For Manhattan Families:
RE: Talking Points for the 1115 Waiver Hearings
Date: Monday, October 31, 2011 12:50 PM Dear Council Member, The field of developmental disabilities in NYS is at a critical crosssroads. In the next few weeks, there will be extremely important opportunities for all of us to provide valuable input into the develpment of the new 1115 Medicaid waiver. I urge you to attend and be involved in two important meetings: a November 4 briefing meeting on the 1115 waiver and a November 9 public hearing on the waiver. You must register to attend the November 4 meeting and to testify at the November 9 hearing. Go to http://www.opwdd.ny.gov/2011_waiver/index.jsp. Please attend and/or testify at the November 9 hearing. Below we have provided you with comprehensive talking points designed to outline the Council’s position on this important development. Marco Damiani Chair, Manhattan DD CouncilPLEASE SHARE WITH YOUR GROUPS AND PROGRAMS
I have been asked by the United Special Needs Advocates of New York City to forward the talking points below about the 1115 waiver. This group is encouraging people to sign up to testify at the upcoming OPWDD hearings on the 1115 waiver, which will radically change the funding and delivery of services for people with developmental disabilities. The group is also urging families to attend the hearings even if they don’t plan to speak in order to let OPWDD know that families do have concerns about the 1115 waiver plans. For more details about the hearings and to testify, go to http://www.opwdd.ny.gov/2011_waiver/. Thanks, Margaret PuddingtonUnited Special Needs Advocates – New York City
Queens: Ed Leahy: eleahy@nyc.rr.com Bronx: Tina Veale: tvveale@hotmail.com Manhattan: Meri Krassner mkrassner@srotheatrical.com Staten Island: Laura Kennedy: llkennedy@siuh.edu Brooklyn: Charles King: cbking@att.net, Ray Ferrigno: mrferrigno@verizon.netOverview of the 1115 Waiver Plan
Almost all OPWDD services are now funded through Medicaid. The 1115 Medicaid waiver is a different Medicaid funding option that would replace the current Medicaid options. The goals of the 1115 waiver are to increase: person-centered services, self-determination, choice; inclusion in the community; flexibility of services; access to needed services, including mental health and substance abuse services; and efficiencies (by reducing costs). The 1115 waiver would fund and deliver services through managed care organizations. All Medicaid services would be included in the waiver: both long-term developmental disabilities services and medical services. Managed care organizations called DISCOs would coordinate ALL Medicaid services for each individual. The DISCOs would be paid a specified amount per person per month (a “capitated” amount) to cover all the person’s services. The amount for each person would be based on an assessment of that particular person’s needs and supports. Like medical insurance companies, the DISCOs would have networks of providers. The DISCOs would serve as fiscal intermediaries, contracting with and paying providers for all Medicaid services. The DISCOs would be non-profit entities familiar with developmental disabilities services.Talking Points About the 1115 Waiver
Please review the following talking points (NOT listed in order of priority). For your testimony, select just one or two points. Illustrate your points by describing how your family will be affected. You will be limited to 3 minutes. 1. There must be separate capitation allocations for each individual’s long-term services and medical services. Unanticipated high medical expenses must not be permitted to cause a reduction in the amount available for needed long-term services. 2. Fiscal incentives must be provided to the DISCOs to serve people with complex medical or behavioral needs. The funding structure must adequately support needed services for these individuals, especially considering OPWDD’s commitment to serving people in the community rather than in more costly institutions, such as nursing homes or behavior treatment facilities. DISCOs must be monitored to ensure that they do not reject high-cost individuals. 3. The DISCOs must be protected from significant fiscal losses. The DISCOs could very well lose money because they have to stay within their capitated allocations to pay for medical services as well as long-term care. If individuals have unanticipated long hospitalizations, for example, DISCOs could lose money. If people’s needs exceed available resources, DISCOs could lose money. If there is no fiscal mechanism to protect DISCOs from huge losses, the DISCOs will need to protect their resources and make up their losses. They could end up depriving people of needed services; rejecting high-cost individuals; insisting on lower-cost options (home-sharing or family care instead of group homes), even closing down facility-based residential and day services. DISCOs could cut funding to providers, which would reduce the quality of services, thereby not only limiting quality of life but also jeopardizing health and safety. It is essential to build into the plan fiscal risk management—a way to permanently limit large losses—that will protect the DISCOs from fiscal instability or insolvency. 4. For-profit agencies should be barred from providing long-term developmental disabilities services. With funding already limited in a capitated system, there will be no “extra” funds to be wasted on agency profit. The profit portion will decrease the amount left for actual service provision. Moreover, the for-profit provider will answer to two masters with different agendas: its shareholders who want profits and OPWDD which wants high-quality services. The fact that some medical providers, labs, etc., are for-profit does not present the same problems because medical services are short-term with a clear-cut goal. But developmental disabilities services have a much more complex mission, dealing with the many facets of a person’s life over the long term. Current regulations prohibit for-profit developmental disabilities providers for a very good reason: the profit motive detracts from their mission, and we get less bang for the buck. In a time of fiscal austerity, it is essential to maximize the use of all available funds. 5. Maintain the traditional residential and day program service models that meet the needs and desires of individuals and their families. We understand that there are fiscal pressures to reduce costs, and we understand that residential and day services consume most of the OPWDD budget. Nevertheless, it is unthinkable to wreak havoc in the lives of people who currently rely on, and thrive on—and have chosen—these services. OPWDD has assured parents that there will be no disruption of existing services in year 1 of the waiver, but there are no assurances that thereafter these models won’t be replaced by less expensive models such as home sharing or family care, which are inappropriate or unsafe for many people. 6. New residential development must proceed as the fiscal situation permits. Residential waiting lists are already long. People who need 24/7 residential services must have the full range of options available, both traditional group homes and other models. It is unreasonable to expect that all those who need 24/7 residential services will be accommodated by vacancies in existing residences. There will not be a sufficient number of vacancies for all in need. Moreover, particular vacancies may not be appropriate for the individuals or their desired setting. People requiring 24/7 residential care deserve choice, just like everyone else. 7. To ensure choice, people must be permitted to continue with service providers that are outside their DISCO’s network. People should not be forced to give up long-standing relationships with trusted developmental disabilities providers or medical personnel. 8. Respect the choice of those people currently residing in 24/7 residences who are assessed as not requiring that level of care. Those who desire a less restrictive model should indeed move, but those who feel part of the residential family and do not want to move must not be forced. 9. Families with children at home must receive sufficient supports to help them cope with stressful on-going situations while they wait—and wait and wait—for residential services. Respite once a week won’t keep families out of crisis. Families need a full menu of respite, community habilitation, behavior management, crisis, and other supports just to keep life bearable. 10. Build a growth factor and a cost-of-living adjustment (COLA) into the 1115 waiver agreement. Each year well over 1,000 new people enter the OPWDD system. If the budget remains flat, which is likely in the continuing fiscal crisis, the fiscal pot we have now will have to accommodate new people, too. That means reduced funding for the 126,000 people currently being served. Over time, the OPWDD per-person allocation could shrink significantly. Additionally, without a COLA, it will be impossible to provide needed raises for our workforce, thus jeopardizing workforce stability. OPWDD should not be forced to negotiate a growth factor and COLA each year with the Legislature; that is too risky in today’s fiscal and political climate. Instead, we must protect future services by adding a growth factor and a COLA to the 1115 waiver design.IAC INFORMATION:
In NY state advocacy is being coordinated by several State/City advocacy groups (UCP, NYSARC, NYSACRA, NYSRA and IAC).The downstate agencies are in contact with all these groups. IAC works with all of them and is our lead agency for downstate.
What’s in the Governor’s Budget Proposal?
OPWDD
• Overall, there is a “less than 1%” reduction in overall funding to OPWDD which is the result of continuing savings from cuts in the last budget — there are no new cuts.
• There is also no COLA or trend
• That said, money will be available to fund 5900 new opportunities:
o 3000 are naturally occurring openings in existing services
o 2900 new opportunities will be funded allowing 50 people to move out of developmental centers, 140 people to return from out of state schools or be placed after aging out of in-State residential schools in addition to other residential, respite, crisis, employment and community integration opportunities.
• There will be an additional 700 opportunities funded through last year’s budget to be available this year.
• $334 million over 5 years (including $56 million this year) will be made available for enhanced fire safety efforts including capital improvements, enhanced standards, unannounced fire drills, better training and safety plans and direct relations with local fire personnel.
• The Executive’s proposal contains language authorizing the establishment of pilot programs under the 1115 People First Waiver and
• The Executive’s proposal reconfigures the DDSO structure,
o centralizing some functions like hiring and staff training including new hiring screening and minimum qualifications and incident management and investigations and
o reconfiguring Directors positions creating 5 Regional Directors who will work with voluntary agencies in regions mirroring the current OMH regional structure (Long Island is one region, NYC another, Hudson Valley is included with the Capitol and Taconic regions plus two others upstate) and Directors of State Operations who will oversee DDSO’s and other State Operations.
• OPWDD will be authorized to consolidate certain back-office functions like purchasing and IT for additional savings which will be reinvested in the new opportunities outlined above and OPWDD State positions will be reduced through attrition by about 114 FTE’s.
• Administrative cost reforms and a $199,000 cap on executive compensation paid from State funds as outlined in the previously sent Governor’s Executive Order which mirrored the language contained in his budget proposal.
• Although not in the budget, OPWDD will be looking at Community Hab rates.
Early Intervention/DOH
The executive budget continues historic Medicaid reforms initiated in 2011 from the Medicaid Redesign Team recommendations. There are a number of Early Intervention reforms proposed by the Governor which will save $99 million over 5 years “without impacting services”:
• Centralize Fiscal oversight: The state will centralize fiscal administration of the EI program through a fiscal intermediary contract. Counties will be relieved of responsibility for contracting with EI providers, administering provider payments and seeking third party reimbursement.
• Expand Insurance Coverage: Require commercial health insurance to include EI service providers in their networks.
o Out of network services will be allowed with sufficient justification and at rates established by DOH
o Providers will be required to:
♣ bill Medicaid and Insurance Companies directly
♣ join insurance networks
♣ negotiate rates with insurers and accept these rates as payment in full for services (providers won’t be permitted to bill other entities to recoup the full cost of services if not covered by the negotiated rate)
♣ exhaust all appeals if a claim is denied before billing the municipality
o Insurance companies must:
♣ Ensure that a sufficient number of providers are members of their networks
♣ Ensure that Early Intervention services are not counted toward any lifetime or annual limit in a policy
Service Coordinators will be responsible for ensuring that the IFSP is implemented no later than 30 days after the projected date of the initiation of services.
In addition, discontinuing planned cost of living adjustments, reductions in program funding and administrative efficiencies in government operations will save $19.2 million in 2012-13 and 36.2 million in 2013-14.
Education
A commission will be created by Executive Order with the mandate to change New York’s education paradigm to focus on school accountability – in both management and teaching. It is not clear whether Special Education will be part of this group’s focus.
Preschool Special Education
According to DOB, “the state’s investment in Preschool Special Education has doubled over the past ten years to a projected State cost of $1.1B for the upcoming school year. School districts, while making the most programmatic decisions, do not share in the costs of preschool special education which are paid by the State and counties 59.5 and 40.5% shares respectively”.
The Governor’s budget proposes:
• to apportion all growth in Preschool Special Education costs above each county’s share of 2011-12 school year costs equally to school districts, the State and the county
• increase the role of counties when providers request an exception to existing payment rates.
• There is also language which calls for justification when a distant provider is chosen over closer suitable providers
• Proposed budget language prohibits, in most cases, children from being evaluated by the same agency that provides the child’s educational services or by an evaluator with a “less than arms length” relationship to the agency, to “avoid the inherent potential for conflict of interest in these relationships”.
• There is additional money in the budget for the Commission on Quality of Care to strengthen the agency’s core mission of protecting the health and safety of vulnerable individuals in the state’s care, consistent with recommendations from the preliminary report from the Governor’s Special Advisor on Vulnerable Persons (Clarence Sundram) expected to be released early 2012 including five additional investigators to conduct broader systemic investigations in ways that will improve the state’s ability to analyze and respond to allegations and incidents of abuse and transferring the ombudsman from OPWDD to the CQC.
• Clarence Sundram’s report will likely be published over the next couple of weeks and will be accompanied by legislation necessary to enact his recommended reforms which will “combat high costs and unacceptable conditions in certain state-run facilities and nonprofit agencies by improving systems and increasing standards for hiring and disciplining staff plus other long overdue reforms” including a centralized 24-hour hotline for reporting abuse and neglect allegations across systems (funding contained in the proposed OCFS budget).
More to come!
Winifred S. SchiffAssociate Executive Director for Legislative Affairs
INTERAGENCY COUNCIL
of Developmental Disabilities Agencies, Inc.
150 West 30th Street, 15th floor
New York, NY 10001
o – 212-645-6360
c – 917-750-1497
wini@iacny.org
www.iacny.org