1 Joint Advisory Council JAC August 14 2019

1 Joint Advisory Council (JAC) August 14, 2019

2 Agenda Highlights • Opening Remarks • Intellectual and Developmental Disabilities Health Home (I/DD HH) Progress Report • Community Habilitation and the Community First Choice Option (CFCO) • Upcoming I/DD HH and Managed Care Dashboard • Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Update • Home and Community Based Services (HCBS) Waiver • Public Comment Period

3 OPENING REMARKS

4 INTELLECTUAL AND DEVELOPMENTAL DISABILITIES HEALTH HOME (I/DD HH) PROGRESS REPORT

5 I/DD HH Performance/Progress Data Highlights Through June 30, 2019 I/DD HHs exceeding benchmark for IAM Completion at 81% I/DD HHs approaching benchmark for Life Plan Completion at 60% I/DD HH enrollment continues Almost 7, 000 new enrollees, since 7/1/18 97% enrolled in HH

6 Technical Assistance (TA) Review • April/May 2019 – Office for People With Developmental Disabilities (OPWDD) undertook TA Review of all I/DD HHs • Reviews Included: • Interviews with Intake Representatives, Leadership, Care Managers and Quality Improvement Representatives • Standard Operating Procedures • I/DD HH Data • Target Sample of Individual Records • Areas of Focus: • • Intake Life Plan Implementation and Monitoring Service Access Processes Quality Improvement

7 Technical Assistance Review Recommendations for I/DD HHs 1. Ensure Support for Person-Centered Planning Practices 2. Ensure Comprehensive Care Management • Build capacity in responding to needs related to health, behavioral health and high-risk life circumstances 3. Improve Documentation Practices 4. Develop Comprehensive, IT-supported Tracking 5. Prioritize Regional Health Information Organization (RHIO) Connectivity 6. Facilitate Systemic, Therapeutic, Assessment, Resources and Treatment (START) Referrals and Linkage 7. Formalize Developmental Disabilities Regional Office (DDRO) Connections 8. Build Capacity in Specialized Areas • Self-Direction, Medical Diagnoses, Identification of Risk Factors, Behavioral Health, Employment, Housing

8 COMMUNITY HABILITATION AND THE COMMUNITY FIRST CHOICE OPTION (CFCO)

9 Understanding the Medicaid Program NYS Medicaid Home & Community Based Services (HCBS) Waiver State Plan

10 Waiver vs. State Plan HCBS Waiver State Plan • Allows States to waive certain Medicaid program requirements • Can be ‘targeted” -- Not available to all Medicaid individuals • Time limited - Must be renewed • Capped number of recipients • Services must be available to all eligible Medicaid enrollees • Do not expire • No cap on the number of recipients

11 CFCO State Plan What is CFCO? CFCO Service Delivery Description • • CFCO is an optional State Plan authority allowing States to offer home and community-based services to eligible • Medicaid enrollees • Expands access to attendant services and supports to help with everyday activities • Becomes available Jan. 1, 2020 CFCO Eligibility CFCO in Managed Care Many CFCO Services are already included in the Consumer controlled, Available to individuals managed care benefit personal assistance who fulfill all of the package offered to eligible services/ supports for following criteria: enrollees: Activities of Daily o Eligible for o Consumer Living (ADLs) and Medicaid with Directed Instrumental Activities “regular rules” Personal of Daily Living (IADLs) o Have an Assistance and health-related institutional level o Home Health tasks of care as Aide determined by No “Budget Authority” o Homemaker/Ho the functional usekeeper Services must be assessment (Personal Care provided to all used by that Level 1) Medicaid-eligible population o Personal Care populations (DOH, o Are living in their Level 2 OMH, and OPWDD) own home or a o Personal family member’s Provided in the Emergency home community Response System

12 CFCO Services • Many CFCO services overlap with HCBS covered under 1915(c) Waivers and will also transition to mainstream managed care CFCO Authorized Services • • • CFCO State Plan • • • Assistive Technology (AT)* Vehicle Adaptations (V-mods)* Community Transitional Services (CTS)* Moving Assistance Environmental Modifications (E-mods)* Community Habilitation */ Skill Acquisition Maintenance & Enhancement (SAME) Personal Care Home Health Care Aide Consumer-Directed Personal Assistance Services Personal Emergency Response (PERS) Home Delivered Meals Durable Medical Equipment (DME) OPWDD Comprehensive 1915(c) Waiver* *CFCO Service overlaps with OPWD Comprehensive Waiver

13 How Will CFCO Operate? Two Different Approaches: People enrolled in the Waiver & in Fee-For-Service People enrolled in the Waiver & in Managed Care

14 Eligibility: CFCO vs. Waiver If I meet CFCO eligibility I receive… I receive Community Habilitation today: If I do not meet CFCO eligibility or I Self-direct with Budget Authority, I receive… Skills Acquisition Maintenance & Enhancement (SAME) Under CFCO Community Habilitation under the HCBS Waiver

15 What Differs: Who Authorizes CFCO Services? For Overlapping CFCO Services for People with I/DD enrolled in Fee-For. Service (FFS) Other Services for all CFCO eligible people enrolled in FFS All CFCO Services for Anyone Enrolled in Managed Care • OPWDD • Local Department of Social Services (LDSS) • Managed Care Plan

16 Service & Planning Process Doesn’t Change Community Habilitation Delivered by OPWDD Certified Agency Skills Acquisition, Maintenance & Enhancement (SAME) Delivered by OPWDD Certified Agency Derived from at least one “My Goals/Valued Outcome” identified in the individual’s Life Plan A Staff Action Plan describe how staff will support achievement of the Goals/Valued Outcome Staff deliver and document services in accordance with the Staff Action Plan Every six months, the Staff Action Plan is reviewed – what is achieved – any needed changes

17 Consistent Service Authorization • OPWDD stakeholders have requested greater consistency across the state in the process for authorizing services • Consistency ensures: • The same process for all individuals, and • CFCO services that overlap with OPWDD services will be authorized appropriately by Managed Care Plans

18 Service Authorization Guidance • Will describe the most appropriate service levels for different sub-groups of individuals - based on age, living situation and individuals’ needs • Recommended levels of service can be exceeded with clinical justification • Each person’s authorization is still individually tailored to meet his/her need

19 The Community Habilitation (CH) Service • OPWDD is analyzing CH service data to understand how CH is being used today • CH is a skill-building service, not to be used solely for supervision and assistance with ADLs, IADLs, safety, etc. • If analysis indicates a need for an additional service type, OPWDD will explore options for enhancing the service array, via a waiver amendment process

20 Additional Information Managed Care Community of Practice: https: //www. mc-cop. com/resources NYS Department of Health (DOH) CFCO Webpage: https: //www. health. ny. gov/health_care/medicaid/redesign/ community_first_choice_option. htm For Questions: CFCO@health. ny. gov

21 UPCOMING I/DD HH AND MANAGED CARE DASHBOARD

22 OPWDD Data Strategy • Promoting accountability and transparency for individuals, families, providers, employees and stakeholders • Providing accurate, timely and actionable data to support effective decision making around the delivery of supports and services and ensure the integrity of the IT systems used as a source • Balance quality/performance reporting with assurances that person-specific confidential data will be handled appropriately

23 OPWDD Data Strategy Data Roadmap § Public facing displays of aggregate data Open Data § Plan for monitoring provider performance and service delivery § Metric development § Clinical Advisory Group Quality Strategy § Comprehensive highlevel data strategy Data Governance Data Sharing § Accuracy and reliability of source data § Privacy and security controls § Specific arrangements to share information

24 I/DD Health Home Performance Source Technical Assistance Reviews Progress Reports Description OPWDD/DOH conduct technical assistance reviews and designation reviews to ensure Health Homes (HHs) are providing quality care OPWDD monitors the performance of I/DD HHs on key process metrics. It is anticipated that a dashboard will be made publicly available by March 2020

25 I/DD Health Home Performance Source Description Life Plan Data System (LPDS) On a periodic basis, I/DD HHs will extract key data elements from finalized Life Plans and forward this data to OPWDD. This data will be used by OPWDD to monitor Life Plan quality, include the calculation of the I/DD specific health home measures. Data transfers are to begin December 2019. It is anticipated that baseline, Year 1, reports for all I/DD HHs will be available in 2020. Reports will be updated annually to assess I/DD HH progress. Medicaid Analytics Performance Portal (MAPP) The MAPP is administered by DOH and is a performance management system that will provide tools to the Health Home network to support providing care management for the Health Home population. Future dashboards are anticipated to provide operational information and performance indicators for I/DD HHs. DOH also currently tracks information on mainstream Health Homes through the Care Management Annual Report Tool (HH CMART).

26 I/DD Clinical Advisory Group (CAG) • OPWDD reconvened the I/DD CAG and the first meeting was held on May 3, 2019 • Information regarding the I/DD CAG is available on the DOH website as follows: • I/DD CAG Membership: https: //health. ny. gov/health_care/medicaid/redesign/dsrip/vbp_lib rary/cag/2019 -07_cag_members. htm • I/DD CAG Meeting Presentation: https: //www. health. ny. gov/health_care/medicaid/redesign/dsrip/cl inical_advisory_group. htm • The next I/DD CAG quarterly meeting will be held on September 24, 2019

27 Managed Care Performance • OPWDD will provide information to our stakeholders about the status of the FIDA Demonstration Program and enrollment of individuals with I/DD in mainstream managed care. • Examples include: • Enrollment in FIDA • Quality Measures (As reported to DOH) • Enrollment in MC Mainstream Plans o This includes the number of individuals enrolled in Mainstream who are eligible for CFCO benefit in the mainstream product.

28 BREAK

29 FULLY INTEGRATED DUALS ADVANTAGE FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (FIDA-IDD) UPDATE

30 Enrollment by Numbers • 1, 365 = Current Enrollment • 186 are Willowbrook Class Members County of Residence NYC Residence Breakout Overall Age Distribution NYC 689 Bronx 148 21 -29 118 Nassau 362 Brooklyn 214 30 -39 182 Rockland 72 New York 91 40 -49 196 Suffolk 161 Queens 126 50 -59 381 Westchester 81 Richmond 110 60 -69 316 70 -79 127 Residential Setting ICF 151 80 -89 39 IRA/CR Supported 68 90+ 6 IRA/CR Supervised 664 Family Care 25 Community Setting 453

31 Enrollment Activity New York Medicaid Choice (NYMC) reporting activities: • Call Center took 101 FIDA-IDD related calls • 5, 059 since program inception • Average of 99 per month (last 12 month) • Average call length is 13 minutes 58 seconds • Enrollments by language: • • English 1257 Spanish 48 Chinese 4 Italian 2 • Participated in 415 Outreach Presentations for FIDA-IDD • 128 Announcement Notices mailed in June to newly eligible individuals • 29, 005 have been mailed to date • Since April 2016 – 449 disenrollment transactions - 53% of disenrollment's attributed to “wish to return to prior care/service provider” • 13 % Became Excluded • 11% Did Not Like the Rules of Their Plan

32 Grievance and Appeal Activity FIDA-IDD Grievances & Appeals Q 1 2018 Q 2 2018 Q 3 2018 Q 4 2018 Q 1 2019 Q 2 2019 Grievances 0 15 13 13 5 14 Appeals 2 1 6 6 3 0 Reporting Period January 2018 through June 2019: • 60 Grievances • Primary reasons: • 37 Non-emergency transportation • 5 Provider balance billing members • 3 DME • Others reasons: assistance with employment, guardianship, etc. • 27 Appeals • Primary reasons: • 13 for denial of inpatient stay claims • 5 CDPAS service related • Other reasons: Denial of Services

33 FIDA-IDD Quality Withhold Measure Definitions CMS Core Measures* Measure: Assessments Percent of Participants with initial assessments done within 90 days of enrollment Measure: Consumer Governance Board Establishment of Participant advisory board or inclusion of Participants on governance board Measure: Submission of Encounter Data Encounter data submitted accurately and timely NYS FIDA-IDD State Specific Measures# Measure: Participants with Documented Discussion of Care Goals Percent of Participants with documented discussion of care goals Measure: Long Term Care Overall Balance Percent of Participants who did not reside in a nursing facility for a long stay at the time of enrollment and did not reside in a nursing facility for a long stay during enrollment PHP met all measures in 2016 -2017

34 HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER

35 1915(c) Waiver October 2019 Renewal Timeline • November 2019 Submission with approval by January 1, 2020 • 5 year extension of current agreement with minor technical updates: • Removal of Medicaid Service Coordination language • Fiscal projections, Revisions to rate setting methodologies, • Level of Care Eligibility Determination (LCED) Inclusion of Nurse Practitioners • Quality Improvement technical updates

36 PUBLIC COMMENT PERIOD