Title of Presentation1 Family Forums: Designing the Future.

Title of Presentation 1

Family Forums: Designing the Future

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Agenda

• NYIN.org• Value-based Business Model• Care Coordination Model• Response to the NYS Transformation Agenda

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NYIN.org

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NYIN: Value-based Managed Care

NYIN is driven by a simple idea that providers listening to and working with individuals & families can create and design a viable business model that works for everyone.

We hold to the ideals of choice, access, and quality of life

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A picture of the new world NYS Medicaid $$$

NYIN DISCO* with Insurance License

Network of Providers (Agencies you know)

Medicaid Recipients = Enrollees (Persons Served and Families)

Access and Choice of Service

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* DISCO - Developmental Disabilities Individual Supports and Care Organization

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DISCO Benefit Package OPWDD Auspice Services OPWDD Comprehensive

Waiver Services Day Treatment ICF/IID Art 16 Clinic Svcs: OT, PT,

SLP, Clinical Social Work, Psychology, Nutrition, Rehab Counseling, Podiatry, and Dentistry.

Care Coordination provided by the DISCO

DOH Auspice Services Adult Day Health Care Dentistry DME and Hearing AIDS Home Care (offered under any auspice:

hospital-based, nursing home-based, and free-standing programs)

Non Emergency Transportation Optometry/Eyeglasses OT, PT, SLP Personal Care Personal Emergency Response System Private Duty Nursing Psychology and Clinical Social Work Respiratory Therapy Skilled Nursing Facility Podiatry

OMH/OASAS Auspice Services OASAS Inpatient OMH Institutional

Program (PC/RTF) & private psychiatric hospitalizations

Personal Recovery Oriented Services (PROS)

Outpatient – OMH, OASAS

Psychology and Clinical Social Work

OMH day treatment

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Care Coordination Model

Current Anticipated

Community

Linkages and Referrals

Advocacy/ Life

Planning

Eligibility and Benefits

Management/Assessment

Coordination with

Providers

MSC (Case management)

Designated Care Coordinator:

Central point of contact

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What is Care Coordination?• Provides a person-centered, integrated system for medical, health and social

support services

• Creates an individual care plan • Connects individuals with all their providers • Ensures timely communication with providers and community supports • Measures, monitors and improves quality informed by individual outcomes • Utilizes electronic information to support integrated and coordinated care

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Responses to NYS Transformation Agenda

NYIN will continue to take a leadership role in:

• Individual Services and Supports (Self-Direction)

• Employment Opportunities: Cleaning with Meaning a “green” home cleaning business run by people with disabilities.

• Community Integration: Our Place a new day services model using neighborhood spaces and self-directed activities.

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What you can do going forward• Take advantage of these Family Forums. Ask questions.

• Stay connected to NYIN – NYIN.org

• Ensure eligibility for services is formally established through the local DDRO

• Stick with or get connect to an agency you know - to maintain continuity of services

• Keep informed

• Be an advocate

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Contact the NYIN Agency You Know

UCP of NYC212.683.6700 ext [email protected]

HeartShare718-422-3204Olga.Golubeva@heartshare.orgwww.heartshare.org

[email protected] http://

www.occupations.org/pdf/CBHS_brochure.pdf

YAI [email protected]

[email protected]

[email protected]

[email protected]

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Agencies You Know Governing Agency Communities Served

Coordinated Behavioral Health Services (CBHS)*

Westchester, Mid-Hudson Region

HeartShare Human Services of New York New York City

The Institutes for Applied Human Dynamics (IAHD)

New York City, Westchester

Lifespire New York City, Lower-Hudson Region

Services for the UnderServed (SUS) New York City

United Cerebral Palsy of NYC (UCP/NYC) New York City

The Young Adult Institute (YAI) New York City, New Jersey, Long Island, Mid-Hudson Region

* CBHS is a consortium which includes Abilities First, Crystal Run Village Inc., New Hope Community, Occupations Inc., and Westchester Jewish Community Services

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Business Council members

• Ability Beyond Disability• Birch Family Services• Camp Venture, Inc.• CP Associations of New

York State• Children’s Village• Community Based

Services, Inc.• Edwin Gould Services• Epilepsy Foundation of

Metro NY

• F.R.E.E., Inc. • Hawthorne Foundation• Head Injury Association• Opengate, Inc. • Richmond Community

Servies• The Rose F. Kennedy

Center• St. Vincent’s Services• A Very Special Place

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NYIN

UAM Bd. Observer

UCP of NYC

Heart Share IAHD CBHSYAI SUS

UAM

Loans

Reinsurance Agreement

Business Plan

Administrative / Management Services

Agreement4

Costs of Application split 50/50 by NYIN and UAM

OPWDDDISCO Application

Business Partnership

Owners

$

$

Life- spire

Business Partnership

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Acronyms• ADA – American with Disabilities Act • AT – Assistive technology• CASA – Community Alternative Systems Agency• CDPAP – Consumer Directed Personal Assistance Program• CDS – Consumer Directed Services• CMS – Centers for Medicare and Medicaid • CR – Community Residence • CSS – Consolidated Supports and Services • DC – Developmental Center • DD – Developmental Disabilities • DDRO – Developmental Disabilities Regional Office • DISCO - Developmental Disability Individual Support and

Care Coordination Organizations• DOH – Department of Health • DQA – Division of Quality Assurance • EI – Early Intervention • FIDA – Fully Integrated Dual Advantage Programs• FSS – Family Support Services • HCBS – Home and Community Based Services • HIPAA – Health Insurance Portability and Accountability Act • HUD – Housing and Urban Development • ICF – Intermediate Care Facility • ICS – Individual and Community Supports

• IEP – Individual Education Plan • ILC - Independent Living Center• IRA – Individualized Residential Alternative• ISE – Individualized Service Environment • ISP – Individualized Service Plan• ISS – Individualized Support Services • IWRP – Individual Work Related Plan • LCED – Level of Care Eligibility Determination • MA – Medicaid • MLTCP – Managed Long Term Care Plan• MSC – Medicaid Service Coordination • NCI – National Core Indicators• OPWDD - Office for People with Developmental Disabilities• PCP – Person Centered Planning • PCP – Primary Care Physician• PCSS – Plan of Care Support Services• POM – Personal Outcome Measures• SA – Self Advocacy • SCAP – Service Coordination Activity Plan • SCBA – Service Coordination Basic Agreement • SD – Self Determination • SE – Supported Employment • SSDI - Social Security Disability Insurance• SSI – Supplemental Security Income

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Developmental Disabilities Individual Support and Care Coordination Organization (DISCO)

NYIN, as a DISCO, has developed plans to:

• Enroll individuals who voluntarily opt to enroll in 2014-15

• Provide person-centered planning for all individuals enrolled

• Handle the flows of funds (per member, per month)

• Promote living and active engagement in the most integrated setting

• Ensure that each individual who chooses to do so can self-direct his or her services