Logo & Publication Redesign & Art Direction: The Source | Okinawa, Japan
Self Direction Redesign November 5, 2014 Association of Day Services Providers.
-
Upload
alexander-martin -
Category
Documents
-
view
216 -
download
1
Transcript of Self Direction Redesign November 5, 2014 Association of Day Services Providers.
![Page 1: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/1.jpg)
Self Direction Redesign
November 5, 2014Association of Day Services Providers
![Page 2: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/2.jpg)
Today’s Agenda
• Final Self Direction Model
• Current Status of Self Direction
• Questions
![Page 3: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/3.jpg)
Today: CSS Budget
3
![Page 4: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/4.jpg)
CMS Mandated Changes
4
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.
![Page 5: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/5.jpg)
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
5
![Page 6: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/6.jpg)
What Remains the Same
![Page 7: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/7.jpg)
7
Will continue to allow the person self directing to:
• 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.
Employer Authority
![Page 8: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/8.jpg)
Will continue to allow people who self direct to:
• 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.
8
Budget Authority
![Page 9: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/9.jpg)
• 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.
9
Self Direction Expansion
![Page 10: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/10.jpg)
Self-Directed Services Align w/ HCBS Services
10
Self-Hired /Individual Directed Services**
Services Supporting Self Direction
Community Habilitation Live-in Caregiver (monthly unit)
SEMP Support Brokerage (1/4 hour unit)
Respite Fiscal Intermediary (monthly unit)
Individuals Directed Goods & Services ($10 per unit)Community Transition Services (one-time payment)
**Billed in ¼ hour units
![Page 11: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/11.jpg)
Self – Hired (FI Supports Person)
11
![Page 12: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/12.jpg)
Individual Directed Goods and Services (IDGS)
12
![Page 13: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/13.jpg)
Camp
![Page 14: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/14.jpg)
Community Classes & Publicly Available Training/Coaching
![Page 15: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/15.jpg)
Coaching/education for parent(s), spouse and advocates.
![Page 16: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/16.jpg)
Clinician Consultants, Independent Contractors –
![Page 17: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/17.jpg)
Clinician (Direct-Provision of Therapies/ Therapeutic Activities Not Otherwise Funded in
the State Plan)
![Page 18: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/18.jpg)
Health Club/Organizational Memberships/Community Participation
![Page 19: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/19.jpg)
Household-Related Items and Services
![Page 20: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/20.jpg)
Paid Neighbor
![Page 21: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/21.jpg)
Self-Directed Staffing Support
![Page 22: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/22.jpg)
Transition Programs for Individuals with IDD
![Page 23: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/23.jpg)
Transportation
![Page 24: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/24.jpg)
Proposed FI Choices
24
![Page 25: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/25.jpg)
Agency Supported Self Direction
25
![Page 26: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/26.jpg)
Direct Medicaid Purchased Services
26
Individual can choose to purchase HCBS Waiver services through a traditional voluntary Medicaid provider:
![Page 27: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/27.jpg)
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
![Page 28: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/28.jpg)
We Want You to Know
OPWDD is committed to ensuring:
• Continuity of supports - we expect almost all 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
28
![Page 29: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/29.jpg)
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
![Page 30: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/30.jpg)
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
![Page 31: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/31.jpg)
Summary
• Changes are required – opportunity to make changes to support growth of self direction
• Transformation focus continues to be on expansion of self direction
![Page 32: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/32.jpg)
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
![Page 33: Self Direction Redesign November 5, 2014 Association of Day Services Providers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649d6d5503460f94a4e60c/html5/thumbnails/33.jpg)
Questions??