FSSAC Meeting Minutes – 9/25/17

1. Announcements

The following committees are subcommittees of the Manhattan DD Council. Family members are welcome to attend any or all.

Family Support Services Committee
Tuesday, October 10, 2017, 10:00 am – noon
Sinergia, 2082 Lexington Ave., 4th floor
Information: Yesenia Estrella (212) 928-5810; yestrella@esperanzacenter.com

Transition Committee
Wednesday, October 11, 2017, 9:30 am – noon
AHRC, 83 Maiden Lane, 11th floor Board Room
Information: Kathy Kelly (212) 780-2724; Kathy.kelly@ahrcnyc.org

Legislative Committee
Next meeting to be announced.
Information: Jim Malley (212) 928-5810 x 101; Jmalley@esperanzacenter.net

MSC Committee
Friday, September 29, 2017, 10:00 am – noon
Topic: OPWDD’s CAS – new assessment tool; START – new crisis prevention and intervention program
Adapt Community Network (formerly UCP), 80 Maiden Lane, 4th floor
Information: Carol Lincoln (718) 859-5420 x 225; clincoln@adaptcommunitynetwork.org.

DD Council
Thursday, October 12, 2017, at 9:30 am – noon
Sinergia, 2082 Lexington Ave., 4th floor
Information: Marco Damiani (212) 947-5770 x 456; manhattanddcouncilchair@gmail.com

Please see separate e-mail for announcements of availability of all types of programs for people with developmental disabilities – for Manhattan and/or NYC residents.


2. Important Advocacy Issue – Margaret Puddington
Margaret announced that the Senate was poised to vote on the Graham/Cassidy bill – the latest attempt to repeal Obamacare and slash Medicaid. In NYS 90% of I/DD services are funded through Medicaid, so any cut would be disastrous.

This bill is a block grant, which is the same as a cut. The block grant would give a fixed amount to each state, and each state would have to serve all its Medicaid recipients out of that block. Hundreds of billions in Medicaid will be cut.

During the course of this Advisory Council meeting, we learned that the bill was defeated! But we anticipate that it will rear its head again in a similar form in the future. Please be on the lookout for action alerts, and take whatever actions are requested in order to defeat proposed cuts to Medicaid.

3. Speaker: Kate Bishop, Director of Program Development, OPWDD, on Self-Direction

Power Point Used: NYC Family Meeting for SD 92517

Kate began with a general overview of Self-Direction for attendees who were unfamiliar with it. She explained that in traditional services, the person fits into the program with all its parts, and money is paid to the agency. With Self-Direction, on the other hand, you have your own budget, called a personal resource allocation (PRA), and you put the pieces together to purchase your desired services, which are paid from the PRA. You cannot just use the PRA for anything, only for allowable categories of services. The current assessment form, DDP2, is used to set the amount of the PRA. PRAs have different levels for children and adults because children are in school and don’t need weekday activities, but adults do need day services. In Self-Direction you can hire your own staff. You can also purchase an agency service.

After meeting with your circle of support to see what supports you want, your start-up broker puts the plan and budget together. 62% of all PRA budgets goes for staff support (community habilitation, respite, SEMP). At present you can pay your self-hired staff more than they make in agency programs; you can also pay for staff benefits. The budget must be approved by the OPWDD regional office.

The fiscal intermediary (FI) handles the human resources work connected with hiring staff and paying all bills. The FI is the employer of record. Recently, CMS approved an increase in the fee for FIs.

In 2014 there were 2,000 individuals enrolled in Self-Direction. In the last three years, enrollment nearly quadrupled: there are now 7,500 individuals with budget authority. Only 170 people with budget authority have disenrolled from Self-Direction. With such fast-paced growth, the FI infrastructure needed to be shored up. The newest FI agency is Meaningful NY. OPWDD is aware that different FIs may have different interpretations regarding allowable services. Additional FI training is needed to clarify the rules.

To learn who is choosing Self-Direction, OPWDD compared large samples of people in Self-Direction and in traditional services. While it had been generally assumed that Self-Direction benefits mostly people who are relatively independent, Kate’s powerpoint demonstrates that proportionally there is no significant difference in adaptive and health scores between people in the two groups. However, over twice the proportion of people with normal or above normal functioning level are represented in the Self-Direction group, whereas higher proportions of people with severe or profound impairments were found in traditional services. The most striking finding is that the proportion of higher behavior scores among children ages 0-21 was significantly greater in Self-Direction, possibly because Self-Direction enables those with behavioral challenges to create what actually works for them.

Kate then answered questions that had been submitted in advance of the meeting. She grouped the questions by theme.

• Restrictions: OPWDD is working to simplify Individualized Goods and Services (IDGS) rules.
• Caps: Expenses cannot exceed caps—e.g., housing subsidy, although OPWDD has a work group looking into that particular cap.
• Durable medical equipment: Self-Direction cannot replace what must be purchased with your Medicaid card. IDGS can pay only if there is a Medicaid denial, and then, only up to $3,000.
• Payment in advance of service delivery: FIs cannot pay before the service (e.g., a community class) has been delivered because of Medicaid billing rules. Medicaid won’t pay until a service is completed.
• Prompt payments: FIs do pay staff and regular monthly bills promptly. But when the issue is more complex, payment tends to get delayed. There are no rules about when FIs must reimburse. Better IT could help develop a better system for monitoring payments. FIs are supposed to provide the enrollee with a monthly expenditure report.
• Managed care: Self-Direction will be an important part of managed care. PRAs will eventually be set by OPWDD using the Coordinated Assessment System (CAS). In about 5 years, payment will come from the managed care entity.
• Medication administration in uncertified settings: Currently, there are several providers who are doing this. OPWDD is expecting FIs to get training, procedures, and policies in place to implement this. For some individuals the problem can be addressed by technology. CDPAP workers are permitted to administer medications; some I/DD workers can be both CDPAP and community habilitation and can administer medications during their CDPAP hours.
• Overtime rule: In a family where there are two children with I/DD in the home, overtime must be paid to the worker working over 40 hours—even if it’s 30 hours for child A and 15 for child B— because technically there is one employer: the FI. This is a Department of Labor regulation.



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