DISABILITIES SYSTEM FACES ENORMOUS CHANGES Discussion NYC FAIR November 5 2014 FOUR MAJOR FOCUS AREAS Services for People in Need The Workforce Financing of the current system Impact of Managed Care ID: 275128
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THE DEVELOPMENTALDISABILITIES SYSTEMFACES ENORMOUS CHANGES
Discussion NYC FAIR
November 5, 2014Slide2
FOUR MAJOR FOCUS AREAS
Services for People in Need
The Workforce
Financing of the current system
Impact of Managed CareSlide3
Services for People in NeedFACTS to be Addressed
More than 13,000 people across the state have expressed a need for services
6,400 indicate a need for residential supports within the next two years
NYS has presented an ICF closure plan which will eliminate more than 1600 residential opportunitiesSlide4
Actions to PresentNYS needs to rethink its ICF closure plan-to insure that the plan does NOT eliminate current capacity
Current plan will dramatically affect the current small regional homes for the medically involved-these homes were established as an alternative to nursing homes and as a result of Olmstead requirementsSlide5
Actions to PresentBackfills will NOT address this need. The rate of growth for people who need residential supports outweighs the typical vacancies.
NYS is currently reporting multi-billion dollar surpluses-they have an obligation to recognize and plan for the needs of these people and their families.
NYS is advocating that CSS can help yet, they have not been able to have CMS approve of their plan in this area.
Individuals with complex needs may not be best supported in their family home. Slide6
The Workforce FACTS to be Addressed:
Support system that helps more than 125,000 people must have a stable, quality workforce.
People with disabilities who require supports will be competing with the baby boomers who are advancing into a period where they require supports.Slide7
Actions to PresentEstablishing and Maintaining a strong and stable workforce requires funding. While the current budget recognizes a slight increase to DSP salaries for this budget, the increase proposed in the next budget cycle is not funded.
Recognition and credentialing of the DSP’s are key elements in ensuring the continuity of care the people we support requires.Slide8
Financing of the Current System
Facts to be addressed
:
Rate Rationalization can not be created based on the stresses of yesterday
Financing structure cannot use arbitrary neutrality measures
The continuing uncertainty surrounding the State’s fiscal policy in general and provider reimbursement specifically undermines any real progress toward transformationSlide9
Actions To PresentThe rate structure needs to reflect the projected workload
The rate structure needs to create fiscal incentives that reward lower cost options such as community habilitation, supported employment, day habilitation without walls and personal care
The system and the rate structure needs to ensure an emergency response mechanism to address people and families in crisis.Slide10
CMS RelationshipTrust/HCBS Waiver Final Rule (5 year transition)
Self Direction
Workshops
ICFs
Bulk/Daily Billing
Conflict Free Service Coordination
Person Centered
DOH Control
10Slide11
TransformationRate Rationalization (2014)- State Rates/CFR
Supervised IRA/Daily
7/1; Phase-in; Acuity
HCBS Waiver Renewal (1915-c)
Front Door (Statewide Process)
START (Closure/Crisis
I
ntervention)
11Slide12
HCBS Waiver (1915-c)Final Rule (Residential/Non-Residential)
-Full Access to Community
-Privacy/Freedom
-Own Schedule/Access to Food
-Visitors/Accessible
-Person Centered
12Slide13
Managed CareDISCOs (1915-b Waiver)
DD-FIDA
DSRIP
13Slide14
DISCOs/Managed Care1915 b/c Waiver (update & renewal)
2015 start
RFP- Summer/Fall 2014
MOU
Readiness Review
Capitation Rates
Contracts/Financing
Mandated Enrollment
14Slide15
DD-FIDA1115 Waiver2015 Start Date
MOU
Readiness Review
Capitation Rates
Contracts/Financing
15