The Balancing Incentive Program’s
Goals and Activities Supporting
OPWDD’s Transformational Agenda
November 7, 2014
YAI NYSDASP Conference
Improving outcomes for people one life at a time!
Transformation Agreement with CMS
A. OPWDD’s commitment to CMS for achieving ambitious
goals for system reform and personal outcomes
 Self-Direction
 Employment
 De-institutionalization
 Expanded Housing Options
─Improving outcomes for people one life at a time─
Expanding SELF-DIRECTION
 OPWDD continues to provide education to at least
1,500 beneficiaries (with designated representatives
as needed) per quarter beginning on April 1, 2013.
 Growing # of individuals self-directing
 Published OPWDD’s self-direction policy
Expanding opportunities for EMPLOYMENT
 Increase number of individuals employed
 Ended admissions to sheltered workshops on July 1, 2013
 A transformation plan for increasing participation in
competitive employment is published:
o Encourage businesses to hire people with developmental
disabilities
o Increase opportunities for high school students to
transition to employment
o Improve the quality of supported employment services
Transitioning People from Workshops to
Employment & Other Community Activities
 Implementing a multi-year strategy to identify and support
workshop participants who are interested in competitive
employment.
 Converting workshops to an integrated business model
 Supporting other options when competitive employment is not
appropriate:
o community habilitation
o day habilitation
o CSS to support volunteer, recreation, senior center, or other community
activities for people who are retirement age
o For individuals who want to continue to work obtaining employment
in a former workshop that has converted to an affirmative business or
social enterprise will be an option.
DE-INSTITUTIONALIZATION
 Over the past several decades, 30,000 people moved out of
institutional settings and into community-based living
arrangements.
 Since March 2011, we helped more than 300 people
transition from institutional settings to homes in the
community—reducing the institutional population by nearly
24%.
 Today, fewer than 1,000 people live in campus-based
institutional settings operated by OPWDD.
 Plans are in place to transition 148 residents from Finger
Lakes and Taconic ICFs by January 1, 2014.
Closing Developmental Centers
• In July 2013, Governor Andrew Cuomo announced
the schedule for closing four institutional-based
campuses:
 O.D. Heck in Schenectady (March 31, 2015)
 Brooklyn (December 31, 2015)
 Broome in Binghamton (March 31, 2016)
 Bernard M. Fineson in Queens (March 31, 2017)
Expanding COMMUNITY RESIDENTIAL OPTIONS
 NYS Supportive Housing Development - $1.8 million to assist
180 people by providing supports such as rent subsidies and
community habilitation, consolidated supports and services,
and residential habilitation provided through individual
residential alternatives (IRAs).
 HUD-Approved Federal Housing Counseling Program offering
a variety of counseling sessions, educational workshops, and
projects.
 OPWDD is expanding its cadre of trained housing
coordinators and housing specialists across the state.
 OPWDD’s Home of Your Own Program helps individuals,
income-eligible parents/guardians, direct support
professionals, and other qualified members of OPWDD’s
workforce become homeowners. Over 700 people assisted
to date.
 New York State Home and Community Renewal
(NYSHCR) partnership encourages housing projects to
offer a preference in tenant selection for people with
developmental disabilities (up to 20 percent of a project’s
total units).
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Commitments of the
Transformation Agreement
There is still significant progress to be made in LongTerm Supports and Services for individuals with
developmental disabilities in reaching the multi-year plan
to achieve:
 Robust integrated employment and self-direction
models,
 Expand community based housing options
 Ensure that individuals are residing in the most
integrated setting possible
 Develop a responsive and accountable quality
infrastructure.
Balancing Incentive Program Overview
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BIP, authorized by Section 10202 of the Patient Protection and
Affordable Care Act of 2010 (Pub.L.111-148), provides
enhanced Federal Medical Assistance Percentages to
qualifying states.
NYS’ BIP application was approved in March 2013, and the
State was awarded $598.7 million.
The State must implement three structural changes:
 Establish a No Wrong Door/Single Entry Point eligibility
determination and enrollment system
 Develop Core Standardized Assessment Instruments for
determining eligibility for non-institutionally-based long term
supports and services (LTSS)
 Develop a Conflict-Free Case Management System
Balancing Incentives Program (BIP)
Purpose: to provide grants & enhanced FMAP to
states to increase access to non-institutional
long-term supports/services
Program Goals:
 To help states develop new ways to support more people
in community settings
 To support structural changes that increase institutional
diversions and access to long-term supports/services
With MFP, BIP is part of CMS’s strategy to redesign
long-term supports/services.
Balancing Incentives Program
Requirements:
 States must have spent less than 50% of their total
Medicaid medical assistance expenditures on noninstitutionally based long-term supports/services.
 States must implement structural changes:
 a “No Wrong Door/Single Entry Point” system.
 Conflict-free case management
 Core standardized assessment
 States must use the enhanced FMAP only to
provide new or expanded HCBS.
 Quarterly reporting
Allowable Ways to expand HCBS
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Increase waiver slots/clear waitlist
Fund new services
Increase rates to attract more providers
Create No Wrong Door/Single Entry Point structure
Host meetings with Stakeholders
Training & Staffing
Technology for referrals and coordination across agencies
Equipment for assessors
Unallowable Ways to expand HCBS
 Brick and mortar construction of NWD/SEP sites
 Nursing home capacity building
 Replacing existing state HCBS commitments (i.e., MOE
provision)
BIP Structural Changed &
State Workgroups
No Wrong Door
 Coordination of Integrated Care through DISCOs
 Build on our CHOICES platform
Standardized Assessment
 Developing CAS through Case Studies.
 CAS aligns with DOH’s UAS-NY, both built on interRAI
Conflict-Free Case Management
 DISCO Contract Language – will separate care planning from
funding decisions for individuals, ensure meaningful choice of
service providers, opportunity to change DISCOs and a fair,
centralized appeals process
No Wrong Door
Origins of the No Wrong Door Initiative
• The balancing incentive program requires a No Wrong
Door system.
• The intent is to improve access to and expand
community Long Term Supports and Services
Definition of Long Term Services and Supports
(LTSS)
• The NWD work team is currently evaluating a
“Consumer friendly” definition of LTSS, such as that
provided in the 2014 AARP LTSS Scorecard report:
• A range of services and supports for people who need assistance
with routine activities of daily life (such as bathing, eating, preparing
meals, and shopping for necessities) because of a physical,
cognitive, or chronic health condition that is expected to continue for
an extended period of time. LTSS consist mainly of assistance from
another person with these routine activities. Supports also include
assistive equipment such as wheelchairs and environment
modifications such as ramps.
No Wrong Door Requirements
• Deliver standardized information about LTSS options
whether an individual seeks information from:
– - A 1-800 number
– - A website (including an online questionnaire)
– - A local office that is part of the state’s NWD network
Provide individuals with assistance in accessing
Medicaid or non-medicaid LTSS services
Structure
• The draft (not yet finalized) structure will consist of
“Hubs” and Specialized NWDs.
• The hubs – or main point of contact, will be the NY
Connects entities (will be expanded geographically to
cover the entire state)
• There will be two “Specialized NWDs”:
• The Office of Mental Health will serve as a Specialized
NWD
• and . . .
OPWDD as a Specialized No Wrong Door
• OPWDD’s Front Door, currently providing information,
assisting with enrollment, screening, coordinating and
approving assessments and/or care plans will serve as a
Specialized NWD organization for people with
developmental disabilities.
• New York Connects serving in its capacity as a hub, will
not replace the OPWDD Front Door.
• The hub, and associated website (which is in planning
stages), are intended to enhance access to assistance.
• Individuals who are already OPWDD eligible will not
need to go to the hub first.
What will the NWD Hub do?
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Assist individuals of all ages & populations
Provide information about LTSS
Conduct NWD Screens as appropriate
Coordinate and share information with specialized
NWDs through secure database as needed (database
creation is in the works)
• Coordinate applications for public benefits and other
services; and
• Provide Information to Specialized NWDs for
comprehensive assessments and care planning
What will the OPWDD Specialized NWD do?
• - Provide OPWDD specialized expertise
• - Coordinate with the hub
• - Assist people accessing the OPWDD “Front Door”
system with a NWD screen, as indicated
• - Consult on completed online questionnaires and
NWD screens
• - Review completed NWD screens shared with
OPWDD through secure database
• - Utilize available information for comprehensive
assessment and care planning
When?
• Implementation of the No Wrong Door is anticipated for
late 2015.
• More info will be shared as processes are finalized.
Uniform Assessment System (UAS)/
Coordinated Assessment System (CAS)
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Goals of Needs Assessment
Standardized needs
assessment that identifies
individual needs and
strengths to inform
Person-centered care
planning
Ability to draw on
individual or aggregate
level data for
quality monitoring
purposes.
An assessment tool that
can inform acuity
levels for resource
allocation.
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CAS Development and Validity
Study
• In consultation with interRAI, OPWDD created the CAS based
on the interRAI ID/DD tool , additional items from their suite
of assessments, and OPWDD specific items. The CAS is
currently in draft format.
• A validity study of the CAS will begin mid-November.
– Design of the validity study was done by the Center for
Human Services Research (CHSR) at the University at
Albany and reviewed by an independent consultant at the
University at Western Michigan.
– CHSR will provide the analysis for the validity study.
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CAS Validity Study
• Who may be asked to participate in the validity study?
– Individuals ages 18 years of age or older receiving at least
one OPWDD service may be randomly selected for
participation.
– 25 stratified sample groups have been identified in order
to provide a “deeper dive” into specific areas of need
and/or service provision.
– Participation is voluntary and choosing to participate/not
participant will not impact services.
• Use of Data and Results
– In addition to validating the CAS, data will be used to
develop acuity measures for the CAS.
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– Results are expected in summer 2015.
For More Information…
InterRAI Integrated Assessment Suite:
www.interRAI.org
CAS specific questions:
coordinated.assessment@opwdd.ny.gov
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3rd Structural Change
Conflict Free Case Management
• Federal policy focused on unbiased care
coordination and person centered planning
• Waiver applications/agreements have been and
continue to be reassessed to ensure case
management structures that are conflict free
• DISCO Contract Language – will separate care
planning from funding decisions for individuals,
ensure meaningful choice of service providers,
opportunity to change DISCOs and a fair,
centralized appeals process
The Care Coordination Guidance
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Core Functions of Care Coordination
Person Centered Elements
Face-to-Face meetings and caseloads
Competencies and Trainings
Conflict Free Case Management
Self-Direction Concepts
Willowbrook
Conflict Free Case Management
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Informed Choice
Assessment
Organizational Structure
Grievances and Appeals
OPWDD Oversight
Person Centered Planning (PCP)
Person
Centered
Outcome
Based
Person
Directed
Participatio
n of those
that the
individual
selects
Information,
Support and
Accommodations
Community
Integrated
Wellness
and Dignity
of Risk
In addition to Structural Changes.
BIP Funds Support:
• Increase community-based service opportunities for
individuals with developmental disabilities.
• Transition and divert individuals who are elderly and/or
disabled from institutional to community-based settings.
• Develop additional housing options to support high
need/high cost Medicaid recipients in stable, sustainable
and safe community environments.
• Expand Money Follows the Person opportunities for
individuals to transition out of institutional settings into
community-based, non-institutional residential settings.
Transformation Fund RFA
http://www.opwdd.ny.gov/opwdd_resources/procurement_opport
unities/bip-transformation-funding-opportunity
Important Dates
8/13/14
Request for Applications Release
8/27/14
Letters of Intent Due
9/3/14
Questions Due via Email for Q&A
9/9/14
WebEx Overview of RFA
9/17/14
RFA Updates and Responses to Applicant Questions Posted
10/22/14 Applications Due
12/1/14
Awards
Grant Period
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Transformation Fund grants will be awarded on a
competitive basis.
All proposals must be received by October 22, 2014 by
5:00 p.m.
All funding decisions will be made following the
completion of application review and appropriate
approvals.
The 10-month contract period for BIP Transformation
Fund demonstration projects is expected to begin on
December 1, 2014 and end on September 30, 2015.
All funds must be expended by September 30, 2015.
Transformation Fund RFA
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An unprecedented opportunity for organizations to
make strategic investments to transform noninstitutional Long Term Services and Supports
(LTSS) for individuals with developmental
disabilities.
Specifically, OPWDD is looking for investments that
complement the Balancing Incentive Program (BIP)
Goals as outlined New York State’s BIP Work Plan
and the guiding principles of New York’s Health
System Transformation for Individuals with
Developmental Disabilities Agreement
(“Transformation Agreement”).
Eligible Applicants
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Non-profit organizations
Local Governments
Advocacy Groups for individuals with developmental
disabilities.
Applicants must be registered as a qualified Vendor
and have a confirmed NYS Vendor ID #.
Applicant must be in compliance with all applicable
State and federal licensing, certification, and other
requirements.
Grant Funds May Not Be Used For:
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Capital costs such as brick and mortar projects or to
supplement existing General Funds.
To duplicate existing LTSS or increase institutional capacity.
To match any other Federal funds.
To provide services, equipment, or supports that are the legal
responsibility of another party under Federal or State law
(e.g., vocational rehabilitation or education services) or under
any civil rights laws.
To supplant existing State, local, or private funding of
infrastructure or services such as staff salaries for programs
and purposes other than those disclosed in the application.
Examples of Qualified proposals for goal
of increasing the number of individuals
Self-Directing may address:
• Activities supporting the new role of the Fiscal
Intermediary (FI) in the self-direction redesign;
• Statewide and/or regional partnerships
supporting the information technology
infrastructure of FI operations
• Education and Outreach Activities for promoting
the Choice to Self Direct
Examples of Qualified Proposal to
increase the number of individuals
in competitive Employment:
• Providing vocational assessments to working age
individuals currently receiving day habilitation and
workshop services that identify the types of supports
needed to assist in obtaining competitive employment.
• Developing person-centered transition plans for
workshop and day habilitation participants that detail
how supports will be provided to assist individuals in
obtaining competitive employment.
• Developing peer mentoring networks to support day
habilitation and workshop participants as they transition
to competitive employment.
Examples of Qualified Proposal to
increase the number of individuals in
competitive Employment (cont’d):
• Developing strategies to create self employment
opportunities for workshop and day habilitation
participants through the operation of a business.
• Providing technical assistance and support to assist
workshop providers to convert to competitive
employment business models consistent with the Home
and Community Based Services (HCBS) waiver
definition of community settings.
• Developing strategies for retirement age workshop
participants to engage in meaningful senior, recreational
or social activities.
Example of Qualified Proposals Supporting
the transition of individuals from institutions
to settings that meet HCBS standards may:
• Develop new models for supporting individuals and families during
transitions
• Develop mechanisms/trainings or protocols to ensure waiver settings
for transitioning individuals meet new HCBS settings standards
• Creates initiatives to place and support individuals in non-certified
settings?
• Develop mechanisms/trainings/ protocols to ensure compliance of
person-centered planning with new PCP standards?
• Coordinate all housing resources for people with disabilities across
state agencies, local governments and municipalities.
Examples of Qualified Proposals for
Community Based Housing Options,
including Family Care
• Develop a scientific strategy to Identify housing needs for people
with intellectual and developmental disabilities on a regional and/or
statewide basis improving access to existing housing resources.
• Develop a scientific strategy to identify housing resources for people
with intellectual and developmental disabilities on a regional and/or
statewide basis.
• Develop a 5- Year Plan to increase the number and type of
community-based housing stock available (i.e., region by region) to
people with intellectual and developmental disabilities.
• Coordinating all housing resources for people with disabilities across
state agencies, local governments and municipalities
Examples of Qualified Proposals for
Community Based Housing Options,
including Family Care (Cont’d)
• Implement a Family Care Demonstration that is multi-cultural
and seeks to recruit services of specialist in the medical
protection and advocacy, education and other professional
fields to become providers of Family Care.
• Develop a strategy to coordinate and implement a "Banking
Committee" for the HOYO Program.
• Develop and implement "Making Homes that Work" for People
with Autism.
• Develop an innovative Outreach and Marketing
Demonstration Model that is ongoing and may be used in
diverse regions. (i.e., Recognition Events - Retention and
Recruitment).
Examples of Qualified Proposals for
Community Based Housing Options,
including Family Care (Cont’d)
• Develop a research-based Family Care "think-tank" that will review
existing, and propose new methodologies to redesign the Family
Care Program.
• Address fiscal and legal constraints in moving Shared Living Models
forward.
• Propose an array of innovative community - based choice and
intensive services that will provide an alternative to IRAs and ICFs
Care without compromising quality and safety.
• Develop Regional and Statewide HUD-Approved Housing
Counseling Training Sessions for housing coordinators and et.al that
will lead to HUD-Approved Certified Housing Counselors.
• Develop a Strategy to Redesign the Family Care Program
Example of Qualified Proposals to meet
the structural challenges of
Transitioning to Managed Care may:
• Provide assistance to agencies to support administrative and
operational efficiencies.
• Provide assistance to agencies to support the consolidation of
duplicative administrative functions within the provider network.
• Provide information technology assistance to agencies that lay the
foundation for a move to electronic data systems that will allow
agencies and individuals to communicate changing needs and
support plans in an immediate or more timely method.
• Provide assistance for use of the Care Coordination Data Dictionary
allowing for the standardized collection and dissemination of
information to a DISCO with greater consistency.
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NY START Mission
• NY START will increase the community capacity
to provide an integrated response to people with
intellectual/developmental disabilities and
behavioral health needs, as well as their families
and those who provide support. This will occur
through cross systems relationships, training,
education, and crisis prevention and response in
order to enhance opportunities for healthy,
successful and richer lives.
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NY START
• NY START - will provide community-based
crisis prevention and intervention services for
individuals with intellectual/developmental
disabilities (I/DD) and co-occurring mental health
(MH) and behavioral health needs.
• NY START – will help individual obtain adequate
treatment options when they need them most in
the least restrictive setting possible.
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Core START Elements
• Trained Linkage Coordinators;
• In-home therapeutic supports (ages 6 – adult);
• Site Based Therapeutic Resource Centers
(ages 21 +) – planned and emergency use;
• Crisis support 24 hours/7 days a week;
• Team response time, 2-3 hours;
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Core START Elements (cont’d)
• Consultation, assessment, service evaluation;
• Employs data driven, evidence-informed
practices and outcome measures;
• Technical support to maintain program integrity
and fidelity to the START model;
• Person-centered focus; and
• Focus on understanding problems in the context
of the system of support.
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Components of START
• Augments existing system of support - does not
replace it;
• Multi-level cross system linkages (local,
statewide, national);
• Clinical education teams, online training forums;
• Family support and education;
• Standardized protocols for cross systems crisis
prevention and intervention designed to connect
MH and I/DD providers.
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START Outcomes
• Reduction in inpatient and emergency services
use.
• Traditional MH providers become more willing to
serve individuals with I/DD.
• Cross systems planning becomes core service
element.
• START is proven to be cost effective.
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Provider Partnerships
Linkage Agreements
The purpose of an affiliation/linkage agreement
is to establish a collaborative framework in order
to improve outpatient supports, community
linkages, treatment outcomes and decrease the
need for hospitalization and/or the loss of
community placement.
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Questions?