Sunday, November 6, 2011

NYS OPWDD Statewide Plan 2011-2015

The Office of People with Developmental Disabilities (OPWDD) has posted their new State Comprehensive Plan, which will completely change the way services are funded and delivered under the 1115 Research and Demonstration Waiver, called the People First Waiver. All Medicaid services and supports for persons with developmental disabilities will ultimately be funded and managed through the new waiver agreement between New York State and the Centers for Medicare and Medicaid Services (CMS). Once the 1115 waiver is approved by CMS, the planning and testing of project pilots as well as the transition will take place over the next five to ten years.

The new system will incorporate key features:
  • Informed care coordination for people with complex medical and behavioral needs.
  • Transformed long term care based on person-centered planning, individual responsibility and self-determination.
  • New reimbursement models for institutional and community based care systems.
  • An expanded range of community-based services to allow individuals in institutional settings to transition into the community.
  • Redesigned assessment tools and eligibility processes.
  • Improved health and safety outcomes through a transferred quality management system.

Services will be financed and paid differently, and care management will be the responsibility of not for profit managed care organizations authorized by OPWDD, known as Developmental Disabilities Individual Support and Care Coordination Organizations (DISCOs). All Medicaid services would be included in the waiver; both long term developmental disabilities services and medical services. They will perform at least two primary roles: a) care coordination and b) fiscal intermediation, providing services directly to individuals and/or contracts with a group of providers. As fiscal intermediary, the DISCOs will receive a monthly capitation payment to fund all Medicaid covered services and coordinate non-Medicaid services in an individual’s service plan.

The Statewide Comprehensive Plan is a 90-page document which you can find here: 507 Plan. It is important that people read and review it thoroughly.

The 1115 waiver is the lynchpin of the State Plan, so it is crucial for the future of persons with developmental disabilities and their families. The system is at a crossroads, and we are encouraging parents to testify at upcoming hearings on November 9. Go to Public Hearing for full details.

This is a time of transformation in the service system, so we urge you to participate in the various initiatives pertaining to the 1115 People First Waiver and other events as the planning phase progresses during the year.

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