I. Introductions were completed.
II. Minutes were approved; if you were unable to open them, they are available as always on the DD Council website (www.manhattanddcouncil.org).
III. Announcements: Handouts
Camp Oakhurst
Overnight respite provided for people with developmental disabilities, 2-12 night stays. Sessions are scheduled year round and in the summer it is like a sleep away camp. There are separate sessions for children and adults. Applications are received throughout the year. Emergency overnight respite care is available for children and adults with physical and/or developmental disabilities. See attached for details.
The Family & Professional Resource Fair
Presented by the Manhattan Developmental Disabilities Council on December 14, 2015 at a new location, the New York Academy of Medicine, 1216 Fifth Avenue at 103rd Street. Flyer is attached.
AHRC New York City
Program vacancy list is attached. Contact the person indicated if you have someone who is in need of the service. There are openings in Recreation, Community Habilitation, Overnight Respite, Employment and Business Services, Adult Day Services, Residential and other programs.
QSAC
Please see attached for current program openings in each borough and Long Island. Openings include Early Intervention, Medicaid Service Coordination, Day Habilitation, Social Skills Group and others.
YAI
See attached for vacancy highlights for the month of December 2015. There are openings in Family Services, Respite, Education, Day Services, Employment Services, Residential Services, Healthcare and the Autism program. In addition, YAI’s Self Advocacy Association presents “In My Shoes Workshop Series” open to individuals, families, caregivers and professionals. Registration recommended but walk-ins welcome. It is a three part series scheduled for 1/5/2016, 2/13/16 and 3/10/16. See attached for more information.
NYC Fair
• Public hearing on developmental disabilities issues, sponsored by NYS Senator Perkins and Assemblyman Rodriguez, Thursday, January 14, 2016, 6-9 pm, State Office Building, 163 West 125th Street, 8th floor, conference rooms A, B, C.
• Discussion with Transformation Panel members about their recommendations, Wednesday, January 20, 2016, 6-8 pm, IAC, 150 West 30th Street, 15th floor.
Presentation on Fully Integrated Dual Advantage (FIDA) managed care plans for people with both Medicare and Medicaid, by JoAnn Lamphere, OPWDD, and Al Kaplan, AHRC NYC
Al Kaplan acknowledged that there is a good deal of anxiety among all stakeholders in the DD field about managed care. Managed care will mean changing from a fee-for-service model to a capitation model—a per member per month payment. The state and federal governments have pushed for managed care in order to get more predictability with fixed payments per member per month. Managed care entails provision of care coordination by a managed care organization. The Medicaid Redesign Team mandated managed care for Medicaid recipients, and the Legislature signed off on this. DD had been temporarily carved out. Insurance companies do not have experience with the DD population. The insurance model is a medically driven model dealing with episodic and preventable conditions. DD services don’t fit that model because people with DD have chronic need for ongoing, not time-limited, habilitative services. Actuarials for insurance companies look at risk by incidence (100% for DD) and termination (duration of need). Creating the notion of what the risk is for people with DD is very challenging. Additional concerns among stakeholders are that the goal of moving to managed care is really to save money: the managed care organization controls the funding and the license; care coordination could move toward utilization control; and the quality of services could decline.
Al discussed the new FIDA demonstration: Partners Health Plan (PHP), which is governed by Metro ARCs. It is a DD-centric model in which the funding and license are controlled by family-governed agencies. He stated that a FIDA could work well because it is a DD model, not an insurance model. The FIDA starts with an assessment using the POMs process. An interdisciplinary team works with the person’s circle to create a life plan, which is prescriptive. The life plan governs what gets funded. Every provider is committed to the life plan, rather than to financial goals. Residential services will be carved out. Enrollment in PHP is voluntary and will begin in March 2017, with implementation in April 2017.
Joanne Lamphere pointed out the importance of partnerships between government and managed care organizations. The critical issue is what the state’s commitment is to drive better services. Previously, we have had fragmentation and not positive outcomes. NYS spends 18% of all Medicaid funds across the nation. Fee-for-services supports more services, but not necessarily value. There is a need for accountability. Joanne emphasized that, done well, managed care can provide enormous benefits for people.
The new FIDA is the first launch in the country of managed care for all dually eligible populations (people receiving both Medicaid and Medicare), including people with DD. The vision is getting a better life. Across the nation, 9 million people are dually eligible. Integrating Medicare and Medicaid has many benefits: for example, providing management of care with an interdisciplinary team and a care manager, online access, not having to bounce back and forth between Medicare and Medicaid which reduces the time lag. FIDA involves partnerships with CMS, DOH, and OPWDD. It means one-stop shopping for services. PHP is the only plan selected by CMS for a FIDA for individuals with DD. The PHP demonstration will run from April 2016 to December 2020. In NYS, about 60% of people with DD are duals.
Please see the two attached powerpoints by Al and Joanne for more information.
IV. State News – Donna Limiti
The two agencies chosen to operate the START program in NYC will be announced soon. Implementation will be in January. NYC will have two teams, one covering Brooklyn/Staten Island, and the other Manhattan/Bronx/Queens. A report from the two other regions in the state that began START a year ago reveals that the number of psychiatric hospitalizations and ER visits was reduced dramatically.
There is a lack of respite opportunities in every region. To learn what the barriers are, OPWDD sent a survey to all agencies that provide respite. The data received have now been tallied. The three reasons that respite is sometimes difficult to obtain include: difficulty hiring staff, the reimbursement rate, transportation costs. OPWDD is re-examining the respite reimbursement formula. All 5 boroughs conducted respite focus groups, consisting of provider agencies, MSC agencies, families, individuals, and IAC representatives. Results will be shared when available.
There is a new collaborative effort between OPWDD and OMH to develop a system where both agencies collaborate to support a person with a dual diagnosis. This was attempted once before but was not successful because people stayed in the hospital beds and were not discharged because the families were not able to take them home. In this new effort, a hospital in NYC will develop a discrete unit for adults with DD; in Buffalo, where there is high demand for intensive psychiatric services for children, a hospital will develop a pediatric unit. When ready for discharge the individuals will be able to move to an OPWDD-operated step-down unit in the community for up to a year. This will facilitate integration in the community, with people either returning home or moving to another setting. Implementation is expected by the end of 2016.
The Transformation Panel is still looking into ways to pay for the administrative costs of a managed care entity without using funds dedicated for services. One way is to use an existing managed care entity, as the infrastructure will already be available. Another idea is to carve out residential services from managed care, at least initially. Options are still under discussion.
Donna announced that OPWDD will permit co-location of residences in two-family homes.
V. City News – Sandra Piggee
No report was presented.
VI. IAC/Federation – Jim Malley
IAC:
IAC’s is currently:
• Planning to present comment at the public hearing sponsored by the NYS Senate committee on mental health in January.
• Disappointed that the Governor, citing high costs, vetoed a bill which would have restored a recent cut to Article 16 clinics.
• Disseminating their position on minimum wage increase: that the current gap between DSP salaries and the minimum wage must be maintained.
• Hosting a housing developers forum on December 21.
• Developing an on-line training package for board members, targeted for release next month.
• Concerned about the impact of a NYC Department of Health requirement that all children in congregate settings receive the flu vaccine, fining schools that do not comply.
• Joining in the formation of the first provider association coalition: COPA, the Coalition of Provider Associations.
• Preparing for the Commissioner’s visit and presentation on January 28. IAC will develop its budget position by February 11. Lobby Days will be March 1 and 2.
Federation:
There was no Federation meeting; however, borough representatives met at IAC on December 3 and continued discussions on legislative items and strategies.
VII, Committee Reports
Family Support Services: Wendy De Leon, Amy Bittinger, and Yesenia Estrella reported that work on the Fair is continuing. The Fair will be Monday, December 14, 2015, 10:00 am – 2:00 pm, NY Academy of Medicine, 1216 Fifth Ave. at 103rd St. Volunteers are still needed as greeters and guides. Volunteers are also needed Friday afternoon, December 11, to help with preparation of the bags for attendees. There will not be a December committee meeting. Next meeting: Tuesday, January 12, 2016, 10:00 am – noon, Sinergia, 2082 Lexington Ave., at 125th Street, 4th floor (Location Change). Information: Wendy De Leon (917) 965-2950 x 109, wdeleon@ucpnyc.org.
Legislative: The legislative visits to select Manhattan legislators are almost completed. Response has been supportive. Next meeting: to be announced. Information: Jim Malley (212) 928-5910 x 101; jmalley@esperanzacenter.net.
Transition: At the last meeting, the needs of the 2016 graduates were reviewed. There are fewer than 100 graduates; more than half are OPWDD eligible and have MSC. It appears that about a third will want supported employment, and the rest will want day hab or day hab/prevoc. The committee discussed how to improve the transition process, beginning earlier, targeting 14year-olds as they enter high school. The committee would like to increase collaboration with parent coordinators. Next meeting: Wednesday, January 13, 2016, 9:30 am – noon, AHRC, 83 Maiden Lane, 11th floor board room. Information: Kathy Kelly (212) 780-2724; Kathy.kelly@ahrcnyc.org.
Manhattan Family Support Services Advisory Council: To encourage families to attend the Fair on December 14, it was decided not to have a December meeting. Next meeting: Tuesday, January 5, 2016, 10:00 am – noon, Sinergia, 2082 Lexington Ave. at 125th Street. Topic: Donald Lash, Executive Director, Sinergia, will present on encounters by people with DD with the law. Information: Margaret Puddington (212) 799-2042; Margaret.puddington@gmail.com.
Service Coordination: Next meeting: Friday, December 18, 2015, 10:00 am – noon, UCP, 80 Maiden Lane, 2nd floor training room. Topic: INCLUDEnyc. Information: Carol Lincoln (718) 859-5420 x225; clincoln@ucpnyc.org.
Childrens/Education Committee: Christina Muccioli announced that a co-chair is still needed for this committee. She stated that there are currently three main issues:
• paucity of teachers and teacher assistants in special education preschools
• new flu vaccine immunization requirement: children are requirement to have it; exemptions only for religious or medical reasons
• need for substantial tuition increase for 4410 special education preschools
Next meeting to be announced. Information: Christina Muccioli (212) 780-2532; Christina.muccioli@ahrcnyc.org.
Outreach & Family Engagement: Lynn Decker reported that a Council social media workgroup is continuing to develop options.