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Questions & Answers

1. What is the People First Waiver?

2. How will the People First Waiver protect the health and safety of people with developmental disabilities?

3. What will the People First Waiver do for people with developmental disabilities?

4. Will the People First Waiver place individuals with developmental disabilities who receive New York State supports and services into managed care?

5. How will Care Coordination be provided under the new waiver?

6. What opportunities exist for the public to participate in the waiver development process?

7. What is the process and timeline for development of the People First Waiver application?

8. My home is a Supervised IRA and I want to stay here. What if the needs assessment indicates that I don’t need a supervised residence?

9. If I am satisfied with my services, will I be able to keep these services even if my current agency isn’t part of a managed care organization’s network?

10. How will the 1115 waiver address the needs of people who are more vulnerable and need more assistance?

11. What happens if a needed service or state funds are not currently available? Will the residential registration list get worse?

12. How will OPWDD prevent DISCOs from self-referring individuals and families to the DISCO’s own services instead of to the service providers the individual/family wants?

13. Will everyone who currently receives services need to be reassessed?

14. What will happen to Medicaid Service Coordinators, and will their role change?

15. I like my MSC; will I be able to keep my current MSC?

16. The need for supervised residential settings still exists even though the trend is toward supportive settings and more flexible, community based residential services. How will these needs be addressed? Will the residential wait list get worse?

17. If the DISCOs receive and manage the funds for services, who will ensure that individuals get quality services and not the cheapest services?

18. What if there are more needs than the capitated rate will support? Will the person’s services be limited by the rate or will the DISCO absorb the cost?

19. Will DISCOs have the right to say they will not serve an individual due to his or her high level of need?

20. How will changes in care (including medical care) be accommodated under the managed care structure, and how will such changes impact someone’s long-term care services?

21. Will the People First Waiver provide Family Support Services? What will the role of the FSS Committee be?

22. How will OPWDD measure quality in DISCOs as they are being implemented?

23. How will DISCOs and the ‘People First’ waiver ensure informed consumer choice?

24. The previous waiver model was designed to have a service coordinator chosen by each consumer to not only provide referrals and coordinate care, but to act as the primary formal advocate. Who will be responsible for this role once the DISCO care coordinators are providing the care coordination?

25. What assurances will be put in place to ensure cultural competencies amongst care coordinators?

26. Will people be able to maintain their longstanding relationships with their current OPWDD waiver service coordinators under the new ‘People First’ waiver? If so, how will it be designed?

27. Is OPWDD considering an ombudsman program to provide independent individual assistance and advocacy? (The state’s application for an amendment to the NY Partnership Plan includes such a proposal for people with disabilities and chronic illness in Medicaid Managed Care.)

28. How do you envision current providers making the transition to becoming DISCOs? What resources will be offered to help with that transition?

29. What role will consumers and their advocates play in designing the new system to ensure their providers successfully transition so people can continue to receive services from known entities

30. How will OPWDD guard against the conflict of interest presented by the model of providers as DISCOs? Will assessment, authorization, and care coordination functions be kept separate? Will this new model still operate under the traditional capitated system of managed care?

31. Will managed care capitation rates be available before the final RFA is out so providers can decide whether they can afford to apply to be DDISCCOs?

32. What is being done to address concerns that MCOs won’t be able to recruit local specialists outside big cities, particularly in rural areas across the state?

33. Where will funding for administrative and case coordination functions come from?

34. What is the plan for assessing how many people will have 24-hour support needs? Is information being analyzed so the right decisions can be made on how to provide for this group of people?

35. For young people transitioning from school to adult life, what will be different about their choices as a result of the ‘People First’ waiver?

36. Given the state’s long-term plans for full integration of all Medicaid managed care services, what does OPWDD see as the long-range future for DISCCOs (which can be provider based) vs. the commercial insurance-based medical care models?

37. How does/will OPWDD manage the possibly competing goals of saving money vs. ensuring quality services?

38. How do the state’s obligation under Olmstead and DISCOs connect? How will the requirement that services be provided in the most integrated setting (which for most means their own home) be enforced and advanced?

39. How will the ‘People First’ waiver – and more pressingly, individual and community supports (ICS) – connect to the State Plan Community First Choice (CFC) Option? DOH, OPWDD, and OMH have already begun to design CFC. Through which door will people access services? How will CFC’s requirement for a person-centered planning process coordinate with the care coordination component of ‘People First?’

 


 

1. What is the People First Waiver?

The People First Waiver is an opportunity to develop important improvements to the developmental disabilities service system.

The People First Waiver will allow New York State to work closely with individuals, family members, and outside experts in health care and long-term care to create system improvements that expand community-based services, reduce institutional services, and offer New Yorkers with developmental disabilities comprehensive services from multiple service systems in more efficient, person-centered, responsive, and accountable ways. The People First Waiver is an opportunity to learn from those we serve how to make the system better and to design and test the needed improvements.

The People First Waiver is NOT a Medicaid Block Grant.

The People First Waiver will be an agreement with the federal government for New York State to operate a comprehensive system of supports and services for individuals with developmental disabilities. As with the Office for People With Developmental Disabilities’ (OPWDD) current service system, supports and services will be accessible within available resources to people who meet service eligibility criteria. Transition from the current service system to delivery of services under the new structure of the People First Waiver will be carefully planned and described to everyone currently receiving services to ensure minimal disruption in service delivery.

The People First Waiver is NOT a means to restrict or expand service eligibility.

The People First Waiver will allow New York State service agencies to improve how they coordinate eligibility determinations for individuals who require services and supports from more than one agency. In addition, developing the People First Waiver application will allow OPWDD and its stakeholders to examine issues related to service eligibility and assessment of need (e.g., the eligibility determination process) and design system improvements that will ensure that services respond to individuals’ unique needs with the most effective and appropriate level of support.

The People First Waiver is NOT a means to meet target budget reductions.

New York State, like many states, is experiencing a serious budget crisis. The crisis has affected State agency budgets for the past two years and is predicted to continue to impact future State budgets. The People First Waiver is not a means to address these ongoing budget needs. Rather, it is an independent opportunity for New York State to improve its service system for people with developmental disabilities in many ways, including reforms to the way services are supported by federal Medicaid funds. In short, the waiver is how New York State will make sure the service system for people with developmental disabilities has a sustainable fiscal base, one which secures federal Medicaid support and provides a more transparent connection between funds and services so that all funds (New York State and federal Medicaid funds) are used first and foremost to support people.


2. How will the People First Waiver protect the health and safety of people with developmental disabilities?

Protecting the health and safety of people with developmental disabilities is paramount for OPWDD. Over the course of several months, distinct design teams will engage noted subject matter experts in exploring and designing key elements of the waiver application. One design team will specifically focus on ensuring that the People First Waiver achieves enhanced quality management through a new and comprehensive quality management system. The system will be designed to measure and track outcomes for individuals and performance of the system as a whole. It will also allow OPWDD to measure its progress towards the stated goals of the People First Waiver. In addition, the quality management system that is developed will incorporate the reforms that OPWDD is currently putting in place to strengthen the care and oversight system including enhanced procedures for reporting and responding to incidents, recruitment and hiring, ensuring a positive work environment, supervisory oversight, protecting individual and family rights, promoting proactive techniques for limiting the need for hands-on interventions, improving agency wide awareness, data management, and investigations.


3. What will the People First Waiver do for people with developmental disabilities?

The People First Waiver will accomplish essential system reforms within New York’s system of care for individuals with developmental disabilities.

Today, OPWDD provides services to individuals with developmental disabilities within the framework of a program design established more than three decades ago. That program design has supported tremendous progress, but today these outdated fiscal and administrative mechanisms actually impede further advancement. The People First Waiver will allow OPWDD to craft a new, more efficient system design that will protect the health and safety of all individuals while increasing the effectiveness and sustainability of supports and services for future generations. Beginning now and throughout the five-year period of the People First Waiver, OPWDD will design and demonstrate effective ways to infuse the principles of quality, choice, and community into the core of a more efficient and accountable service delivery system.

OPWDD’s regular and ongoing discourse with its many stakeholders, including individuals who receive services and their families, has allowed the agency to determine several key outcomes for the People First Waiver. Specifically, it will demonstrate:

  • That improved care coordination for people with developmental disabilities with complex medical and behavioral health needs can be achieved through specialized systems of care management and coordination.
  • That a transformed long-term care system that places person-centered planning, individual responsibility, and self-determination at the forefront can enhance care and individual satisfaction and lower Medicaid costs.
  • That new reimbursement models for institutional and community-based care systems can encourage efficiency, improve accountability, and reduce costs.
  • That an expanded range of community-based services can allow many individuals currently living in institutional settings to transition to the community such that future institutional services can be provided on a temporary basis to prepare individuals for successful community living.
  • That redesigned assessment tools and eligibility processes can ensure “no wrong door” access for people who need to access Medicaid services under any State agency.
  • That improved health and safety outcomes can be assured through a transformed comprehensive quality management system that is driven by performance metrics linked to personal outcomes and system performance.

4. Will the People First Waiver place individuals with developmental disabilities who receive New York State supports and services into managed care?

With the People First Waiver, OPWDD’s service system is moving to a care management structure in which “fee for service” service delivery will eventually be replaced by some form of a capitated/global payment model of service provider reimbursement. The waiver design and implementation process will allow New York State to develop and test over time care management methods that are carefully planned, designed and evaluated for their effectiveness at delivering person-centered services that are appropriate to each individual’s needs with enhanced degrees of personal choice and control over the services received.

Last summer, the People First Waiver design teams explored possible mechanisms for providing comprehensive care with appropriate levels of personalized supports and expanded personal choice and control. They then recommended to the Steering Committee ways of providing and managing care coordination that will accomplish the goals of the waiver. New York is now preparing to design and implement demonstration projects that will test these recommendations, and with the lessons learned from these demonstrations, will develop a specialized system of care management that provides a full range of individualized health care and long term care services to people with developmental disabilities.

Th future service system will align with the New York State Department of Health’s ongoing efforts to reform public health services (see Redesigning the Medicaid Program web site and will implement federal health care reform in New York State.


5. How will Care Coordination be provided under the new waiver?

During the initial years of the People First waiver, New York will focus on improving the coordination and delivery of OPWDD’s traditional long-term care services for people with developmental disabilities. Later, through select pilot projects, the new waiver will allow New York to develop and test new models of coordinating more comprehensive care that includes broader services in the areas of primary and behavioral health care and addiction. Through each phase of this multi-year transition to comprehensive care coordination, New York’s service systems will build the needed administrative structure and assessment tools to provide person-centered, integrated needs assessment and service planning that will assess a person’s strengths, needs and preferences and develop an individualized comprehensive care plan. Services will be managed and monitored by an identified care management organization that may or may not be the provider of services.


6. What opportunities exist for the public to participate in the waiver development process?

Developing the waiver design will take approximately twelve months before federal approval. Implementation planning will then take place of the first twelve months of the five-year waiver period. This process will be a multi-faceted, transparent, and collaborative effort engaging all stakeholders and providing everyone with many opportunities to be heard:

  • OPWDD has established a People First Waiver web page that serves as the informational hub for the application development process, providing detailed information on the process of the waiver application, the calendar of workgroup meetings, meeting summaries, background materials, and numerous online opportunities for members of the public to submit comments and questions.  OPWDD’s home page links directly to the new People First Web page.
  • In April and May 2011, Commissioner Burke began meeting with small groups of individuals with developmental disabilities and family members across the state to listen and gather important input on the needs of the new system.
  • In late May and early June 2011, and again in October and November 2011, OPWDD held public forums on the People First Waiver, as well as public hearings in November on the Statewide Comprehensive Plan (5.07 Plan) which adopted the recommendations of the People First Waiver design teams.
  • During the waiver design process last summer, OPWDD also solicited public input through structured online opportunities to provide comment.
  • During November and December 2011, OPWDD collected comments and ideas for the waiver reforms from anyone who wanted to comment through a formal Request for Information.
  • Currently, OPWDD is holding regular monthly videoconferences with groups of individuals and family members within each region of the state and bi-monthly videoconferences with representatives from voluntary service providers and OPWDD employees. These presentations are posted on the People First Waiver Web page.
  • During April 2012, Commissioner Burke and other OPWDD leaders held seven public briefings around the state, presenting the current status of the waiver development process and collecting public comments and questions.
  • Throughout the remainder of 2012, OPWDD will continue to oversee extensive implementation planning for the waiver reforms. This process will occur in collaboration with individuals, family members and voluntary service providers and also include opportunities for public comment.

As OPWDD continues to keep the public informed, the public is invited to express their ideas in the following ways:

  • Visit the People First Waiver web page where specific opportunities to provide input will be posted throughout the project.
  • Email comments or questions to People.First@opwdd.ny.gov.
  • Phone the People First comment line at1-866-946-9733 or TTY: 1-866-933-4889 to leave your question or comment.
  • Contact your region’s People First Waiver Liaison to learn about local presentations being held and opportunities to participate in regular videoconference updates.

7. What is the process and timeline for development of the People First Waiver application?

Development of the People First Waiver is occurring through an intensive, structured, and transparent process involving individuals with developmental disabilities and family members, service providers, State agency leaders, staff, and many outside experts in the fields of health care management, long-term care, behavioral health care, and developmental disabilities.  During the summer of 2011, design teams with multiple workgroups explored and designed key elements of the waiver, and throughout this process, the People First Waiver Web page hosted numerous opportunities for the public to submit relevant comments. A People First Waiver listserv notified those who wish to receive e-mail notification of these kinds of opportunities and other key milestones in the development of the application. Visit the People First Waiver Web page to subscribe to the listserv. OPWDD anticipates receiving federal approval of the waiver agreement with the Centers for Medicare & Medicaid Services sometime in 2012, after which a full year of waiver implementation planning will occur. During the first year of the waiver agreement, OPWDD will also launch focused case studies with high performing service providers to examine some of the key concepts of the waiver reforms and prepare to request applications for pilot testing care coordination organizations beginning in 2013. Each phase in this process will include careful evaluation of the resulting outcomes for individuals and the service system.


 

8. My home is a Supervised IRA and I want to stay here. What if the needs assessment indicates that I don’t need a supervised residence?

The new needs assessment will not indicate where a person should live. It will result in information about a person’s abilities, desires, interests and natural supports that will then be considered during an extensive process of person-centered planning with the individual, his or her family members and advocates and the care coordinator. Therefore, the waiver will not require that anyone leave their home. It is not intended to disrupt people’s lives or to undo services that are working well to meet people’s needs or, but rather, to ensure that people in all areas of the state are supported effectively in the most integrated settings and that they can experience better personal outcomes. The waiver will offer enhanced needs assessment, person-centered planning processes, and expanded community-based supports and services that will allow transition to more integrated service settings for those who desire and can benefit from them.


 

9. If I am satisfied with my services, will I be able to keep these services even if my current agency isn’t part of a managed care organization’s network?

Developmental Disabilities Individual Support and Care Coordination Organizations (DISCOs) will be required to allow access to out-of-network providers where necessary to meet an individual’s needs. The parameters for access to out-of-network providers will be determined during the first year of implementation planning. In addition, during the transition to the new DISCO system, OPWDD may require that DISCOs contract with current providers who wish to continue providing services to ensure provider choice and that individuals and families are able to continue being served by their current providers.


 

10. How will the 1115 waiver address the needs of people who are more vulnerable and need more assistance?

Contracts between DISCOs and New York State OPWDD will require that DISCOs operate sufficiently robust networks of provider partners to support people with all levels of service needs. The new uniform needs assessment protocol and enhanced person-centered planning process will also assure that even those individuals without family members or advocates receive a thorough assessment of all of their needs and that the resulting information is used to shape a life plan that will address their personal needs and goals. Care coordination staff will receive training in conducting person-centered planning that includes instruction in how to work with and determine the preferences of individuals who are unable to express their own desires.


 

11. What happens if a needed service or state funds are not currently available? Will the residential registration list get worse?

While the People First Waiver will help New York State to operate an improved and sustainable person-centered system of supports and services, it will not alleviate the State’s current economic challenges. However, OPWDD hopes to use the waiver to better match service supply with individuals’ needs. The People First Waiver can do this by: 1) expanding provider’s community-based capacity in clinical and behavioral support services 2) Better matching available services with the need for those services; and 3) developing expanded options for individualized residential supports that assist people to experience more inclusive settings with supports while costing less. Over time, these changes are expected to improve the system’s overall capacity to provide all services to individuals when their needs are identified. As the waiver establishes a new menu of support options and improves how we can match services to identified needs, OPWDD will evaluate the need for additional development, taking into account the needs of individuals on the registration list, the available resources within OPWDD’s current housing stock, and our ability to develop these additional, flexible resources.


 

12. How will OPWDD prevent DISCOs from self-referring individuals and families to the DISCO’s own services instead of to the service providers the individual/family wants?

OPWDD will ensure there is individual advocacy both within and outside the DISCO, as well as due process rights to appeal any recommendations not supported by the individual and his or her advocates. There are several key system components to address the issue of self-referral. First, assessment of an individual’s strengths, interests and needs will occur outside the DISCO through OPWDD. Second, the information that results from the needs assessment will be used to inform a person-centered planning process that focuses on meeting the expressed needs and life goals for the individual as identified by the individual and his or her family, advocates or support staff. Third, there will be clear and readily available information regarding the performance of DISCOs’ service providers’ that will allow individuals and families to make a more informed choice of service providers.


 

13. Will everyone who currently receives services need to be reassessed?

Yes, eventually, all people receiving OPWDD will be reassessed. Reassessment of the nearly 100,000 individuals who receive OPWDD Medicaid services will take a significant amount of time. Transitioning to the new comprehensive needs assessment will be done in phases, using it first in the focused case studies that will begin upon federal approval of the waiver in 2012, and later in the pilot DISCOs that will be established to test the managed care service model, likely beginning in 2013. After the pilot projects are ending, in 2015, and DISCOs are established, the assessment will be offered more broadly and particularly for people who are new to the system. Finally, individuals who have been in the service system prior to the waiver will have the opportunity to be reassessed. Doing so will be done carefully and slowly over several years, and with full input from individuals and their families, their circles of support and advocates.

OPWDD’s objective is not to disrupt lives, but through reassessment with a uniform tool, to obtain accurate, up-to-date information about each person’s service needs that will inform person-centered planning which, in turn, will lead to more individualized services and improved outcomes. The exact timing of each stage of this implementation of the needs assessment protocol is not yet determined, but we know it will occur slowly over the course of the five-year waiver agreement and likely beyond it.


 

14. What will happen to Medicaid Service Coordinators, and will their role change?

The services now provided within Medicaid Service Coordination (MSC) will transition to “care coordination” within the People First waiver. These changes will not be fully implemented until the new DISCO structure is implemented statewide in the later years of the waiver. There are many opportunities for the talented staff who now serve as Medicaid service coordinators to continue to play important roles in the lives of individuals and families. For example:

  • We expect that most Medicaid service coordinators will provide care coordination within a DISCO;
  • In addition, there is an important role for independent advocacy, both within and outside a DISCO, and today’s Medicaid service coordinators will be well positioned for this role;
  • New flexible services will mean that more people can live independently, but may need specialized community supports to live successfully. Today’s service coordinators could serve as ‘independent living specialists’ to help a person navigate leases, household finances and connecting with neighbors and community resources;
  • Flexible family supports will include the opportunity to work one-on-one with a “community specialist,” which is another possible role for today’s Medicaid service coordinators.

 

15. I like my MSC; will I be able to keep my current MSC?

OPWDD is committed to ensuring as much continuity in people’s services as possible during the transition to DISCO operations, but we do not know with certainty if each person’s current MSC will be able to continue to provide care coordination.


 

16. The need for supervised residential settings still exists even though the trend is toward supportive settings and more flexible, community based residential services. How will these needs be addressed? Will the residential wait list get worse?

OPWDD recognizes that there will always be a need for 24/7residential opportunities for people with developmental disabilities. While the state and federal fiscal environment remains challenging, it is likely that OPWDD will only have limited funding to develop new homes with 24/7 supports. During this time and the initial years of the People First Waiver, however, OPWDD will do the following to create the most appropriate residential service opportunities for individuals and their families and to assess need:

  1. Help those who are able and desiring to move to less restrictive settings - Working with the nonprofit providers of the approximately 2,000 individuals who are currently residing in homes with 24/7 supports and their families who are seeking a different, more independent residential setting, we will make it happen. This will create additional residential opportunities for individuals, including those in need of 24/7 supports.
  2. Re-evaluate the openings in 24/7 supported settings - Annually there are approximately 800 openings that occur in homes that have 24/7 support. Each year these openings will be re-evaluated for their continued role in meeting the residential needs of people within the OPWDD system. OPWDD will seek to convert any residential resources that are not appropriate to meet identified needs to resources that can support other residential service options that will better match needs.
  3. Reinvest savings- Reinvest a portion of the savings generated in expanded community supports.
  4. Develop a continuum of residential support options- The current system has placed an artificial limit on the amount of support an individual can receive if they live in a home that has less than 24 hour support. Therefore, we need to develop new options for community-based living including the provision of a full range of supports in certified and non-certified settings, development of shared living arrangements, and creation of more flexible individual support services that can assist with rent payments for private apartments. The waiver will allow the testing of these kinds of creative options that allow people to experience greater independence and community inclusion, while preserving group home capacity for those whose needs require such a setting.
  5. Re-examine how OPWDD assesses need when individuals and their families approach OPWDD for services- The current system allows individuals and families to not only indicate the type of services that that they want, but also the intensity level of that service without the benefit of a true assessment of need. This has created false expectations, ones that cannot be achieved. Going forward, the system must focus on meeting people’s needs.
  6. Evaluate the Registration List - As the waiver establishes a new menu of support options and improves how we can match services to identified needs, OPWDD will evaluate the need for additional development, taking into account the needs of individuals on the registration list, the available resources within OPWDD’s current housing stock, and our ability to develop additional, flexible supports.

 

17. If the DISCOs receive and manage the funds for services, who will ensure that individuals get quality services and not the cheapest services?

The People First Waiver will include a significantly enhanced quality oversight and improvement system. This new system will measure how well providers support people to achieve their individual goals, as well as how effectively the agencies operate, govern themselves, and support the important direct care workforce support, among other things. The new system will provide detailed information on agency performance to the public to support informed decision making and choice. It will also offer recognition and enhanced roles within the system for providers who demonstrate the highest levels of performance. In addition, the new needs assessment protocol will connect up-to-date and accurate information about each person’s abilities and needs directly to resource allocation, service planning and delivery, ensuring that services are delivered in the right way and provide the right level of support for each person. This reform will prevent a widespread scale back in the level of services and focus providers on meeting needs rather than on delivering any particular levels of particular services.


 

18. What if there are more needs than the capitated rate will support? Will the person’s services be limited by the rate or will the DISCO absorb the cost?

DISCOs will receive a capitated payment for each person enrolled. This means that the DISCO will receive a standard rate for each person they support, or a “per-person” rate. These rates will be determined in such a way as to accommodate the full range of service needs within the DISCO’s service population (i.e. tiered level of funding). With this funding, the DISCO will be required to meet all of the service needs of its members. There is no individual limit on the money that can be spent on an individual’s services. So, if the needs assessment and service planning indicate the individual needs a particular service, he or she will receive the service even if it is costs more than the capitated payment to the DISCO. Meeting the needs of individuals who require more intensive services cannot occur at the expense of other individuals’ services and supports.


 

19. Will DISCOs have the right to say they will not serve an individual due to his or her high level of need?

No. OPWDD will establish DISCOs through contracts. These contracts will require DISCOs to serve individuals with all levels of service need and to operate sufficiently robust networks of provider partners to do so. DISCOs will not be allowed to drop individuals due to their service needs. The per-person funds provided to a DISCO will be determined by OPWDD and the NYS Department of Health and will be actuarially sound, based on service cost data for individuals within the OPWDD system and other factors such as geographic location. The rates will accommodate the full range of service needs within the DISCO’s service population. Having an independent need assessment process will also help to ensure that DISCOs do not minimize anyone’s service needs.


 

20. How will changes in care (including medical care) be accommodated under the managed care structure, and how will such changes impact someone’s long-term care services?

Under the new waiver, individuals and their family members or advocates will have continuous access to their care coordination team leader to request reviews and service plan changes as needs change. Information will be updated to reflect the individual’s current functioning and needs. When needs change, services will adjust accordingly. An individual’s long-term care services cannot be diminished because of a need to increase his or her medical care.


 

21. Will the People First Waiver provide Family Support Services? What will the role of the FSS Committee be?

Under the People First Waiver OPWDD will continue to offer supports to families, including education and training, respite and crisis intervention, but these services will be funded through the DISCO. In addition, the waiver will result in development of new, flexible kinds of family supports and services. The Statewide FSS Committee will continue in its advisory role to the commissioner related to family supports and services, and OPWDD will continue to have a role for the local councils as well.


 

22. How will OPWDD measure quality in DISCOs as they are being implemented?

Within the People First Waiver and as part of its ongoing Quality Improvement Strategy, OPWDD’s Division of Quality Improvement (DQI) will continue its site-based surveys of agencies to monitor service provision. In addition, OPWDD will begin reviewing how DISCOs provide care coordination and monitor the quality of services provided by their service providers. As part of these functions, OPWDD will further develop performance and outcome-based metrics to be used to measure DISCO performance.  These new measures will focus on outcomes for individuals as well as individual and family satisfaction with services received and will include activities such as surveying individuals regarding the information they receive about their rights and the process to express concerns and objections; surveying individuals regarding their receipt of health care services based upon their Individualized Service Plan (ISP) and assessment; sampling individuals who were served by DISCOs that were provided education on self-directed service options and encouraged to make an informed choice of self-directed service options; and assessing the percentage of graduating students above baseline that transition from a high school into a Supported Employment program. OPWDD developed these measures with guidance from Delmarva, a national consulting group that has assisted numerous states in developing performance measures. OPWDD’s focused case studies that begin in 2013 will also provide a valuable opportunity to test new performance measures and provide important feedback for advancing OPWDD’s performance measurement.


 

23. How will DISCOs and the ‘People First’ waiver ensure informed consumer choice?

DISCOs will be required to provide clear and understandable information about service options to their enrolled members. Part of the care coordinator’s role will be to provide advocacy to the individual by assisting the individual to understand the services available and how they can be provided to meet his or her needs. OPWDD, as part of its DQI survey process, will confirm that individuals were given a choice of providers within the plan’s network.  In addition, as part of its ongoing “Employment First” initiative, OPWDD will be measuring the choice that individuals are given to receive employment supports if they are interested in working.  The annual NCI review will also collect data on the person’s satisfaction with services and choice in services and providers.


 

24. The previous waiver model was designed to have a service coordinator chosen by each consumer to not only provide referrals and coordinate care, but to act as the primary formal advocate. Who will be responsible for this role once the DISCO care coordinators are providing the care coordination?

Care coordinators will be responsible for advocacy within their overall leadership on the care coordination team, serving as the primary point of contact for the individual and providing linkage and referral to services, coordination and monitoring of service delivery, record keeping and benefits management. In addition, advocacy will continue to be provided by other parties including the OPWDD regional offices, outside advocacy groups, the Justice Center, individuals’ selected representatives, and Mental Hygiene Legal Services. OPWDD is now preparing applications for the 1915 b waiver and an amendment to the current 1915 c waiver and proposing establishment of a specialized advocacy entity that is independent from the DISCO. (See question below related to the ombudsman function.)


 

25. What assurances will be put in place to ensure cultural competencies amongst care coordinators?

New York State law and regulation require that managed care organizations accommodate individuals’ communication needs by providing information in easily understood formats and in ways that meet the needs of people who speak a language other than English as a first language and/or who have a hearing, visual, physical or cognitive impairment. In addition, NYS must require each DISCO to make oral interpretation services available free of charge to each potential enrollee and enrollee. OPWDD’s quality oversight will ensure that DISCOs are providing care coordination and service delivery in culturally competent ways and continually working to improve their performance.


 

26. Will people be able to maintain their longstanding relationships with their current OPWDD waiver service coordinators under the new ‘People First’ waiver? If so, how will it be designed?

It is likely that many of today’s Medicaid Service Coordinators will transition into roles related to care coordination in DISCOs. However, as the DISCOs are formed from existing service providers, it is impossible to know which service providers will become part of which DISCOs. Therefore, while it is possible, it is not likely that individuals will retain their current service coordinator once they enroll in a DISCO.


 

27. Is OPWDD considering an ombudsman program to provide independent individual assistance and advocacy? (The state’s application for an amendment to the NY Partnership Plan includes such a proposal for people with disabilities and chronic illness in Medicaid Managed Care.)

The Access, Enrollment & Advocacy Work Team is examining possible ways for the new service system to ensure independent advocacy for individuals. While advocacy will be available through several parts of the new system (e.g. the care coordinator, regional OPWDD offices, and individually designated representatives, the Justice Center), many stakeholders have expressed the need for additional “outside” advocates to be available to assist individuals. OPWDD, in its waiver application to CMS, is committing to the creation of an ombudsman function that is outside the DISCO.


 

28. How do you envision current providers making the transition to becoming DISCOs? What resources will be offered to help with that transition?

It should be noted that a separate entity will be established to be the DISCO, but with leadership and board membership that is drawn from experienced providers within the OPWDD system. In March 2013, OPWDD will issue a Request for Applications to become a pilot DISCO. In response, providers will submit applications that describe how they will provide care coordination and deliver services through networks of providers they establish. When the initial pilot DISCOs are authorized to begin operating, they will enroll members and begin receiving funds and providing services for every individual they enroll. The reimbursement rates will be established so that DISCOs can meet the full range of needs of their enrolled members. OPWDD is also working with the NYS Division of Financial Services to explore options for supporting pilot DISCOs to sustain fiscal risk if necessary, including the establishment of risk corridors.


 

29. What role will consumers and their advocates play in designing the new system to ensure their providers successfully transition so people can continue to receive services from known entities?

Individuals and advocates have been involved in every step of the process of developing the People First Waiver, either through participation in design teams, by submitting comments and testimony at hearings, briefings and statewide videoconferences, or more recently, by participating on targeted work teams. The new system of DISCOs is being developed from providers who currently support individuals with developmental disabilities. Moreover, OPWDD will establish pilot DISCOs that contract with existing providers to assure continuity of care for individuals. The DISCO contracts will require DISCOs to provide an explicit role for enrollees on their boards.


 

30. How will OPWDD guard against the conflict of interest presented by the model of providers as DISCOs? Will assessment, authorization, and care coordination functions be kept separate? Will this new model still operate under the traditional capitated system of managed care?

OPWDD will design several system components to address the issue of self-referral. First, as noted prior, the DISCO must have a separate corporate structure. Second, an independent, comprehensive and consistent needs assessment process that involves the people who know the individual best will ensure that people in all parts of NYS have access to the services they need. OPWDD will retain responsibility for conducting the needs assessment that will inform the DISCO’s person-centered planning process. Third, clear and readily available information regarding service providers’ performance will allow individuals and families to make an informed choice of service providers. Fourth, and most importantly, the person-centered planning process will actively engage individuals and their family members, advocates and direct care staff in decision-making. This process will be separate from the other functions of the DISCO. There will also be advocacy available from the regional offices of OPWDD and from both inside and outside the DISCO. And, finally, there will continue to be a due process grievance and appeals process for individuals and families who do not agree with service planning recommendations. The DISCOs will operate within existing managed care law and regulation and receive a capitated payment.


 

31. Will managed care capitation rates be available before the final RFA is out so providers can decide whether they can afford to apply to be DDISCCOs?

Data will be available to all applicants regarding costs and utilization, but final capitation rates will not yet be approved by CMS when the final RFA is issued.


 

32. What is being done to address concerns that MCOs won’t be able to recruit local specialists outside big cities, particularly in rural areas across the state?

DISCOs will be required to demonstrate the adequacy of their network of providers to meet the anticipated needs of their enrolled members, although the state does recognize that in more remote areas access is a challenge. OPWDD expects that the DISCOs will be better able to leverage and create partnerships with the needed specialists than providers current can under the fee-for-service system, even if those specialists are scattered across a large area. In addition, they will be required to provide for out-of-network services when needed services are not available through their networks.


 

33. Where will funding for administrative and case coordination functions come from?

Funding for these functions will be contained in the capitated reimbursement rate paid to the DISCOs.


 

34. What is the plan for assessing how many people will have 24-hour support needs? Is information being analyzed so the right decisions can be made on how to provide for this group of people?

The new comprehensive needs assessment process will indicate individuals’ strengths and needs. This information will be used in person-centered planning with the individual, his or her family, staff, clinicians and advocates. Until this new tool, known as the Coordinated Assessment System, is in use throughout the entire service system, however, OPWDD will continue to rely on the Developmental Disabilities Profile (DDP) and an enhanced person-centered planning process. The CAS will be used first in small case studies in 2013, and in the initial DISCO pilots with those who voluntarily enroll. Later, it will be rolled out across the state for all new comers and people who request it. It will be several years before everyone in the service system can be assessed with the CAS.


 

35. For young people transitioning from school to adult life, what will be different about their choices as a result of the ‘People First’ waiver?

In addition to the new comprehensive needs assessment process, students transitioning to adult life will also be afforded more community-based clinical services, more employment supports, and a more comprehensive person-centered planning process coordinated by a lead care coordinator who, by working with the student’s family, teachers and others, can develop a plan of comprehensive services that are integrated and delivered according to the student’s needs. It will also be easier to access services from other service systems such as medical services and behavioral health services, as well as the long-term supports and services typically provided by OPWDD.


 

36. Given the state’s long-term plans for full integration of all Medicaid managed care services, what does OPWDD see as the long-range future for DISCCOs (which can be provider based) vs. the commercial insurance-based medical care models?

DISCOs will be specialized managed care organizations that will ultimately provide comprehensive care planning and service delivery for individuals with developmental disabilities. They will be the long-term managed care service system for this population. They will need to interface with medical providers when the pilot DISCOs transition from providing only long-term supports and services to providing comprehensive care, including acute and primary medical services. There may be several models of cooperation that can be developed to integrate health care with long-term supports based on regional resources. OPWDD expects this transition to begin in parts of the state in 2015.


 

37. How does/will OPWDD manage the possibly competing goals of saving money vs. ensuring quality services?

OPWDD will improve efficiency within the system primarily by establishing a consistent approach to assessing needs and improving the ability of the system to plan and deliver services that respond to each individual’s needs. By creating a more complete array of services and levels of support, individuals will be able to receive just the right level of support to meet their needs. In addition, by networking providers together, administrative efficiencies will occur. At the same time, OPWDD will develop new ways of measuring and reporting quality to the individuals and families we support. New metrics will be developed that reveal how well individuals are progressing toward their goals, how effective their supports and services are at achieving the life they want, and what their levels of satisfaction are with their services. This information will be available to individuals and families so they will be able to see the effectiveness of different providers within the DISCO.


 

38. How do the state’s obligation under Olmstead and DISCOs connect? How will the requirement that services be provided in the most integrated setting (which for most means their own home) be enforced and advanced?

OPWDD’s provision of supports and services to individuals with developmental disabilities through DISCOs will be subject to the Olmstead decision. DISCOs will have to meet individuals’ needs in the most integrated settings. The National Council on Disability published in 2012 its Guiding Principles: Successfully Enrolling People with Disabilities in Managed Care Plans. In this document, they recommend that institutional services be included in the managed care “benefit package” and that the managed care entity be liable for these services. The OPWDD design will include institutional services in the benefit package and make the managed care entity liable for the payment of these services, thus creating a strong incentive for them to develop and support alternative supports in the community.


 

39. How will the ‘People First’ waiver – and more pressingly, individual and community supports (ICS) – connect to the State Plan Community First Choice (CFC) Option? DOH, OPWDD, and OMH have already begun to design CFC. Through which door will people access services? How will CFC’s requirement for a person-centered planning process coordinate with the care coordination component of ‘People First?’

OPWDD is currently working with the NYS DOH to determine how to integrate the new OPWDD service system with the CFC option. People with developmental disabilities will access and receive all of their supports and services through the DISCO. All services provided will be planned with a comprehensive person-centered planning process coordinated by a lead care coordinator and supported by input from an integrated care coordination team.


Created on Wednesday, 11 Jan 2012 at 1:13 pm.

Last updated on Friday, 15 Aug 2014 at 12:47 pm.