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The Changing State of Developmental Disabilities Service in New York |
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Many changes are being planned that will significantly alter the Developmental Disabilities service system as we know it today. This primer will brief you on pending changes at OPWDD that you may not be aware of as they progress along a course that has been mandated by Governor Cuomo’s plans to reduce Medicaid spending in NY State. THE BUDGET The story starts with a June 20, 2010 article published in the Poughkeepsie Journal, citing the enormous cost of residential programs operated by OPWDD (then, still referred to as OMRDD) The article brought to public attention that NY State OMRDD charges Medicaid almost $5,000 a day per person for residential services in OMRDD-operated facilities (we get about $8,500 a month per person for our supervised residences) and unfavorably compares what other states get for the same service (about $900 per day in CT). Clearly the amount was in excess of what was needed, but OMRDD used the excess funds to pay for other vital services for consumers. The vital services include residences, day programs, employment and family support programs for those in the community. However, since the article brought negative attention to the funding stream, the Federal government is forced to normalize OMRDD rates rendering the current model “unsustainable”, and OMRDD began to look for ways to restructure funding. If you have been following along with the Governor’s progress in achieving many of his campaign goals, he has achieved an impressive volume of tasks since taking office in January. One of the goals, reducing Medicaid spending, has had a profound effect on the future of services to individuals with developmental disabilities in NY State. Governor Cuomo formed a Medicaid Redesign Team (MRT) whose goal was to brainstorm as many ways as possible to reduce the cost of providing Medicaid services in the State. Of the 70 recommendations that the MRT proposed, only one directly affected clinical services provided the DD population by placing annual caps on visits to Article 16 clinics. Over the course of the last two years, OPWDD has borne the brunt of budget cuts by reducing employees through retirement and not refilling open positions. This year, budget cuts were sustained by agencies as rates were reduced across the board. Agency received funding cuts ranging from 2% to 7%. ABUSES IN RESIDENTIAL PROGRAMS In parallel with Medicaid Redesign and budget cuts, the NY Times ran three articles exposing abuses to consumers that were occurring in OPWDD-run residences throughout the State. Here are links: March 13, 2011 At State-Run Homes, Abuse and Impunity http://www.nytimes.com/2011/03/13/nyregion/13homes.html?_r=2&ref=nyregion March 30, 2011 Cuomo to Tighten Requirements for Workers in Homes for Disabled http://www.nytimes.com/2011/03/30/nyregion/30group.html?scp=1&sq=requirements%20for%20workers%20in%20homes%20for%20disabled&st=cse June 6, 2011 A Disabled Boy’s Death, and a System in Disarray Even though these articles confined their allegations to OPWDD, all residential settings, including those run by voluntary agencies, become painted with the same broad brush. The news of abuses that were overlooked and swept under the rug caused the Governor to replace the OPWDD Commissioner and other high-level OPWDD staff lost their jobs as well. Many new initiatives have been put in place to tighten up the regulations concerning allegations of abuse and to centralize reporting of abuse for the entire field. OPWDD has been given authority to impose monetary fines if agencies delay responses to allegations. Many of OPWDD’s problems arise from the collective bargaining agreement with the union that represents the state’s residential workers. Certain provisions in the agreement make it difficult to terminate abuse and neglectful workers. THE RESULT These two parallel paths converge at the naming of a new OPWDD Commissioner, Courtney Burke. It is speculated that she was hired by the Governor because of her familiarity with government-level health care and Medicaid design and implementation as a researcher with the Rockefeller Institute State Health Policy Research Center. The path that OPWDD has chosen to take is to apply to the Federal government for a waiver of regulation that will allow them to restructure the funding and implementation of all DD services, including services that are currently not included under OPWDD auspices, most notably healthcare services. According to the definition at the Center for Medicare & Medicaid Services website, “Section 1115 of the Social Security Act gives the Secretary of Health and Human Services broad authority to authorize demonstration projects likely to promote the objectives of the Medicaid statute.” Referred to generically as an “1115 Waiver”, Commissioner Burke has dubbed the demonstration project the “People First Waiver”. We have had a single briefing on the direction of the People First Waiver. A steering committee has been formed along with multiple subcommittees, called Design Teams. The ultimate goal is to set up a managed care system based on per-person capitated rates. The rates will be based on estimates of the average annual costs of care for a person with DD. Case Coordination will be handled by an intermediary organization, called a Managed Care Organization (MCO). The MCO will administer these funds on behalf of the consumers to pay for the services they need, quite like an insurance company handles claims. Funds will be managed from one all-inclusive allotment which will provide case coordination, residential, adult services, community habilitation, therapies, etc., plus medical, substance abuse and mental health treatment not currently covered by OPWDD services. The MCO will contract with other provider agencies to actually provide the services to the consumer. The application has already been made (you can follow progress on OPWDD’s webpage here: http://www.opwdd.ny.gov/2011_waiver/index.jsp ). These demonstration projects typically have a 5-year duration and are then renewed in multi-year increments. As an example, the current unsustainable method of funding we now use is the result of a similar “1915” waiver project called Home & Community Based Services which allows states to take funds previously earmarked for institutionalization and use them to create a service system that allows consumers to live and be sustained in the community instead. We believe that the Commissioner intends to move quickly to have some substantial elements in place within the first year. PLANNING AHEAD Things that are clear: OPWDD is looking for large agencies, or networks of smaller agencies, to become MCO’S; agencies, other than those who qualify to be a MCO, will be relegated to sub-contracting with these MCO’S. Consumers are likely to retain an element of choice at least with respect to MCO’S that are available and to the extent they can negotiate with the MCO of choice for requested services. Voluntary agencies anticipate a trend toward having to work cooperatively and sharing resources as a way to become a stronger whole.
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