Announcements: handouts-fssac-nov-16
Manhattan Family & Professional Resource Fair
Tuesday, December 13, 2016
10:00 am – 2:00 pm
New York Academy of Medicine
1216 Fifth Avenue @ 103rd Street
Margaret announced that volunteers are needed for the Fair: to do registration, set up, clean up, help to direct people. The following volunteered: Maggie Sanchez, Reina Gonzalez, Elizabeth Ayala, Ana Tejada, Maylos Morales, Joey Perez, Sunny ONeil.
See Meeting Dates Below
2. NYC Fair Legislative Advocacy Campaign – Elly Rufer
Elly explained that NYC Fair, a family advocacy group that is independent of agencies, is supporting the statewide advocacy efforts of the Coalition of Provider Associations to increase the insufficient salaries of direct support professionals (DSPs). 90% of services for people with developmental disabilities are funded by Medicaid. That means that in NYS, Medicaid pays 50% of the cost of these services, and NYS pays the other 50%. 80% of the cost of services is for DSPs. Because DSP salaries are so low, many leave for higher pay in other fields; recruitment and retention of DSP staff is extremely difficult. The minimum wage is scheduled to rise to $15/hour by 2018, and the budget does provide funds to meet the minimum wage, but that does not resolve the problem. In 2018 a new worker could get $15/hour at McDonalds, for much easier work. Why would someone take on such exhausting work when s/he could make the same at McDonalds. Our argument is that DSP is not a minimum-wage job: the work is very challenging, the responsibility is huge, and the training requirements are intense. We need to convince the Governor to raise DSP salaries beyond the minimum; we already have much support among NYS legislators. The Coalition is asking for $45 million per year for 6 years, which would eventually bring average salaries in NYC/LI to $17.72/hour.
The situation is the same for nonpublic 853 schools and 4410 preschools. Teachers and teacher assistants earn much more in the public schools, and there is a severe shortage of both in the non-public schools.
Elly urged people to check out the NYCFAIR.org website and sign up for e-mails. You can use the sample letters at your Thanksgiving tables, encouraging families and friends to contact their elected officials.
3. Speaker: Donna Limiti, NYC Director, OPWDD, on OPWDD Updates, Part II
Donna explained that everything in OPWDD is changing. OPWDD no longer sets its own rates, and the federal Centers for Medicare and Medicaid (CMS) set much policy. Change is necessary because funds are not bottomless and there is not enough to meet current needs and also serve new people. Money is now controlled at the central OPWDD office, not by the boroughs as previously. The borough used to be able to approve services according to urgency of need. Now everyone goes through the Front Door, and the local DDRO authorizes the services until the point where the central office says there is none left.
Donna says she is optimistic about the future because OPWDD has already developed services and rules and can do it again. But this period is difficult because we don’t know all the answers. We need to change because we need to stretch the funds: certified housing is very expensive; and because some services are viewed as isolated, apart from the community (more on this under HCBS settings requirement below). Donna urged families to experiment, try the new services, not expect the same old ones, and stop thinking that at age 21, your child needs to move out to a certified group home.
Newer residential models include Individual Supports and Services (ISS), which is a rental subsidy, whereby the state pays part of the rent. The person(s) can get in-home supports living independently, but not 24-hour supports. However, there are some creative ways, through self-direction, where a person could possibly have 24-hour support using a live-in caregiver. Another model is family care, where the person lives in someone’s home and the host provides skills development.
Rates for respite have been revised, and some providers aren’t able to manage with the new fee. OPWDD’s Acting Commissioner is trying to figure out how to make up the difference between the fee and the actual cost of the respite. This is still under negotiation with CMS.
Regionalization of rates. Rate changes is also an issue for other services. There is now regionalization of rates, for example, for residential services. Previously, there were different rates for different populations with different support needs. Also, previously an agency could get a rate appeal if someone needed intensive staffing. But now there is only one rate. People with more challenges are not readily being served. The rate change was phased in over 4 years, but still caused many agencies to lose millions of dollars. OPWDD has been trying to address this issue and has proposed to CMS as part of its waiver renewal application that OPWDD would accept clinical justification for the need to hire additional staff and if approved would fund that. Phase one of this agreement would cover people new to an agency; phase two would cover people already with an agency whose needs have changed. Phase three would cover people in day programs.
Conflict-free case management: CMS is requiring that case management/service coordination/MSC not be provided by a person’s service provider. The problem is how to honor family choice. Many families have close relationships with their MSCs and don’t want to change. OPWDD is now developing a transition plan to conflict-free case management. The goal is to avoid disruption of services or huge financial losses to agencies. OPWDD hopes to develop an independent entity, which could be a collaboration of agencies, to provide case management. There might be different tiers of case management ranging from relatively easy cases to higher-needs cases. This would provide a career ladder for the case manager to move up the tiers. OPWDD will issue a request for proposals to ask agencies for their conception of what this entity should be, incorporating the concept of health homes (looking at a person with significant health concerns as a whole person).
HCBS settings requirement: OPWDD’s waiver services are funded under the Home and Community Based Services Waiver (HCBS). The settings requirement under that waiver mandates that individuals/services be integrated in the community, that individuals have choice of residence and roommate, that individuals have access to food at all times, free access to the phone, etc. House rules, such as dinner at 6 or curfew, are not permitted. All services must be individualized. However, if health and safety of an individual would be compromised under an aspect of the settings requirement, the agency can develop a behavior support plan that bypasses that settings requirement. OPWDD must comply with the requirement over a transition period.
CAS: Currently OPWDD uses a DDP2 form to assess a person’s skills. The score determines funding for the person’s residence. OPWDD is transitioning to the Coordinated Assessment System (CAS) to replace the DDP2. The CAS is a suite of assessments, much more comprehensive than the DDP2. The CAS collects information from a variety of sources: the person, others who know him/her best such as the family, etc. The CAS is quite time-consuming. It is not yet validated. Once it is, evaluations will begin with adults new to the system. In 2020 it is anticipated that CAS scores will determine funding for an individual.
Dashboard: OPWDD has posted a dashboard, called By the Numbers, on its website, containing data on the numbers of people getting new services.
Meeting Schedule:
DD Council
Thursday, November 10, 2016, 9:30 am – noon
Sinergia, 2082 Lexington Ave., 4th floor
Information: Marco Damiani (212) 947-5770 x 456; manhattanddcouncilchair@gmail.com
Family Support Services Committee
See Fair announcement above
Information: Yesenia Estrella (212) 643-2840 x 349; yestrella@sinergiany.org
Transition Committee
Wednesday, December 14, 2016, 9:30 am – noon
AHRC, 83 Maiden Lane, 11th floor
Information: Kathy Kelly (212) 780-2724; Kathy.kelly@ahrcnyc.org
Legislative Committee
Next meeting to be announced
Information: Jim Malley (212) 928-5810 x 101; jmalley@esperanzacenter.net
Childrens/Education Committee
Next meeting to be announced
Information: Christina Muccioli (212) 780-2532; Christina.muccioli@ahrcnyc.org