1 Joint Advisory Council (JAC) Tuesday, December 11,

1 Joint Advisory Council (JAC) Tuesday, December 11,

1 Joint Advisory Council (JAC) Tuesday, December 11, 2018 2 Agenda Highlights Welcome/Opening Remarks Role and Responsibility of JAC Update on: Care Coordination Organizations (CCO) Childrens Health & Behavioral Health Transformation Specialized Intellectual and Developmental Disabilities Plan

Provider Led (SIP-PL) 3 ROLE AND RESPONSIBILITY OF THE JAC 4 Mission The JAC will serve as the primary advising authority regarding the design of managed care models that will provide services to individuals with intellectual and developmental disabilities (I/DD) The JAC will provide:

Advice Feedback Guidance Commentary 5 Open Meeting Format Moving forward the JAC will be conducted in an opening meeting format Stakeholders will be able to listen and watch the discussion via webcast Meeting agendas and materials will be posted to the Office for People With Developmental Disabilities (OPWDD) website a week in advance

6 Realigning Focus Building off of the constructs outlined within the Transformation Panel Recommendations the JAC will focus on: Care Management and Assessment Employment and Life in the Community Flexibility and Responsiveness Residential Support Self-Determination Supporting Family Supporting Staff 7 Moving Forward

The JAC will be expanded to include appointed members of existing committees and advisory councils to ensure full representation of the stakeholder community The JAC will consider input and provide advice to OPWDD and the Department of Health (DOH) 8 Proposed Future Makeup Organization Proposed Number of Members OPWDD Providers

Provider Associations Care Coordination Organizations (CCOs) Self-Advocates Parent Associations Managed Care Organizations (MCOs) County Partners State Partners 23 23 12 34 34 23 12

34 (DOH, Office of Mental Health (OMH), Developmental Disabilities Regional Office (DDRO), Developmental Disabilities State Operations Office (DDSOO)) Total 20 - 25 9 Next Steps Confirm participation of current members Develop plan for members who have not participated in 2018

Identify and determine new membership for 2019 Outreach to new members 10 CCO IMPLEMENTATION UPDATE 11 Care Manager Outreach and Communication As of October, 99.8% of enrollees have an assigned Care Manager and an assigned Care Manager Supervisor

Data has been collected and made available to OPWDD Regional Offices to assist individuals and families to identify Care Manager and contact information, where needed OPWDD will continue to monitor CCOs to confirm all individuals have a Care Manager and Care Manager Supervisor 12 Ongoing Implementation Activities Continued engagement with CCOs, individuals and families Policy updates will be issued to address transition issues that have been raised Ongoing trainings scheduled to address the Life Planning Process Cycle

13 Face to Face Contact 92% of all CCO enrollees have had a face to face visit with their Care Manager In October, letters were sent to each individual without a face to face meeting communicating their Care Manager name and contact information OPWDD is monitoring progress to ensure face to face contacts have occurred for all enrollees 14 Care Management Services

Delivered Care Management Services were provided to over 80% of individuals enrolled during the month of July 90% of individuals received a service in August 2018 The State continues to monitor data to confirm services are being delivered to individuals 15 State Outreach Activities Collected Care Manager notes and supporting documentation confirming Care Management activities OPWDD called individuals and families to

ensure concerns had been resolved and, where needed, OPWDD assisted in resolution OPWDD reached out to CCOs to request immediate action be taken on behalf of families, as appropriate 16 Statewide Actions Items CCO phone systems in place to ensure individuals and families can reach a live person CCO organizational charts posted with regional Care Managers contact information State/CCO weekly call to monitor ongoing activities

CCO Monitoring & Facilitation Ongoing CCO reporting Care Manager and Supervisor assignment Completion of assessment and Life Plan development Case load sizes Service authorizations for new individuals Two focuses 1. Customer service and 2. Information technology OPWDD has hired technician to facilitate the resolution of information technology issues Progress has been made care managers are completing assessments and Life Plans have been completed

17 18 CHILDRENS HEALTH & BEHAVIORAL HEALTH TRANSFORMATION 19 Key Components of Childrens Medicaid System Transformation Transition of six 1915(c) Waivers to 1915c Childrens Consolidated Waiver and concurrent1115 Waiver authority OPWDD Care at Home Waiver (CAH) DOH CAH I/II Waiver OMH Serious Emotional Disturbance (SED) Waiver Office of Children and Family Services (OCFS) Bridges to Health (B2H) SED,

Developmental Disability and Medically Fragile Waivers Alignment of 1915(c) Home and Community Based Services (HCBS) under one array of HCBS Remove the Managed Care exemption for children now in six 1915(c) Waivers Transition to Health Home Care Management Current 1915(c) Waiver providers transition to Health Home Care Management provided under 1915(c) transition to Health Home Care Management 20 Medicaid Redesign Team (MRT) Goals of Childrens Medicaid System Transformation Keep children on their developmental trajectory

Maintain child at home with support and services Maintain the child in the community in least restrictive settings Identify needs early and intervene Focus on recovery and building resilience Prevent escalation and longer term need for higher end services Maintain accountability for improved outcomes and delivery of quality care Ensure that the Transition is Seamless for Children and their Families 21 Health Homes Serving Children Kids currently receiving services in one of the six childrens waivers will receive Care Management through one of the Health Homes Serving Children

(HHSC) Current CAH Case Management providers are working with DOH to link up with a HHSC and preserve continuity of care for the children that they serve These activities began well over a year ago Almost all of our current CAH Case Management providers will transition to Health Home Review of Current Status of Transition and New State Plan Services On June 21, 2018 the Center for Medicare and Medicaid Services (CMS) advised the State it should use a concurrent 1915(c) and 1115 waiver to

implement the Childrens Medicaid Redesign On June 28, 2018, the State submitted to CMS a conceptual road map and timeline for implementing the concurrent waivers Consistent with that timeline, on August 7, 2018 the State submitted a draft 1915(c) Childrens Waiver to CMS and posted the draft for public comment. Comments were due September, 23, 2018 On August 23, 2018, the State has also submitted to CMS draft Standards Terms and Conditions for implementing amendments to the concurrent the 1115 Waiver

State submitted to CMS draft State Plan Amendment (SPA) to OLP, CPST, and PSR on January 1, 2019 and Family Peer Supports on July 1, 2019 CMS is now reviewing draft documents 22 Draft, Preliminary Timeline Subject CMS Conceptual Agreement and Timely Approvals* Preliminary Draft Date* Implement three of Six New State Plan Services* (Other Licensed Practitioner, Psychosocial Rehabilitation,

Community Psychiatric Treatment and Supports) January 1, 2019 Transition to Health Home Begins January 1, 2019 1915(c) Childrens Consolidated Waiver, new array of April 1, 2019 HCBS in Managed Care, remove exemption and exclusion for 1915(c) Consolidated Waiver children from Managed Care** Implement Family Peer Supports State Plan Service July 1, 2019

Three year phase in of Level of Care (LOC) July 1, 2019 Behavioral Health Benefits to Managed Care July 1, 2019 Foster Care Population to Managed Care July 1, 2019 Implement Remaining New State Plan Services - Youth Peer Support and Training and Crisis Intervention January 1, 2020

* New State Plan Services are called Children and Family Treatment and Support Services (CFTSS) 23 HCBS Array of Services in Childrens Waiver

Community Habilitation Day Habilitation 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 Pain and Symptom Management

Palliative Care Bereavement Palliative Care Expressive Therapy Palliative Care Massage Therapy Non-Medical Transportation 24 Timeline Next Steps Conceptual Approval by CMS Enrollment into Health Homes Serving Children begins January 1st March 31, 2019 All existing CAH Case Management providers will transition to Childrens Health Home provided they have a business services arrangement with the Health Home. DOH has been working with each provider on readiness activities.

Only a handful of smaller providers are choosing to not be part of this transition. Implementation on April 1, 2019 25 More Information Available at: https://www.health.ny.gov/health_care/m edicaid/redesign/behavioral_health/childr en/1115_waiver_amend.htm 26 SPECIALIZED INTELLECTUAL AND DEVELOPMENTAL DISABILITIES PLAN

PROVIDER LED (SIP-PL) 27 Managed Care Qualification Document Posted to the DOH website on Friday, August 31, 2018 https://www.health.ny.gov/health_care/medicai d/program/medicaid_health_homes/idd/draft_i dd_1115_waiver.htm Public comment period extended to October 17, 2018 OPWDD began holding public forums to inform, educate and receive feedback from individuals, families and other stakeholders

Public Comment Overview 78 comments received 28 About 50% of the comments were from parents Others were from six of the seven CCOs, provider association members, OPWDD providers, and several advocacy groups Major Themes: Request for an extension of the timeline; Enhanced public outreach and stakeholder engagement; Concerns related to access to specialty providers and the potential loss of services, including the impact on self-direction; Clarification on the relationship between CCOs and SIPs-PL; and More information on the grievance and appeals process

Response to Public Comment forthcoming 29 SIP-PL Timeline Key Events Anticipated Date Release of DRAFT OPWDD Managed Care Requirements September 2018 and Standards document for comment Release of Final OPWDD Managed Care Requirements and November 2018 Standards and Application Deadline for Plan Submission of Applications to New York February 2019 State

State announces approved SIPs-PL June 2019 SIPs-PL begin to voluntarily enroll individuals with I/DD August 2019 Expansion to Mandatory enrollment begins Statewide for individuals with I/DD 2021-2022 30 Questions/Discussion

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