Title of Presentation1 Family Forums: Designing the Future.
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Transcript of Title of Presentation1 Family Forums: Designing the Future.
Title of Presentation 1
Family Forums: Designing the Future
Family Forums 2
Agenda
• NYIN.org• Value-based Business Model• Care Coordination Model• Response to the NYS Transformation Agenda
Family Forums 3
NYIN.org
Family Forums 4
NYIN: Value-based Managed Care
NYIN is driven by a simple idea that providers listening to and working with individuals & families can create and design a viable business model that works for everyone.
We hold to the ideals of choice, access, and quality of life
5
A picture of the new world NYS Medicaid $$$
NYIN DISCO* with Insurance License
Network of Providers (Agencies you know)
Medicaid Recipients = Enrollees (Persons Served and Families)
Access and Choice of Service
Family Forums
* DISCO - Developmental Disabilities Individual Supports and Care Organization
Family Forums 6
DISCO Benefit Package OPWDD Auspice Services OPWDD Comprehensive
Waiver Services Day Treatment ICF/IID Art 16 Clinic Svcs: OT, PT,
SLP, Clinical Social Work, Psychology, Nutrition, Rehab Counseling, Podiatry, and Dentistry.
Care Coordination provided by the DISCO
DOH Auspice Services Adult Day Health Care Dentistry DME and Hearing AIDS Home Care (offered under any auspice:
hospital-based, nursing home-based, and free-standing programs)
Non Emergency Transportation Optometry/Eyeglasses OT, PT, SLP Personal Care Personal Emergency Response System Private Duty Nursing Psychology and Clinical Social Work Respiratory Therapy Skilled Nursing Facility Podiatry
OMH/OASAS Auspice Services OASAS Inpatient OMH Institutional
Program (PC/RTF) & private psychiatric hospitalizations
Personal Recovery Oriented Services (PROS)
Outpatient – OMH, OASAS
Psychology and Clinical Social Work
OMH day treatment
Family Forums 7
Care Coordination Model
Current Anticipated
Community
Linkages and Referrals
Advocacy/ Life
Planning
Eligibility and Benefits
Management/Assessment
Coordination with
Providers
MSC (Case management)
Designated Care Coordinator:
Central point of contact
Family Forums 8
What is Care Coordination?• Provides a person-centered, integrated system for medical, health and social
support services
• Creates an individual care plan • Connects individuals with all their providers • Ensures timely communication with providers and community supports • Measures, monitors and improves quality informed by individual outcomes • Utilizes electronic information to support integrated and coordinated care
Family Forums 9
Responses to NYS Transformation Agenda
NYIN will continue to take a leadership role in:
• Individual Services and Supports (Self-Direction)
• Employment Opportunities: Cleaning with Meaning a “green” home cleaning business run by people with disabilities.
• Community Integration: Our Place a new day services model using neighborhood spaces and self-directed activities.
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What you can do going forward• Take advantage of these Family Forums. Ask questions.
• Stay connected to NYIN – NYIN.org
• Ensure eligibility for services is formally established through the local DDRO
• Stick with or get connect to an agency you know - to maintain continuity of services
• Keep informed
• Be an advocate
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Contact the NYIN Agency You Know
UCP of NYC212.683.6700 ext [email protected]
HeartShare718-422-3204Olga.Golubeva@heartshare.orgwww.heartshare.org
[email protected] http://
www.occupations.org/pdf/CBHS_brochure.pdf
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Agencies You Know Governing Agency Communities Served
Coordinated Behavioral Health Services (CBHS)*
Westchester, Mid-Hudson Region
HeartShare Human Services of New York New York City
The Institutes for Applied Human Dynamics (IAHD)
New York City, Westchester
Lifespire New York City, Lower-Hudson Region
Services for the UnderServed (SUS) New York City
United Cerebral Palsy of NYC (UCP/NYC) New York City
The Young Adult Institute (YAI) New York City, New Jersey, Long Island, Mid-Hudson Region
* CBHS is a consortium which includes Abilities First, Crystal Run Village Inc., New Hope Community, Occupations Inc., and Westchester Jewish Community Services
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Business Council members
• Ability Beyond Disability• Birch Family Services• Camp Venture, Inc.• CP Associations of New
York State• Children’s Village• Community Based
Services, Inc.• Edwin Gould Services• Epilepsy Foundation of
Metro NY
• F.R.E.E., Inc. • Hawthorne Foundation• Head Injury Association• Opengate, Inc. • Richmond Community
Servies• The Rose F. Kennedy
Center• St. Vincent’s Services• A Very Special Place
Family Forums 14
NYIN
UAM Bd. Observer
UCP of NYC
Heart Share IAHD CBHSYAI SUS
UAM
Loans
Reinsurance Agreement
Business Plan
Administrative / Management Services
Agreement4
Costs of Application split 50/50 by NYIN and UAM
OPWDDDISCO Application
Business Partnership
Owners
$
$
Life- spire
Business Partnership
Family Forums 15
Acronyms• ADA – American with Disabilities Act • AT – Assistive technology• CASA – Community Alternative Systems Agency• CDPAP – Consumer Directed Personal Assistance Program• CDS – Consumer Directed Services• CMS – Centers for Medicare and Medicaid • CR – Community Residence • CSS – Consolidated Supports and Services • DC – Developmental Center • DD – Developmental Disabilities • DDRO – Developmental Disabilities Regional Office • DISCO - Developmental Disability Individual Support and
Care Coordination Organizations• DOH – Department of Health • DQA – Division of Quality Assurance • EI – Early Intervention • FIDA – Fully Integrated Dual Advantage Programs• FSS – Family Support Services • HCBS – Home and Community Based Services • HIPAA – Health Insurance Portability and Accountability Act • HUD – Housing and Urban Development • ICF – Intermediate Care Facility • ICS – Individual and Community Supports
• IEP – Individual Education Plan • ILC - Independent Living Center• IRA – Individualized Residential Alternative• ISE – Individualized Service Environment • ISP – Individualized Service Plan• ISS – Individualized Support Services • IWRP – Individual Work Related Plan • LCED – Level of Care Eligibility Determination • MA – Medicaid • MLTCP – Managed Long Term Care Plan• MSC – Medicaid Service Coordination • NCI – National Core Indicators• OPWDD - Office for People with Developmental Disabilities• PCP – Person Centered Planning • PCP – Primary Care Physician• PCSS – Plan of Care Support Services• POM – Personal Outcome Measures• SA – Self Advocacy • SCAP – Service Coordination Activity Plan • SCBA – Service Coordination Basic Agreement • SD – Self Determination • SE – Supported Employment • SSDI - Social Security Disability Insurance• SSI – Supplemental Security Income
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Developmental Disabilities Individual Support and Care Coordination Organization (DISCO)
NYIN, as a DISCO, has developed plans to:
• Enroll individuals who voluntarily opt to enroll in 2014-15
• Provide person-centered planning for all individuals enrolled
• Handle the flows of funds (per member, per month)
• Promote living and active engagement in the most integrated setting
• Ensure that each individual who chooses to do so can self-direct his or her services