A NEW DD DEMONSTRATION

1. A NEW DD DEMONSTRATION Change Is Coming… NYSACRA Annual Leadership Conference November 29,2012

2. A New DD Demonstration New Considerations for the DD Population • 1915-b and c Waiver/1115 Waiver • Case Studies • Pilots/DISCOs • FIDA (Fully Integrated Duals Advantage/MLTC)

3. A New DD Demonstration • OPWDD Work Teams (August 2012) Access/Enrollment/Advocacy Care Coordination Modernizing the Financial Platform -Roadmap to Managed Care/Draft RFA for Pilot DISCOs (Released 9/2012)

4. A New DD Demonstration What will the new Waiver/Demonstration do? • Managed Care approach for Long Term Care and Medical services • Capitated Payments vs. fee-for-service • Flexibility and innovation • Assessment using interRAI (CAS) • Outcome-based Quality Measures • Increased Accountability

5. A New DD Demonstration CONCERNS • Impact of functioning with fewer/fixed resources/collaboration • Transition of those individuals being supported today • Impact upon the workforce • Uncertainties LTC and Managed Health Care • Funding Risk/Regulatory Issues • Care Coordination/Utilization Review

6. A New DD Demonstration • OPTIONS For Providers - Wait for OPWDD/DISCO * Likelihood * Implications - Be a Provider in a Future Network * Implications - Work on a MLTC/FIDA

7. A New DD Demonstration • The FIDA Demonstration - Medicaid Managed Long Term Care (MLTC) - OPWDD Medicaid Capitation - OPWDD Fully-Integrated Duals Advantage (FIDA)

8. A New DD Demonstration

9. A New DD Demonstration • Medicaid Managed Long Term Care (MLTC) - Benefit Package of Covered Services: Non-Emergency Transportation to receive covered services Private Duty Nursing Care Management Personal Emergency Response System Audiology/ Hearing Aids Dental Personal Care Medical Social Services Nursing Facility Care Hospice Optometry and Eyeglasses Over-the-Counter Drugs Nutrition Podiatry Home Care Services

10. A New DD Demonstration • OPWDD Medicaid - Benefit Package of Covered Services: Service Coordination (plan of care support and MSC) Supported Employment Family Care Community Residences Family Support Services Community Habilitation Day Habilitation Enhanced Supported Employment Individualized Residential Alternatives Consolidated Supports and Services Housing/Individual Support Services (including Assistive Technology and Environmental Modifications) Respite Services Prevocational Services Residential Habilitation Intermediate Care Facilities Crisis Intervention Intensive Behavioral Services

11. A New DD Demonstration • OPWDD FIDA Demonstration - Up to 10,000 Dual Eligibles (Medicaid and Medicare) Statewide - Age 21 and over - Eligible for OPWDD Services - Not Being Served in an OMH Facility

12. A New DD Demonstration • OPWDD FIDA Services - Capitated Managed Care providing services including: Abdominal Aortic Aneurism Screening Aids Adult Day Health Care Ambulance Ambulatory Surgical Centers Assertive Community Treatment (ACT) Assisted Living Program Assistive Technology (state plan and supplemental to state plan) Bone Mass Measurement Cardiac Rehabilitation Services Cardiovascular Disease Screening Case Management for Seriously and Persistently Mentally Ill Mammograms Medicaid Pharmacy Benefits as allowed by State Law Medical Nutrition Therapy Medical Social Services Medicare Cost Sharing Medicare Part D Prescription Drug Benefit as Approved by CMS Medication Therapy Management Mobile Mental Health Treatment Moving Assistance

13. A New DD Demonstration • OPWDD FIDA Services (cont’d) Non-Emergency Transportation Nutrition OMH Licensed CRs Cervical and Vaginal Cancer Screening Chemotherapy Chiropractic Clinical Research Studies Colorectal Screening Community Integration Counseling Community Transitional Services Comprehensive Medicaid Case Management Consumer Directed Personal Assistance Services Continuing Day Treatment Day Treatment Defibrillator Depression Screening Diabetes Monitoring, Screening, Supplies and Testing Durable Medical Equipment Emergency Care Environmental Modifications Family-Based Treatment Health/Wellness Education Health Homes Hearing Services

14. A New DD Demonstration • OPWDD FIDA Services (cont’d) HIV Cobra Case Management HIV Screening Home and Community Support Services Home Delivered and Congregate Meals Home Health Home Maintenance Services Home Visits by Medical Personnel Immunizations Independent Living Skills and Training Inpatient Hospital Care (including Substance Abuse and Rehabilitation Services) Inpatient Services during a non-covered inpatient stay Inpatient Mental Healthcare (including over 190-day lifetime limit) Intensive Psychiatric Rehabilitation Treatment Programs Kidney Disease Services Other Supportive Services the Interdisciplinary Team Determines Necessary Outpatient Drugs Outpatient Hospital Services Outpatient Mental Health Outpatient Rehabilitation (OT, PT, Speech) Outpatient Substance Abuse Outpatient Surgery Palliative Care Pap Smear and Pelvic Exams Partial Hospitalization (Medicaid and Medicare) PCP Office visits

15. A New DD Demonstration • OPWDD FIDA Services (cont’d) Peer-Delivered Services Peer Mentoring Personal Care Services Personal Emergency Response Services (PERS) Personal Recovery Oriented Services (PROS) Podiatry Positive Behavioral Interventions and Support Private Duty Nursing Prostate Cancer Screening Prosthetics Pulmonary Rehabilitation Services Routine Physical Exam 1/year Service Coordination Skilled Nursing Facility Smoking and Tobacco Cessation Social and Environmental Supports Social Day Care Social Day Care Transportation Specialist Office Visits Structured Day Program Substance Abuse Program Telehealth Urgent Care Vision Care Services Wellness Counseling

16. A New DD Demonstration • OPWDD FIDA DD Services Agency with Choice/Financial Management Services Article 16 Clinic Services Community Habilitation Community Transition Services Consolidated Supports and Services Day Habilitation Day Treatment Environmental Modifications and Adaptive Devices Family Education and Training ICF/MRs Intensive Behavioral Services Live-in Caregiver Pathway to Employment Prevocational Services Residential Habilitation Respite Support Brokerage Supported Employment

17. A New DD Demonstration • MLTC Medicaid/OPWDD Medicaid/OPWDD FIDA Rate Structure - Capitated Payment Per Member Per Month - Payment Does Not Vary Based Upon Amount of Service or Setting - Regional Costs Are Reflected in Payment Amount - Risk Adjusted for Acuity - Rate is Set Annually by DOH for MLTC, DOH/CMS for FIDA and/or OPWDD for OPWDD Medicaid

18. A New DD Demonstration • MLTC Medicaid/OPWDD Medicaid/OPWDD FIDA - Network of Providers - Care Management Model - Operating Plan with Policies and Procedures: - Care Management - Enrollment/disenrollment - Service authorization criteria - Grievance and appeals - Quality assurance and performance improvement

19. A New DD Demonstration NYSARC DOWNSTATE REGION MSO • Nassau, Westchester, Suffolk Rockland, New York City • Quality Outcomes/CQL; Business Practices; • IT and Technology; Training MCO -Nassau, New York City, Westchester, Suffolk, Rockland, North Shore/LIJ, and Others -MLTC, OPWDD Medicaid, OPWDD FIDA

20. A New DD Demonstration • TIMELINES/ NEXT STEPS - 2013 - MLTC Medicaid and OPWDD Medicaid for Long Term Care Services Begin - DISCO RFA/ Pilots Begin - Some MSO actions begin - 2014 - OPWDD FIDA Begins (includes Medical Services) - 2015 – Non-Pilot DISCO Rollout - ???? – Capitated Payments for all Medical Services