The Balancing Incentive Program’s Goals and Activities Supporting

OPWDD’s Transformational Agenda

November 7, 2014YAI NYSDASP Conference

Transformation Agreement with CMS A. OPWDD’s commitment to CMS for achieving ambitious

goals for system reform and personal outcomes

Self-Direction

Employment

De-institutionalization

Expanded Housing Options

─Improving outcomes for people one life at a time─

Improving outcomes for people one life at a time!Improving outcomes for people one life at a time!

Expanding SELF-DIRECTION

OPWDD continues to provide education to at least 1,500 beneficiaries (with designated representatives as needed) per quarter beginning on April 1, 2013.

Growing # of individuals self-directing

Published OPWDD’s self-direction policy

Expanding opportunities for EMPLOYMENT

Increase number of individuals employed Ended admissions to sheltered workshops on July 1, 2013 A transformation plan for increasing participation in

competitive employment is published:o Encourage businesses to hire people with developmental

disabilitieso Increase opportunities for high school students to

transition to employmento Improve the quality of supported employment services

Implementing a multi-year strategy to identify and support workshop participants who are interested in competitive employment.

Converting workshops to an integrated business model

Supporting other options when competitive employment is not appropriate:o community habilitationo day habilitationo CSS to support volunteer, recreation, senior center, or other

community activities for people who are retirement ageo For individuals who want to continue to work obtaining employment

in a former workshop that has converted to an affirmative business or social enterprise will be an option.

Transitioning People from Workshops to Employment & Other Community Activities

DE-INSTITUTIONALIZATION

Over the past several decades, 30,000 people moved out of institutional settings and into community-based living arrangements.

Since March 2011, we helped more than 300 people transition from institutional settings to homes in the community—reducing the institutional population by nearly 24%.

Today, fewer than 1,000 people live in campus-based institutional settings operated by OPWDD.

Plans are in place to transition 148 residents from Finger Lakes and Taconic ICFs by January 1, 2014.

Closing Developmental Centers

• In July 2013, Governor Andrew Cuomo announced the schedule for closing four institutional-based campuses: O.D. Heck in Schenectady (March 31, 2015)

Brooklyn (December 31, 2015)

Broome in Binghamton (March 31, 2016)

Bernard M. Fineson in Queens (March 31, 2017)

Expanding COMMUNITY RESIDENTIAL OPTIONS NYS Supportive Housing Development - $1.8 million to assist

180 people by providing supports such as rent subsidies and community habilitation, consolidated supports and services, and residential habilitation provided through individual residential alternatives (IRAs).

HUD-Approved Federal Housing Counseling Program offering a variety of counseling sessions, educational workshops, and projects.

OPWDD is expanding its cadre of trained housing coordinators and housing specialists across the state.

OPWDD’s Home of Your Own Program helps individuals, income-eligible parents/guardians, direct support professionals, and other qualified members of OPWDD’s workforce become homeowners. Over 700 people assisted to date.

New York State Home and Community Renewal (NYSHCR) partnership encourages housing projects to offer a preference in tenant selection for people with developmental disabilities (up to 20 percent of a project’s total units).

Commitments of the Transformation Agreement

• There is still significant progress to be made in Long-Term Supports and Services for individuals with developmental disabilities in reaching the multi-year plan to achieve:Robust integrated employment and self-

direction models, Expand community based housing options Ensure that individuals are residing in the

most integrated setting possible Develop a responsive and accountable quality

infrastructure.

Balancing Incentive Program Overview• BIP, authorized by Section 10202 of the Patient Protection and

Affordable Care Act of 2010 (Pub.L.111-148), provides enhanced Federal Medical Assistance Percentages to qualifying states.

• NYS’ BIP application was approved in March 2013, and the State was awarded $598.7 million.

• The State must implement three structural changes: Establish a No Wrong Door/Single Entry Point eligibility

determination and enrollment system Develop Core Standardized Assessment Instruments for

determining eligibility for non-institutionally-based long term supports and services (LTSS)

Develop a Conflict-Free Case Management System

Balancing Incentives Program (BIP)

Purpose: to provide grants & enhanced FMAP to states to increase access to non-institutional long-term supports/services

Program Goals: To help states develop new ways to support more

people in community settings To support structural changes that increase

institutional diversions and access to long-term supports/services

With MFP, BIP is part of CMS’s strategy to redesign long-term supports/services.

Balancing Incentives ProgramRequirements: States must have spent less than 50% of their

total Medicaid medical assistance expenditures on non-institutionally based long-term supports/services.

States must implement structural changes: a “No Wrong Door/Single Entry Point” system.Conflict-free case managementCore standardized assessment States must use the enhanced FMAP only to

provide new or expanded HCBS. Quarterly reporting

Allowable Ways to expand HCBS Increase waiver slots/clear waitlist Fund new services Increase rates to attract more providers Create No Wrong Door/Single Entry Point structure Host meetings with Stakeholders Training & Staffing Technology for referrals and coordination across

agencies Equipment for assessors

Unallowable Ways to expand HCBS Brick and mortar construction of NWD/SEP sites Nursing home capacity building Replacing existing state HCBS commitments (i.e., MOE

provision)

BIP Structural Changed & State Workgroups

No Wrong Door Coordination of Integrated Care through DISCOs Build on our CHOICES platform

Standardized Assessment Developing CAS through Case Studies. CAS aligns with DOH’s UAS-NY, both built on interRAI

Conflict-Free Case Management DISCO Contract Language – will separate care

planning from funding decisions for individuals, ensure meaningful choice of service providers, opportunity to change DISCOs and a fair, centralized appeals process

No Wrong Door

Origins of the No Wrong Door Initiative

• The balancing incentive program requires a No Wrong Door system.

• The intent is to improve access to and expand community Long Term Supports and Services

Definition of Long Term Services and Supports (LTSS)

• The NWD work team is currently evaluating a “Consumer friendly” definition of LTSS, such as that provided in the 2014 AARP LTSS Scorecard report:

• A range of services and supports for people who need assistance with routine activities of daily life (such as bathing, eating, preparing meals, and shopping for necessities) because of a physical, cognitive, or chronic health condition that is expected to continue for an extended period of time. LTSS consist mainly of assistance from another person with these routine activities. Supports also include assistive equipment such as wheelchairs and environment modifications such as ramps.

No Wrong Door Requirements

• Deliver standardized information about LTSS options whether an individual seeks information from:

– - A 1-800 number– - A website (including an online

questionnaire)– - A local office that is part of the state’s NWD

network

Provide individuals with assistance in accessing Medicaid or non-medicaid LTSS services

Structure

• The draft (not yet finalized) structure will consist of “Hubs” and Specialized NWDs.

• The hubs – or main point of contact, will be the NY Connects entities (will be expanded geographically to cover the entire state)

• There will be two “Specialized NWDs”:• The Office of Mental Health will serve as a

Specialized NWD• and . . .

OPWDD as a Specialized No Wrong Door

• OPWDD’s Front Door, currently providing information, assisting with enrollment, screening, coordinating and approving assessments and/or care plans will serve as a Specialized NWD organization for people with developmental disabilities.

• New York Connects serving in its capacity as a hub, will not replace the OPWDD Front Door.

• The hub, and associated website (which is in planning stages), are intended to enhance access to assistance.

• Individuals who are already OPWDD eligible will not need to go to the hub first.

What will the NWD Hub do?

• Assist individuals of all ages & populations• Provide information about LTSS• Conduct NWD Screens as appropriate• Coordinate and share information with

specialized NWDs through secure database as needed (database creation is in the works)

• Coordinate applications for public benefits and other services; and

• Provide Information to Specialized NWDs for comprehensive assessments and care planning

What will the OPWDD Specialized NWD do?

• - Provide OPWDD specialized expertise• - Coordinate with the hub• - Assist people accessing the OPWDD “Front

Door” system with a NWD screen, as indicated• - Consult on completed online questionnaires

and NWD screens• - Review completed NWD screens shared with

OPWDD through secure database• - Utilize available information for

comprehensive assessment and care planning

When?

• Implementation of the No Wrong Door is anticipated for late 2015.

• More info will be shared as processes are finalized.

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Uniform Assessment System (UAS)/

Coordinated Assessment System (CAS)

Goals of Needs Assessment

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CAS Development and Validity Study

• In consultation with interRAI, OPWDD created the CAS based on the interRAI ID/DD tool , additional items from their suite of assessments, and OPWDD specific items. The CAS is currently in draft format.

• A validity study of the CAS will begin mid-November.– Design of the validity study was done by the

Center for Human Services Research (CHSR) at the University at Albany and reviewed by an independent consultant at the University at Western Michigan.

– CHSR will provide the analysis for the validity study.

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CAS Validity Study• Who may be asked to participate in the validity study?

– Individuals ages 18 years of age or older receiving at least one OPWDD service may be randomly selected for participation.

– 25 stratified sample groups have been identified in order to provide a “deeper dive” into specific areas of need and/or service provision.

– Participation is voluntary and choosing to participate/not participant will not impact services.

• Use of Data and Results– In addition to validating the CAS, data will be used

to develop acuity measures for the CAS.– Results are expected in summer 2015.

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For More Information…

InterRAI Integrated Assessment Suite: www.interRAI.org

CAS specific questions: coordinated.assessment@opwdd.ny.gov

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3rd Structural ChangeConflict Free Case

Management• Federal policy focused on unbiased care

coordination and person centered planning• Waiver applications/agreements have been and

continue to be reassessed to ensure case management structures that are conflict free

• DISCO Contract Language – will separate care planning from funding decisions for individuals, ensure meaningful choice of service providers, opportunity to change DISCOs and a fair, centralized appeals process

The Care Coordination Guidance

• Core Functions of Care Coordination• Person Centered Elements• Face-to-Face meetings and caseloads• Competencies and Trainings• Conflict Free Case Management• Self-Direction Concepts• Willowbrook

Conflict Free Case Management

• Informed Choice• Assessment• Organizational Structure• Grievances and Appeals• OPWDD Oversight

Person Centered Planning (PCP)

In addition to Structural Changes. BIP Funds Support:

• Increase community-based service opportunities for individuals with developmental disabilities.

• Transition and divert individuals who are elderly and/or disabled from institutional to community-based settings.

• Develop additional housing options to support high need/high cost Medicaid recipients in stable, sustainable and safe community environments.

• Expand Money Follows the Person opportunities for individuals to transition out of institutional settings into community-based, non-institutional residential settings.

Transformation Fund RFA

http://www.opwdd.ny.gov/opwdd_resources/procurement_opportunities/bip-transformation-funding-opportunity

Important Dates

8/13/14 Request for Applications Release

8/27/14 Letters of Intent Due

9/3/14 Questions Due via Email for Q&A

9/9/14 WebEx Overview of RFA

9/17/14 RFA Updates and Responses to Applicant Questions Posted

10/22/14 Applications Due

12/1/14 Awards

Grant Period

• Transformation Fund grants will be awarded on a competitive basis.

• All proposals must be received by October 22, 2014 by 5:00 p.m.

• All funding decisions will be made following the completion of application review and appropriate approvals.

• The 10-month contract period for BIP Transformation Fund demonstration projects is expected to begin on December 1, 2014 and end on September 30, 2015.

• All funds must be expended by September 30, 2015.

Transformation Fund RFA• An unprecedented opportunity for

organizations to make strategic investments to transform non-institutional Long Term Services and Supports (LTSS) for individuals with developmental disabilities.

• Specifically, OPWDD is looking for investments that complement the Balancing Incentive Program (BIP) Goals as outlined New York State’s BIP Work Plan and the guiding principles of New York’s Health System Transformation for Individuals with Developmental Disabilities Agreement (“Transformation Agreement”).

Eligible Applicants

• Non-profit organizations

• Local Governments

• Advocacy Groups for individuals with developmental disabilities.

• Applicants must be registered as a qualified Vendor and have a confirmed NYS Vendor ID #.

• Applicant must be in compliance with all applicable State and federal licensing, certification, and other requirements.

Grant Funds May Not Be Used For:

• Capital costs such as brick and mortar projects or to supplement existing General Funds.

• To duplicate existing LTSS or increase institutional capacity.

• To match any other Federal funds.

• To provide services, equipment, or supports that are the legal responsibility of another party under Federal or State law (e.g., vocational rehabilitation or education services) or under any civil rights laws.

• To supplant existing State, local, or private funding of infrastructure or services such as staff salaries for programs and purposes other than those disclosed in the application.

Examples of Qualified proposals for goal of increasing the

number of individuals Self-Directing may address:

• Activities supporting the new role of the Fiscal Intermediary (FI) in the self-direction redesign;

• Statewide and/or regional partnerships supporting the information technology infrastructure of FI operations

• Education and Outreach Activities for promoting the Choice to Self Direct

Examples of Qualified Proposal to increase the number of individuals in competitive

Employment:• Providing vocational assessments to working age individuals currently receiving day habilitation and workshop services that identify the types of supports needed to assist in obtaining competitive employment.

• Developing person-centered transition plans for workshop and day habilitation participants that detail how supports will be provided to assist individuals in obtaining competitive employment.

• Developing peer mentoring networks to support day habilitation and workshop participants as they transition to competitive employment.

Examples of Qualified Proposal to increase the number of

individuals in competitive Employment (cont’d):• Developing strategies to create self employment

opportunities for workshop and day habilitation participants through the operation of a business.

• Providing technical assistance and support to assist workshop providers to convert to competitive employment business models consistent with the Home and Community Based Services (HCBS) waiver definition of community settings.

• Developing strategies for retirement age workshop participants to engage in meaningful senior, recreational or social activities.

Example of Qualified Proposals Supporting the transition of

individuals from institutions to settings that meet HCBS standards

may:• Develop new models for supporting individuals and families

during transitions• Develop mechanisms/trainings or protocols to ensure waiver

settings for transitioning individuals meet new HCBS settings standards

• Creates initiatives to place and support individuals in non-certified settings?

• Develop mechanisms/trainings/ protocols to ensure compliance of person-centered planning with new PCP standards?

• Coordinate all housing resources for people with disabilities across state agencies, local governments and municipalities.

Examples of Qualified Proposals for Community Based Housing Options, including Family Care

• Develop a scientific strategy to Identify housing needs for people with intellectual and developmental disabilities on a regional and/or statewide basis improving access to existing housing resources.

• Develop a scientific strategy to identify housing resources for people with intellectual and developmental disabilities on a regional and/or statewide basis.

• Develop a 5- Year Plan to increase the number and type of community-based housing stock available (i.e., region by region) to people with intellectual and developmental disabilities.

• Coordinating all housing resources for people with disabilities across state agencies, local governments and municipalities

Examples of Qualified Proposals for Community Based Housing Options, including Family Care

(Cont’d)• Implement a Family Care Demonstration that is multi-

cultural and seeks to recruit services of specialist in the medical protection and advocacy, education and other professional fields to become providers of Family Care.

• Develop a strategy to coordinate and implement a "Banking Committee" for the HOYO Program.

• Develop and implement "Making Homes that Work" for People with Autism.

• Develop an innovative Outreach and Marketing Demonstration Model that is ongoing and may be used in diverse regions. (i.e., Recognition Events - Retention and Recruitment).

Examples of Qualified Proposals for Community Based Housing Options, including Family Care

(Cont’d)• Develop a research-based Family Care "think-tank" that will

review existing, and propose new methodologies to redesign the Family Care Program.

• Address fiscal and legal constraints in moving Shared Living Models forward.

• Propose an array of innovative community - based choice and intensive services that will provide an alternative to IRAs and ICFs Care without compromising quality and safety.

• Develop Regional and Statewide HUD-Approved Housing Counseling Training Sessions for housing coordinators and et.al that will lead to HUD-Approved Certified Housing Counselors.

• Develop a Strategy to Redesign the Family Care Program

Example of Qualified Proposals to meet the structural challenges

of Transitioning to Managed Care may:

• Provide assistance to agencies to support administrative and operational efficiencies.

• Provide assistance to agencies to support the consolidation of duplicative administrative functions within the provider network.

• Provide information technology assistance to agencies that lay the foundation for a move to electronic data systems that will allow agencies and individuals to communicate changing needs and support plans in an immediate or more timely method.

• Provide assistance for use of the Care Coordination Data Dictionary allowing for the standardized collection and dissemination of information to a DISCO with greater consistency.

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NY START Mission

• NY START will increase the community capacity to provide an integrated response to people with intellectual/developmental disabilities and behavioral health needs, as well as their families and those who provide support. This will occur through cross systems relationships, training, education, and crisis prevention and response in order to enhance opportunities for healthy, successful and richer lives.

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NY START • NY START - will provide community-based

crisis prevention and intervention services for individuals with intellectual/developmental disabilities (I/DD) and co-occurring mental health (MH) and behavioral health needs.

• NY START – will help individual obtain adequate treatment options when they need them most in the least restrictive setting possible.

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Core START Elements

• Trained Linkage Coordinators;• In-home therapeutic supports (ages 6 –

adult);• Site Based Therapeutic Resource Centers

(ages 21 +) – planned and emergency use;• Crisis support 24 hours/7 days a week;• Team response time, 2-3 hours;

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Core START Elements (cont’d)

• Consultation, assessment, service evaluation;

• Employs data driven, evidence-informed practices and outcome measures;

• Technical support to maintain program integrity and fidelity to the START model;

• Person-centered focus; and• Focus on understanding problems in the

context of the system of support.

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Components of START

• Augments existing system of support - does not replace it;

• Multi-level cross system linkages (local, statewide, national);

• Clinical education teams, online training forums;

• Family support and education;• Standardized protocols for cross systems

crisis prevention and intervention designed to connect MH and I/DD providers.

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START Outcomes

• Reduction in inpatient and emergency services use.

• Traditional MH providers become more willing to serve individuals with I/DD.

• Cross systems planning becomes core service element.

• START is proven to be cost effective.

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Provider Partnerships

Linkage AgreementsThe purpose of an affiliation/linkage agreement is to establish a collaborative framework in order to improve outpatient supports, community linkages, treatment outcomes and decrease the need for hospitalization and/or the loss of community placement.

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Questions?