Transcript Power Point Template 2

Self Direction Redesign
November 5, 2014
Association of Day Services Providers
Today’s Agenda
• Final Self Direction Model
• Current Status of Self Direction
• Questions
Today: CSS Budget
1. Self
Hired Staff
4. State
Paid
/Housing
subsidies
2.
Purchased
Services
3.
Contractors/v
endors
5.
17.5%
Admin
CSS
Price
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CMS Mandated Changes
 The monthly unit is unacceptable.
 Each element in a person’s current CSS plan that is eligible for
Medicaid funding must be separately billed to eMedNY.
 FMS reimbursement must be separately billed; based on the
level of support an individual elects to purchase.
 Effective date of conversion for all CSS plans is 10/1/14.
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CMS Mandated Changes
 Each self-directed service component in a person’s CSS plan
must be aligned with an HCBS Waiver service.
 The rate paid for self-directed services cannot exceed the
amount paid for provider-controlled services
 Medicaid payment is limited to the PRA, no exception to allow
up to prior cost of services
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What Remains the Same
Employer Authority
Will continue to allow the person self directing to:
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make decisions about who works for them.
recruit people to work for them.
decide what they need staff to do to help them,
how many hours of help they need and when
they need that help.
supervise their staff and change staff if they
aren’t satisfied.
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Budget Authority
Will continue to allow people who self direct to:
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make choices about the services they need.
make decisions about their services and
supports based on their funding.
decide what services are paid for and who is
paid to provide them; the person decides how
much to pay self-hired staff
manage their OPWDD budget in a responsible
manner.
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Self Direction Expansion
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Required reforms will create opportunity for
design changes that will make self directed
supports choice clearer and more direct
There will be increased opportunity to expand
self direction options and streamline access to
self directed options
Educational opportunities will be provided on
all of the changes.
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Self-Directed Services Align w/ HCBS Services
Self-Hired /Individual
Directed Services**
Community Habilitation
Services Supporting Self Direction
SEMP
Support Brokerage (1/4 hour unit)
Respite
Fiscal Intermediary (monthly unit)
Live-in Caregiver (monthly unit)
Individuals Directed Goods &
Services ($10 per unit)
Community Transition Services
(one-time payment)
**Billed in ¼ hour units
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Self – Hired (FI Supports Person)
Self-Hired - Individual directs
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Staff Salary
Staff Schedule
Arrangements for Back-up Staff
Person has option to be
Employer of Record
FI Supports Individual with
payroll/admin functions and
other staffing supports as
chosen (such as CPR training)
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Individual Directed Goods and Services (IDGS)
Service Description:
• Are services, equipment, or supplies that addresses
a need in the individual’s service plan.
• For individuals living in non-certified settings.
Can be used for Transportation, Small Kitchen
Appliances, Laundry services, Chore services
• Annual cap is $32,000
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Camp
Funding may be requested for the cost of summer camp in a self-directed plan
for a camp that is able to provide the needed safeguarding supports and supports
to achieve the person’s valued outcomes.
Camps can be either focused on supporting individuals with disabilities or camps
that are available to the general public.
Directly related to a valued outcome.
Annual Cap of $4,000
Community Classes & Publicly Available
Training/Coaching
Classes available to the general public in any subject area that relates to a
person’s valued outcomes (Art, Dance, Exercise, Cooking, Computer Training, Etc.)
Sessions with a private trainer (physical education/exercise) may be covered as
long as the service relates to a valued outcome).
Classes must be related to a habilitative need in the individual’s person-centered
plan and not just for recreational purposes.
Classes must be non-credit bearing; IDGS funding is for non-matriculating
students.
Not to exceed the published fees as outlined in the entity’s published course fees.
Coaching/education for parent(s), spouse
and advocates.
IDGS funding is for Parent/Spouse/Advocate to attend/participate in educational
opportunities (not covered by other public programs) that assist participants and
those close to them to achieve goals established in the individual’s service plan.
Self-directing individual is over age 18 (Under 18 is through FET).
May Include registration, and conference fees
Annual cap $500/year based on Family Education & Training (FET) pricing
parameters in 1915(c) HCBS waiver.
Clinician Consultants, Independent
Contractors –
Consultants/contractors are clinical specialists who are hired for the following
purpose:
Evaluate an individual’s habilitation plan; training self-hired staff in delivering the self
directed plan.; evaluation of the effectiveness of the self-hired staff in carrying out the
services in the self-directed plan
Consultants/contractors services cannot replicate any service available through a
third-party insurer, the Medicaid State Plan or the HCBS Waiver Service.
Consultants must provide a written outline of services to be delivered prior to
approval; consultants must provide an annual update of progress/provision of service
and need to continue.
The hourly amount paid to the therapist cannot exceed the 90th percentile for the
regional hourly wage for the therapeutic or consultant’s professional discipline
Clinician (Direct-Provision of Therapies/
Therapeutic Activities Not Otherwise Funded in
the State Plan)
Hippo Therapy:
Therapeutic Riding & Equine-assisted Activities
Aquatic, Art, Massage, Music, Play Therapy
All Services – Ordering, Treatment Plan & Documentation Requirements
See detailed description in IDGS chart
Health Club/Organizational Memberships/
Community Participation
Health club memberships; Community membership dues -- Funding for a gym, health club or
other community organization membership may be included in the self-directed plan for reasons
of health and fitness or community integration in accordance with the participant’s valued
outcomes.
Membership is for individual only; no family memberships allowed with IDGS funding.
The club/organization must offer open enrollment to the public, and cannot be a private club
with a closed membership where membership is available by invitation only.
An individual may have multiple memberships to health clubs.
Annual cap $1500/year.
Household-Related Items and Services
Item cannot be funded through any other funded program and may include Appliances that
assist a person to live more independently (i.e., a microwave oven for someone who cannot
safely use a stove or oven)
Appliance must benefit the individual and be related to a valued outcome as well as be related to
health and safety.
Household support (cleaning, minor maintenance, snow removal, lawn mowing) only for
individuals not living in the family home.
Note: The Community Transition Services (CTS) waiver service and funding cap remains separate
from IDGS funding in this category.
Annual cap $1500/year.
Paid Neighbor
Stipend paid to neighbor to be “on-call” to assist a person who lives
independently. If the paid neighbor is called upon to provide direct services,
he/she is paid an hourly wage for the delivery of self-hired community
habilitation.
The specific duties are defined in a contract signed by the paid neighbor and
the Fiscal Intermediary.
Monthly cap $800
Self-Directed Staffing Support
Assistance with scheduling self-hired staff and with assisting the person to
complete staffing related paperwork
Not to duplicate FI employer responsibilities or Broker services related to
development of the person’s self directed plan.
The ‘self-hired’ staff person providing this support is not a staff person of a NFP
agency and is not a person who is active in assisting the person with decisionmaking regarding his/her self directed services
Not to exceed payment of $20/hour
Transition Programs for Individuals with IDD
Tuition for non-credit bearing transition programs for individuals with IDD who have already
completed their educational program (i.e. ‘aged out’).
The coursework must address a person’s valued outcomes and address skill building and
employment outcomes.
Programs may be provided in non-site based settings, on college campuses, but not in locations
certified by OPWDD.
Coursework may include training on personal care skills, and socialization skills; training is
provided to support vocational outcomes for the person.
To be funded via a person’s self direction budget, the program cannot be funded by ACCESS-VR,
IDEA or other funding sources.
Services are time-limited and cannot exceed a two year timeframe.
No room and board costs are fundable.
Published fees cannot be exceeded. Per class limit for tuition is $350/course. Where tuition is on
a monthly basis, not to exceed $800/month
Transportation
Funding may be requested for the cost of service related transportation that is directly related to
valued outcomes, safeguards and services identified and approved in the self-directed plan.
Reimbursement for service related miles may be made to:
Staff person who drove his/her personal vehicle to a service related activity,
Participant who drove or was driven in his/her personal vehicle to a service related
activity,
or
Friend or family member who drove his/her personal vehicle to a service related activity
No cap but must be consistent with published rates
Proposed FI Choices
Level 1
Level 2
Level 3
• FI minimal involvement – FI might just bill IDGS, or pay
housing subsidy
• Individual manages staff hiring, negotiates wages
• Individual is Employer of Record
• FI supports individual with payroll/admin functions,
performs background checks, same duties as Level 1
• Current model – FI manages all self-directed services for
individual
• Assists individual in managing staff; provides training to
individual on his or her employer responsibilities.
• Same duties as Level 2
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Agency Supported Self Direction
Individual Purchases
HCBS services from a
voluntary Medicaid
provider
Individual chooses to
purchase services at
provider wage which
includes:
• Individual selects staff and agency
hires staff (co-management)
• Person has employer authority
• Agency is Employer of Record
• Wage within agency scales for staffing
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Clinical Oversight
Backup Staffing
Program Management
Behavioral Training
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Direct Medicaid Purchased Services
Individual can choose to purchase HCBS Waiver services through
a traditional voluntary Medicaid provider:
Community
Habilitation
Respite
SEMP
Day
Habilitation
Pathway to
Employment
Prevocational
Services
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Implementation Status
• Weekly CO workgroup meetings and calls with
the SD Liaisons
• Technical Assistance being provided; new
Guidance has been issued
• Meetings with FIs individually and group to
review changes and strategize solutions
• Training to MSCs and Brokers underway
• More than half of the total plans have
converted
We Want You to Know
OPWDD is committed to ensuring:
• Continuity of supports - we expect almost all
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supports will continue uninterrupted
Provision of needed technical assistance for
plan conversions
Opportunities for education and discussion will
be available on a statewide and regional basis
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Challenges Encountered
• PRA changes impact service budgets
• FI rate change to monthly fee – Need to ensure
that costs are sufficient to cover FI tasks
• Direct clinical supports not allowed as duplicative
of state plan services
• Employment support concerns – job developers
• No payment for experimental therapies
• Behavioral consultation – regional concern
Transition Solutions Identified
• Continuity of Care Provisions
• Education regarding Options to Manage
Conversions
• Business Model Reviews by FIs
• Transformation Grants with Opportunities of
Innovation in Self Direction
Summary
• Changes are required – opportunity to make
changes to support growth of self direction
• Transformation focus continues to be on
expansion of self direction
Opportunities for Self Direction
• MSCs can connect interested individuals to
self direction
• Request for self direction through Front Door
if new to services and through Service
Amendment if want a change
• Self Directed plans can blend agency
supported and self hired staff supports for
customized Person Centered plan
Questions??