Tag Archives: opwdd

IAC’s: Another On Time NYS Budget

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Download PDF: IAC Budget Recap 2015

IAC’s: Another On Time New York State Budget

By Wini Williams

Late on March 31st (actually 1:30 am on the 1st), the legislature passed the final budget bills which were still being printed on the last day. The Governor “postponed” many of the reforms he previously insisted on, including minimum wage, ethics and education, to have an on-time budget for the 5th consecutive year. As for programs and services for people with intellectual/developmental disabilities…..here’s what happened:
State Education Department (SED)
IAC is very hopeful that SED will request an increase for both 4410 and 853 programs, in the 3-3.5% range, through the usual process that exists outside of the budget. The Assembly had called for a 2.4% increase in the budget. However, we felt a more significant increase was necessary and therefore, they removed their request for a specific percentage. We will continue to support these increases through the next few months. The Assembly also included a delay in the implementation of regional Special Education Itinerant Teacher (SEIT) rates till July 2016 which we were concerned would derail the 4410 increase mentioned above. The final agreement contains welcome language which enables regional SEIT rates to be implemented as soon as SED is ready, but no later than July 2016. As always, the blanket waiver of NYS requirements for special education, proposed by the Governor every year, was defeated in the final version.
OPWDD
The Governor proposed $30 million for new services ($120M all shares fully annualized) and we had lobbied for modest increases for specific needs including $11.25M for residential development for people in desperate need, living at home with families and $3M for the expansion of Supported Employment, which is a State priority. In the end, only $2M ($8M all shares fully annualized) was added for new opportunities for families who can no longer care safely for their loved ones with developmental disabilities at home and an additional $1M to be used to facilitate the collection of information on peoples’ needs (so that good planning for the future can be accomplished). It is also intended to help advance the work of the transformation panel, charged with examining and making recommendations on the future of our service system (which our own Peter Pierri sits on). Language was included which ensures choice for people currently attending sheltered employment programs, the collection and dissemination of information on regional need for planning purposes (to be financed by the additional $1M), as well as reporting on the efficacy of the Front Door, and other provisions from bills that were vetoed by the Governor last legislative session. We will provide details on these provisions in the near future.
 DOH
Early Intervention:
Again this year, EI was ignored. According to the Department of Health, there was a decrease in spending for the program of $4.8M last year even though the number of children and the utilization
intensity per child stayed relatively the same and many new providers entered the system. We will get additional information on these claims so that we can develop a strategy for next year since we know that our providers have been discontinuing services for the last few years with no increases for virtually 20 years for this life-changing program.
Article 16 Clinics:
Two years ago, a 2% across the board cut was made to clinics and other Medicaid services, but for Article 16 clinics, the cut was taken based on utilization thresholds. Clinics which managed to reduce the number of therapies per person below the threshold received no cut. Others which were unable to reduce the number of services based on the individual needs of patients received as much as a 5% cut. Last year that cut was restored except for the Article 16 clinics. Despite support from the Legislature to add language which would direct the DOH to restore the Article 16 cut, the Department’s opposition to the restoration prevailed. We will continue to address this issue through the rest of the legislative session. Staff contact: wini@iacny.org

NYSARC’s Budget Results

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Download .PDF :New Budget Language nysarc

From NYSARC:

New Budget Language (the full text of these language changes is below)

The Legislature and the Governor agreed to a series of provisions that will provide greater oversight, planning and transparency relating to the implementation of a number of significant policies at OPWDD, including the following:

  • Residential services:  OPWDD is required toissue a report as a result of its  statewide review of individuals with developmental disabilities currently on the residential (waiting) list, including information regarding  services currently provided  to  such  individuals,  and  any  available  regional  information on priority placement approaches and housing needs  for such individuals. The report will update the progress the  office has made in meeting various transformational goals for people on the waiting list. Furthermore,  the commissioner, of OPWDD, in  consultation  with stakeholders, is directed to  establish a plan to increase housing alternatives for people with developmental disabilities.  The report must be issued by February 15, 2016.
  • Employment choice:  OPWDD will develop a plan to assist individuals transition to integrated work settings that will “provide choice of work settings for individuals with DD.”  The plan will solicit and analyze stakeholder input, involve outreach and education, set forth “a detailed analysis of options available to meet the needs and goals of those individuals who currently cannot or choose not to transition to integrated community work settings.”  The plan must be submitted by February 15, 2016.
  • Transformation panel:  Codifies OPWDD’s existing transformation panel which will develop a transformation plan.  The transformation plan will include recommendations  and  strategies  for  maintaining  the  fiscal  viability of service and for supporting delivery systems for persons with developmental disabilities. The plan will include strategies that will enable OPWDD  to  comply  with  federal  and  state  service delivery requirements and  provide appropriate levels of care. It will also study increasing access to self-directed models of care; enhancing access to integrated housing;  increasing integrated employment opportunities; and the program design and fiscal model for managed care. OPWDD must report the recommendations of the panel to the Legislature by February 15, 2016.
  • DC census issues:  OPWDD is required to provide the Legislature with monthly updates on developmental center deinstitutionalization which will include reports on current census, census reductions, support for discharged residents, etc.
  • Front Door:  By February 15, 2016, the commissioner  OPWDD shall  report on the extent to  which  front  door policy has been implemented; has improved  community education and available service options; has connected  individual  needs  to available services; and, has enhanced opportunities for self-direction.  OPWDD shall also make information available information regarding how the Front Door process determines priority placements and provides access to services.
  • Nurse Practice: Language is included to allow direct support employees to perform certain tasks in non-certified settings provided they are under the supervision of a nurse.  Final authorization is subject to a memorandum of understanding (MOU) between OPWDD and the State Education Department.  This authorization is critical for service expansion of the existing service system in order to meet unmet needs.
  • Transportation study:  Language is included to authorize OPWDD to contract with an entity to study the transportation needs of people with disabilities and to authorize the development of a pilot project to meet those needs.  Transportation, especially in rural areas, poses a critical barrier to employment and other important activities for people with developmental disabilities.
  1.  OPWDD budgetary additions in Aid To Localities (Funding for non-for-profits)

1)      $2 million in additional funding for people living at home with “caregivers who are unable to care for them.”  This equates to $4 million once matching federal funds are included and, it appears, $8 million worth of programming when fully annualized.

2)      $1 million which appears to be aimed at facilitating the information gathering and reporting requirements contained in budget language as well as the work of the Transformation Panel, though more detail is needed to evaluate this funding addition.

Additional items

  • A reserve fund of $850 million proposed by the Governor was passed as part of the State budget.  The fund is for possible retroactive federal claims relating to overbilling at Developmental Centers. The Legislature appeared to be on the verge of eliminating the reserve fund.  Steven Kroll sent a  letter to Speaker Heasty and Majority Leader  Skelos urging the Legislature to pass the fund as it was proposed by the Governor.  We are pleased that the Legislature did that.
  • Language was included in the budget to authorize reform of Special Education Itinerant Teacher rates (SEIT).  Reform of SEIT rates is seen by many as a necessary first step to obtaining a growth factor for 4410 preschool programs.
  • Language was included in the budget to review salaries for various elected and unelected State officials, including the commissioner of OPWDD.

 

Self-Direction Community of Practice meeting with Kerry Delaney, Acting Comm., OPWDD

Advocacy, Resources, Self-Direction, ,

By Lynn Decker

On March 30th, about 30 NY Metro families met by video-conference with Acting Commissioner Kerry Delaney and Kate Marlay, Deputy Director. Division of Person-Centered Supports, and Kate Bishop, Director of Health and Community Support, Division of Person Centered Supports.  This gathering was organized through NY Metro SD Community of Practice and we thank Mary Somoza for securing the meeting.

The agenda included the reduction in compensation to Fiscal Intermediary agencies that took effect on October 1, 2014, along with a variety of other elements of that “re-invention” of Self-Direction.  OPWDD staff recognized that the FI Compensation is an issue demanding attention, but stated they will be unable to re-open it for consideration with CMS until there is a year of experience data to present, and that can’t occur until July 2015 at the earliest.  They reviewed several measures they are offering to FI agencies in the meantime to provide financial assistance in the interim, including the Balancing Incentives Program grants that were announced in February.

Also discussed were the reductions in the available Personal Resource Allocation for some participants under the new formula, and the restrictions on rates and licensure for certain clinical consultants to Self-Direction plans.  OPWDD staff sought details from families to assess the impact of the first of these and possible alternatives or solutions to the other.

Exclusion of Individually Directed Good and Services (IDGS) funding for settings that are ‘specialized’ rather than integrated, which many families stated were the only suitable programs for their family member at this time, was also discussed.  Non-traditional but disability-focused programs that offer enhanced supports for behavior or physical mods that make it possible to develop skills needed for success in integrated settings are desired by many families, but excluded from Self-Direction funding.  OPWDD staff were less receptive to these concerns, saying that such settings needed to be made integrated in order to qualify for IDGS funds.

And finally, the inadequacy of the housing subsidy formula for any market priced housing in areas well served by transit was raised, along with inadequate support to access existing affordable housing offerings that may be appropriate.  The role of housing discrimination when approaching a potential landlord with documentation of housing subsidy on the basis of disability was also raised.

The commissioner expressed broad general recognition of family concerns and promised a face-to-face meeting with this group in the future.

If you or your family member are eligible for OPWDD funded services and wish to pursue Self-Direction with Budget Authority, you may request to join the google group for this parent effort at https://groups.google.com/forum/#!forum/ny-metro-self-direction-community-of-practice

Lynn Decker

Executive Board Member, NYC FAIR
lynn_decker@me.com

Changes in Delivery of Services for People with Disabilities, By Jim Karpe

Action Alerts, Advocacy, ,

Changes in Delivery of Services for People with Disabilities

OPWDD Transformation: Explanation and Commentary                                 March 3, 2015

Written by Jim Karpe, Member of the Executive Committee of NYC FAIR

Note: PDF File and Footnotes are at the end of the page

What is going on?
The system in New York is going through a transformational change. We wrote this document to empower you.[1] We want to help you influence the future of disability services in New York State.

The primary state agency responsible for providing and overseeing service, Office of People With Developmental Disabilities (OPWDD), has asked for public comment during the month of March. You can submit your comments at any time before April 1, 2015.

quality@opwdd.ny.gov, With subject line: HCBS Settings Transition Plan comments

-or-

OPWDD Attention: DQI HCBS Settings
44 Holland Avenue, 4th Floor
Albany, New York 12229

OPWDD has issued “explanatory” documents written in impenetrably dense bureaucra-tese.[2] There is also a 32-page power-point[3] which is slightly better– but only slightly. For example, the 11th slide of the power-point has 7 different acronyms (with zero explanations).

What is this?

In the paragraphs that follow, you will find out what is at stake, presented in clear and concise language, and almost no acronyms.   With the investment of only a few minutes reading, you will get the answer to the question: What is at stake? What is getting proposed?   And you can then contribute a comment to OPWDD. Links to the official documents are included, if you have the time to dive in.

Here, we also provide you with our own responses– on some issues, a blend of multiple responses, since NYC FAIR embraces a diverse group of people who sometimes disagree with each other. Just like any other family. And, we invite you to join our family. There are no dues, no blood test. The only qualification: You care about the issue. Maybe because someone in your family has a disability and you want to advocate for them. Self-advocates are welcome— by definition, you are in your family.

Without further ado, here is what is at stake.

Overall, what is at stake?

The life our family members will live. Our ability to get them the services they need.
The OPWDD (Office of People With Developmental Disabilities) controls the system
which delivers the “ordinary needs of special people”:

  • Housing
  • Transportation
  • Recreation
  • Jobs

OPWDD is re-structuring the system, in response to demands placed on every state by the Federal Agency in control of Medicaid funding, CMS (Center for Medicare & Medicaid Services).

NYC FAIR Commentary

At first glance, it appears there is an amazing system being put into place. The OPWDD Transformation Plan power point has beautiful language about “person centered planning” and providing choice. However, the reality of OPWDD plans falls short of the rhetoric in the opening remarks. The plan specifies the elimination of several important options, and the “pruning” has already started[4]. Meanwhile, implementation of the new choices has been delayed or bungled. The result is a severe narrowing of options.   Offering a choice among unsuitable alternatives is really offering no choice at all.

There are three fundamental problems. The first and most severe, is that the transformation plan eliminates options that are tailored to the needs of those individuals with more severe issues.
We have a moral obligation to take care of the most vulnerable. Let’s not abandon that obligation by eliminating programs and services– especially since those changes are not actually required by the Feds. The guidelines from CMS allow for a wide range of housing options and employment programs. The New York State plan calls for dismantling “safety net” options, and thus will reduce choice in the worst way for the most vulnerable.

The second fundamental problem is lack of ways to ensure transparency and accountability—in brief, “no teeth”, no actual follow-up. Instead, time after time what actually emerges are more additions to the thicket of rules which prevents delivery of needed services, and a distressing lack of transparency at OPWDD and very little routine reporting about OPWDD activities. The gaps in reporting makes it difficult or impossible to answer even basic questions such as: How many individuals are unemployed? “In God we trust; all others must bring data.”

Third, failure to implement the actual service delivery. Sometimes the delivery falls short, sometimes a failure to even get started. One example, the Front Door, a program launched in 2013 to welcome new families to OPWDD, was and is severely under-staffed. Consequently, to many families it appears jammed shut.

NYC FAIR calls upon the OPWDD to expand options rather than prune them, and to practice transparency and accountability—starting with regularly scheduled releases of information about waiting lists and service delivery.

Housing for people with disabilities

The plan specifies what kind of housing and supports will be funded. OPWDD says it will eliminate funding for all facilities which house more than four individuals.

NYC FAIR Commentary

We want to ensure that each person with disabilities gets the type of housing they need. To achieve that, for real choice, for real person-centered-planning, the system needs to offer a true range of housing options. For example, “clusters” of housing for dozens of individuals can provide specialized medical and therapeutic services, while also meeting all the published criteria for
self-determination in housing, such as the right to privacy, visitors, etc. CMS clearly states that “the regulation does not specify size”[5].

To make sure the system offers appropriate options, we need to have routine transparency and accountability. One simple example: How many people with disabilities are waiting for housing? All we know for sure is that the number is large and growing–probably well over six thousand.

NYC FAIR calls upon OPWDD to expand the range of housing options, including the preservation of settings with more than four individuals.

Employment for people with disabilities

OPWDD has determined that it will eliminate all sheltered workshops– despite its own assessment that only half of the participants will make the transition to supported employment.[6]

NYC FAIR Commentary

For those who are capable of work, the daily routine provides structure and dignity to life.
We want to provide this to as many individuals as possible. Based on NY State reports[7], fewer than fifty-five hundred people with disabilities have jobs (supported employment). Another eight thousand are in sheltered workshops. That means no work at all for thousands and thousands of recipients of OPWDD services.

Closing workshops will not magically propel thousands into the workforce. Instead, they will go into group Day Habilitation programs, or worse, into stay-at-home non-programs. Rather than eliminating workshops, OPWDD should transform them. CMS allows sheltered workshops, as long as they are not completely sheltered: “a state could allow pre-vocational services delivered in facility-based settings that encourage interaction with the general public (for example, through interaction with customers in a retail setting).”

NYC FAIR calls upon OPWDD to fix the sheltered workshops, rather than shutting them down. Add retail settings for selling their production, or create other ways to “encourage interaction”. An imperfect daily work routine is far superior to no work at all.

Self-Direction

The Federal agency, CMS, urges the expansion of self-direction, and OPWDD proclaims this as one of their initiatives. However, the reality is that less than three thousand families have self-directed plans. And perhaps fewer than two thousand– the lack of transparency makes it impossible to tell.

NYC FAIR Commentary

Self-Direction (SD) is one excellent option. But it is not for everyone. For starters, as organized today, Self-Direction requires a heavy investment of time from an unpaid advocate– usually the parents. Further, recent changes in the program have created additional obstacles, including the low rates offered to specialists who are paid through Self-Direction. Even worse, the change in fee structure for Financial Management Services (FMS) has caused agencies to reconsider their involvement in the program. Without a strong network of FMS agencies, there cannot be an expansion of the program.

NYC FAIR calls upon OPWDD to make the many changes required to preserve Self-Direction as a viable option, and then to go further: Make it easier to use.

Staffing

NYC FAIR Commentary

The Transformation Plan does not directly address staffing. But paid staff are the ones who actually deliver the services which provide a range of options and opportunities. Without a trained and stable work force, there is no delivery of anything. And in response to poor pay, trained staff members have to leave for other jobs in order to meet their own needs for food and housing. High turn-over disrupts service delivery, and also creates higher costs for recruiting and on-boarding, including training.   The OPWDD plan highlights the problem: “While OPWDD has trained over 2,000 staff of provider agencies in the areas of assessment, planning, job development and job coaching, the turnover of provider agency staff is such that ongoing provider training is necessary.”[8]

To create and deliver a wide range of options, we need well trained personnel. And that requires a competitive salary and benefits package, to retain those trained personnel.

NYC FAIR supports a routine annual Cost Of Living Adjustment increase for staff.

 

[1] We are NYC Family Advocacy Information Resource (NYC FAIR) a newly formed advocacy group.
We are family members of individuals with intellectual and developmental disabilities (I/DD), and concerned others. www.nycfamilyadvocacyinformationresource.org

[2] The OPWDD documents related to the March 2015 commentary period are listed at

www.opwdd.ny.gov/opwdd_services_supports/HCBS/announcement-for-public-content

Direct link to 15-page public commentary announcement: www.opwdd.ny.gov/node/5902

Documents about transition plan: www.opwdd.ny.gov/opwdd_services_supports/HCBS/hcbs-settings-toolkit

[3] Direct link to 32-slide powerpoint: www.opwdd.ny.gov/node/5905

[4] Example, closures of residences and workshops in Hudson Valley:
northcountrynow.com/news/st-lawrence-nysarc-facing-closure-work-centers-0137255

[5] See Question 5 on page 8 of

www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/q-and-a-hcb-settings.pdf

[6] “OPWDD estimates that 50% of workshop participants could successfully transition”, page 7 of www.opwdd.ny.gov/node/4791

[7] See public reports available from New York Employment Services System www.nyess.ny.gov

[8] Page 5 of www.opwdd.ny.gov/node/4791

What is at stake in OPWDD Transformation March 3, 2015 PDF