Self Direction Redesign

November 5, 2014Association of Day Services Providers

Today’s Agenda

• Final Self Direction Model

• Current Status of Self Direction

• Questions

Today: CSS Budget

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CMS Mandated Changes

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The monthly unit is unacceptable.

Each element in a person’s current CSS plan that is eligible for Medicaid funding must be separately billed to eMedNY.

FMS reimbursement must be separately billed; based on the level of support an individual elects to purchase.

Effective date of conversion for all CSS plans is 10/1/14.

CMS Mandated Changes Each self-directed service component in a person’s CSS plan

must be aligned with an HCBS Waiver service.

The rate paid for self-directed services cannot exceed the amount paid for provider-controlled services

Medicaid payment is limited to the PRA, no exception to allow up to prior cost of services

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What Remains the Same

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Will continue to allow the person self directing to:

• make decisions about who works for them.

• recruit people to work for them.

• decide what they need staff to do to help them, how many hours of help they need and when they need that help.

• supervise their staff and change staff if they aren’t satisfied.

Employer Authority

Will continue to allow people who self direct to:

• make choices about the services they need.

• make decisions about their services and supports based on their funding.

• decide what services are paid for and who is paid to provide them; the person decides how much to pay self-hired staff

• manage their OPWDD budget in a responsible manner.

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Budget Authority

• Required reforms will create opportunity for design changes that will make self directed supports choice clearer and more direct

• There will be increased opportunity to expand self direction options and streamline access to self directed options

• Educational opportunities will be provided on all of the changes.

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Self Direction Expansion

Self-Directed Services Align w/ HCBS Services

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Self-Hired /Individual Directed Services**

Services Supporting Self Direction

Community Habilitation Live-in Caregiver (monthly unit)

SEMP Support Brokerage (1/4 hour unit)

Respite Fiscal Intermediary (monthly unit)

Individuals Directed Goods & Services ($10 per unit)Community Transition Services (one-time payment)

**Billed in ¼ hour units

Self – Hired (FI Supports Person)

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Individual Directed Goods and Services (IDGS)

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Camp

Community Classes & Publicly Available Training/Coaching

Coaching/education for parent(s), spouse and advocates.

Clinician Consultants, Independent Contractors –

Clinician (Direct-Provision of Therapies/ Therapeutic Activities Not Otherwise Funded in

the State Plan)

Health Club/Organizational Memberships/Community Participation

Household-Related Items and Services

Paid Neighbor

Self-Directed Staffing Support

Transition Programs for Individuals with IDD

Transportation

Proposed FI Choices

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Agency Supported Self Direction

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Direct Medicaid Purchased Services

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Individual can choose to purchase HCBS Waiver services through a traditional voluntary Medicaid provider:

Implementation Status

• Weekly CO workgroup meetings and calls with the SD Liaisons

• Technical Assistance being provided; new Guidance has been issued

• Meetings with FIs individually and group to review changes and strategize solutions

• Training to MSCs and Brokers underway• More than half of the total plans have

converted

We Want You to Know

OPWDD is committed to ensuring:

• Continuity of supports - we expect almost all supports will continue uninterrupted

• Provision of needed technical assistance for plan conversions

• Opportunities for education and discussion will be available on a statewide and regional basis

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Challenges Encountered• PRA changes impact service budgets• FI rate change to monthly fee – Need to ensure

that costs are sufficient to cover FI tasks• Direct clinical supports not allowed as duplicative

of state plan services• Employment support concerns – job developers• No payment for experimental therapies• Behavioral consultation – regional concern

Transition Solutions Identified

• Continuity of Care Provisions• Education regarding Options to Manage

Conversions • Business Model Reviews by FIs• Transformation Grants with Opportunities of

Innovation in Self Direction

Summary

• Changes are required – opportunity to make changes to support growth of self direction

• Transformation focus continues to be on expansion of self direction

Opportunities for Self Direction• MSCs can connect interested individuals to

self direction• Request for self direction through Front Door

if new to services and through Service Amendment if want a change

• Self Directed plans can blend agency supported and self hired staff supports for customized Person Centered plan

Questions??