Category: CCO

SWAN Needs Support From Legislature

  • SUPPORT OPWDD SERVICES

The Office for People with Developmental Disabilities (OPWDD) is THE voice and advocate in state government for the very unique needs of individuals with intellectual and developmental disabilities (IDD).  We seek additional funding, as well as administrative and legislative support to sustain critically needed supports and services, and to address unmet need.  Following years of imposed budget neutrality even as need has grown; it has become imperative that OPWDD’s budget be increased.  Only this can ensure that essential services for our most vulnerable citizens are safeguarded despite the self-imposed Medicaid budget cap.

  • SUPPORT OUR WORKFORCE

Sadly, the workforce crisis continues, as a result of both chronic inadequate state funding of nonprofit services for individuals with IDD and the raise in the minimum wage.  There are still alarmingly high vacancy rates, staff turnover and work force gaps creating instability for our loved ones. This shortage contributes to gaps in oversight, lack of care continuity and increased training needs, all of which create additional invisible costs, increased risk for individuals and potential liability for the state.  Efforts to finance, build and retain a strong workforce in the nonprofit sector for individuals with IDD are essential in sustaining New York’s service delivery system for our most vulnerable citizens.   

  • SUPPORT THOSE WITH COMPLEX NEEDS

Individuals with complex physical and/or behavioral needs require a significantly higher level of supports and services.  Current rate rationalization models have made it increasingly impossible for these individuals to access appropriate services due to the increased cost and specialty of care they require. We seek either additional/ongoing funding to ensure appropriate, sustainable service delivery for our most complex individuals or “needs based” funding mechanisms to provide incentive and ensure sustainability of service delivery for all levels of complexity.

  • GET CARE MANAGEMENT RIGHT BEFORE CONSIDERING MANAGED CARE

A new system of Care Management was introduced on July 1, 2018.  This shifted Medicaid Service Coordination to seven new Care Coordination Organizations (CCO) that oversee Care Managers.  They are a critically important component of access to and delivery of services.  Unfortunately, this well intended consolidation has fallen far short of expectations.  For many, the enhanced care management promised has been little more than an endless process of questionable assessments while many families have seen a revolving door of care managers.  Accurate evaluation and assessment of need, as well as meaningful quality measures must be fully and effectively operational; technology across all systems needs to be aligned and integrated so as to provide for consistent, data driven enabling and quality control. Without this resolution, moving on to Managed Care is not advisable.

SWAN-legislative-messaging-1-14-20-FINAL-VERSION-2

SWAN Meeting With OPWDD Leadership – 9/17/18

SWAN Sept 17 mtg with OPWDD FINAL

Meeting Summary – 9/17/18

Attendees: OPWDD – Acting Commissioner Kerry Delaney,Kate Marley, Neil Mitchell, Greg Roberts, Leslie Fuld , Roger Bearden, Abiba Kindo

SWAN: Brad Pivar, Pat Curran, Meri Krassner, Elly Rufer, Fran Kermian*, Kathy Bunce*, Jim Karpe*, Barb DeLong, (*via video/teleconference)

Note: Action items are in bold for quick reference

 

Discussed the draft of NYS Medicaid Managed Care Organization I/DD System Transformation Requirements (SIP-PL) out for public comment. Kerry acknowledged our request for an extension on the time period and advised us that there would be a two-week extension that will announced formally shortly.   Further she emphasized that they will always take feedback regardless of published deadlines.

 

Kerry also shared that they are working on a simple summary presentation to educate families on the upcoming changes which would be posted to their website so families could see it. . She asked SWAN to gather what we think would be FAQ’s from a family or individual’s perspective as well as areas of concern so they can be addressed. Requested one-week turnaround which later was revised to ASAP. SWAN members forwarded their input to Greg Roberts directly.

 

The Coordinated Assessment Tool (CAS) was discussed. Many members of SWAN have had an opportunity to experience the CAS in the last 3 months. We shared our various experiences and Kerry indicated that the CAS leadership team in Albany absolutely needs to hear feedback from the experience and where the CAS failed to describe the person accurately. Furthermore, she heard us on the problem of amending the CAS and the need for a clear amendment process. It is unknown WHEN/IF the CAS is replacing the DDP-2. Further, she said the CAS was not intended to determine individual budgets but rather rate setting. ACTION: Kate/Diane will schedule a meeting with SWAN about the CAS.

 

CCO implementation was discussed. OPWDD acknowledged that they were aware of Medisked having issues but to their knowledge they indicated things were resolved. They understand there has been significant frustration and are meeting with CCOs weekly, however the Medisked issues have to be resolved between the CCO’s and the vendor directly.

In addition OPWDD acknowledged the pain families are experiencing with the requirement to change Care Manager based on Tier level. OPWDD indicated that they are working with the CCO’s to devise strategies to allow some flexibility with case load, team assignments, etc.

Discussion regarding the expectation of CCO’s evolving into MCO’s. OPWDD indicated it was hard to tell how it will evolve – their preference would be for providers to apply. They mentioned that CCO’s may incorporate into a different entity apply as well. They expect their will be three MCO’s.

 

Workgroups were discussed and SWAN’s disappointment that it appeared that all the work fell into a black hole. Kerry indicated that final drafts will go back to each workgroup. Further ALL drafts will go to all SWAN members. In the process of prioritizing them, they will be implementing those recommendations that do not have fiscal impact and then determining if there are funds to cover other recommendations. Kerry also indicated that all workgroup leads would be required to present the items to their workgroup. Tamika Black is Deputy Commissioner of Quality.

We discussed the ongoing workforce crisis and how desperate families and individuals are feeling. Kerry agreed and indicated that as a field, we need to come together to discuss how to make it better in a proactive fashion. Kerry will request Sharon to send the workforce report to Brad. (He will forward to SWAN). In addition, SWAN shared that Self Direction is in general, broken.

 

We talked about the various organizational changes and our concern that so much institutional knowledge is walking out the door. We further expressed our continued expectation that OPWDD remains as its own entity and not be swallowed up by DOH. Kerry indicated that it will continue as its own entity and that DOH is deferential to OPWDD’s experience.

 

Kerry suggested that we should have monthly teleconferences to insure communication channels are open. She will have Suzanne set them up and advise us and that they are very helpful in dealing with CMS.

SWAN asked Kerry who in DOH should we be reaching out to inform/educate/advocate with. Kerry will advise.

 

 

 

 

Dated: 9/24/18

SWAN MEETING HELD WITH OPWDD 4/19/18

SWAN April 19 2018 mtg with OPWDD

Meeting held on April 19, 2018

Attendees: OPWDD – Acting Commissioner Kerry Delaney, JoAnn Lamphere, Jay Kiyonga, Kate      Bishop, Neil Mitchell, Meagan O’Conner, Greg Roberts,

SWAN: Brad Pivar, Pat Curran, Kathy Bunce*, Jim Karpe*, Meri Krassner*, Roy Probeyan*, Fran Kermian*, Dan Maillet*   (*via teleconference)

 

Meeting held on April 19, 2018

Attendees: OPWDD – Acting Commissioner Kerry Delaney, JoAnn Lamphere, Jay Kiyonga, Kate      Bishop, Neil Mitchell, Meagan O’Conner, Greg Roberts,

SWAN: Brad Pivar, Pat Curran, Kathy Bunce*, Jim Karpe*, Meri Krassner*, Roy Probeyan*, Fran Kermian*, Dan Maillet*   (*via teleconference)

Update on open action items:

  • SWAN appreciates being a part of the workgroups and looks forward to continued active participation. Kerry Delaney will continue to involve families in policy, messaging, and governance. This will be a continued and ongoing objective.
  • Discussion regarding road map to Managed Care. OPWDD suggested that SWAN review what is available on website in terms key steps and target dates and provide any feedback/questions to OPWDD. Also blueprint document is in process and they expect it to be posted sometime in August. Involvement will initially be voluntary and will move to mandatory at some point.  Jim Karpe suggested that a topic for our next discussion be regarding what they envision managed care to look like for the I/DD world. JoAnn suggested that a prerequisite be for SWAN to review the Transition document available on the website.
  • Brad Pivar has established ongoing communication with the Justice Center and has provided the Justice Center with focal points from each family group to facilitate involvement and local meetings. In addition the next SWAN meeting with Justice Center will be scheduled in combination with other meetings in Albany.
  • Still waiting for additional information on ABLE tax credit policies from Paul Francis’ office. SWAN will follow up with Shelly.
  • SWAN will follow up with Shelly W regarding her offer to set up meeting with new Medicaid Director
  • Great progress in communication with DOH regarding MAPP. SWAN white paper provided to DOH & OPWDD identifying key requirements. Follow up meeting occurred 2 weeks ago and good progress has been made toward first two priorities. By 4/27 we hope to know what the MAPP template will look like. JoAnn emphasized that the 27th is a tentative date and reminded us of the “crawl, walk,run” discussion. It was also pointed out that not all data will be available until the CCO’s are up and running.

New Business:

  1. Staffing
  • Discussion regarding the loss of several key people at some of the regional offices. There is considerable concern relating to the loss of deep institutional knowledge as the “baby boomers” are retiring. Kerry shared that the turnover in the last five years is unprecedented and they expect it will continue for another 5 to 10 years. They agree it is a major and critical issue. Succession planning is important and will continue. OPWDD acknowledged that it took over a year to identify the right person to replace Donna Limiti. (with Mary Grace Guiliano) Their focus is to keep the day to day operations up and going. OPWDD urges SWAN to bring any specific concerns to Meaghan and Abiba..
  • SWAN offered their support to provide advocacy to the “2nd floor” as to the importance of OPWDD and the value they can provide. It was acknowledged that the budget reflects a 32 position decrease. Kerry shared that a majority of those positions have been in central office so the regions can continue to serve individuals. She indicated that these type cuts can often be dealt with without significant impact as they align divisions, seek synergy, etc. Jay indicated that whereas they hate to see any cuts at all, they are pleased that everything else in the budget was position and OPWDD received $120MM of new money.
  • Brad P. shared that participation in self direction has doubled, however the department has not grown accordingly. OPWDD indicated they would be happy to discuss further…  Dixie (OPWDD) indicated that there has been grown in the SD staff in LI regional office

 

  1. Coordinated Assessment System (CAS) 
  • SWAN shared that there is significant angst among families across the state with the CAS and particularly around the appeal process (or lack thereof)  The website doesn’t seem to have any information that is current that could help inform individuals/families. It was also communicated that it doesn’t appear that the MSC understands what is expected of them and can answer the detailed questions that families have. Is there a work process flow as well as a Role Clarity chart available? It was suggested that if loved ones of SWAN steering committee members were assessed, there would be first-hand knowledge that we could share and help to improve and communicate to others.
  • Kate Bishop acknowledged the concerns and shared that they have been conducting a lot of MSC education. Further, she indicated that they have a “quality review” process and not an “appeal” process and there is no time limitation on this. They did conduct a 100 person survey to see if the process was working. Almost 50% said the process had been followed. There is a written document to that provides the output. SWAN indicated that they are hearing that the output is terribly difficult to understand. OPWDD understands that there needs to be improvement and that they have created a guidance document to understand how to interpret the output. Also included is how the CAS interfaces with the person centered planning process. As it relates to SWAN participating In the assessment, Kate indicated that that may be a possibility Barb D. will submit names of willing steering team members to Kate.
  • JoAnn indicated that stakeholder advisory groups have been helping along the way. They understand how critical it is to get it all done properly. When there are problems, they are evaluating, is it the process, or the interpretation or not having the right people.
  • Jay indicated that OPWDD has informed CMS that the CAS will be used to set residential rates in July 2019. SWAN indicated the urgency to get it right.
  • Additional discussion regarding how families and individuals are informed about the feedback loop, the quality review process and how to confirm the results are a true reflection of their loved ones need and abilities. OPWDD is working on improving the website to provide increased knowledge. However, communication must occur that it exists.
  • JoAnn indicated that as they work thru improving information on the website, that families start with their MSC and then direct their concerns to Diane Woodward and Kate Bishop.

 

  1. .CCOs
  • SWAN shared that all family groups have been hosting meetings with the CCO’s in that region presenting. All family groups have been also distributing the OPWDD schedule for public session and encouraging family members to attend. We will continue to host CCO’s at our meetings.
  • Pat C. indicated that many families do not have the time to go to these public forums. OPWDD shared they would be posted a recorded forum to their website  They are also relying heavily on the MSC’s to communicate the message since they are the primary conduit of information. However, SWAN indicated that many times the MSC’s know less than we do.
  • Kate shared that lots of information was sent out to MSCs. One of the challenges is that there are 400 different organizations with different levels of competency. The move to CCOs will help empower the Care Manager and it will be easier to communicate when they have a smaller caseload
  • Internal discussions have been robust with many concerns, confusion and fear. Some families have indicated they are not receiving a standardized message
  • The written material provided by OPWDD and the brochure were well received. The “chart” was particularly helpful.
  • Kerry indicated that there are a number of protection and continuity of care provisions. She emphasized that the goal of CCO’s are not to decrease level of service.
  • OPWDD indicated that any MCO will need to have a very broad network
  • Barb D suggested we have another discussion in 4 to 6 weeks as CCO “go live” gets closer. Jay emphasized that if critical issues come up in the meantime to reach out sooner 

 

.

Dated: 4/30/2018

 

 

 

  • SWAN appreciates being a part of the workgroups and looks forward to continued active participation. Kerry Delaney will continue to involve families in policy, messaging, and governance. This will be a continued and ongoing objective.
  • Discussion regarding road map to Managed Care. OPWDD suggested that SWAN review what is available on website in terms key steps and target dates and provide any feedback/questions to OPWDD. Also blueprint document is in process and they expect it to be posted sometime in August. Involvement will initially be voluntary and will move to mandatory at some point.  Jim Karpe suggested that a topic for our next discussion be regarding what they envision managed care to look like for the I/DD world. JoAnn suggested that a prerequisite be for SWAN to review the Transition document available on the website.
  • Brad Pivar has established ongoing communication with the Justice Center and has provided the Justice Center with focal points from each family group to facilitate involvement and local meetings. In addition the next SWAN meeting with Justice Center will be scheduled in combination with other meetings in Albany.
  • Still waiting for additional information on ABLE tax credit policies from Paul Francis’ office. SWAN will follow up with Shelly.
  • SWAN will follow up with Shelly W regarding her offer to set up meeting with new Medicaid Director
  • Great progress in communication with DOH regarding MAPP. SWAN white paper provided to DOH & OPWDD identifying key requirements. Follow up meeting occurred 2 weeks ago and good progress has been made toward first two priorities. By 4/27 we hope to know what the MAPP template will look like. JoAnn emphasized that the 27th is a tentative date and reminded us of the “crawl, walk,run” discussion. It was also pointed out that not all data will be available until the CCO’s are up and running.

New Business:

  1. Staffing
  • Discussion regarding the loss of several key people at some of the regional offices. There is considerable concern relating to the loss of deep institutional knowledge as the “baby boomers” are retiring. Kerry shared that the turnover in the last five years is unprecedented and they expect it will continue for another 5 to 10 years. They agree it is a major and critical issue. Succession planning is important and will continue. OPWDD acknowledged that it took over a year to identify the right person to replace Donna Limiti. (with Mary Grace Guiliano) Their focus is to keep the day to day operations up and going. OPWDD urges SWAN to bring any specific concerns to Meaghan and Abiba..
  • SWAN offered their support to provide advocacy to the “2nd floor” as to the importance of OPWDD and the value they can provide. It was acknowledged that the budget reflects a 32 position decrease. Kerry shared that a majority of those positions have been in central office so the regions can continue to serve individuals. She indicated that these type cuts can often be dealt with without significant impact as they align divisions, seek synergy, etc. Jay indicated that whereas they hate to see any cuts at all, they are pleased that everything else in the budget was position and OPWDD received $120MM of new money.
  • Brad P. shared that participation in self direction has doubled, however the department has not grown accordingly. OPWDD indicated they would be happy to discuss further…  Dixie (OPWDD) indicated that there has been grown in the SD staff in LI regional office

 

  1. Coordinated Assessment System (CAS)
  • SWAN shared that there is significant angst among families across the state with the CAS and particularly around the appeal process (or lack thereof)  The website doesn’t seem to have any information that is current that could help inform individuals/families. It was also communicated that it doesn’t appear that the MSC understands what is expected of them and can answer the detailed questions that families have. Is there a work process flow as well as a Role Clarity chart available? It was suggested that if loved ones of SWAN steering committee members were assessed, there would be first-hand knowledge that we could share and help to improve and communicate to others.
  • Kate Bishop acknowledged the concerns and shared that they have been conducting a lot of MSC education. Further, she indicated that they have a “quality review” process and not an “appeal” process and there is no time limitation on this. They did conduct a 100 person survey to see if the process was working. Almost 50% said the process had been followed. There is a written document to that provides the output. SWAN indicated that they are hearing that the output is terribly difficult to understand. OPWDD understands that there needs to be improvement and that they have created a guidance document to understand how to interpret the output. Also included is how the CAS interfaces with the person centered planning process. As it relates to SWAN participating In the assessment, Kate indicated that that may be a possibility Barb D. will submit names of willing steering team members to Kate.
  • JoAnn indicated that stakeholder advisory groups have been helping along the way. They understand how critical it is to get it all done properly. When there are problems, they are evaluating, is it the process, or the interpretation or not having the right people.
  • Jay indicated that OPWDD has informed CMS that the CAS will be used to set residential rates in July 2019. SWAN indicated the urgency to get it right.
  • Additional discussion regarding how families and individuals are informed about the feedback loop, the quality review process and how to confirm the results are a true reflection of their loved ones need and abilities. OPWDD is working on improving the website to provide increased knowledge. However, communication must occur that it exists.
  • JoAnn indicated that as they work thru improving information on the website, that families start with their MSC and then direct their concerns to Diane Woodward and Kate Bishop.

 

  1. .CCOs
  • SWAN shared that all family groups have been hosting meetings with the CCO’s in that region presenting. All family groups have been also distributing the OPWDD schedule for public session and encouraging family members to attend. We will continue to host CCO’s at our meetings.
  • Pat C. indicated that many families do not have the time to go to these public forums. OPWDD shared they would be posted a recorded forum to their website  They are also relying heavily on the MSC’s to communicate the message since they are the primary conduit of information. However, SWAN indicated that many times the MSC’s know less than we do.
  • Kate shared that lots of information was sent out to MSCs. One of the challenges is that there are 400 different organizations with different levels of competency. The move to CCOs will help empower the Care Manager and it will be easier to communicate when they have a smaller caseload
  • Internal discussions have been robust with many concerns, confusion and fear. Some families have indicated they are not receiving a standardized message
  • The written material provided by OPWDD and the brochure were well received. The “chart” was particularly helpful.
  • Kerry indicated that there are a number of protection and continuity of care provisions. She emphasized that the goal of CCO’s are not to decrease level of service.
  • OPWDD indicated that any MCO will need to have a very broad network
  • Barb D suggested we have another discussion in 4 to 6 weeks as CCO “go live” gets closer. Jay emphasized that if critical issues come up in the meantime to reach out sooner 

 

.

Dated: 4/30/2018

 

 

 

Concerns about CAS (Coordinated Assessment System) – 11/15/17

SWAN – CAS White paper 11-15-2017 FINAL

Summary

The Coordinated Assessment System (CAS) is becoming the standard tool used by OPWDD (New York State’s Office of People With Developmental Disabilities) to determine the care needed for an individual with an Intellectual and/or Development Disability (I/DD).
OPWDD must make significant and immediate course corrections to this process.

The concerned parents and family members of New York State want to ensure the CAS is

  1. Accurate
  2. Administered effectively.
  3. Amended if it does not accurately reflect the person.

We are most concerned about the process for amending a CAS report. Any assessment tool will sometimes fail, and consequently there must be a process to correct inaccuracies. Assessments of people with I/DD are especially prone to error, due to the high degree of variability in this population– variations in health, behavior, physical ability and cognition.

Amended thru an Appeals Process

Recent presentations by senior OPWDD personnel have pointed to the low rate of reported problems as evidence of the accuracy of CAS. Unfortunately, the low rate of reports is actually evidence of the imperfections in the current complaint and appeals process. The Medicaid Service Coordinator (MSC) is supposed to discuss the CAS results with the individual and their family within a few days of the completion of the report. The MSC is then supposed to inform OPWDD about any problems and report them to coordinated.assessment@opwdd.ny.gov, the designated email address for complaints and problems.

In practice, the process for error detection and correction can break down in many ways, including:

  1. Individual does not currently have an MSC, due to high turn-over.
  2. MSC does not inform the family that a CAS is going to be administered.
  • MSC does not send the CAS Summary to the family/guardian/individual.
  1. No discussion of results with the family and individual.
  2. Family and individual are not informed of complaint process.
  3. Incomplete follow through on the family complaint.

Amendment Recommendations:

  1. Introduce direct reporting from individuals and family members in addition to reports from MSCs.
  2. Ensure that the family/guardian/self-advocate is informed of the appeals process for the CAS. Mandate a plain-English document outlining the process timelines and the appeals process. The person administering the CAS must obtain signatures of the individual and their family member on a copy of that document, with another copy left with the family/person.

Effective Administration

Families and providers have complained that behavioral issues and physical limitations have not been explored. “Sub-assessments” may not have been executed, even when clearly called for. Some assessors act as if they are compensated based on the number of completed assessments, and not on their accuracy. If this is true, it is ironic that as we start the process of converting to a Value-Based system, we are falling into the same old trap by rewarding Assessors for volume.

It is important to include support staff at the time of the assessment since the term “circle of support” may be interpreted by families to mean only friends and family.

Effective Administration Recommendations:

  1. Accommodations for those who are not fluent in English.
  2. When no response, record whether ‘chose not to’ or ‘unable to’ respond.
  3. Use measures of quality and accuracy to determine compensation to the assessors.
  4. Ensure that family members are always informed of the assessment.
  5. In addition to family members, interview Direct Support Professionals and Residence Directors. Find DSPs with the most exposure to the individual.
  6. Publish the CAS, including the branching structure, so that family members and professionals can ensure that appropriate sub-assessments are performed. When individuals know which questions they should be asked, they can serve as a real-time quality check.

Accuracy of the Instrument

Aside from problems with administration, the instrument itself is not fine-grained enough. Tasks are not broken down into sufficient detail, and the categories are too broad. Examples:

  • An individual who can tear lettuce was categorized as “able to perform 50% of meal preparation tasks.” Placed into the same category was another individual who can prepare a simple meal with no assistance.
  • Individuals are credited with independent toileting, despite their inability to wipe themselves and to wash their hands afterward. This has a direct impact on health.

Overall, the assessment often produces an inaccurate view of the individual. Someone who cannot feed or toilet themselves may be improperly classified as not needing support for these vital activities because they can do part of the task.

Accuracy Recommendation:

Given that the CAS instrument itself is unlikely to be revised, there must be a path which allows for corrections when needed through additional evidence. In some cases that will have to include supplemental assessments, including adaptive behavior scales such as a Vineland Adaptive Behavior Scale, ABAS®-III, SIBͲR, ABESͲR2, or ABDS