1. Announcements: SEE BELOW
2. Report on September Statewide Family Support Committee meeting
Margaret reported on the September 15 statewide Family Support Committee meeting.
• Commissioner Burke reported that during Hurricane Irene, OPWDD and non-profits evacuated about 1,200 people from low-lying areas. This was an extremely complicated process, and staff were outstanding.
• An analysis of OPW strengths and weaknesses is underway and will be presented to OPWDD leadership.
• Because of the recent exposure of the issue of nonprofit executive compensation in the New York Times and elsewhere, Governor Cuomo has appointed a task force to survey nonprofits on compensation practices. The survey is beginning with OPWDD and is a sampling of agencies. The task force will review the surveys and formulate recommendations; these will be general recommendations, not agency-specific.
• The Commissioner distributed a list of OPWDD accomplishments, March-August 2011. The accomplishments include:
o Imposing higher standards for new employees within state-operated facilities
o Supporting Employees with Consistent Standards and Training
o Centralized Incident Management Reporting
o Strengthening investigations
o Encouraging Abuse Reporting
o Partnering with Law Enforcement
o Holding Bad Employees Accountable – Table of Penalties
o Instituting Oversight & Accountability of Nonprofit Providers
o Creating and Strengthening Safety Initiatives
o Building Positive Relationships through Culture Change
o Increasing Communication
• 5. The Division of Quality Management is creating provider performance profiles based on four outcomes: home, health, relationships, work/productivity. The profiles will include provider scores so that families can compare provider scores against a statewide average and against other specific providers. This project will begin by profiling MSC providers. Eventually the profiles will be posted on the OPWDD website. There may also be rewards for good performance.
• 1115 Waiver. Was powerpoint was presented. You can find comprehensive information, including video interviews, at http://www.opwdd.ny.gov/2011_waiver.
3. Speakers: Al Kaplan and Judy DeIasi, AHRC, on the 1115 Waiver
Al and Judy explained that currently OPWDD operates almost entirely under Medicaid— Medicaid waivers and Medicaid state plan services. Medicaid is a funding source. The current funding isn’t working well. Thus OPWDD is proposing to switch to a different Medicaid waiver: the 1115 waiver, which is a research and demonstration waiver. Under this waiver, any federal regulation can be waived, except for the percentage that the federal government contributes. (In NYS Medicaid is funded 50% by the state and 50% by the federal government.) OPWDD must agree not to spend any more federal dollars than are now being spent. OPWDD will do this by adopting a capitation agreement: not spending more in future than the current average per-person cost. This most likely means that over time the average per-person cost will be reduced from its current level because additional people will be served. The 1115 waiver agreement would be for 5 years, with renewals.
Because of the fiscal crisis, the state can’t contribute as much money as in the past. And any cut in state dollars means the loss of the matching federal dollars. NYS provides a lot of care—the most in the country. But NYS doesn’t have enough funding to continue providing services at the current level. Also, under the current waiver, there are 5,000 different reimbursement rates for services and 120 different billing categories. This bureaucratic maze adds to the costs. OPWDD realizes that the current costs are not sustainable in the future. Thus, the need for OPWDD to apply for the 1115 waiver.
At this point, OPWDD’s design of the 1115 waiver is a general plan. There is a tremendous amount of material available on the OPWDD web at http://www.opwdd.ny.gov/2011_waiver/ , including video interviews. However, there is much that is not yet worked out. The transition from the current system to the 1115 waiver is highly unclear at this point.
Jason Helgerson, NYS Medicaid director, comes from Wisconsin which adopted a capitation waiver with managed care for the frail elderly and people with developmental disabilities. OPWDD’s 1115 waiver would also be designed as a capitation waiver within a managed care system.
The 1115 waiver would include long-term services (residential, day, community hab, etc.) and also medical services. The managed care organizations would coordinate—and pay for—all types of Medicaid services. Each MCO would have a network of providers. OPWDD is calling the managed care organizations DISCOs (DD Individual Services and Care Coordination Organizations).
Costs for our population can be high per person with many receiving 24/7 residential services and day hab programs as well as costly medical care. It is not clear how/whether high and/or unanticipated medical costs, such as hospitalizations, could be accommodated by the DISCOs. For this reason, many believe it is too risky to include both long-term care and medical services in the waiver and that they should be kept separate.
The Wisconsin model does not include medical services. Even so, in Wisconsin 3 managed care organizations are on the brink of bankruptcy, 3 more are in fiscal trouble, and the other 3 are ok.
Managed care is a health care model, in which doctors determine what people need. This is a different philosophy than a person-centered model whose goal is to enrich people’s lives. These are two different philosophies.
Typical managed care organizations generally take funding off the top—17% of the total budget is usual. Plus our DISCOs would need a reserve fund for emergency expenses. Thus, DISCOs could take 20%-23% off the rate. It is not clear how OPWDD would handle this issue. OPWDD doesn’t want typical insurance managed care organizations; they want developmental disability agencies to become DISCOs, and to have them run under the DD agencies’ existing administration rate, which is a good deal lower.
Already there is barely any new residential development. OWPDD wants to keep people at home longer. But a lot of families do need 24/7 residential care. OPWDD will need to figure out how to do both. DISCOs that are financially stretched will want to cut costs, not underwrite new residential development.
All things considered, it is essential that DISCOs be run by nonprofit agencies.
Eventually, the 1115 waiver process would begin with an individual assessment of needs and goals. The assessment tools would be new and updated. The assessment would produce a score which would be linked to an amount of funding, the capitated value for that person. The DISCOs would then work with the person/family to plan for services. The entire process of allocating, selecting, and paying for services is not yet clear, but it is critical for self-advocates and families to have their choice of DISCO and of provider.
The 1115 waiver would allow OPWDD to eliminate some burdensome regulations that are costly, which would be an advantage.
A major goal of the 1115 waiver is to close state institutions: OPWDD aims to reduce the institutions from the current census of 1260 people down to 300 within 5 years.
The first 2 or 3 years of the 1115 waiver will be testing of pilots. Implementation will proceed gradually. How services will or will not change for people currently being served is unclear. What services will be available for new families, and whether residential services will be available for people needing 24/7, is also unclear.
OWPDD is hoping for approval of its 1115 waiver by April 1, 2012. OPWDD anticipates releasing its 5.07 plan, containing the design proposals for the 1115 waiver, in October. Subsequently, hearings will be held on the plan. If you have questions or concerns about the 1115 waiver, it is very important to speak up at the hearings and let OPWDD know your feelings.
Announcements:
Manhattan Family & Professional Resource Fair
Thursday, December 1, 2011, 10:00 am – 2:00 pm
Church of St. Paul the Apostle, 405 West 59th St. at 9th Ave.
Info on services and supports from over 90 service providers.
Family Support Services Committee
Tuesday, October 11, 2011, 10:00 am – noon
YAI, 460 West 34th Street at 10th Avenue, 11th floor
Information: Amy Bittinger (718) 859-5420 x 234
DD Council
Thursday, October 13, 2011, 9:30 am
YAI, 460 West 34th Street at 10th Avenue, 11th floor
Information: Margaret Puddington (212) 799-2042
Transition Committee
Wednesday, October 12, 2011, 9:30am – noon
AHRC, 83 Maiden Lane, 11th floor
Information: Kathy Kelly (212) 780-2724
Childrens Committee
Thursday, October 6, 2011
Jewish Guild for the Blind, 15 West 65th Street
Information: Christina Muccioli (212) 780-2532
Legislative Committee
To be announced
Information: Judith DeIasi (212) 780-2667
OPWDD’s September Newsletter
To read this online newsletter, go to www.opwdd.ny.gov/newsletters/september_2011.
The Friendship Circle
This organization has started a new program, the Sunday Circle, a 2-hour monthly drop off program where children with disabilities and their teen buddies enjoy physical fitness, specialized art and music, with a Jewish theme. No fee. Contact Dina Shanowitz 646-820-1066 or dina@friendshipnyc.com.
Jewish Religious Services for Families with Special Needs
• Rodeph Sholom, Rosh Hashanah, Friday, September 30. 2011, 11:00 am – noon. Rodeph Sholom synagogue, 7 West 83rd Street (bet. Columbus and Central Park West)
• B’nai Jeshurun, Havdalah (end of Shabbat) service, Saturday, October 29, 2011, 5:45 – 7:00 pm, 257 West 88th Street (bet. Broadway and West End Avenues).