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1115 Waiver Update
March 6, 2012—The Office for People with Developmental Disabilities (OPWDD) has established a Waiver Discussion Board process to provide a venue for individuals with disabilities, their families and advocates to receive updates about the waiver development process and ask questions. The second videoconference meeting was held on February 14, and addressed current planning for comprehensive care coordination under the waiver.
The meeting was led by Gerald Huber, Acting Deputy Commissioner, Division of Person-Centered Supports and Katherine Marlay. Acting Director, Division of Person-Centered Supports and head of the People First Waiver Unit. Mr. Huber gave an opening presentation and then they took questions from the audiences at each meeting location. A brief summary of key points is below.
Timeline. OPWDD is currently in conversations with the Center for Medicare and Medicaid Services (CMS) regarding their waiver application. They anticipate approval of the People First Waiver in the next three to four months. They plan on requesting applications for pilot projects this spring, and anticipate those pilots beginning around January, 2013. The pilots would run for approximately two years, with a goal of beginning statewide enrollment in Developmental Disability Individual Support and Care Coordination Organizations (DISCOs) at the end of 2014 or beginning of 2015.
Needs Assessment. Under pressure from CMS to avoid potential conflicts of interest, OPWDD is now planning on having Needs Assessments conducted independently of the DISCOs. It appears likely that conducting the assessment will be a State function, although the State may choose to do so through contracts with agencies with appropriate capacity, as is frequently done for long term care assessments now. OPWDD is planning on adopting the InterRAI suite, which has also been adopted by the Department of Health (DOH) for its Uniform Assessment System (UAS-NY). OPWDD hopes to automate the assessment tool and integrate it into a larger electronic record system that IBM and the State University of New York (SUNY) have proposed to build if they receive a recently submitted grant from CMS for that purpose. The next Waiver Discussion Board meeting, on March 13, will focus on the assessment tool.
Independent Advocate. Under pressure from CMS to avoid potential conflicts of interest, OPWDD is now planning on having some form of independent advocate, outside the DISCOs, available to individuals and families. It is not yet clear what form such services will take, but it may remain a State function.
Focused Case Studies. These are small projects to test elements of the Waiver proposal. They are intended to begin as soon as OPWDD has received CMS approval and run for approximately a year. OPWDD anticipates a year of planning leading into the implementation of pilot projects.
Pilot Projects. OPWDD anticipates starting primarily with a partially capitated model, where pilot providers will be expected to manage all long term care services, such as home health care and habilitation services, while physical health care services would be provided through fee for service Medicaid or Medicaid managed care. (A so far unanswered question is how this new timeline would intersect with the State’s current plans to require all Medicaid recipients to be enrolled in some form of managed care by April 1, 2014.) They do seem to believe that some providers will be ready to offer a comprehensive, fully capitated option.
DISCOs. OPWDD is still planning on having at least two DISCOs available in all areas of the State, but they are considering what options they might offer in areas where only one DISCO is available. Currently, they are considering whether individuals might be permitted, in that case, to opt out of the DISCO and self-direct their services within some sort of support framework.
DISCOs will be expected to offer all individuals self-direction options and an individual service budget (with employer and budget authority). They will be expected to offer substantial provider networks, and OPWDD stressed that there will be a strong emphasis placed on enabling continuity of care via highly inclusive networks. It has not yet been determined how large of an area a DISCO will be expected to serve.
DISCOs will be licensed (most likely under Article 44 of the Public Health Law, according to a recent statement by Jason Helgerson, the New York State Medicaid Director), and OPWDD will involve DOH in regulatory oversight of the DISCOs. Additionally, DISCOs will have responsibility for oversight of their providers.
Individuals with developmental disabilities who are dually-eligible for Medicaid and Medicare will be served by DISCOs, rather than by the dual eligible demonstration project currently being developed by DOH, according to Mr. Helgerson.
Medicaid Service Coordination. OPWDD sees these responsibilities being transferred to the DISCOs, with the potential that different aspects of the current position, such as care management and family support, may be played by different individuals in the DISCO structure. MSC services will continue until everyone is enrolled in a DISCO.
Medically Fragile Children. In response to an audience question, Ms. Marlay stated that OPWDD currently believes that the Care at Home program is very effectively serving this population, and that therefore OPWDD does not expect that the transition to DISCOs will lead to many service changes in this area. She expressed a hope that DISCOs would assist in creating greater coordination of service delivery between the educational system and the OPWDD system.
Aging Families and Individuals with Developmental Disabilities. OPWDD mentioned recent conversations with the State Office for the Aging (SOFA) and DOH regarding the possibility of creating a blended funding model to allow care at home for both aging parents or other caregivers and the aging individuals with developmental disabilities for which they care. While it did not appear that the conversation was too far advanced, OPWDD did seem positive about the direction of the conversation.
Other developments include:
- The “key issues to care coordination” cited by OPWDD in February included: 1) DISCO’s potential conflict of interest in service planning and service delivery; 2) Independent advocacy; 3) Retaining choice of provider.
- As part of implementation planning, OPWDD is speaking of finding ways “to provide continuity—either through the DISCO, OPWDD or service providers.” In fact, OPWDD stated, “Individuals may maintain existing service providers to ensure minimal disruption to people’s lives,” …though no details have been disclosed about how this will work.
- OPWDD stated that there will continue to be a due process appeals mechanism for individuals and families who do not agree with service planning recommendations.