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- OPWDD and Legislative Updates – Margaret Puddington
- The Governor’s proposed budget is due to be released around mid-January, including funding for services for people with I/DD. The state already faces a $4 billion budget deficit. And NYS is looking for ways to ease the new tax burdens (regarding property and state and local taxes) imposed by the Federal Tax Reform, some of which may add to the deficit.
- At the federal level, depending on Congress’s actions regarding Medicaid, and the federal contribution to the expansion of Medicaid, NYS could be facing an even larger deficit. It is possible that NYS might have to cut its own Medicaid budget. Moreover, over time, the tax cuts might result in enormous deficits. In order to reduce the deficits, there would have to be spending cuts—probably on entitlements like Medicaid, Medicare, SNAP, SSI, SSDI, rental assistance, and more. That is extremely serious and could affect funding for all services for people with I/DD.
- Our main advocacy issue last year was getting salary increases for direct support professionals (DSPs). Despite the bleak budget picture in NYS, we will continue this year to support higher salaries for DSPs. We have no option: turnover rates and vacancy rates continue their alarming rise. Last year, the bFair2direct care campaign won two 3.25% increases, the first due this month, and the second April 1. This was to be a 6-year campaign. But now we are facing budget deficits and uncertainties. Nevertheless, we need to try to keep DSP salaries at least somewhat above the minimum. The new state minimum in NYC will be $13/hour as of December 31, 2017; $15/hour December 31, 2018. We must keep plugging away if we are to retain our essential DSPs.
- Don’t miss the next FSSAC meeting (see above in Announcements) to find out what is in the budget, and what we are planning to do about it.
- Report on the Statewide Family Support Services Committee – Margaret Puddington
ACTING COMMISSIONER KERRY DELANY:
Residential: OPWDD issued requests for 455 certified residential services for all NYS regions. (Uncertified opportunities are funded through the Front Door, working with providers 1:1). There were over 175 proposals from 104 agencies. The requests were targeted to people living at home with aging caregivers, or caregivers unable to continue providing care. [Awards announced subsequent to the meeting: $58.9 million awarded to 53 provider agencies creating 83 new homes for 459 people. This was not new money; it came out of the $120 million already available in the current budget for every type of new service for people with I/DD.]
Abiba Kindo also explained that there are two residential waiting lists: the Residential Request List which is for all people who expressed a future interest in residential placement. It has 11,000 – 12,000 individuals registered. The other list is the Certified Residential Opportunity list, listing people actively seeking certified residential opportunities now for a need within 3 years.
CCO Transition Plan: The federal Centers for Medicare and Medicaid approved a change in waiver authority for OPWDD services from the 1915C Medicaid waiver to the 1115 Medicaid waiver, which is said to be more flexible. The transition plan was posted on OPWDD website. Comments were encouraged and were due Jan. 5. OPWDD held two rounds of forums to explain the Coordinated Care Organizations (CCOs). OPWDD received 6 applications from entities seeking to become CCOs. Contingent award letters will be sent by the end of January. At that point CCOs can outreach to people/families to sign up or opt out. People can enroll, switch or disenroll at will. MSC agencies will contract with a CCO, so that you can get your same MSC, if desired, by enrolling in his/her affiliated CCO.
Statewide FSS Committee Minutes: OPWDD is exploring use of a concise version of the minutes for posting on the website; the present model is too detailed and lengthy.
CAS – DIANE WOODWARD
Margaret did not report on this presentation because it is the topic of today’s presentation.
FSS Booklet: This booklet will contain basic information for families about the FSSACs. The draft has been approved.
Comprehensive Guidance: A small group of OPWDD FSS Liaisons are working to standardize policies around family support services, and also to standardize practices for family reimbursement programs.
DQI: As previously reported, regarding oversight of waiver respite programs, which the FSSACs used to have, The Division of Quality Improvement (DQI) and the Statewide FSS have agreed that joint site visits are unworkable for a number of reasons. Instead, DQI will give semi-annual reports to the Statewide Family Support Committee on serious deficiencies or systemic inadequacies, and on plans of corrective action from agencies. DQI will identify trends. FSSACs will raise with DQI issues of concerns regarding particular programs and will provide topic areas for training of DQI auditors. The emphasis of DQI is mostly on compliance, while the FSSAC orientation is toward quality.
- Speakers: Kathy Broderick, Acting Chief Operating Officer, and Kathy Kelly, Director of Entitlements and Placement, AHRC, on OPWDD’s new Coordinated Assessment System (CAS)
OPWDD needs a centralized, standardized method to assess people with I/DD. For many years, the assessment instrument used by OPWDD was the Developmental Disabilities Profile 2 (DDP2). This was a guide to what the person needs and wants. The DDP2 was developed collaboratively. It was administered by the agency serving the person and was, for the most part but with some exceptions, accurate.
Both the state and federal government questioned whether providers might be exaggerating people’s needs, so they directed OPWDD to devise a more neutral process. OPWDD and its representatives, not providers, would administer this new tool. OPWDD adapted the InterRAI tool for the I/DD population. This was not a collaborative process; the tool was developed by an outside entity. No one is permitted to see the actual tool.
The CAS is being administered gradually. So far, about 17,000 people have been assessed. Eventually, everyone served by OPWDD will have a CAS assessment. At present it is being used as a planning tool for the ISP. But ultimately, perhaps within 5 years, the CAS assessment will determine the funding for services for each individual. That is why it is critical that CAS assessments be accurate reflections of the person’s needs and wants.
The CAS is not a yes/no scoring tool. It is a conversation reliant on the answers given by the person and his/her family, as well as others. The problem is that the person and/or family may overstate the person’s capabilities, giving the impression that the person needs less support that he or she actually needs.
The CAS process has the person at the center. The CAS covers 16 domains, including communication and vision, cognition, everyday activities, health conditions, mood and behavior, etc. The assessor interviews or observes the person, interviews people who know the person well (in addition to family members, someone who has known the person for at least 30 days and has seen the person in the last 3 days), and reviews the person’s records. The assessor produces a summary report which goes into an OPWDD data bank called CHOICES. The MSC retrieves the report and shares it with the person/family.
The family has the right to be present as the CAS interview; the assessor should honor reasonable requests for a different date.
The role of the MSC is critical: (1) to initially provide contact information for the individual and family and facilitate setting up the appointment; (2) to retrieve the summary and share and discuss it with the person/family and hopefully with the residence and other primary providers as well; (3) to incorporate the results of the assessment into the person-centered planning process and the ISP; and (4) to identify any errors and if so to notify and work with OPWDD to address them .
Unfortunately, due to huge imminent changes in the MSC field, there has been tremendous MSC turnover. So in reality, there are many instances where the MSC function is being only partially filled. This adds to the problem of correcting errors.
The InterAgency Council (IAC) learned anecdotally of widespread errors in CAS summaries that have been done. To determine the extent and severity of errors, IAC issued a formal survey as to the accuracy of CAS summaries among 8 residential agencies. They discovered egregious errors and an error rate of 42%. AHRC looked at their own individuals’ CAS summaries, and among 50 summaries, found a 50% error rate. Among the errors were: person scored as totally independent in toileting although wears diapers; person scored as independent in mobility although relies on a wheelchair.
At present, there is no way to go back and change the CAS summary. Only the MSC can put the errors on record, sending notice to a designated OPWDD e-mail box. An addendum to the CAS will then be produced, but it is not part of the CAS summary, so the CAS summary stands on its own, and the addendum may be overlooked.
TIPS for Families
- Review your relative’s records prior to the assessment. The assessor is likely to review the ISP, psychological, psychosocial, medical, comprehensive functional assessment (for ICF residents only), psychiatric eval if there is a mental health diagnosis, neurological eval if pertinent. Ensure that the records are accurate. If not, have them corrected.
- Request that certain people who know your relative well be interviewed for the CAS to ensure that people who do not know your relative well (e.g., a new staff person) are not the only ones interviewed.
- Carefully review the CAS assessment.
- Put in writing to your MSC any errors in the CAS summary.
- If errors are significant enough, ask for a re-do of the CAS and for the existing erroneous CAS to be marked invalid.
- Always answer honestly. When answering questions about the person’s ability/performance in completing a task or skill, answer with how the person typically performs the task/skill—not how the person performs on his/her best day or worst day.
- Don’t be afraid to ask for clarification of the questions.
- Ask your MSC if your family member has had a CAS Assessment completed already. If so, make sure the MSC has shared with you the Summary reports and reviewed them with you. There should be a conversation around these reports, not just something you receive in the mail.
If there are significant errors in the assessment, the family should be persistent in getting them corrected. There is no due process or fair hearing for the CAS, but individuals do have rights under Part 633 and 635 in the OPWDD regulations. In light of the fact that these CAS summaries will in a few years be used to determine funding for all individuals, families should advocate strongly to correct any significant CAS errors.
Please see attached powerpoint and handouts.cas-presentation-handout-1
Family & Provider Information Committee
Tuesday, January 23, 2018, 10:00 am – noon
Sinergia, 2082 Lexington Ave., 4th floor
Information: Information: Carol Lincoln (718) 859-5420 x 225; firstname.lastname@example.org.
Next meeting to be announced.
Information: Jim Malley (212) 928-5810 x 101; Jmalley@esperanzacenter.net
Thursday, February 8, 2018, 9:30 am – noon
Presentation by IAC on the Governor’s Proposed Budget
IAC, 150 West 30th Street, 15th floor
Information: Marco Damiani (212) 780-2661; email@example.com
NEXT Manhattan FSS Advisory Council
Thursday, February 8, 2018, 10:00 am – noon
Presentation by IAC on the Governor’s Proposed Budget; meeting Co-sponsored by the Manhattan DD Council
IAC, 150 West 30th Street, 15th floor
Information: Margaret Puddington (212) 799-2042; Margaret.firstname.lastname@example.org