Provider Association Meeting

June 20, 2016

Helene DeSanto provided the following update on behalf of the Commissioner:

Work continues on the implementation of the Transformation Panel recommendations. The recommendations were divided into those items that can be immediately accomplished and those that will take time. KPMG is assisting. On Wednesday there will be a second follow up meeting with the panel members to provide updates.

OPWDD leadership has been doing a lot of work to determine what to do with the extra funds in the NYS budget. Ten million dollars will be used to fund new residential services. An effort is underway to redefine the priorities areas for those waiting for housing.

OPWDD hopes to put out an updated timeline on the plan for managed care this summer.

RRR in ICFs- AbibaKindo

OPWDD is processing PPA’s for under $5,000 for provider owed ICFs.

For leased ICFs, Agencies need to apply for preservation funds for renovations up to $30k. Over $30k, apply for a PPA.

Managed Care Update- JoAnnLamphere and Kate Marlay

OPWDD re-engaged Mercer and got a better sense of savings and cost to transforming to managed care.

Great launch of FIDA IDD. Currently there are 250 people enrolled.

Conflict free case management –- service coordination violates the HCBS transition plan. OPWDD is required by CMS to submit a plan on how conflict free case management will be achieved. This plan is required to be submitted in October with the waiver renewal application.

  • This will be done through the creation of regional care coordination entities, organized by providers. This will set the path to managed care. Probably in 2017, MSC would be absorbed into the care coordinating entity. These entities would become the ACOs. There will be at least two per region.
  • It is yet to be determined if this will follow the health home model or a care coordination model used by other areas.

DQI Protocols- Tamika Black & Barbara VanVechten

OPWDD is redesigning their survey process. (see powerpoint)

Their goal to become more efficient and be more transparent with a focus on quality outcomes.

Protocols will be linked with Agency Quality Performance (AQP). DQI still visits every site.

HCBS standards will be incorporated into the one review.

Removal of multiple protocols and instead only have:

  • Site review, Person-centered review and Agency review
  • Site Review (begins Oct 1) - site characteristics, safety, safeguards, risk (based on agency history, trends) and will include observations and conversations. No longer picking a person and focusing on the chart.
  • Person-Centered Review (Nov) - all the services they get, planning, service delivery, quality of life
  • Agency Review (Dec) - hiring practices are appropriate, quality oriented items, QI planning process, regulatory compliance, community connections, general agency management and effective leadership.
  • In September, DQI will have a training on the new reviews.

If a person gets services from multiple providers, any concerns will be addressed with the specific provider in which the issue occurs. The sample will be small, but will include all services over a few days, including all providers. Exit conference feedback will be provider specific.

Allocation of the $10,000,000-Megan O’Connor

Reconvening regional stakeholder advisory groups.

Will be sharing the written charter in a few weeks.

  • Region 1 $1,987,038
  • Region 2 $1,520,708
  • Region 3 $1,782,327
  • Region 4 $2,796,396
  • Region 5 $1,913,531

Working internally to identify a process.

Criteria around the membership. Establish the stakeholder groups in the next few weeks.

Providing state wide orientation to the members and will outline roles and responsibilities.

10-12 member, at least 4 family, 2 service recipients, state ops, regional office, county MH commissioner, expert advisement such as a housing navigator or housing specialist. The groups can pull in providers if they choose for insight or to share best practices, but there will be no providers on this group.Training will occur with MSCs and MSC supervisors.

Residential Support Categories- looking internally at people’s circumstances and will be put in a new designated categories. MSC’s will be notified of the new designation

  • Emergency Need
  • Substantial Need
  • Current Need

Smoking Cessation- Roger Bearden and Jill Pettinger

OPWDD is focusing on smoking cessation due to safety concerns and the health of those served. They are looking at ways other state Agencies and non-profits have done this successfully to identify best practices.

Legislative Update- Roger Bearden and Greg Roberts

18,923 bills introduced in both houses

434 were tracked by OPWDD, 28 of those passed both houses (including budget bills).

Safe patient handling has no enforcement

(See powerpoint for details)

Work Groups- Roger is looking to create awork group which will conduct a monthly look at the upcoming regulatory projects. Get Roger names of anyone who may be interested.

Transportation Enrollment Update- Liz Misa (DOH)

(See powerpoint for details)

Providers will be auto enrolled if they operate the following:

  • Certified site based DH
  • Site based pre-voc
  • Supervised and Supportive IRA’s
  • ICF’s
  • Enrollment will occur by corporation
  • OPWDD subcontractors must seek enrollment- will be required to complete enrollment
  • All enrolled providers and subcontracted transporters much have drivers enrolled in lens
  • No blanket waivers will be issued

Audit protocols are being developed and overseen by OMIG

Vehicles retirement age- further guidance will be issued after survey

Documentation will be required indicating transportation was provided including- name date address and time. There iscurrently no form.

IRAs only need to document “community inclusion” when traveling to multiple locations during one trip.

DOH will share contacts at DOT and OMIG in case providers have questions.

Respite Program Update- Donna Cater (DOH) and Laura Rosenthal

Reviewing survey data currently

The number of enrollees is something providers have been calling about. Don’t be concerned. It will all be explained in the web ex.

Admin is not in there, only operating dollars and transportation cost.

OPA update- Donna Cater (DOH)

If the administrator of the account is gone, contact HCRA Pools.org to get new Admin/log in.

Rate sheets- no longer on OPA. Very lengthy sheets which detail how rate is made.

No 7/1/16 rates yet issued.

A request made to go over rate sheet to explain to provider how the rates are calculated. This will be considered later in the year.

Property Cost Verifications

ICF 7/1/15 rates will be in by the end of the week.

CRP- new fees are in the system and will show up in cycle 2028. Letter going out this week. Capital is added on this as well.

Attestations- four areas:

  • Pre-voc error non Medicaid dollars ended up in the rate we and shouldn’t be.
  • Supervised IRA- adding in nutrition and psychology, need to sign an attestation that those are the dollars you need (CMS wants this).
  • Supportive IRA- adding for supplemental day and personal care. If you changed your mind and those dollars are no longer there, you can subtract.
  • Supervised and Day Hab- dollars coming out for OT, PT and speech. Based on the clinical survey completed. You can adjust. But, make sure you can back it up. It will be looked at.

Supervised and Day Hab, should have been taken out on 4/1/16, will be taken out on 7/1/16, and will take out 15 months.

Supportive add in - first add in, 15 months.

Taking out the clinical dollars, goes back to 4/1/16.

Property update for respite- 1/1/16 should be done next week.

Variable rate for individuals with complex needs. 7/1/16 was the target date.

Two things still looking at:

  • Transfer between programs at the agency
  • People in crisis within the agency

Analysis of Retainer Days of IRAs- Donna Cater (DOH)

Providers expressed concern with the 14 days maximum payment for retainer days. Many people who enter a rehabilitation facility are there for a minimum of 30 days. Donna explained they have no answer at this point. OPWDD and DOH will discuss, but are hesitant to bring it up with CMS due to the current set up of unlimited therapeutic days. Raising the issue could create more problems.