1. Announcements: Up-Coming Meetings
Family Support Services Committee
Tuesday, October 8, 2013, 10:00 am – noon
YAI, 460 West 34th Street, 11th floor
Information: Amy Bittinger (718) 859-5420 x 234; Abittinger@ucpnyc.org
Transition Committee
Wednesday, October 9, 2013, 9:30am – noon
Location to be announced
Information: Kathy Kelly (212) 780-2724; Kathy.kelly@ahrcnyc.org
Legislative Committee
To Be Announced
Information: Jim Malley (212) 928-5810 x 101; Jmalley@esperanzacenter.net
Children’s Committee
Friday, October 4, 2013, Registration/refreshments at 9:30 am; Meeting 10:00 am – noon
Jewish Guild for the Blind, 15 West 65th Street, Auditorium
Information: Christina Muccioli (212) 780-2532; Christina.muccioli@ahrcnyc.org
Service Coordination Committee
Monday, September 30, 2013, 10:00 am – noon
UCP, 80 Maiden Lane, 2nd floor
Speaker: Michael Levy, MTA on travel training
Information: Carol Lincoln (718) 859-5420 x 225; Clincoln@ucpnyc.org
DD Council
Thursday, October 10, 2013, 9:30 am
District 75, 400 1st Avenue
Information: Marco Damiani (212) 273-6188; Marco.damiani@yai.org
“Community Dialogues”
OPWDD will hold conversations with stakeholders about community inclusion, the expansion of employment, and meaningful community activities for people with developmental disabilities. The Manhattan sessions will be held at Morton Street September 16, 12-4; September 20, 10-2 and 4-7 (statewide); September 26, 4-7 (statewide videoconference). To register, contact Evette Herdsman: 212-229-3037.
2. Summer Legislative Advocacy
The borough DD Councils agreed to hold a summer legislative advocacy campaign, titled Getting to Know Us. The purpose is to strengthen our relationship with our legislators; to thank them for supporting us in the last budget session; and to impress upon them the need for additional funding in the next budget. In Manhattan we decided to emphasize program visits whenever possible rather than office visits. The program visits have been immensely successful, helping to deepen legislators’ understanding of people with developmental disabilities and their needs and services. In cases where there are only small group homes in a legislator’s district, we did not try to arrange a visit but instead had constituents visit the legislators in their offices.
As of this meeting, the following legislators have made program visits: Krueger, Hoylman, Rosa, Gottfried, Silver, Rodriguez, Perkins, Espaillat. The following legislators had office visits instead: Serrano, O’Donnell, and Quart. We have scheduled program visits with:
Farrell, Glick, Rosenthal, and Kavanagh. Yet to be scheduled: Wright, Kellner, Squadron.
In addition, we plan to visit our federal representatives because the Centers for Medicare and Medicaid (CMS) are playing such a critical role in service design and reimbursement rates going forward. We did visit Nadler’s office and will schedule visits to other Manhattan representatives.
3. Report on Statewide Family Support Committee
Acting Commissioner Laurie Kelley: The Acting Commissioner pointed out that OPWDD has drawn down more federal funding than any other state, yet we haven’t demonstrated to CMS the quality of our services because we haven’t been using measurable outcomes. We need to demonstrate to CMS a measurable improvement in person-centered planning, the number of people employed, number of people in self-direction.
Rate rationalization: OPWDD has been working with the Department of Health on rationalizing the reimbursement rates for services to reflect more accurately additional factors that must be taken into account in rate setting, such as an e-score (evacuation score). CMS wants a price per person, not a cost that is based on a particular setting. There is on-going negotiation with CMS over what will be included in the People First waiver. Initially it will be dental and long-term care services. However, there are benefits to including medical services as well, including sharing of information and collaborating across systems.
Front Door: OPWDD currently has two fellows assigned to assess what’s working and what’s not. The Commissioner is aware of the difficulties with the Front Door and wants to use the fellows, mystery shoppers, and feedback from families, especially from families who are unfamiliar with OPWDD and its jargon and forms. I mentioned the problems we are experiencing with the Front Door in the city: no one getting through the Front Door; no one is being enrolled and thus programs won’t meet their contractual numbers; families still need help with eligibility but programs now may not count the time they spend in assisting families to obtain documentation of eligibility; the Front Door requirements will act as a disincentive for families who just want “light” family support services such as reimbursement or parent support; and several other issues.
Future of Family Support Services: The Commissioner said that this is not known at this time. We need to demonstrate to CMS the value of family support services: cost avoidance (such as forestalling residential services, avoiding crisis, enabling parents to work). We also discussed the need for a family support point person in Albany, especially now with so many retirements and new people as family support coordinators.
School District Outreach Strategies: OPWDD has been conducting outreach to the schools in order to ensure: good outcomes for graduates; interventions to try to avoid residential school placements; voluntary opportunities in the schools that will increase successful post-grad employment; working together with schools to identify supports that families need.
Currently, in the schools, there is a stunning lack of awareness of OPWDD, and families are not receiving OPWDD services. OPWDD is not informed prior to residential placement, and there are many new graduates without adult supports.
Now each DDRO will have transition coordinators who will connect with the schools. Evette Herdsman, 212-229-3037, is the Manhattan transition coordinator. OPWDD wants better communication at the local school level for transition, services, and help for students at risk of residential placement.
Culture Change Initiative: Goal is lasting structural and social changes within OPWDD to shared ways of thinking, beliefs, values, relationships, procedures. OPWDD wants to align values with policy and procedures. Themes: awareness, respect, teamwork. The focus should be on the relationships between staff and the people served, hiring, training, and supervision.
Accomplishments so far:
- Leadership – various trainings (positive outcomes, restraints, etc.)
- Policy/structure – PROMOTE, agency reorganization, etc.
- Work systems/QI – incident reporting, health and safety alerts, etc.
- Workforce/talent development – code of ethics, core competencies, staff trainings, etc.
- Transformation agenda – Road to reform
4. Speaker: Kathy Broderick, Associate Executive Director, AHRC, on Current Developments Affecting Services for People with Developmental Disabilities
Kathy Broderick spoke about the recent NYS budget and its impact on services. She pointed out that OPWDD had $90 million cut from its total budget of $5 billion. The Weisenberg Coalition bill—sometimes called the restoration bill—is now on the Governor’s desk, and he has 10 days to sign it. The bill does not provide any new money nor is it a guarantee that there will be no reduction. Kathy suggested people might want to contact the Governor to urge him to sign it. [He did subsequently sign the bill.] In response to a question, Kathy replied that the NYS Constitution obligates NYS to care for its “needy.” Lynn Decker investigated and found the exact language: Section 1 of Article 17 of the Constitution reads: ”The aid, care and support of the needy are public concerns and shall be provided by the state and by such of its subdivisions, and in such manner and by such means, as the Legislature may from time to time determine.”
Kathy pointed out that we need to figure out how to better utilize the money we have by, for example, looking at 24/7 residences to see whether some people may be overserved. She pointed out that the situation now is very different from what it used to be. In the past, all or most school graduates were placed, but last year, only 37% of graduates were placed.
Kathy advised families of school-aged children needing services to begin the process as early as possible. Families should get documentation of their child’s eligibility, make sure that OPWDD knows about their child, and link up with an agency. She cautioned against waiting until the child is 21, at which point there may be few suitable opportunities.
Kathy explained that OPWDD is no longer setting reimbursement rates for services; the NYS Department of Health has taken that function over, utilizing rate rationalization. Rate rationalization looks at all rates in a given area and selects factors that should be supported in the rates, such as salary for direct support professionals, fringe rates, administration, OTPS (Other than Personnel Support: food, electricity, gas, maintenance, etc.). For example, all providers of a certain service would be brought to the same rate. Every provider would get that rate, which might be above or below the current rate. Rate rationalization generally doesn’t take account of any level of need differential. OPWDD did have a differential. DOH is finalizing rate rationalization for ICFs, IRAs, and day habilitation. The main factor in the rate is direct support salaries. Agencies that pay more than that new rate will lose. Another factor is fringe. Again, agencies providing more will not be reimbursed the full amount. Long-standing agencies that pay relatively higher salaries and fringe costs will lose. Also, the rate rationalization methodology doesn’t take into account the different costs around the state. They are using 3 regions. But there is great disparity within even a single region. For example, Westchester, downstate, NYC, and Suffolk comprise one region.
To accommodate to the new rates, some agencies will have to take a cut and will have to terminate money-losing programs. Some agencies may not be able to survive.
There may still be some money left over from previous budgets that can be used for Consolidated Supports and Services (CSS), which allows much flexibility in terms of designing supports.
The deadline for people to enroll in managed care has been extended, but not yet set. People with developmental disabilities had been carved out of managed care, but no longer. Typical insurance companies do not understand the needs of our population, which are so different from the ill people they typically serve. People with DD do not get cured; our services are lifelong and not time-limited.
Improved medical care has increased the life span of people with DD. Of all the people served by OPWDD, 11.7% are age 80 or over! These people will need a higher level of care, although the OPWDD budget has been reduced.
“DISCOs” are OPWDD’s term for managed care. Currently, the deadline for licensure of a managed care organization has been pushed back; a DISCO must be licensed by the time it is ready to begin operations, not by the time of initiation of the pilots.
Advantages of managed care: long-term services will be better coordinated, and cost containment will force some positive changes, such as use of alternatives to expensive emergency room services.
Kathy underscored that much of the future remains uncertain, but she believes we will proceed with managed care, there will be a managed care pilot by July 2014, and that initial services under managed care will be long-term services, dental, physical therapy, occupational therapy, and speech therapy.
The families thanked Kathy for sharing her insights and for explaining complex issues so clearly—not once, but twice!