OPWDD’s Transformation Update

NYSACRA Leadership Conference December 4, 2014 Kate Bishop Director, Health and Community Support, Division of Person Centered Supports at the NYS Office for People With Developmental Disabilities

OPWDD’s Transformation Agenda Aims to Provide Supports That:

 Are fully integrated into the individual’s community of choice  Focus on the person’s needs and wants  Result in outcomes that can be measured

Why Managed Care?

 Each year, approximately 8,000 people with a variety of needs come to OPWDD seeking services.

 We need to create new and innovative ways to deliver and fund supports consistent with our vision in a changing landscape.

Where Are We Now:

   Awaiting approval of the 1915 b/c (People First) waiver. Anticipate DISCOs to begin coordinating care October 2015. We released the Certificate of Authority for DISCOs/Start-up Grant Application. Applications are under review, with announcement on funding expected in January.

OPWDD’s Big Picture Initiatives

Three big initiatives are designed to improve the system and ensure individuals and their families get the services they need: • 1. The Transformation Agenda • 2. The Front Door • 3. The HCBS Waiver Renewal

Transformation Agenda

Shared goals agreed upon by New York State and the federal Centers for Medicare and Medicaid Services (CMS) to: • Close institutions and support individuals living in the community • Support individuals to be competitively employed • Provide opportunities for individuals to self direct their own services

Community Living

OPWDD Activities to Support Community Living

• • • Enhancing system capacity through partnerships System education on broader array of living environments Reduce reliance on institutional supports – Developmental Center closure and reduction plans – Community ICF transition plan

25 000 20 000

20 062 Institutional Decline: 1975 -2014

15 000 10 000 5 000 0 1970 1980 1990 2000

634

2010 2020

Employment

OPWDD Activities to Increase Employment Outcomes

• New service initiated in July 2014—Pathways to Employment—to provide greater assessment and skill building to facilitate improved job matches • Changing supported employment model and reimbursement to incentivize job retention; January 2015 implementation 13

OPWDD Competitive Employment Goal

• 700 new people engaged in competitive employment (net increase) • Employed in an integrated community setting (general workforce) • Earning at or above minimum wage 14

OPWDD Competitive Employment Outcomes

DATE

As of April 1, 2013 As of March 31, 2014

NET GAIN NUMBER EMPLOYED*

7,044 7,369

325

*Employed in integrated setting at or above minimum wage. 15

Self Direction

Self-Direction

Goals:

 Provide education to at least 1,500 beneficiaries (with designated representatives as needed) per quarter beginning on April 1, 2013.

 Increase # of individuals self directing by 1,245 by March 31, 2014.

 Submit OPWDD self-direction policies for CMS approval, January 2014

Education on Self Direction

Year One -Total Growth of People who Self Direct

19

Transformation Progress

Year Two Update

Transformation Agenda Connection to Federal Initiatives

 Several federal initiatives have been made available to assist us in the transformation, including the Money Follows the Person (MFP) program and Balancing Incentives Program (BIP) (total $250m)  MFP and BIP help OPWDD maximize resources by adding specialized funding focused on accomplishing transformational goals

The HCBS Waiver Renewal & Managed Care

• Managed care supports our mission and helps OPWDD meet its goals by: – Providing better and more seamless access to services – Removing “silos” that create barriers to services across systems – Emphasizing outcome-based supports – Incentivizing providers who achieve quality outcomes while using funds efficiently

• The HCBS waiver renewal will include two new models for self-direction, allowing individuals to select from an array of services and supports that will allow them to live as independently as possible • The new HCBS settings regulations will see OPWDD and its providers offer services to individuals emphasizing choice and autonomy • New funding models for supported employment are currently being developed

The Front Door

• Educate individuals and families about service options that can help meet their needs • Assist individuals in seamlessly and quickly accessing services • Emphasize integrated supports and how people can gain more control over their services and life plan.

The most significant changes are: • Expedited processes for some individuals seeking non-waiver services, including FSS and ISS; also for individuals who are seeking only Supported Employment and/or Pathways to Employment.

• At initial contact, expedite work on determining eligibility, accessing Medicaid if needed, and securing a referral to service coordination services.

• Decrease the time needed for the development of a service plan through the Preliminary Individualized Service Plan (PISP) • Implementing a streamlined process for individuals who are already receiving services but are seeking changes or additions.

The Coordinated Assessment System (CAS)

• Validity Study is underway with stratified sample of individuals receiving support • Upon completion of study, validity of CAS will be determined and any needed adjustments undertaken • The data from the study will be used to develop acuity scoring of need levels for people receiving supports • OPWDD is working with DOH to determine how the information will inform reimbursement in both FFS and Managed Care environment • It is expected that the CAS will be implemented by late summer 2015

Systemic Therapeutic Assessment Resources and Treatment (START)

• Launched in Western New York and Finger Lakes. Next roll-out is for Capital District, Hudson Valley, and Taconic. • The program’s goal is to provide response and prevention services to individuals with intellectual or developmental disabilities and behavioral health needs, as well as their families and those who provide support within the community.

• NY START is not a separate system and does not replace existing services. • The NY START program will provide training, consultation, therapeutic services and technical assistance to enhance the ability of the community to support individuals with intellectual and developmental disabilities and complex behavioral health needs, and focuses on establishing integrated services with agency providers. • Providing supports that help individuals to remain in their home or community placement is NY START’s first priority.

What Comes Next?

• Continuing process improvements to the Front Door, including an informational video for individuals, are in development • Building upon our excellent success with the transformation agenda - OPWDD will continue to set and meet goals in its key focus areas • Now that our rate issues have largely been resolved, OPWDD has proposed a timeline to CMS that will allow for managed care start-up on a voluntary basis