OPWDD Provider Association Meeting
March 16, 2015
Notes
Welcome – Acting Commissioner Kerry Delaney
-Commissioner Delaney reminded everyone that OPWDD has created a Transformation Panel to look at financing managed care, determine what benefits would be included and how DISCO’s may be structured. She discussed the panel’s first two meetings (one a general overview and the second on Self Direction) briefly and said she wanted the public to be aware of their activities. Agendas and minutes will be posted on the OPWDD web site. The panel will issue draft recommendations, which will be presented at regional public meetings, and then a final report will be issued.
-OPWDD is hosting a full day conference on Sheltered Workshop transformations on May 8 in Albany, and is strongly encouraging sheltered workshop providers to attend. They also encourage attendance by stakeholders such as family members and program participants. The provider associations will offer suggestions on how the day should be presented.
-OPWDD has asked CMS to approve extending Template rates until October 2017. They don’t know if CMS will approve it but will let providers know.
-OPWDD acknowledged that full Room and Board costs were not included in rationalized rates, but they are working on a way to include them, back to July 1, 2014. Acting Commissioner Delaney announced that for those agencies who have supervised IRA R&B supplementation the Budget Neutrality % has been raised to 100% from 66.44% for the period 7/1/14 through 3/31/15. For all Supervised IRA providers the impact is $17 million statewide and $22 million on a full annual basis. The additional funds will be received by agencies within the next 2 weeks at the latest. For the period 4/1/15 forward the Provider Associations have agreed to work with OPWDD and DOH on a methodology that will enable the supplementation to continue to be fully funded.
Provider Association Issues
-Provider Associations expressed concern with the OMIG audit protocols for SEMP, and that they required people to work at minimum wage or better. OPWDD said they have met with OPWDD and it has been changed. Providers noted it hasn’t been changed on the OMIG website, and OPWDD will ask OMIG to correct that.
-Providers asked OPWDD to consider enhancing rates at Supportive IRA’s which will be accepting people needing 24/7 services. OPWDD doesn’t yet have a method to do this. Providers also asked for more information regarding how the rates are factored for acuity.
Community Pool – Laura Rosenthal
-It was noted that OPWDD held a webinar about this, and that the webinar was the time to ask questions. FAQ’s will be distributed this week. Providers noted difficulty in projecting revenue, due to lack of clear information on Template and rationalized rates. OPWDD said to use the rate data they had. Providers noted that some partial year funding for people was difficulty to project for a full year. OPWDD said providers needed to do their best. DDAWNY pointed out that some providers had deficits only on the Day or IRA side of their budget, and wondered if the Pool reimbursement could be based on either Day or IRA, not on the surplus/deficit of both. OPWDD said that they could separate ICF and HCBS services, but could not separate individual waiver services. Laura Rosenthal asked that any other questions be sent to her, ASAP, to be included in their FAQ’s.
FEGS Update – Helene DeSanto and Abiba Kindo
-Helene reported that OPWDD was working with providers to transfer all FEGS services by the end of March. OPWDD will find a way to advance funds for those services. There continue to be news reports related to their bankruptcy but OPWDD will not comment on or discuss this.
Incident Management/Justice Center – Megan O’Connor and Leslie Fuld
-Megan reminded providers that investigations must be filed within 50 days, and that OPWDD has begun fining providers for late investigation filings. Leslie reminded providers that Corrective Action Plans must be filed on IRMA as of January 1, 2015. New regulations will be issued on monthly updates – for agencies that are waiting for Justice Center findings, they will not have to do monthly updates when the regulations are issued.
Provider Association Subgroup
-A small group of the Provider Associations has been discussing issues with Sally Berry on the Front Door issues and the Service Amendment process. Questions were raised about timelines and PISP’s done by the Front Door. Jill Pettinger will be providing training to Front Door staff on clinical assessments to enhance the PISP’s. Also, the EAA form is being revised to include more information for providers. OPWDD is going to create a provider group to discuss Front Door issues. It will meet quarterly. (Does DDAWNY want a representative?)
HCBS Settings Update – Maryellen Moeser
-Maryellen reported that their two sub-groups are meeting, and they expect to complete their recommendations on Heightened Scrutiny by April. The Day Services groups will meet March 30.
New to OPWDD Residential Services in 2014
-OPWDD shared that 851 people moved into a community residence in 2014. They presented a demographic analysis by a PowerPoint presentation, showing that most new admissions were “aging out”. OPWDD noted that many of these individuals moved from living with aging caregivers. (The PowerPoint is attached.)
Real Property Assurance Agreement – Roger Bearden
-Roger noted that there have been a number of program auspice changes for properties, and that OPWDD has no method to reimburse the new provider for the property costs. They will issue new regulations to allow reimbursement, only for un-depreciated costs and financing. At the same time, OPWDD will be establishing liens on properties for the amount of their “property interests”. They will be initiating this soon, and include it in the PPA process. OPWDD will require a signed agreement as a part of the PPA, and will file it as a lien in the pertinent County Clerk office. The agreement will require that physical sites be used to provide services, that providers are required to maintain the properties, and that OPWDD will assume the possession of the mortgage and the property upon default. There was a great deal of discussion about the problems this would cause with financing bodies, especially for tax-exempt bondholders. All current PPA applications are on hold while this is in process.
Rate Transformation – Donna Cater
-Donna reported that all rate sheets affected by the 2% COLA have been issued except for ICF’s and Respite. For Family Support contracts, the methodology for adding the 2% is confusing.
-Rate approval for ICF’s is still in process, due to an issue with Medicare rules on UPL (Upper Payment Limits).
-Four services methodologies were submitted for CMS and, if they are approved, they will issue regulations for the rate changes. SEMP and Family Care will be fee-based, while Pre-Voc and Respite will be rate based.
-DOH had been proposing SEMP fees of $61.29 for Region 1 (NYC); $59.21 for Region 2 (LI, Westchester, Putnam and Rockland); and $52.19 for Region 3 (Rest of State). DOH announced that these fees will actually be higher than the ones previously announced. The new proposed SEMP fees will be announced possibly this week. In addition, OPWDD has committed to a streamlined prior approval process for individuals who are in need of more than 250 hours annually and 200 hours of intensive and extended support respectively in SEMP. The prior approval process will mirror the one that OPWDD used for providers to seek additional hours of support in the Employee Training Program (ETP).
-Donna also acknowledged that they are working on extending Template rates, but they will need to provide CMS with evidence that there were extra costs for people on Template rates. They will need to find a way for providers to track the costs for Template funded services separately.
-Kate Marlay reported that letters will be sent to providers of “Individual Day Hab” noting that effective 10/1/15 this will be eliminated, and people in that service must be transferred to Community Hab or regular Day Hab.
-Kate also reported that an issue has risen regarding people in residential programs getting clinical services. For supervised IRA’s and CR’s, the residential program is required to provide all nursing, behavioral and nutrition services. This will limit the capability of people in IRA’s and CR’s to receive Article 16 clinic and Home Health Services “in the residence”. For supportive IRA’s and Family Care, residents will be limited in receiving “Supplemental Day Hab” and those individuals will need to get those services in the residence or through Community Hab. These changes will go into effect 10/1/15 and will be explained further in a future letter to providers. After the change on 10/1/15, only people living at home can receive supplemental Day Hab.
-OPWDD will be sending a letter to ICF providers soon reminding them that they plan to begin recoupments in April.