Transcript Tapping Federal Opportunities to Support Transformation

THE TRANSFORMATIONAL
AGENDA FOR NY’S PEOPLE FIRST
WAIVER
MAY 7TH 2013
Care Coordination
Case Studies
RFA
Front Door
DISCO
ICS
Coordinated Assessment System (CAS)
RFI
People
First
Waiver
InterRAI Pilots
CQL
Managed Care
Personal Outcome Measures
Today’s Agenda
 Why Reform Now
 Major Parts of our
Transformational Agenda with
CMS
 Status of DISCO Development
 Transformation Agreement
 Contract Requirements
 Next Steps
Why Reform Now? – 3 Factors
1. The sustainability factor - how do we sustain
appropriate service provision within fiscal realities?
2. The relevancy factor - are the services we currently
offer those that families and individuals coming
into our service system are seeking?
3. The compliance factor - in light of Olmstead and
recent federal decisions on ADA, will the menu of
service options we provide allow us to meet the
goals of Olmstead and federal requirements?
4
OPWDD Transformation
As OPWDD pursued development of the People First
Waiver, we worked with CMS to define priority
elements of system transformation:
 Expanding opportunities and supports for
EMPLOYMENT
 Expanding COMMUNITY SERVICE OPTIONS –
supportive housing, community-based services
 Expanding SELF DIRECTION options
 OLMSTEAD PLAN- Creating opportunities for people
to move from institutions to integrated settings
Transformation Documents
 “Putting People First: OPWDD’s Road to
Reform” – comprehensive review of system reforms
recently achieved and underway
 “The OPWDD Transformation Agreement”
Appendix H of the DRAFT NYS Partnership
Plan Amendment (DOH 1115 Waiver)Articulates clear commitments for achieving
ambitious goals for system reform and service
delivery
Transformation Agreement
The Agreement contains commitments for OPWDD
related specifically to:
 Money Follows the Person (MFP) Demonstration
 Balancing Incentives Program (BIP)
 1915 b/c Applications
 Residential Transitions and Supportive Housing
 Supported Employment Services and Competitive
Employment
 Self-Direction
Federal Opportunities
Money Follows the Person (MFP)
Demonstration
An opportunity to receive enhanced federal
support for rebalancing the long-term care system
by transitioning people with Medicaid from
institutions to community settings.
Balancing Incentives Program (BIP)
Authorizes grants and an enhanced federal
Medicaid match to states that make structural
changes to increase access to non-institutional
long-term supports and services.
MANAGED CARE
• A Means or Road Map to System Reform
• Components of Managed Care in NY need to
include critical elements of CMS guidelines for
transformation:
– Housing and community integration
– Employment goals for all
– Opportunities for Self-Direction to those who
choose it
Waiver Process Update
Action Item
Timing
Status
Waiver Applications Submission
(1915 c amendment & 1915 b application)
April 1, 2013

Solicit Letters of Intent & Post Medicaid data
Mid-April 2013

Post final Request for Applications for DISCOs
Spring 2013
Hold Statewide VC on Medicaid Data
May 2013
Anticipated Approval of Waiver Applications by
CMS
October 1, 2013
 DISCOs begin enrolling volunteer members
 DOH Duals Demonstration begins enrolling
members into the first DD FIDAs (fully
integrated care for Medicare & Medicaideligible individuals)
January 2014
Managed Care Legislation
 The NYS legislature recently passed managed care
legislation that authorizes delivery of specialized IDD
services through a managed care structure.
 The People First Waiver, when approved by CMS, will
authorize the operation of DISCOs and OPWDD now
is focusing on establishing initial DISCOs.
 Later, OPWDD will request additional authority from
CMS to initiate delivery of specialized IDD services
through MLTCPs and HMOs and solicit those
applicants through separate actions.
Managed Care Legislation
 The enacted NYS budget authorizes several options
for specialized IDD services within managed care:
DISCOs
Managed Long Term Care Plans (MLTC)
Medicaid Managed Care organizations (HMOs)
 Each type is regulated by the same managed care
regulations and standards and must possess
experience with IDD services.
 OPWDD is initiating formation of DISCOs first.
DISCOs
 Governed by:
Public Health Law Article 44,
Mental Hygiene Law § 13.40,
Social Services Law §364-j
DOH regulations at 10NYCRRSubpart 98-1
federal regulations at 42 CFR Part 438
 Will have modified reserve requirements to facilitate
start-up.
 Must be controlled by one or more non-profit
organizations with experience providing or
coordinating health and long-term care services to
people with IDD.
MLTC or Medicaid Managed Care
 Same qualification standards for organizations will
apply (controlled by nonprofit, exp. with IDD).
 Same standards will apply for quality assurance,
grievances and appeals, informed choice, personcentered planning and marketing.
 Must have ability to provide or coordinate services
for people with IDD – either on its own or by
affiliation with another entity with experience, and
which will oversee or implement the coordination
and planning of IDD services.
Benefit Package
OPWDD Auspice Services
 OPWDD Comprehensive
Waiver Services
 Day Treatment
 ICF/IID
 Art 16 Clinic Svcs: OT, PT,
SLP, Clinical Social Work,
Psychology, Nutrition,
Rehab Counseling,
Podiatry, and Dentistry.
 Care Coordination
provided by the DISCO
DOH Auspice Services
 Adult Day Health Care
 Dentistry
 DME and Hearing AIDS
 Home Care (offered under any auspice:
hospital-based, nursing home-based,
and free-standing programs)
 Non Emergency Transportation
 Optometry/Eyeglasses
 OT, PT, SLP
 Personal Care
 Personal Emergency Response System
 Private Duty Nursing
 Psychology and Clinical Social Work
 Respiratory Therapy
 Skilled Nursing Facility
 Podiatry
OMH/OASAS Auspice
Services
 OASAS Inpatient
 OMH Institutional
Program (PC/RTF) &
private psychiatric
hospitalizations
 Outpatient – OMH,
OASAS
 Psychology and
Clinical Social Work
 OMH day
treatment
15
DISCO Contract
The DISCO Contract will:
 Build off NYS DOH’s Contract for Managed
Long-term Care Plans.
 With amendments to accommodate
provisions needed to reflect the specialized
developmental disabilities service system.
 And amendments to accommodate
recommendations of the Targeted Work
Teams.
DISCO Contract
The DISCO Contract will describe:
 DISCO authorization requirements
 Enrollment responsibilities
 Requirements to provide written materials, to
communicate in ways that are understood & in needed
languages
 DISCOs’ obligations to their downstream providers
 Care coordination obligations
 Records, reporting & certification requirements
 DISCO Payment
 And more
Suggestions for Providers
 Understand managed care law and regulation
 Network with other regional providers to understand
strengths, opportunities to collaborate
 Identify and articulate your strength and future role
in a service network (DISCOs will need to provide all types of
services for all types of individuals.)
 If interested in forming a DISCO:
Attend Statewide VC on Medicaid service data
Review Request for Applications
Review DISCO contract
OPWDD’s Next Steps
 Solicit applications for DISCOs (Post Final RFA,
Finalize the DISCO Contract, Hold Medicaid Data
VC)
 Implementation Planning for launching DISCOs
and cross system care management
 Program and Policy redesign to meet
Transformation Agreement commitments in
employment, self-direction, community housing
Most Importantly - Continued dialogue with
individuals, families & providers