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The People First Waiver
September 23, 2011
So, Why do an 1115 Waiver?
It’s not just about the here and now.
Its about where we are now and
where we’ll be in a decade and the
years following that.
Its about coming together as a
community to plan for a future that is
shaped by us, not ‘for’ us.
POLICY ENVIRONMENT
Immediate Economic Trends
•
Long-Term Federal Forecast
Medicaid Expenditures for People with
Developmental Disabilities
Growing Faster than the Average Rate of Inflation
OPWDD Medicaid Expenditures 6.2%
Inflation Rate 3.26%
Difference 2.94%
Average percentage growth from Annual Growth in CPI-U (Northeast urban) (All Items) (SFY 05-06 TO SFY 09-10) – 3.26% from 2005
through 2010
WHERE ARE WE AT WITH 1115
DESIGN?
Where are we now?
Design teams worked diligently to develop
recommendations
Access and Choice
Benefits and Services
Care Coordination
Fiscal Sustainability
Quality
Public forums on 5.07 Plan (Design Team
recommendations) – October/November 2011
Ongoing conversation with CMS
Development of RFI/RFA for Pilot Projects
“Vision” can be defined and
understood as follows:
• Vision should describe a set of ideals and
priorities, a picture of the future, a sense of what
makes an organization/system special and
unique.
• a core set of principles that the organization/
system stands for, and a broad set of compelling
criteria that will help define
organizational/system success in getting there.
(Oren Harari)
What ‘Vision’ is emerging from
the Design Team Process?
• Respect for individuals and families,
person-centered principles and
individualized outcomes will be the
driving force in the service system.
•
People First Vision
• There will be comprehensive and integrated
coordination of care for individuals.
• There will be greater access, choice and
flexibility in service delivery.
• Individuals with developmental disabilities
who need to access Medicaid services from
multiple state agencies will face “No Wrong
Door.”
People First Vision
• There will be rational, equitable, and efficient
financial resource distribution based on
individual needs rather than historic program
costs.
• There will be appropriate financial incentives.
• Quality metrics will be used to guide policy
and fiscal decisions.
People First Vision
• There will be a comprehensive method to
measure service outcomes for people with
developmental disabilities.
• People with high levels of behavioral needs
will receive responsive community services in
community-based settings.
Vision for the Future
To establish a person-centered service system that delivers coordinated
care with funding that is transparent and targeted to needs.
Three Main Elements of Reform:
1.Creating a Person-Centered, Demand-Oriented System
-Valid Needs Assessment
-Equitable Resource Allocation
-Choice of plans, providers and services
2. Enhanced Care Coordination and Person-Centered Planning
-“No Wrong Door”
-Designed to meet the needs of people with developmental disabilities
3. Modernized financial platform
-Transparent funding streams that support individuals, not programs
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Basic Tenets of People First Waiver
Quality
Meaningful
Person- outcomes for Choice and
centered
individuals Flexibility
Planning
with DD
Community
SO WHAT DOES THIS REALLY
MEAN?
What will remain the same?
• Open communication and collaboration
• OPWDD will continue in its role.
• The health, safety, and rights of people with
developmental disabilities will continue to be
of paramount concern.
• Our service providers will be the foundation of
the new service delivery system.
•
What else will remain the same?
• The services and supports that people receive
today will still exist, although they may be
defined and financed differently.
• As we retool the types of services provided we
will work to ensure continuity of care for
individuals and families and avoid abrupt and
disruptive transitions.
What will be different for
individuals?
• Assessment tools that are strengths-based will
lead to person-centered comprehensive care
plans that will inform and determine equitable
resource allocation.
• This could mean changes for some as
individuals. For most, it will mean
confirmation of their need for close
supervision and support.
What else is different for
Individuals?
• There will be service models that continue to
meet individuals’ needs, but at a lower cost.
• Greater flexibility in where, when, and how
services are delivered.
• Greater access to needed supports across
service system
• Easier mechanisms for self-directed services
options
How will the System be different?
• How services are financed and paid for will be
different. Capitated care management funding
will allow:
• The broadening of service categories
• More innovative community support options
• There will be a team approach to care
coordination.
• Quality will be measured consistently.
The Future of Habilitation Services
• Service definitions and names are likely to
change.
• But, the kinds of supports we provide will be
THE SAME, plus some.
• This broadening of service “buckets” will
enhance flexibility and allow greater creativity
in tailoring service plans to each person’s
needs.
The Future of Habilitation Services
• For example –
• Making these kind of changes to the full
service menu will require:
• Much planning
• Demonstration via Pilot Projects
• Extensive guidance and communication
Recommended Financial Platform
Federal Oversight - CMS
State Oversight - DOH & OPWDD
Medicaid Funds & State Funds
Capitation Revenue Determined by a Needs Assessment Tool(s)
Medicare Funds
Developmental Disabilities Individual Support & Care
Coordination Organization (DISCO)
Not-for-Profit, Fiscal Intermediary that Assumes Financial Risk and Provides Support
& Care Coordination
ü Receives all payments and may be direct service provider(s) and/or
subcontract all needed services
ü May be a comprehensive care entity or a long term care entity with a
contractual agreement with a health care entity
Short Term Therapy
Long Term Therapy
Other Healthcare
Other Long Term
Hospital Services
Specialty Care
Care Services
Primary Care
Self Directed
DD Services
Services
Services
Services
Services
Services
Services
DD/Long Term Care Services All Other Healthcare Services 24
(may be not-for-profit or for profit)
How will DISCOs be unique?
• Current thinking is that the DISCO is a not-for-
profit entity with experience working with
people with developmental disabilities.
• There will likely be risk sharing arrangements
early in the development process.
• Critical role for quality oversight and advocacy
• There will likely be a gradual transition toward
actuarially based rates.
How will we create DISCOs?
• RFI process this Fall – answering key
questions regarding functions and
requirements
• RFA – Inviting regional pilots
• Initial year of implementation planning
• Careful statewide rollout
Important Next Steps
• Completion of Design Team recommendations
• Publication of 5.07 Plan
• Public Forums – October/November 2011
• Finalization of 5.07 Plan
• Ongoing dialogue with CMS
• Development of RFI/RFP for Pilot Projects
People First Waiver
OPWDD
HCBS
State Plan
Waiver Services
Long Term (ICF)
Care
CAH
Waiver
Service
Careful planning and Roll-Out
• Transition of services for individuals and
families
• Careful planning of Assessment Process
and movement toward a more equitable
system
• Focus on the transition of financing
Five-year Transition Plan
Public Resources
People First Waiver Web page:
www.opwdd.ny.gov/2011_waiver
People First e-mail address for comments
and questions: People.First@opwdd.ny.gov
People First comment line:
1-866-946-9733 or TTY: 1-866-933-4889
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