ACANY Overview for OPEN MINDS

Overview of CCO Transition in NYS

1. June 4, 2018
CCO Transition Overview

2. CONFLICTOFINTEREST(COI)
INMEDICAIDAUTHORITIES
2
Sources of COI
When the same entity helps
individuals gain access to services
andprovides services to that
individual, there is potential for COI
in:
•Assuring and honoring free
choice
•Overseeing quality and
outcomes/“self-policing”
•The “fiduciary” relationship
COI under 1915(c)
Requirements at 42 CFR
431.301(c)(1)(vi)
•States are required to separate
case management (person-
centered service plan
development) from service
delivery functions
•Conflict occurs not just if they are
a provider but if the entity has an
interest in a provider or if they
are employed by a provider
Source: CMS

3. MEDICAIDSERVICECOORDINATION
INNEWYORKSTATE
3
•Funded and regulated by the Office for People With Developmental
Disabilities (OPWDD), an independent cabinet-level state agency
•Service coordination assists people with developmental disabilities and
their families in gaining access to services and supports that help them
lead richer lives
•Program is primarily delivered by “voluntary” or not-for-profit agencies—
most of which also operate other waiver programs (e.g. residential,
habilitation, etc.)—that employ qualified service coordinators (MSCs)
•MSCs apply person-centered planning techniques to develop, implement,
and maintain Individualized Service Plans (ISPs) for 100,000+ people
served by the Home & Community Based Services (HCBS) waiver
Source: OPWDD

4. WHICHOTHERSERVICESAREPROVIDED
BYMSC AGENCIES?
4
•Habilitation
–Residential
–Day
–Community
–Prevocational (site-based and
community)
–Pathway to Employment
–Supported Employment
•Respite
•Adaptive Devices –Assistive
Technology
•Environmental Modifications
•Family Education and Training
•Services to Support Self-Direction
–Fiscal Intermediary
–Support Brokerage
–Individual Directed Goods and Services
(IDGS)
•Community Transition Services
•Live-In Caregiver
•Intensive Behavioral Support
•Vehicle Modifications
Source: NYS DOH & OPWDD

5. HOWELSEISNY SPECIAL…?
5
Source: Coleman Institute
Adjusted Spend
Fiscal Effort: how much a state spends on I/DD
LTSS per $1,000 of statewide personal income
(controls for state wealth factors)
Relative Share
$8.56
$3.81
$1.45
New York US Average Nevada
Community Services Fiscal
Effort in the U.S. FY 2015
16.8%
6.2%
I/DD Spend Population
NY Share of Medicaid §1915(c)
HCBS Waiver Expenditures
(I/DD) vs. Share of Population,
2014
Sources: KFF, US Census Bureau

6. ACANY FORMEDBYTHREEPROVIDER
GROUPSSERVINGPEOPLEWITHI/DD
6
ACANY
Advance
of
Greater
New York
Alliance
Care
Network
Long
Island
Alliance
501(c)(3) established in 2014
to give 100+ high-quality,
not-for-profit providers
(25% of total state spend)—
and the people with I/DD &
families they support—a
voice in New York State’s
transition to managed care
ACANY = Advance Care Alliance of NY
I/DD = Intellectual and/or Developmental Disabilities

7. 2017: THREEPRIMARYFACTORS
DRIVINGCCO TRANSITION
7
1115
Waiver
•1915(c) →1115
enables eventual
transition to
managed care
•1115 Waiver
provides more
flexibility to
reimburse new
types of (previously
excluded) services,
e.g. START program
Health
Homes
•Enabled by the
Affordable Care Act
of 2010to promote
holistic, person-
centered care
management
within Medicaid
programs
•Enhanced funding
from Federal
Government
Conflict Free
Care Management
•CMS rule that
requires Care
Management to be
performed
independently of
waiver program
services
•NY is moving
towards
compliance with
Federal mandate
CCO = Care Coordination Organization
START = Systemic, Therapeutic, Assessment, Resources & Treatment
CMS = Centers for Medicare & Medicaid Services

8. RECONFIGURINGSERVICEDELIVERY
8
377 7
Voluntary MSC Agencies Care Coordination Organizations
3,000+
100,000+
Medicaid Service Coordinators
People Supported by MSCs
MSC = Medicaid Service Coordination/Coordinator

9. FOUNDATIONS OFTHETRANSITION
9
Common Technology Platform
Focus on Workforce Transformation
Enhanced Funding

10. MEDISKEDCONNECTEXCHANGE
MULTI-AGENCYBUSINESSINTELLIGENCEPLATFORM
10
Most Electronic Records Do Not Meet the
Needs of the I/DD Community, since they:
•Are problem based
•Address end of life issues
•Result in directions to the care manager
not to the various providers of service
•Do not address needs on a single platform
as required
•Do not use OPWDD language or
requirements (e.g. 633.16, Eating
Guidelines, Care Coordination Dictionary)
•Are not person centered
•Do not integrate CQL POMs
Source: MediSked

11. CONVERTINGSERVICECOORDINATORS
INTOCAREMANAGERS
11
Smooth Transition, Enhanced
Support, More Rewarding Careers
Training
Team
Tools

12. Care
Manager
Provider
Network
Billing &
Claims
Customer
Service
Managed
Care
THEENDGAME: SPECIALIZEDMCOS
FORPEOPLEWITHI/DD
12
Managed Care Organizations Provide Health Plan
Infrastructure for Waiver, Medical, and
Mental Health Services (phased in over time)
CCOs will
Retain Care
Management
Function
2018 2019 –2021
I/DD = Intellectual and/or Developmental Disabilities
CCO = Care Coordination Organization