report Card: NYC FAIR Meeting March 21, 2019

April 16, 2019Advocacy, CCO, Managed Care, Meeting Minutes & Handouts, nyc fair, opwdd, Self-Direction, Traditional Services, Uncategorizedadvocacy, CCOs, complex needs, developmental disabilities, id/dd, managed care, opwdd, self-directionelly.rufer@gmail.com

NYC FAIR Minutes Mar 21 2019 FINAL

Panel:

Jim Moran- Care Design NY
Jay Nagy- Advance Care Alliance
Malik Abdur-Razzaq- PHP
Jackie Spring- Tri-County
Bob Manley- Hamaspik Choice

Elly introduced the panel, and thanked them for coming to speak to the group. She passed the hat to pay for the costs and asked that each panelist speak for a few minutes about their organization

ACRONYMS: CCO – Care Coordination Organization, CM- Care Manager
LP– LifePlan, MCO- Managed Care Organization, OPWDD-Office of People with Developmental Disabilities, DOH – Dept. of Health, CMS– Center for Medicare and Medicaid Services, CDNY- Care Design New York, PHP – Partners Health Plan, ACA- Advanced Care Alliance

Jim Moran commented after Elly’s pass the hat that the CCOs should pay for the translators for the meeting. Elly reiterated that we have not taken money from any agencies or governmental agencies in order to remain impartial.

INTRODUCTIONS

Jim Moran introduction:

CareDesign supports 26K individuals. From LI to Canadian border. 60% of the enrollees are from the Lower Hudson Valley all the way to the end of Long Island. Care Design is working through a number of transition issues. They have launched four advisory boards, each in a different region and have been getting very useful feedback from them. The Advisory Boards have suggested that there be a “What to expect from your CM” guide. Jim commented it would be on their website soon. They have also shared in creating an assessment of staff survey. Their plan is to join as the Care Coordination organization under PHP as a Managed Care entity

Managed Care has not gone well in other states. $8 B system with only $1B of that spent on health, the rest is Long Term Supports & Services

Jay Nagy- ACA.

Also still working through thorough creating a CCO. They have enrolled 25K, solely downstate, Lower Hudson to the end of Long Island. ACA has 530 employees (Care Managers?), but the remaining Care Managers that they have are currently only contracted by through July. Right now, they are working on doubling their Advisory boards. They Get feedback and have a dialogue. They are focused on the future, and for the transition to MC are pooling with two other CCOs to create another option.

Malik Abdur- Razzaq PHP

We take care of 1300 individuals who are dual-eligible, both Medicare and Medicaid. We are the payer, we pay directly so there is less time lag getting services. Soon we will add Medicaid-only members.

Jackie Spring – Tri-county Care.

She remembers when OMRDD was formed initially after Willowbrook. She feels the family voice has been missing and is glad to see it is back. and Jackie is also glad that the commissioner has met with parents.

Tri-County has 10K individuals, from the lower Adirondacks down to LI. The Director of Tri-County is also a director of a Managed Care organization – Hamaspik. . All of the CCOs are working together to solve problems.

Bob Manley Hamaspik- Parent org for Tri-County.

He currently runs a MLTC Managed Long Term Care, for frail elders. But they are creating a MC organization for people with IDD. They want as robust a network as possible, their goal is to get your doctor in the network.

Prepared Questions

It’s been 9 months since the change to CCOs, has your mission changed? If so, how?

Jackie- No, offering quality services was and remains our mission.

Please define the difference between Basic and Comprehensive Coverage?

Jay– Basic involves coordinating only the community-based supports.

Comprehensive, as it says, is community, medical and behavioral needs, the whole person

What is the Impact of this transition to CCOs on Self Direction (SD)?

Folks might find Basic is not adequate support, in terms of CCO’s meeting people’s needs. More of the burden falls on the family.

For each CCO how many are in full, and how many in basic.

Jay– 1K in Basic and Full??

Care Design – 800 in Full or basic??

PHP– None in Full or basic??

Jackie- Most of our members are full

Who do you report to – OPWDD, Dept. of Health (DOH) or Center for Medicare and Medicaid Services (CMS)?

Jackie– We are responsible to all of the above– CMS, DOH, OPWDD. We need to send in weekly reports to OPWDD on how many people are still without a CM, what the status is of the I AM assessments, LifePlans, caseload ratios. A whole roster about everyone who is served.

What incentives are there for doctors to join PHP?

Malik– We do not offer financial incentive. But doctors know they will be paid faster, we will pay after 90 days. Currently only 50/50– doctors say to us, you are new, I don’t want the hassle. But when Managed Care becomes mandatory, we anticipate that the vast majority will join.

Bob– To build a network. You need to financially incentivize. Some Doctors ask for 10x the Medicare rate, but we say no.

Did any of you comment on the proposed plan for Managed Care of people with IDD?

Jim – Care Design sent comments on the draft plan last November. We used this as a platform to talk about the issues which are not addressed by MC. For example, housing, the COLA. Stream-lined, efficient service providers. How do we make this the best it can be. We can send copies of our comments.

Jay-We are still waiting for the State’s response. We commented that they should be making it easier for providers to participate.

Jackie: We commented about providing choice

Has the introduction of CCOs changed the Front Door process?

Jackie- OPWDD does not present the process accurately. People think “I came through the Front Door yesterday, now where is my CM?” They don’t explain the process of establishing eligibility, gathering docs, etc., etc. The people at the Front Door are not explaining the system properly. It is hard to say what an average time is. Some already have Medicaid. Some have good psychological records from school. Or, others are 50 years old and have no paperwork. On a good day, it can take 2 weeks. If you need a Psychological it can take a couple of months.

Who participates in the Life Plan when families are gone?

Malik– Families need to have a plan in place whether it’s other family members, or other people. Work it out with the family. If there are none…the executive director of the agency can serve as the person.

Why have there been no improvements in service delivery?

Jim– This is a challenge we all have – it takes specific data that we don’t have access to

We are paying attention to the challenges with Medisked. None of the CCOs know what services people are enrolled in. Instead, CMs have to enter that data in. Was designed as if it was a new system, of 103K people

Health Homes do not have access to the Medicaid Data Warehouse. So we know service authorizations, not services they are getting. If an agency has not offered the services you need, then the CCO should be helping you solve it. This is not a big secret and it is getting worse, not better. It is about money, and workforce. Need an adequate and competent workforce.

The promise was that the new system with higher pay would be able attract and retain CMs but that is not the case. What is being done to address this?

Jay- This can’t be solved overnight. It will take a while to stabilize the workforce. ACA will be better able to deal with this after the transition year is over.

Jim– We have promoted some CM’s to be supervisors, which has caused a subsequent shortage of and need for more CM’s. Those who have multiple languages have adjusted compensation. We provide higher pay for Masters degrees. CMs are feeling stressed.

Jay– The Tier 4 structure has created a lot of turmoil as well. Tier 4 is made up of people from the Willowbrook class and others. We have had to re-assign CMs to get the caseloads sorted out.

Jackie– It is not crystal clear how people who are not from the Willowbrook class became Tier 4.

Some are from SD. They used the DDP2, plus something “secret”. We are retaining people by offering good benefits.

Information about individuals is not getting to new CMs? Why?

Jackie– Transitioning, and if the CM does not come over to us then the documents did not come over. If they were not uploaded into MediSked we have to enter them from paper. They should be there otherwise.

Jay– Sharing documents has not happened as it should– from agencies, or from the family. Documents are not flowing as freely as they should. We need the Level of Care Eligibility Determination (LCED).

We are pushing for documentation within 72 hours–but it is not yet achieved. Provider Agencies are not sharing docs– just have to work through it.

Jim– It is a struggle to get the docs for 103K people.

CCOs are not responsible for this, but we are working through it, and if you have gone through something new, and CM is asking, it is possible that it is because we have had problems with docs that disappear.

CMs are having problems finding services, even after they have been approved?

Jim– Yes, this is a problem- finding a provider willing to take someone, willing to actually provide service. Leadership needs to step in, a CM can only do so much. We need to have systems in place to track that, and pay attention to that.

Should families be informed of the efforts the CM has made to find services?

Families should be informed of the efforts

If you are not happy with CM, what should you do?

Jay- You need to reach out to the CM’s supervisors, Directors, senior directors, Assistant Vice Presidents, VPs, up to CEO.

How do we get the supervisors?

Jay– ACA has the senior directors on website.

Jim- We expect CMs to provide supervisor’s information, or, you can call into CareDesign.

Jackie- It’s in the welcome letter, including a fridge magnet, and customer service line.

When will the CMs be able to start working on services?

Jackie– We have started tracking that. The LifePlans should be done within 45 days, and then published within 60 days.

Following that service authorization and services. Should begin within 80 days

Malik– We operate as the Front Door for our people. So aside from difficulty with finding CommHab workers, there is not much of a problem.

CAS and I AM and LifePlan

How many LPs have been done? What is the deadline?

Jim- The Initial intention was within 6 months, but now with a new deadline we have until the end of December.

But For tier 4, it was to be done by the end of March. Just yesterday, we were told to submit a plan for why it should not be March 31st.

Jim: CareDesign put in plan for end of May 5.4K

Jay-Disappointing number. We had challenges, system challenges, staff familiarity. The focus now is on Tier 4, and on new entrants.

Why aren’t families allowed to see CAS questions?

Jackie- Don’t know why, but for I AM, we can share. And depending on some questions, you don’t have to ask others. CMs are given liberty to skip over questions like: Where do you want to be buried, do you sleep naked? etc.

There are a number of problems with the CAS-, how to amend, it’s overly long, it’s not informed, not user friendly, some questions are beside the point. Can this be made better?

Malik– CAS, can’t say, we don’t use it. I AM is 45 minutes now for PHP. There is a learning curve, it will get better. Families are part of the process. You should be signing off on the LP. If that is not happening, you should be having a conversation. The portal, MediSked, has an on-line portal for families with MediSked at PHP.

Jackie– CCOs do not have the portal yet. We want to be sure that it will work well, when it is brought up.

Jay- Security requirements for CCOs are delaying the roll-out of a family member portal. We are held to a very high standard. We are working together, all 7 CCOs, to figure out how to make it happen. Meanwhile, can print it out and provide the information.

Jim- We think MediSked cannot meet the security requirements now. Our thought was to provide families with the right access first.

Meri- It is a shame that our families are the learning curve.

Are any CCOs going to be MCOs or be subsidiaries?

Jim- CareDesign will not be an MCO. Plan is to connect to PHP. But we also want to provide CM through a contract to others.

Jay- Working to create something with 2 others.

Bob- Hamaspik is building the MC organization, working with a for-profit.

Jim-The legislation requires, at this time, that an MCO be a non-profit. No ability at this time, for for-profits to come in.

Live questions from audience

Q- Lack of data, lack of staff. Due to transition. What happens on July 1st to change that?

Jim- Have to be creative with work-arounds. Actual service data, will take a while to do.

Staten Island PPS (Performing Provider System) has access. Have to get creative about what to do, when the state does not deliver.

Q- Do you have a dialogue with OPW about these issues?

Jay– We speak as a group every Friday.

Q– The LifePlan, does that replace the Letter of Intent?

Jim- Don’t know what that is…

Jay- Not meant to replace that. It replaces the ISP.

Q-I have a son in a group home– I was advised to choose a CCO independent of that agency. How much autonomy and independence? How much power?

Jay– Certainly the way the CCOs are getting setup, CCOs don’t get to dictate. But we have a dispute resolution process. Legally, we are the independent conflict-free authority.

Jim- The CMs job is to get involved in that. Our goal is to be collaborative. If there is conflict, our job is to represent the individual. We also need to come to an understanding with the agency, service provider. We will elevate it in the organizations, if needed.

Q-The LifePlan is the driving force document. Once it is published, it is locked, and then cannot be changed– only amended. Why isn’t the family allowed to review it before it is “published”?

Jim- Expectation is that families sign off on the plan. If the plan is not right, then there are ways to change it. Can’t be published until the family has signed off on it, and reviewed by the service providers. It is not a matter of “published, and that is it”. There are ways to deal with it.

Jackie-We are asking our CMs to provide a draft of the LP before the LP meeting, and do the tweaking at the meeting, so that the final LP is accurate. Changes that the individual and/or family want, are the changes we are most interested in

Q- How can we inspire our CCOs to work with a sense of urgency? How can I hold them accountable, and

yet also inspire them to do their job?

Takes two hours to get her 5 yr. old to go out the door in the morning. Not effective right now. Not working. Shuffled around by 4 CMs so far.

Jackie-Some of it, we don’t have control over.

Comment Lots of anger, because the CM dropped the ball.

Jackie– I apologize for that. Monitoring them more closely.

Remote, from FREE-

Ralph- I AM is filling in LP. We have not had assurance that the family can get a printout, and verify the answers.

Jim- You can ask for a printout.

How does that create a draft of LP– The I AM does not do it, in and of itself.

Working to stream-line the “I AM”.

Once the plan is done, that is when the CM work really begins…

Q- Where is the training for the family on the LP? How do they learn what should be there?

The auto-generated LP needs to get revised.

CMs are getting distracted with LP, rather than delivering services. What is in each section?

Audience- You need to include us.

Jim- Parents need to be included. We will select parents to work with us to improve.

It seems to focus on group homes, rather than on community living.

Q-(Evan) Inaccurate. People without family. In fee-for-service, they got the service whether appropriate or not. With MC, for those who are not reliable narrators, (good reporters). What are you doing to make it better? For those who do not have someone looking out for them.

Malik– Deal with data. Most of their people are non-correspondents (no strong family). We get the info from the group home; we vet the providers. We do medication review, have found issues. We are being pro-active. Some places, the provider does not have good records. If you have issues with I AM. PHP invented the I AM Have to go back to his shop and look into it.

Q- I AM. Some things that are important, and others are ridiculous.

How do we get to a flexible, accountable vehicle? You liked a certain shampoo, maybe like a new shampoo. It has to be dynamic…. If it isn’t dynamic, then we get stuck.

Jackie– We are trying to train our CMs to know that they have the authority and responsibility to change this. At the beginning, we did not tell them to show you the draft. Now, you can tweak it.

Jim– Expectations are the same as with the MSC. There are different points in people’s lives, when things change. It gets reviewed with family and individual, every six months. And it can be changed at any point in time, if there is a change needed.

Q- Very concerned about how SD will fit into this. There are big problems all around. How does SD fit into this?

Jay- ACA has gotten positive comments about LP from people in SD. There are pockets where things go well, and other pockets not so well. Please provide feedback that LP was bad.

Malik- Those of our members who have SD, we approve budgets in weeks, not months.

Q-SI- How often are these assessments done?

I AM is done once, then LP is renewed every 6 months.

Minutes of NY FAIR’s CCO Meeting : CCOs

May 11, 2018Uncategorizedadvocacy, CCOs, developmental disabilities, id/dd, managed care, opwdd, providerselly.rufer@gmail.com

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.

NYC FAIR’s Basic Primer on CCOs

May 11, 2018Advocacyadvocacy, cco, CCOs, developmental disabilities, id/dd, opwddelly.rufer@gmail.com

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:

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

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