NEXT MEETING: November 9th, 2015
New Crisis Response & Prevention Program
The START program is for individuals who have developmental disabilities and severe behavioral challenges—and who are in crisis. Soon to be launched in New York City, START will offer a variety of therapeutic services geared to helping individuals remain in their home or community placement. Come and learn from Hope Levy, Associate Executive Director for Adult Services, IAC, about this invaluable new program that could make a world of difference to individuals and families in their darkest hours.
Nuevo Programa de Reacción y Prevención de la Crisis
El programa START (“comenzar” en español) es para individuos que tienen una discapacidad de desarrollo y conductas severas desafiantes—y que están en crisis. Pronto a ser lanzado en la Ciudad de Nueva York, START ofrecerá una variedad de servicios terapéuticos dirigidos a ayudar a individuos a quedarse en sus casas o ubicación comunitaria. Ven y aprende de Hope Levy,Directora Ejecutiva Adjunta de Adult Services, IAC, acerca de este invalorable programa que puede hacer un mundo de diferencia a individuos y familias en sus horas más oscuras.
MINUTES, September 21, 2015
- Announcements
DD Council
Thursday, October 8, 2015, 9:30 am- noon
YAI, 460 West 34th Street, 11th floor
Information: Marco Damiani (212) 947-5770 x 456;manhattanddcouncilchair@gmail.com
Family Support Services Committee
Tuesday, October 13, 2015, 10:00 am – noon
YAI, 460 West 34th Street, 12th floor, conference room I
Information: Amy Bittinger (718) 859-5420 x 234; Abittinger@ucpnyc.org
Transition Committee
Wednesday, October 14, 2015, 9:30 am – noon
AHRC, 83 Maiden Lane, 11th floor Board Room
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
Children’s Committee
Next meeting to be announced.
Information: Christina Muccioli (212) 780-2532;Christina.muccioli@ahrcnyc.org
Outreach & Family Engagement
Next meeting to be announced.
Information: Lynn Decker (917) 575-5166; lynn_decker@me.com
- Report on Transformation Panel Public Forum
Margaret reported that OPWDD is holding a series of public forums to allow people to share their views on self-direction, employment, residential supports, and system reform with the Transformation Panel, a group created to advise OPWDD on how best to manage all the ways the system is changing. Manhattan’s forum was September 17, 5-7 pm. It was fairly well attended, but not packed. Everyone who wanted to, was able to speak. Topics were: need for development of 24-hour residential services, concerns about managed care, problems with self-direction, need for highly trained direct support professionals (DSPs), difficulty of recruiting and retaining DSPs, need for appropriate residential services for people with severe challenging behaviors when developmental centers close, need for OPWDD to be more transparent, and many other topics. Several mentioned the possibility of lawsuits related to the closure of the developmental centers and to Self-Direction. Much of the testimony from 9/17 will be posted in full on the NYC Fair websitewww.nycfair.org. OPWDD will catalog all the testimony on its websitewww.opwdd.ny.gov.
- Report on Statewide Family Support Committee
Margaret reported on the September meeting of the statewide Family Support Committee.
Integrated Workshops: The Commissioner reported that OPWDD will be issuing guidance in November on how to restructure sheltered workshops so that they meet inclusion requirements of Centers for Medicare and Medicaid Services (CMS). She emphasized that no workshops will be closed overnight, and that most are planning to restructure to become integrated work settings or business models that allow for interactions with the public. Listening sessions will be held in October, so that feedback can be incorporated in the guidance.
Transformation Panel: The Acting Commissioner explained that the panel has been working on self-direction, employment, housing, and managed care. They are trying to create flexible arrangements for cases where an alternate service option is not working out for people. In their work on managed care, the panel is focusing not on a particular model, but on the essential elements of managed care: advocacy and care coordination.
Rate Rationalization: The work on rate rationalization is nearly finished. The next step will be application for renewal of the HCBS waiver. There is $50 million available from BIP (Balancing Incentive Program) grants for providers in default because of rate rationalization to help them bridge into the new acuity-based structure (that is, a structure based on a measure of the severity of needs of the people being served). OPWDD is working on ways to finely tune acuity. Current tools are not adequate to do acuity-based rates. OPWDD is going to regional rates. Some providers got increases, others got decreases. OPWDD wants to correct the outliers—those with very large increases or decreases—and refine the acuity piece.
Residential Request List: OPWDD is required by the Legislature to present a report on current and future residential needs. OPWDD is calling about 11,000 people on the current waiting list to see if they are still interested in residential services, when and what type of residential services, how much care they need, and what services they currently receive. OPWDD expects to finish the calls in October. If you are on the residential request list but haven’t received a call, you can call them at 1-844-679-3369, Monday through Friday between8am and 4:30pm. It’s important that everyone who needs residential services participate so that government gets a realistic idea of the true numbers of people in need. [Deadline subsequently extended to Oct. 17, 5:00 pm.]
Issues of Local Concern: Statewide committee members represent the different regions of New York State. Members shared what they see as their region’s greatest needs and concerns. Issues included: need for 24-hour residential services, concerns about managed care, need to raise DSP salaries, high DSP turnover due to low salaries, self-direction barriers, long wait for MSC approval, need to expedite Front Door process, lack of services of Western NY, lack of respite workers, better training for respite workers, future of OPWDD itself as the NYS Department of Health takes on a greater role, cuts resulting from respite rate rationalization that may drive respite providers out of business. In future meetings, the committee may decide to select a couple of these issues to work on.
Medical Orders for Life-Sustaining Treatment (MOLST): The committee had a presentation on this topic, which is somewhat technical. The MOLST is for individuals with developmental disabilities who lack the capacity to make their own health care decisions and do not have a health care proxy. Medical decisions which involve the withholding or withdrawal of life-sustaining treatment must comply with the process set forth in the Health Care decisions Act, which was limited to 17A guardians but has been extended to include involved family members. The form specifies which treatments, including Do Not Resuscitate (DNR), are requested to be withdrawn or withheld under certain criteria. The guardians can make decisions but others such as physicians, the residential director if the person resides in an OPWDD residential facility, and Mental Hygiene Legal Services, also have a say. The MOLST form for NYS is available on the NYS Department of Health (DOH) website www.nyhealth.gov/nysdoh.
Rate Reform: Donna Cater of the NYS DOH presented on respite rates. She explained that DOH had to redo methodologies based on CMS requirements. DOH pointed out to Medicaid that respite doesn’t have the economies of scale that IRAs do. Donna Cater stated that there is a huge variation in rates across the state. She discovered that, for example, some providers had 2:1 staffing, some provided transportation, etc. In January the new methodology will go into effect, with different rates for different needs—tiers of service that specify the type of service being provided, such as 1:1, 1:2, transportation. These will be regional rates. Providers will be allowed 90 days to appeal calculation errors, but no other appeals will be permitted. In the future, you will be able to see any provider’s rate for any service on the DOH website:www.health.ny.gov/health_care/medicaid/rates/mental_hygiene. So far IRA, ICF, and group day hab rates are posted.
Guidance to Family Support Services (FSS) Coordinators: The committee had been working to resolve some family support services concerns for over a year and, finally, completed its work. These concerns arose because of changes in how people access services: through the Front Door, one at a time. Additionally, OPWDD stated that there will no longer be statewide RFPs so there was no mechanism for creating new services. Resolving the issues we raised was challenging because in some cases, OPWDD had to devise new strategies and mechanisms that did not exist. For example, the committee wanted a way to identify gaps in services, which is much more difficult now that people are going through the Front Door one at a time and not directly approaching agencies to request a service. Solutions included:
- The Front Door Service Authorization letter will now direct individuals who are unable to access services for which they have been authorized to contact the Front Door.
- The Front Door staff should attend local FSS Advisory Council meetings to discuss service availability
- Local FSS Coordinators should maintain data sheets about services in high demand as well as which programs are full and which have waiting lists.
Solutions to other issues:
- We also resolved that to create a new non-waiver program, such behavior management or parent training, regions must utilize a competitive Request for Proposal (RFP) process.
- We resolved that if a waiver or non-waiver program is terminated, funds can be reallocated to another waiver provider by OPWDD without an RFP.
- We resolved that to expand or create a new waiver program for a group service, such as a recreation program, a request should be made to the Front Door/DDRO. The DDRO would review the proposal and obtain approval. Funding would come from the funds made available for new services in the enacted budget. The initial request may be made either by a provider or by individuals.
- It was also agreed that the FSS Advisory Councils will continue to have oversight of FSS waiver and non-waiver programs and that the Councils will work in cooperation with Front Door staff to identify gaps in services, will participate in reviewing proposals for any local FSS RFPs, will be involved in contract renewals and in any decisions about reallocation of funds.
OPWDD has agreed to disseminate guidance to the FSS Coordinators about these new procedures.
- Speaker: Nadine Daley, Coordinator of Innovative Planning, Center for Family Support, on Personal Outcome Measures (POMs)
Nadine explained that the Council on Quality and Leadership (CQL), an international nonprofit organization, has developed a process for learning what individuals with developmental and other disabilities want their lives to be like. CQL believes that individuals should have choices about their own services, and that if they are not happy with a service, they can choose a different one. CQL has developed ways to measure whether individuals have the outcomes they desire in their lives—Personal Outcome Measures (POMs). They discover what people want and whether they have what they want by having a conversation with the person and/or the people who know the person best. The conversation is a series of questions about the person, his/her world, his/her dreams. The questions are posed by highly trained interviewers. Nadine provided many examples of the outcomes that might arise from the interview, and the discussion at times challenged some of the families’ assumptions. Nadine explained that the goal of POMs is a better life for the person based on his/her own values and choices. Agencies can also use the results of POMs to see whether there are areas they need to improve. Nadine stated that her agency, Center for Family Support, is a CQL-accredited agency, and demonstrated their commitment to the POMs approach.
Please see the attached powerpoint for more information. POMS ppt Nadine Daley