Tag Archives: developmental disabilities

NYC FAIR is making the case to OPWDD that there must be an Ombudsman to appeal to if people are having trouble with their Care Manager or Care Coordination Organization.

Each DDRO (Developmental Disability Regional Office) has

Care Coordination Support Liaisons – https://opwdd.ny.gov/opwdd_services_supports/service_coordination/medicaid_service_coordination/ddso_msc_contacts

This is a listing of the regional Care Coordinator Support Liaisons that can assist if you are having trouble with your Care Manager and are not getting any satisfaction with the CCO. Please contact the Support Liaison for your region.

PLEASE TELL US ABOUT YOUR EXPERIENCE WITH YOUR CCO: mailto:info@nycfair.org

COPA’s Final New York State 2019-2020 Budget Update

April 16, 2019Advocacy, Budget, opwddadvocacy, budget results, developmental disabilities, id/ddelly.rufer@gmail.com

Click Here to Download Copa’s Final Budget Analysis

April 2, 2019

Final New York State 2019-2020 Budget Update

In the early morning hours of March 31, 2019 Governor Cuomo and Legislative Leaders announced an agreement on a final SFY 2019-20 State Budget, just before the April 1st deadline. Legislators worked throughout the day and night passing bills with the Senate adjourning at 3am this morning and the Assembly finishing just before 8am today. The final budget totals $175.5 billion and keeps state spending growth under 2%. The final budget also:

Makes the 2% state property tax cap permanent;
Enacts first-in-the-nation congestion pricing in Manhattan (streets south of 60th) to leverage $15 billion to support the MTA;
Increases education aid by $1 billion;
Creates a commission to study and make recommendations on enacting a public campaign finance system;
Includes a series of criminal justice reforms including eliminating cash bail requirements for misdemeanors and Class E felonies;
Bans the use of plastic bags and allows counties/cities to opt in to a 5cent fee on paper bags;
Adds $500 million for clean drinking water infrastructure needs; and
Expands eligibility for the Excelsior Scholarship Free Tuition Program to households under $125,000.

The Senate returned to Session on the afternoon of April 1^st and the Assembly on the morning of April 2^nd before going home to their districts after a long budget week. The Legislature will be in Session on April 8, 9 and 10^th and will then take a two-week Easter/Passover break beginning on April 11^th. They will return to Session on April 29, 2019 for the remainder of the 2019 Session.

Following is an overview of the final New York State 2019-2020 Budget:

OPWDD

Human Services COLA – $0 We are extremely disappointed that the final budget did not include the COLA (2.9% this year) and defers it to 3/31/21.
#bFair2DirectCare – the final budget included funding for a 2% increase, including salary and salary related fringe benefits, effective 1-1-20, for 100 and 200 codes and another 2% increase, effective 4-1-20, for 100, 200 and 300 codes. $8.4 million state share. Increases provided from 4-1-19 can be counted towards the 1-1-20 2% increase for 100 & 200.
Development – ACCEPTS the Governor’s proposal for an additional $30 million state share this year for a fully annualized all shares $120 million (state and Federal funding) in additional funding available for “Program Priorities,” including; certified housing supports in the community; more independent living; more day program and employment options and increased respite.
Housing – ACCEPTS the Governor’s proposal for an additional $15 million in capital funds to develop affordable housing.
Managed care readiness – ACCEPTS the Governor’s proposal for $5 million for the NY Alliance for Inclusion and Innovation “to improve provider readiness for managed care through the development of best practices, performance measurement and outcome monitoring tools.”
“More efficient use of state resources” – ACCEPTS the Governor’s proposal for OPWDD to continue to work with DOH and CMS on efficiencies including to “reconcile” room and board financial support against actual room and board costs and a proposal to modify rate methodology to reduce admin reimbursement to 15% in accordance with the cap in Executive Order 38 presumably on a program by program basis
Integrated outpatient services – ACCEPTS the Governor’s proposal to add Article 16s to the list of clinics that do not need an additional license to provide those services. Last year, Article 28, 31 and 32 clinics were granted joint licensure to provide any of those clinic services under their current license. Article 16 clinics are now included this year.
Minimum wage funding – ACCEPTS the Governor’s proposal for $47.4 million state funding (for a total of approximately $94.8 with the federal funds included).

SED

The final budget increases public school aid by $1 billion or 3.8% but there are no recommended increases for 4410 or 853 schools. COPA has sent out an Alert asking everyone to contact their Regents to advocate that SED’s 853 and 4410 rate setting letter include:
- $15 million in increased teacher recruitment and retention funding
- A 3.8% tuition increase comparable with the general school aid increase.
Mental Health Education in Schools – ACCEPTS the Governor’s proposal for $1.5 million to prevent bullying, trauma, suicide etc.in schools.
School Waivers – REJECTS the Governor’s proposal that the Commissioner of SED to grant a waiver for any requirement imposed on a local school district, approved private school, or BOCES upon a finding that the waiver will result in implementation of an innovative special education program that is consistent with applicable federal requirements, and will enhance student achievement and/or opportunities for placement in regular classes and programs.

DOH

Early Intervention – ACCEPTS the Governor’s proposal to provide a 5% rate increase for Early Intervention PTs, OTs and SLPs. The Legislature did not expand the 5% increase to all EI providers as COPA had advocated. Additionally, the “covered lives pool” language did not make it into the final budget.
Consumer Directed Personal Assistance Program (CDPAP) Program/ Fiscal Intermediary (FI) Changes – MODIFIES the Governor’s language to require FIs to submit a contract application to DOH within 90 days of it’s posting on the DOH website. Eligible applicants include, but are not limited to, FIs established prior to 2012 and continually providing services, and independent living centers. “The selection of contractors shall be based on criteria reasonably related to the contractors’ ability to provide fiscal intermediary services including but not limited to: ability to appropriately serve individuals participating in the program, geographic distribution that would ensure access in rural and underserved areas, demonstrated cultural and language competencies specific to the population of consumers and those of the available workforce, ability to provide timely consumer assistance, experience serving individuals with disabilities, the availability of consumer peer support, and demonstrated compliance with all applicable federal and state laws and regulations, including but not limited to those relating to wages and labor.” FIs shall report annually to DOH in a form prescribed by the Department. Additionally, the DOH Commissioner shall establish a stakeholder workgroup, no later than May 15, 2019, to address fiscal intermediary services, the needs of consumers including transition plans and criteria for selecting FIs. FI reimbursement would move to a per member/per month methodology with three corridors but we have not yet seen the final parameters or reimbursement amount for those corridors.

Health Facility Transformation Fund Phase IV– ACCEPTS the Governor’s proposal to use $300 million, of the $525 million in new Phase III funding, that was included in the 2018-2019 budget, to fund Phase II applicants that did not receive a grant. These Phase II applicants will be rescored and those who will be awarded a grant, from the $300 million, will be notified by May 1, 2019. There will be a new RFP for the remaining $225 million from phase III with no new funding in the 2019-2020 budget proposal for Phase IV.
Elimination of spousal or parental refusal – REJECTS the Governor’s proposal for a spouse or parent to cover the cost of long-term care services in order to qualify for Medicaid – ($5.9 million) state savings.
Electronic Visit Verification – ACCEPTS the Governor’s proposal of $10 million for EVV costs for home care providers.
Prescriber prevails – REJECTS the Governor’s proposal to repeal prescriber prevails for both managed care and fee for service Medicaid for a savings of ($22.45).
0.8% Across the Board Medicaid Cuts for Article 28 Clinics etc. – REJECTS the original proposal but MODIFIES it to authorize that DOB and the State Health Commissioner MAY use a payment reduction plan to make across the board reductions, if necessary, to State Medicaid spending by $190. 2 million in SFY 2019-20 and 2020-21.
Applied Behavioral Analysis (ABA) – ACCEPTS the Governor’s proposal for Medicaid coverage of ABA for over 4,000 children with Autism Spectrum Disorders, including those who have aged out of the Early Intervention program. $6.4 million for 2019-20.
Medicare Part B Cost-Sharing – REJECTS the Governor’s proposal to amend the language that ensures that payments for individuals who are both Medicare and Medicaid eligible shall be the same if the individual did not have Medicare to ensuring that the payment not exceed the Medicaid rate. The savings is $23.3 million which would result from not paying the Medicare crossover amount to providers. There was concern that this would further limit the number of health practitioners who will to take Medicaid patients.

TBI – ACCEPTS the Governor’s proposal to move the TBI and NHTD waiver program under the Medicaid Global Cap.
Health Home Rate Reduction – INCREASES the Governor’s proposed $5 million to $20 million which will be achieved by “streamlining the outreach reimbursement rate for care managers after initial contact has been established. This reform will incentivize care managers to enroll new members in programs and connect them to the services they require while disincentivizing intense care management over an extended period.” This $20 million program reduction is of concern to our field as CCOs were modeled on health homes and many people with I/DD will require ongoing intense care management.

OMH

Human Services COLA – $0 and defers the COLA (2.9% this year) to 3-31-21.

#bFair2DirectCare – the final budget included funding for a 2% increase, effective 1-1-20, for 100 and 200 codes and another 2% increase, effective 4-1-20, for 100, 200 and 300 codes. $1.2 million state share.

Mental Health Education in Schools – ACCEPTS $1.5 million in the SED budget to prevent bullying, trauma, suicide etc.
Supportive housing and SROs rate increase– ACCEPTS the Governor’s $10 million increase.
Supports for high-need individuals – ACCEPTS the Governor’s $10 million for those residing in adult homes with specialized supports such as peer support and in-reach.
Community Reinvestment- ACCEPTS funding for community services expansion derived from the closure of additional state hospital beds of $5.5 million/$11 million fully annualized.
Capital Funds for Community Based Nonprofit Housing Providers – ACCEPTS $60 million
Behavioral Health Parity – budget includes several million dollars to enhance staff at the Department of Financial Services and the Department of Health to help assure health plans have adequate provider networks and are in compliance with parity requirements. dedicated to network adequacy and reviewing existing health plans to help ensure compliance with parity. Some of the specifics are:
- assures 28 days of SUD services and 14 days of inpatient psychiatric services for youth without the barriers associated with prior or concurrent insurer and health plan approval
- assures access to prescribed medications for treatment of substance use related conditions without prior insurer and health plan approval
- assures that the clinical review criteria used by utilization review agents must be approved by OMH and OASAS
- requires insurers and health plans to post additional information regarding their in-network providers of MH/SU services

Contact us with any questions.

Barbara, JR & Wini

Barbara Crosier

Vice President, Government Relations

Cerebral Palsy Associations of NYS

3 Cedar Street Extension, Suite 2

Cohoes, NY 12047

Phone: (518) 436-0178, Ext. 104

Cell: (518) 424-3198

E-mail: bcrosier@cpstate.org

John R Drexelius, Jr.

Government Relations Counsel,

DDAWNY
Law Office of John R. Drexelius, Jr.

PO Box 141
Buffalo, NY 14223
(716) 316- 7552
E-mail: jrdrexelius@gmail.com

Winifred Schiff

Associate Executive Director for Legislative Affairs

InterAgency Council of Developmental Disabilities Agencies, Inc.

150 West 30th Street 15th floor

New York, NY 10001

Office – 212-645-6360

Cell – 917-750-1497

E-mail: wini@iacny.org

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.