OPWDD SERVICE SYSTEM RATE REFORM 10/20/14

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2 Actions taken at the State and Federal level State Level Budgetary Actions- o Continuing series of reductions over the 6 year period: These cuts have totaled nearly $380 million or nearly a 10% reduction including more than 90 million in 2013/14 and additional cuts of $4.5M in ; No trends in the last 4 years however, included funding for direct support professionals; Severely limiting family and individual access to new or expanded services 2

3 Actions taken at the State and Federal level State Level Policy Actions- 1. Cuomo/Helgerson Medicaid Policy shift in 2011 (through the MRT) No trends in Fee for Service (only available in Managed Care) All Medicaid recipients will eventually be enrolled in Managed Care Medicaid Global Spending Cap 2. Shift all OPWDD Rate Setting to DOH in 2013 Result: shift all Medicaid Policy to DOH Effect: Neutralize OPWDD 3. OPWDD System Transformation Rate Reform for all services by October

4 System Sustainability OPWDD SERVICE SYSTEM RATE REFORM Current System Funding Investment-$8 billion OPWDD services-$7 billion (all funds excluding SSI) o NFP-$4.9 billion including $250 Non-Medicaid o SO-$2.1 billion Health-Medical and Dental/LTC/Behavioral Health-$1 billion At best limited resources for growth with no trends outside of managed care DOH- Global Medicaid Spending Cap provides for inflation and enrollment growth OPWDD System Balance About 91% of OPWDD service funds are invested into OPWDD certified residential and day services. With or without managed care this is not sustainable. 4

5 Actions taken at the State and Federal level State Level Actions- Rate Reform Has to happen Needed before managed care Needed in managed care Must be completed by October 1, 2015 Current Activity-July 2014-Focus on 4 major services: ICF, Waiver day habilitation, IRA supervised and supportive residential habilitation Next 4 Services-January 2015: Pre-vocational; family care, respite and individual day hab 5

6 Actions taken at the State and Federal level State Level Actions- Rate Reform Issues CPA of NYS has delivered on: 1. Linkage to cost (wage equalization factor-wef and to/from transportation) 2. Transition to new res hab methodology 3. Unlimited Therapeutic leave days in IRA s 4. Vacancy days in IRA s 5. Removal of Excess SSI from IRA res hab 6. Increasing R&B supplement budget neutrality % in IRA s w/o lowering res hab budget neutrality on res hab 7. Level of template funding changing to highest level on 4/1/14 8. Day hab half unit rate adjustment for 7/1/14 (won t be just 50% of full rate) 9. Continuation of Reserve for Residential Replacement (RRR) for IRA s 10. ICF recoupment agreement with DOH (shout out to Ed Matthews) 6

7 Actions taken at the State and Federal level State Level Actions- Rate Reform Issues CPA of NYS are still focusing on: 1. DOH/OPWDD following State and Federal regulatory requirements 2. IRA res hab direct support hours 3. DOH taking providers below their actual cost 4. Day hab target rate for half unit of service 5. Use of CAS 6. Template Rates come 10/1/15 (when BIP disappears) 7. Fully funding room and board in IRAs year asset life on IRAs 9. Funding level of CRPs 10. RRR for ICFs 7

8 Managed Care It is still coming! DISCO/MLTC/HMO How many DISCO s will there be? 1915 (b) (c) concurrent waiver was submitted 4/1/13 and is to be resubmitted soon 5-6 year transition? Funding of MCO s will come from within existing resources (5-10%) Current status Time frames (are always moving) Approval of rate reform actions by July 2014 (still not approved as of ) Release of draft managed care rates for potential DISCO applicants use Approval of Waiver by Jan 2015 Release of RFA April 2015 Approval of Applications- Late Summer 2015 Earliest enrollment- Fall 2015 Michigan is the only State operating such a waiver (since 1998) Monitor DOH partnership waiver and enrollment of people in Managed Long Term Care 8

9 Federal Actions- OPWDD SERVICE SYSTEM RATE REFORM Significantly stepped up oversight of NYS and OPWDD services-the Feds are here to stay! Pushed NYS into OPWDD system reform Audit of State services and linkage to NFP services Pushing for financial take backs for SO funded services HCBS Waiver settings regulations finalized on 3/17/14-impacts certified residential and day settings (centers on rights, choice, control, independence and integration) 9

10 It s the end of the world as we know it! What are we to do at the State and Federal levels? 1. Speak with one voice 2. Advocate for what is right 3. Embrace change but challenge what is just plain wrong 4. Re-examine what and how you do everything 5. Re-examine your service infrastructure (housing/day services) 6. Look to develop new service delivery options that meet people s needs and are more flexible 7. Collaborations/Consolidations/Mergers 8. Diversify your service and business portfolio 10

11 Other Questions or Comments? 11