November 22, 2013 Manatt, Phelps & Phillips, LLP

1. Preparing for 2014: Where have we been and where are we going November 22, 2013 Manatt, Phelps & Phillips, LLP

2. Overview of Environmental Scan • Where we are: • Continued federal scrutiny of New York’s Medicaid program • Medicaid Redesign Implementation • OPWDD Transformation • Where we may be headed • What this all means to NYSACRA and its members

3. Where We Are In 2014, the attention will be on implementation, not new policy directions: • ACA/MRT Status • OPWDD Transformation/Waiver/DISCO • Justice Center • Olmstead • E.O. 38/Executive Compensation Regulations

4. ACA • New York’s health exchange began enrolling 10/1/13 • Rocky start, but at least 50,000 obtained coverage/200,000 on their way to coverage • In-Person Assistors (IPAs)/Navigators providing enrollment assistance

5. Medicaid Redesign Team • Global Spending Cap • Initiation of Health Homes • MRT Waiver Amendment • Duals Initiative: FIDA • Care Coordination Imperative: End of fee-for-service • Behavioral Health Initiatives

6. May 3, 2013DISCO Letters of Intent Advance Care Alliance Advocates for the Disabled Affinity Health Plan Alpha Care AMAC AmeriHealth Caritas ArchCare A-Z Representative Payee Care Management of New York CHDFS Inc. EIHAB Human Services EmblemHealth Excellent Home Care Services Extended Manged Long Term Care Fidelis Care General Human Outreach in the Community, Inc. Hamaspik Choice HASC Center Inc. HealthPlusAmerigroup Human Care Services iCircle Kee to Independent Growth LIFE Living Resources Inc. Lower Westside Household Services Magellen Health Services NYIN New York Integrated Network NYSARC Inc. Olympia MLTCP Partners Health Plan Inc. Person Centered Services WNY Residential Resources Staten Island Opportunities Alliance United Healthcare VNSNY Choice Wellcare Young Adults with Special Abilities

7. FIDA* • New partnership between State of New York and CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.   • An estimated 170,000 Medicare-Medicaid enrollees in New York will have an opportunity for more coordinated care.   • New York and CMS will contract with health plans known as “FIDA Plans” that will oversee the delivery of covered Medicare and Medicaid services for Medicare-Medicaid enrollees in New York City, Long Island, and Westchester County. • Specially designated OPWDD FIDA Plans Authorized • MOU with CMS finalized this fall • Rate development underway *Fully Integrated Duals Advantage 7

8. Olmstead • Assist in transitioning people with disabilities into the community from developmental centers, ICFs, sheltered workshops and nursing homes; • Reform the assessment of the needs/choices of clients; • Adopt new Olmstead outcome measures; • Enhance integrated housing, employment, and transportation services; • Improve services to children, seniors, and people with disabilities involved with the criminal justice system; • Remove legal barriers to community integration; and • Assure continuing accountability for serving people with disabilities in the most integrated setting. 8

9. Justice Center • Substantial new obligation on all affected providers • Still a work in progress—on which NYSACRA’s input continues to be very much welcome • As rules become clear, important to identify what needs to be done to make the implementation of the new requirements manageable 9

10. OPWDD Transformation and Rate Rationalization • Principles of Overall OPWDD Reform and Restructuring • Rate Methodology Reform • Timing • Key Issues • Status

11. Executive Compensation and Administrative Expense Caps: Update • Regulations finalized in late May, effective July 1 • Latest regulations exclude clinical/program executive leadership • Guidance documents released in early July: Clarify key provisions, including comparability for 75th percentile test • Reporting obligations commence within 6 months of close of first reporting year • Litigation commenced to challenge regulations—although most cases are directed at DOH regulations

12. Where are we headed • 2013 off-year elections – potential impact on state politics • The Impact of 2013 OPWDD Crisis • Transitions in Executive Branch • Potential Legislative Leadership Changes • Open seats in the Legislature

13. Status of CMS/Congressional Inquiry • OIG scrutiny and Congressman Issa’s investigation • Broadened scrutiny of New York’s Medicaid Program • Consequences for pending waivers and other CMS-NYS issues on developmental disability field

14. 2014 Political Outlook • National political influence on state elections • Statewide offices up for election – Governor, Lt. Governor, Attorney General, and Comptroller • All 213 seats in NYS Legislature • Moreland Act, Criminal Investigations, Sexual Harassment Issues • Current relationship between Governor and Legislature

15. 2014 Session Preview • Fiscal status of New York State • Tax reform, tax cuts, tax increases • MRT/ACA implementation issues • Global cap • Wage parity for home care workers • Political/governmental reform • Women’s equality • Economic development • Education reform (pre-K/common core)

16. What we need to do • Remind policymakers of what you do every day for your clients and their families • Remind policymakers of the historic role you have played • Remind policymakers that a humane society should be judged by how it serves people with the most severe disabilities • Inform policymakers of the economic impact of not-for-profit organizations in their communities • Avoid providing any excuse for policymakers to adopt any additional adverse actions against the field • Strongly resist policies that ultimately punish the individuals and families you serve • Remember the caregivers

17. Questions or Thoughts? Jim Lytle Sandra Rivera Manatt, Phelps & Phillips LLP 30 South Pearl Street Albany, NY 12203 (518) 431-6700 jlytle@manatt.com srivera@manatt.com