On July 18th, Commissioner Courtney Burke spoke at United Hospital Fund’s 2012 Medicaid conference, “Advancing Medicaid Reform”. Commissioner Burke’s presentation focused on the People First Waiver reform process. Please find below a summary of key takeaways.
Ongoing Dialogue with CMS
The Office for People with Developmental Disabilities (OPWDD) is continuing to work closely with the Centers for Medicare and Medicaid Services (CMS) on detailing reforms outlined in the People First Waiver proposal. OPWDD will submit its proposal through a combination of a 1915b and 1915c waiver. The 1915b waiver agreement will authorize the creation of a managed care service delivery system for individuals with developmental disabilities, while the 1915c waiver agreement will establish the specific services and supports that can be provided under the Medicaid program.
Implementation Timeline
Please find below OPWDD’s updated timeline:
- · Summer 2012: Detail the 1915 b/c waiver;
- · Fall 2012: Submit the 1915 b/c waiver application to CMS, roll-out limited use of the new InterRAI assessment tool, and measure outcomes;
- · Fall 2013: Launch DISCO pilots;
- · 2014: Launch some OPWDD Fully-Integrated Duals Advantage programs; and
- · 2015: Roll-out managed care statewide.
Implementation Details: Focused Case Studies
OPWDD will begin focused case studies in November. This process will inform, not replace, person-centered planning in high quality settings. The focused case studies will test concepts such as the assessment tool, care planning process, documentation practices, and new measures of individual outcomes. There are 21 high-performing agencies participating in this process.
The focused case studies will be small-scale and participation will be voluntary. Three groups of individuals will be targeted for participation:
- · Individuals who appear to have independent skills and are living in 24/7 residential settings;
- · Individuals who appear to have high behavioral needs but are receiving little to no OPWDD services; and
- · Individuals identified as wanting alternative supports such as increased self-direction, intensive employment services, and other alternative models of support.
OPWDD anticipates that approximately 1,000 individuals will meet the above criteria and participate in the focused case studies.
Implementation Details: New Quality Metrics
OPWDD will establish clear expectations for quality measurement, ongoing quality improvement, and public accountability in DISCO performance. Performance measurement considerations will include: Article 44 of the Public Health Law requirements, quality assessment and improvement programs, and health information systems that support quality assurance.
Possible metrics include:
- · Rates of emergency department utilization;
- · Rates of hospitalizations;
- · Hospital re-admissions;
- · Access to routine health care;
- · Number of people living in less restrictive settings;
- · Individual satisfaction with living arrangements;
- · Number of people with high levels of assessed behavioral health needs being served in community-based settings; and
- · Number of people served with paid community employment.
Implementation Details: Managed Care Through Pilot Projects
DISCO pilot projects will be based on the Managed Long Term Care (MLTC) program. Contracts and readiness review will also be based on the Department of Health’s template for MLTCs. However, key differences will include:
- · Care coordination requirements;
- · Enrollment broker functions; and
- · The role of advocacy.
Marco R. Damiani
Senior Director
YAI Network
and
Chair, Manhattan Developmental Disabilities Council