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Care Coordination
E-VISORY
The Care Coordination E-VISORY is an electronic publication which provides information on policies, guidance, available programs and services, and training opportunities related to Care Coordination services. In order to receive an email notification when a new Care Coordination E-Visory is posted, or to view past issues, visit the following link: Care Coordination E-Visory
ISSUE # 15-2019 June 4, 2019 Materials for June 5, 2019 Quarterly Care Manager’s Conference The Quarterly Care Manger’s Conference is being held on June 5, 2019 via WebEx from 9:30am-12:30pm. The conference agenda is as follows:
• Medicaid Indemnity Fund
• New Changes to New York State Voting Laws
• Administrative Memoranda Revisions and Clarifications
• Children’s Waiver Overview
• Coordinated Assessment System (CAS) Update NOTE: The materials that will be referenced during this conference are attached to this E-Visory. There will not be any materials distributed on the day of the conference. Click here to sign up for the Quarterly Care Managers Conference in the SLMS (sign in required). You can also search Learning in the SLMS for OPWDD-QCMC to locate the conference. If you have any issues with registration or logging in on the day of the conference, please contact Talent and Development by email at [email protected] or by phone at 518-473- 1190. If you need assistance on how to access the OPWDD SLMS or how to create an account information can be found at the following links:
• SLMS Account Creation (First time users) https://opwdd.ny.gov/opwdd_careers_training/training_opportunities/slms-account-creation
• SLMS Login (Existing users) https://nyslearn.ny.gov/
• Using SLMS https://opwdd.ny.gov/opwdd_careers_training/training_opportunities/slms-user-guide
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Welcome to the Quarterly
Care Manager’s Conference
June 5, 2019
Angie Francis
Statewide Care Manager and NY START Coordinator [email protected]
Amanda Harper
Assistant Statewide Care Manager Coordinator
Welcome
InformationMaterials can be found in the Care
Coordination E-Visory at:
https://opwdd.ny.gov/opwdd_services_supports/service_coordination/medicaid_service_coordination/msc_e-visories
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AgendaWelcome
Hot Topics
Medicaid Indemnity Fund (MIF)
New Changes to New York State Voting Laws
Administrative Memoranda Revisions and Clarifications
Children’s Waiver Overview
Coordinated Assessment System (CAS): Update
Closing
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Hot Topics• Care Coordination Organization (CCO) Policy Manual
• Care Coordination Support Liaison (CCSL)
• Care Management Contacts
• Information Sharing
– https://www.nycourts.gov/forms/Hipaa_fillable.pdf
• Level of Care Eligibly Determination (LCED) Redetermination
– CCO LCED Date Transmittal Form
• https://opwdd.ny.gov/opwdd_login/choices
• Information Sessions
– https://opwdd.ny.gov/providers_staff/care_coordination_organizations/msc_webinars
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CCO Provider Policy Guidance and Manual Update
• CCO Provider Policy Guidance and Manual is available at:
https://opwdd.ny.gov/providers_staff/care_coordination_organizations/providers/cco-manual
• As CCO policies are updated or created, guidance documents will be posted to OPWDD’s website in the "CCO Policy and Updates" at the above link.
• Currently the following updated information is posted:
• CCO Policy Update Memorandum-September 2018
• CCO Care Manager Checklist-Revised September 2018
• Service Authorization Post July 1, 2018-issued January 7, 2019
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OPWDD Regional Office Care Coordination Support Liaison (CCSL)
• The CCSLs can provide information and assist with understanding Care Coordination Organization (CCO) Care Management program requirements
• https://opwdd.ny.gov/opwdd_services_supports/service_coordination/medicaid_service_coordination/contacts
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CCO Care Management Contacts
• CCO Liaison contacts for each CCO are now available on the OPWDD website for individuals and families that need help with their care manager
• https://opwdd.ny.gov/opwdd_services_supports/service_coordination/care_management_contacts
Medicaid Indemnity Fund
(MIF)Presented by:
Elena DeStefano, Director, Revenue Support Field OperationsDivision of Enterprise Solutions
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What is the Medical Indemnity Fund?
• Established in public health law in 2011
• Funds future health costs for certain individuals (see next slide)
• Operated by NYS Dept. of Financial Services
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Who is Covered by the Fund?
• Plaintiffs in medical malpractice actions
• April 1, 2011 or later
• Birth-related neurological injuries
• IADLs/ADLs impacted
• Sources of information
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What Is Covered by the Fund?
• Medical treatment • Hospital-based care, including surgical care• Nursing care• Dental care• Prescription and non-prescription medication• Durable Medical Equipment• Assistive Technology• Some home and vehicle modifications• Rehabilitation• Custodial and respite care• Care management• Transportation for medical care• Copays and deductibles
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What Is Not Covered?
• OPWDD services
• Consolidated Children’s Waiver (previously CAH) services
• Early Intervention/IEP services
• Health insurance premiums
• Services covered by any commercial health insurance
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More Information
www.dfs.ny.gov/consumers/health_insurance/MIF/Home
www.dfs.ny.gov/docs/insurance/mif/mif_bill.pdf
(855) 696-4333
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New Changes to New York State
Voting LawsPresented by:
Michael Orzel, OPWDD Statewide NVRA CoordinatorShelly Okure, Statewide Coordinator for Person Centered Practices
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What is NVRA• The National Voter Registration Act (NVRA)
• It is also known as the Motor-Voter Law.
• Came into existence in 1993 to help ensure that all people with various disabilities were able to use their constitutional right to vote
• State Agencies that have regular contact with people with disabilities were required to develop a plan to conform with NVRA.
• OPWDD is an NVRA agency. Each Regional or State Operations Office has appointed a NVRA Coordinator to assist with this effort.
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What is Executive Order 169
• Governor Cuomo enacted Executive Order 169 on July 4, 2017.
• EO 169 was designed to expand opportunities for all New Yorkers to exercise their right to vote. EO 169 required:
– ALL state agencies to make Voter Registration Forms available (in person and via email) to the individuals and families they serve and the community at large.
– Former NVRA agencies, such as OPWDD, to continue promotion of the voting activity governed by the 1993 NVRA mandates.
– SUNY and CUNY to increase the promotion of student registrations AND to investigate statewide compliance with the legal obligations of the law.
– Department of Motor Vehicle promotes online voter registration forms through their renewal emails.
• Voting education and information is now a statewide effort.
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Governor Cuomo’s 2019 Voting Reforms
• Earlier this year, Governor Cuomo announced new voting reforms designed to enhance voting accessibly for New Yorkers, to ensure NYS elections remain free and transparent and to modernize New York's antiquated voting system.
• Some of the reforms include:
– EARLY VOTING: New York counties will offer early voting to begin 10 days before election day.
– EARLY VOTING SITES: Each county will be required to offer NY voters access to at least one early voting poll.
– EARLY VOTING HOURS: Each county’s early voting sites will be open at least 8 hours on weekdays and 5 hours on weekends to cast early ballots.
– Federal and State Primaries: State and Federal primaries will be combined.
• Before this law, NYS was one of only 13 states that did not offer early voting.
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Restrictions That Have Not Changed
• Care Coordinators are often in a frontline position when speaking to people with I/DD about their interest in registering to vote. If they need your assistance filling out the registration form, there are certain restrictions you must adhere to:
– You must maintain a position of strict neutrality with respect to a person’s political preference or party enrollment.
– You must not display any of your political preferences or party allegiances.
– You may not make any statements or take any actions that will effect the person’s voter registration decisions or to discourage them from registering to vote.
– You must never lead anyone receiving services to believe the availability and continuation of their service are contingent on whether they are registered to vote or not.
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Where Are We Now?
• OPWDD continues to actively participate in promoting Executive Order 169.
– We are developing strategies to share the reforms Governor Cuomo put into place this year with individuals, families and all NYS stakeholders.
– Presenting these changes to you, as Care Managers, is our initial step.
– We have been invited back to highlight voting changes still pending, but it is important for you and those you support to understand the current reforms.
– As always, it is important for you to assist people to register to vote. It is even more critical that they engage in planning, where necessary, to ensure they can get to the polls on election day and fulfill their rights as voting citizens by casting their ballots.
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Questions?
For more information or additional clarification on NYS’ Voting Laws and how they relate to educating and
implementing these laws to support people who receive OPWDD services, contact:
Michael Orzel
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Administrative Memoranda
Revisions and Clarifications
Presented by:Maryellen Moeser, Director
Division of Policy and Program Development
Administrative Memoranda Revisions & Clarifications
1. 2018-ADM-06R, “Transition to People First Care Coordination”
2. 2018-ADM-09R, “Staff Action Plan Program and Billing Requirements”
Reissued May 9, 2019
https://opwdd.ny.gov/opwdd_regulations_guidance/adm_memoranda
Revised transition period for Health Home Care Management and Basic HCBS Plan Support is 1.5 years instead of 1 year
July 1, 2018
Care Management through CCOs begins
June 30, 2019 initial End of
Transition Period
December 31, 2019
Revised end of Transition Period
ADM 2018‐06 R Extends the Transition Period to 1.5 years
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Revised transition period and timelines for Life Plans and Staff Action Plans for Individuals who transitioned on
7/1/2018
No later than 12/31/2019 all ISPs must be transitioned to
finalized Life Plans
(ADM 2018‐06 R, pg. 1)
All individuals transitioning from an ISP to a Life Plan
must have a Staff Action Plan no later than March 1, 2020
(ADM 2018‐09R, pg. 3)
Note: Despite these timeframe extensions, Life Plans and Staff Action Plans should be done as soon as possible.
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Timelines for individuals new to the OPWDD service system
Individuals new to the OPWDD service system do not have a transition period:
• Life Plans for new individuals enrolled after 10/1/2018 are due no later than 90 days after CCO enrollment or HCBS waiver enrollment, whichever comes first.
• Staff Action Plans for new individuals must be in place no later than 60 days after the start of the habilitation service, or the Life Plan review date, whichever comes first.
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“A Life Plan is finalized when it is signed by the Care Manager and the individual receiving services and/or
his/her representative”.
The individual and/or his/her representative signature may be done via signature, email, or other method agreed upon between the Care
Manager and the individual and/or
his/her representative.
“Providers responsible for delivering services documented in Sections II, III
and IV of the Life Plan must acknowledge and agree to implement the provider‐assigned goals, supports, and safeguards associated with those
services, per the finalized plan”.
The service provider’s acknowledgment and agreement may be done via signature, email, or other method agreed upon between the Care Manager and the service provider.
Finalizing a Life Plan (revised policy in 2019-ADM-06 R)
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Finalizing a Life Plan -Clarification for service provider
review • Service providers should demonstrate due diligence in
working with the Care Manager, CCOs, OPWDD and/or others to correct the Life Plan as soon as possible if any inaccuracies or errors are identified.
• This due diligence should be documented indicating service provider’s timely efforts to correct.
- Examples of documentation may include notes in the individual’s monthly summary, e-mails, phone calls, etc.
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Dispute resolution during the Life Plan process(within 45 days)
Disagreement identified during the Life Planning meeting– team attempts resolution
p pIf resolution is not reached through person‐centered planning process, CCO implements
its internal dispute resolution process
If still no resolution, technical assistance can be provided by DDRO
Life Plan Finalization within 45 day timeframe from Life Plan meeting
If disputed element is a If disputed element is a new
goal/support/safeguard, describe it in the IDT
Summary of Life Plan; it does not go in Section II or
III of the Life Plan
If disputed element is associated If disputed element is associated with an already approved
goal/support/safeguard in Life Plan, keep in Section II or III and describe
disputed element in the IDT Summary of Life Plan
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Dispute resolution during Life Plan process
• Within 45 days of the Life Plan meeting, the Care Manager and the individual and/or his/her representative sign the Life Plan.
• With these signatures, the Life Plan is considered final.
• Any disputed elements remain in the “Summary of IDT Meeting” section of the Life Plan (for continued discussion and consensus) and the remainder of the Life Plan is ready for implementation.
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• Providers acknowledge and agree to deliver the provider assigned goals/supports/safeguards associated with their services per the undisputed goals in Sections II and III (including the prior version of currently disputed goals).
• Staff Action Plans (SAPs) are developed and signed by habilitation staff and forwarded to the Care Manager via the Portal or another agreed upon mechanism for prompt communication. – In addition to Care Managers, the SAP should also be provided to:
the individual and his/her representative and any other parties agreed to by the person and his/her representative.
Dispute resolution during Life Plan process
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• Once the Life Plan and corresponding Staff Action Plans are finalized, if an element remains in dispute and no agreement has been facilitated by the Care Manager, then the individual, his/her representative, or a provider may initiate due process proceedings pursuant to 14 NYCRR 633.12 as an objection to a plan of services.
• During the pending due process proceeding, all other elements in the finalized Life Plan and Staff Action Plans shall be implemented.
Dispute resolution during Life Plan process
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Suspension of certain billing standards during the transition period
Life Plan and service billing standards for Life Plans finalized on or before December 31, 2019
Suspended: Waiver service name accuracy —if wasn’t accurately available, will accept
closest to the correct name (e.g., IRA instead of Residential Habilitation; Supported Work
instead of Supported Employment)
Care Managers should identify the correct service provider name and service name in the comments section to support provider
billing claims.
Suspended: Frequency, duration and effective date in Section IV of Life Plan
All Life Plans created or amended after the transition period must comply with all regulatory and policy standards.
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Suspended Staff Action Plan billing standards during transition period
(through 12/31/2019)Only for individuals with ISPs transitioning to Life Plans
Suspended: The initial SAP must be in place no later than 60 days of the start of the individual’s habilitation service, or the Life Plan review date, which comes
first.
Suspended: Evidence demonstrating the SAP was distributed no later than 60 days after: the start of the habilitation services; the Life Plan review date; or the development of a revised/updated Staff Action Plan, whichever comes first.
Despite these suspensions, Staff Action Plans should be done as soon as possible after the Life Plan Meeting or the start of habilitation services.
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New services prior to Life Plan finalization
• When HCBS waiver services are needed prior to the finalization of a Life Plan, there must be sufficient documentation to support service authorization for provider service billing.
• Sufficient documentation prior to Life Plan finalization includes:
– the OPWDD DDRO-approved Request for Service Authorization (RSA);
– the acceptable supporting information justifying the need for services as outlined in the January 7, 2019 Memorandum titled “Care Coordination Organizations Policy Update: Service Authorizations Post July 1, 2018”. Available at:
https://opwdd.ny.gov/providers_staff/care_coordination_organizations/providers/cco-manual/memo
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Thank you – [email protected]
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Children’s Waiver Overview
Presented by:Sally Berry, Director of Service Access, Regional Offices
Division of Service Delivery
Children’s Waiver Transition• DOH-operated 1915c Waiver
• Went into effect on April 1, 2019
• Transitioned six children’s waivers to one consolidated waiver
– Office for People with Developmental Disabilities (OPWDD) Care at Home (CAH) Waiver
– Department of Health (DOH) Care at Home (CAH) I/II Waiver
– Office of Mental Health (OMH) Serious Emotional Disturbance (SED) Waiver
– Office of Children and Families (OCFS)
• Bridges to Health (B2H)
• SED Developmental Disability (DD)
• Medically Fragile Waivers
• Transition from waiver-specific Case Management services to Health
Homes Serving Children (HHSC) Care Management
• Over 6,000 children enrolled in the Children’s Waiver
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Who is Eligible? Children’s Waiver
• Children who have transitioned from the six previously operated Children’s
Waivers and continue to meet HCBS Eligibility criteria
• Children must meet the following Target Population criteria:
• Serious Emotional Disturbance (SED) - former OMH SED Waiver
• Medically Fragile Children (MFC) – former DOH CAH I/II Waiver
• Developmental Disability (DD) and Medically Fragile - former OPWDD
CAH Waiver
• Developmental Disability (DD) and in Foster Care – former OCFS
Bridges 2 Health Waivers
• Children must be at risk for institutional placement in a hospital or nursing
facility (including ICF-IDD).
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CCO/HH & HHSC Comparison • CCO/HH
• Comprehensive Care Management
• Care Management services for individuals currently enrolled in the OPWDD
1915c Comprehensive Waiver
• No age requirement or limit – service option for all individuals meeting OPWDD
waiver eligibility requirements
• Individuals can receive CCO/HH services or the opt-out – Basic HCBS Plan
Support
• Health Home Serving Children (HHSC)
• Comprehensive Care Management
• Care Management services for children currently enrolled in the Children’s
Waiver
• Eligible for children under age 21
• Children can access HHSC or the Independent Entity/opt-out – Children and
Youth Evaluation Services (C-YES)
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HCBS array of services in Children’s Waiver
• Habilitation (Community and Day)• Respite (Planned and Crisis) • Prevocational Services• Supported Employment• Caregiver/Family Supports and Services • Community Self-Advocacy Training and Support• Adaptive and Assistive Equipment • Environmental Modifications• Vehicle Modifications• Palliative Care • Non-Medical Transportation
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Transfer to/from Children’s Waiver to OPWDD Comprehensive Waiver
• There may be times when a child who is already enrolled in the OPWDD Comprehensive Waiver would like to transition to be in the new Children’s Waiver or vice versa.
• OPWDD and DOH are working on further guidance to ensure a smooth transition from one waiver to another and will outline the steps required to transfer an individual.
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Resources
• Health Homes Serving Children (list of HHSC) page on the DOH website
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_children/index.htm
• Where to go if you have questions?https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/1115_waiver_amend.htm
• Webinar is being held in the next few weeks on the HCBS Level of Care Eligibility Process. The target audience is HHSCs and DDROs.
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Coordinated Assessment System
(CAS) Update
Albert Pruett, Assistant DirectorBureau of Assessment Oversight and Coordination
Current implementation progress
• Over 35,000 assessments completed statewide
• Assessments continue to be completed for adults:– Living in any residential setting
– Living at home or independently receiving any service from OPWDD
– Self-directing with budget authority
– Newly determined eligible adults (18 and older)
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CAS Administration Process
The Person
Verify Contact Info and Active Family/Legal Guardian
Interview or observation
Interview People that Know the Person Well
Records Review
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Updates to CAS process• Improvements made to the initial contact letter to the person/family
– Based on feedback from families and providers to simplify and provide expectations in a step-by-step format
• Ongoing and continuous education to providers/families:– Monthly trainings being provided statewide to providers/families
(often more than once a month)• Requests for presentations/training are encouraged and,
whenever possible, these presentations/trainings are delivered in person.
• The Roles and Responsibilities of the Care Manager training have been provided on numerous occasions through the supervisors conference, electronic advisories, Provider Association meetings, Division of Quality Improvement trainings and numerous conferences since February 2016.
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Role of Care Manager Supervisor/Quality Assurance (1.)
• Providers must ensure that their Care Manager Supervisors are providing training and oversight to all Care Managers regarding their roles and responsibilities with the CAS implementation.
• Critical responsibilities:
– Develop processes that help to ensure the understanding of the CAS person-centered administration process
• Care Manager is the source of information about guardianship/actively involved family. Accurate information is critical
• Interview time/location is defined by person – Care Manager is responsible for coordinating the key people
for the interview (e.g. parent, legal guardian)
• Care Manager and providers are responsible for access to requested records
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Role of Care Manager Supervisor/Quality Assurance (2.)
• Develop systems for monitoring/ensuring the use of the CAS summaries for the person-centered planning process– Timely sharing, discussion and review of CAS summaries with the
person, and/or family, and supports (i.e. residential providers). CAS summaries must be shared within 30 days of availability in CHOICES.
– Inclusion in the development of the Life Plan. Examples:• Safeguards• Person prefers change• Individual/family goals• Areas for additional assessment if needed
– Documentation of the review and inclusion of CAS summary information in Care Manager notes
– Documentation of any follow-up questions as well as additional information from OPWDD as a result of these questions
• Ensure that the CAS is included in the agency’s overall person centered planning processes
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Questions About the CAS Summaries
Review CAS Summaries and
Guidance Document
Questions/Comments:
Call
1 (518) 473‐7484
Care Manager: Document in monthly note or Life Plan
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Process for addressing CAS summary questions• The Care Manager is responsible for the following:
– Reviewing and discussing the CAS summary with the person and/or his/her circle of supports (i.e. family/providers)
– Documenting the person’s/circle of supports’ questions/concerns in a monthly note and Life Plan
– Emailing questions/concerns raised by the person/family/providers to OPWDD. Send to: [email protected]
• OPWDD Central Office reviews each case. When warranted, a structured quality review process is carried out. May include:– Review of entire CAS– Review of documents utilized – Care Manager notes and supporting documents– Interviews with family and the person
• Specific details about each question/concern are necessary in order to best support OPWDD’s quality review
• OPWDD will also request documentation of the Care Manager’s CAS summary review process with the person/circle of supports. 06/05/2019
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OPWDD Quality Assurance
• OPWDD completes a quality assurance sample review of all assessors on an ongoing basis.
• Individual guidance and training is reinforced with assessors (both workforces) based on quality reviews.
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QUESTIONS?
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Thank you for attending.
The next Conference is scheduled for
September 11, 2019
Registration for these conferences can be done through SLMS for either the WebEx or VC, please check the SLMS website to register.
https://opwdd.ny.gov/opwdd_careers_training/training_opportunities/slms
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