1. Announcements: See Below for Link to Hand Outs/ Attachments
Regular Committee Meetings see below or calendar.
Information: Irina Tuchina (212) 273-6100 x 2418 OPWDD Public Briefings on the 1115 Waiver To reserve a seat at one of our upcoming presentations, please visit www.opwdd.ny.gov/wp/wp_catalogz2407.js p. The presentation will be recorded and distributed system-wide to assist those unable to attend in person. NYC presentations: April 19, 1:30 PM: Brooklyn (Gymnasium – 888 Fountain Avenue) April 19, 10 AM: Bronx (1301 Morris Park Avenue) Autism Symposium: Growing Up with Autism, Life Transitions, Friday, May 11, 2012, 8:00am-5:00pm,Weill Cornell Medical College, 1300 York Ave., New York, NY 10065, Fee: $100, Information: 212-746-3583
2. Report on the Legislative Breakfast
Judy DeIasi, our guest speaker and chair of the Manhattan DD Council’s legislative committee, reported that this year’s Legislative Breakfast was a stunning success—great speakers, great legislative attendance, great turnout. This year we intentionally focused on parents rather than providers. We had only parent speakers and a parent moderator —Elly Rufer, who did an outstanding job—in order to emphasize how concerned families are about the future of our service system. You can read the speeches and see the photos from the Breakfast at www.manhattanddcouncil.org.
3. Report on Budget
For the second year in a row, Governor Cuomo brought about an on-time budget. The budget for the next fiscal year includes major initiatives on economic development, job creation, government reform and efficiencies. The proposal closes the multi-billion dollar deficit with no new taxes and limits spending growth to two percent. The total State budget is $132.2 billion, a 1.9% spending increase over the current year.
OPWDD
The Governor’s proposed budget for OPWDD was enacted by the State Legislature, which made some relatively small changes. The two major budget categories for OPWDD include State Operations and Aid to Localities. State Operations funds all state-operated programs including institutions, state-operated community programs, and all administration. Aid to Localities funds all voluntary-operated programs. Totals are as follows:
Aid to Localities
- Governor’s OPWDD Proposal: $2,478,841,000
- Final OPWDD Budget: $2,479,141,000
- Change: +$300,000 (.12%)
State Operations
- Governor’s OPWDD Proposal: $ 2,140,718,000
- Final OPWDD Budget: $2,140,718,000
- Change: 0 (0%)
The Legislature used the $300,000 increase in Aid to Localities for Regional Centers for Autism Spectrum Disorders ($250,000) and the Epilepsy Foundation ($50,000).
Executive Compensation – The Legislature rejected the Governor’s budget language limiting executive compensation to no more than $199,000 in State funds. However, the Legislature opted to allow the Governor to handle the issue administratively, through the Governor’s Executive Order, which imposes the same terms and conditions.
Cap on Administrative Expenses – The Governor’s budget language proposed limiting administrative expenses to 25% in the upcoming fiscal year, scaling down to 15% by 2015. The Legislature rejected the Governor’s language. However, it again opted to defer to his Executive Order, which imposes essentially the same conditions.
OPWDD Structural Reorganization – There will be administrative reorganization and streamlining of Developmental Disabilities Service Office (DDSOs). One regional division will be created to oversee services in the non-profit sector; a separate regional division will oversee the state-operated system.
DEPARTMENT OF HEALTH
Insurance Coverage for Early Intervention (EI) Services – The Legislature rejected the Governor’s proposals requiring EI providers to become members of insurance networks and to negotiate rates with insurance companies and accept those rates as full payment.
Utilization of a Fiscal Agent for billing of EI services – The Legislature accepted the proposal to create a fiscal agent to handle billing.
Arms-length Relationship Between Evaluators, Service Coordinators and Providers – The Legislature rejected the proposal to require that EI evaluators be from a different agency than the service providers.
Spousal/Parental Refusal for Medicaid Coverage – The Legislature rejected this proposal to discontinue the waiving of parental income for Medicaid eligibility for children under age 18. A similar proposal has been rejected for the past 25 years. It is noteworthy, however, that this proposal would have had NO impact on eligibility for OPWDD Waiver services and therefore would have had very minimal impact on our families.
4. Report on the Statewide FSS Committee, Margaret Puddington
- • The new budget includes $8 million for family support services statewide. OPWDD will re-look at the methodology previously used to allocate funding to the different DDSOs and will re-evaluate whether OPWDD or the local FSS Advisory Councils will set the priorities.
- • OPWDD is closing Finger Lakes and Taconic developmental centers by the end of 2013, and the Staten Island multiply disabled unit in a few months. In the Finger Lakes region, there has been aggressive community opposition to moving people from the institutions into the community. OPWDD will be issuing requests for services for the non-profit providers to develop residences for people returning from institutions.
- • 1115 Waiver update: OPWDD is in the process of applying to the Centers for Medicare and Medicaid (CMS) for approval of the 1115 Medicaid waiver. OPWDD has been having weekly meetings with CMS about the waiver proposals. CMS is mostly supportive and loves the interRai assessment tool that has been chosen and approves of the way it will be used. (This tool is still being adapted for our use.) DDSO individual and family discussion boards are ongoing. Public briefings about the waiver are now scheduled and will be available for viewing on the web. Once CMS approval of the 1115 waiver is received, OPWDD will begin focused case studies to test some of the 1115 waiver concepts such as assessment and care planning. In the next phase, DISCO pilot projects will begin. Implementation work groups will be established to provide guidance.
- • Presentation on OPWDD’s new behavior management training, PROMOTE: Positive Relationships Offer More Opportunity to Everyone. PROMOTE emphasizes de-escalation of crisis situations. It will replace SCIP-R training (Strategies for Crisis Intervention and Prevention, revised). PROMOTE represents a shift from behavior control and crisis intervention to fostering positive and functional relationships, environments, community, and respect. PROMOTE aims to avert behaviors in the first place instead of relying on physical interventions such as take-downs. It is now being rolled out. Members indicated they would like a presentation on PROMOTE. Margaret will try to arrange it.
5. Nominations Committee, Linda Irby
Linda Irby explained that elections for Council officers—chairperson and executive committee—will be held in June. Officers serve for two years. The current officers are: chair, Margaret Puddington; executive committee, Marie Christopher, Caroline Grant, Gloria Gonsalves, Michael Haas, Kennan Hourwich, Linda Irby, Joey Perez, Julia Rogge, Elly Rufer, Carol Saul, Morna Sheehy, Sharyn Van Reepinghen, Susan Williams, Yee Wah Yee. To be eligible to serve as an officer, a member must have attended 3 meetings within the last year. To nominate yourself or someone else as an officer, please call Linda Irby, chair of the nominations committee, at 212-926-1615.
6. Speaker: Judy DeIasi, Associate Executive Director, AHRC on How Providers Protect Individuals Through the Incident Review Process
Judy explained that OPWDD’s system of managing “incidents” is good. OPWDD’s regulations are stricter than those of OMH, OASAS, or other state human services agencies. The regulations governing incident management are contained in Rules and Regulations Part 624. Incidents are classified as occurrences, reportable incidents, serious reportable incidents, and abuse.
An occurrence is anything that could go wrong but is not serious enough to rise to the level of a reportable incident. For example, a minor injury of unknown origin that did not require more than first aid or an argument between two residents of a group home. Agencies do not report occurrences to OPWDD; they have their own procedures for handling them. But they should be looking at why this happened to decide if there is something the agency could do to prevent a recurrence.
A reportable incident is a death that is expected, an injury requiring the ER but nonadmission, or a missing person (briefly missing only).
A serious reportable incident is more severe than a reportable incident. For example, an unexpected death, a missing person where the person is not capable of being alone, or the use of a restraint.
An allegation of abuse might be for mistreatment, neglect, sexual abuse, physical abuse, psychological abuse, seclusion, unauthorized use of restraint, or violation of a person’s civil rights.
All incidents other than occurrences must be recorded and investigated and reviewed by the agency’s incident review committee. Agencies are required to take protective actions immediately to care for and protect any individuals involved in an incident. Agencies must investigate the cause of the incidents with a view to preventing similar incidents in the future. To do this, they may need to change procedures, retrain staff, fire staff, or take other corrective actions. Agencies are required to report all serious reportable incidents and allegations of abuse to OPWDD within 24 hours. Agencies must have incident management policies that have been approved by their boards of directors.
Clarence Sundram, special advisor to the Commission of Quality of Care and Advocacy for Persons with Disabilities, studied incident management across different state agencies and found OPWDD’s system to be best. He recommends standardizing definitions of abuse, however. OPWDD’s definitions are the most strict—for example, OPWDD defines seclusion as abuse, but OMH permits it.
Despite a basically good system, it is important to understand that things do happen. Even with all the staff training in the world, things happen because human beings make mistakes. It is up to the agency to discipline staff when undesirable things happen.
Parents may get redacted reports of allegations of abuse affecting their child but the reports must be requested in writing. The agency must offer the parents a meeting to discuss the incident.
OPWDD’s regulations governing incident management are available on the OPWDD website: www.opwdd.ny.gov. Under Resources, click Incident Management, then Part 624 Handbook. This Handbook provides a very clear description of every regulation, with examples. It also explains what steps the agency must take.
FSSAC Attachments 4:12