THE TRANSFORMATIONAL AGENDA FOR NY’S PEOPLE FIRST

WAIVERMAY 7TH 2013

Personal Outcome Measures

PilotsPeople First WaiverRFI

Care Coordination

ICSCase Studies

Front DoorDISCO

Managed CareInterRAI

CQL

RFA

Coordinated Assessment System (CAS)

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?

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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 HousingSupported 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 membersDOH Duals Demonstration begins enrolling members into the first DD FIDAs (fully integrated care for Medicare & Medicaid-eligible 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:DISCOsManaged 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 98-1federal 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, person-centered 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

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OPWDD Auspice ServicesOPWDD Comprehensive Waiver ServicesDay TreatmentICF/IIDArt 16 Clinic Svcs: OT, PT, SLP, Clinical Social Work, Psychology, Nutrition, Rehab Counseling, Podiatry, and Dentistry.Care Coordination provided by the DISCO

DOH Auspice ServicesAdult Day Health Care DentistryDME and Hearing AIDSHome Care (offered under any auspice: hospital-based, nursing home-based, and free-standing programs)Non Emergency TransportationOptometry/EyeglassesOT, PT, SLPPersonal CarePersonal Emergency Response SystemPrivate Duty NursingPsychology and Clinical Social WorkRespiratory TherapySkilled Nursing Facility Podiatry

OMH/OASAS Auspice ServicesOASAS Inpatient OMH Institutional Program (PC/RTF) & private psychiatric hospitalizations Outpatient – OMH, OASASPsychology and Clinical Social WorkOMH day treatment

DISCO ContractThe 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 ContractThe 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 dataReview Request for ApplicationsReview 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