Dear Friends, Colleagues and Stakeholders:
New York State makes a greater investment in developmental disabilities services than any state in the nation, and in 2020 we expect to continue this trend. This investment allows OPWDD to be a leader in providing services and supports to people with developmental disabilities. For example, we provide over 38,000 New Yorkers with certified residential opportunities, more than any state in the nation.
At the same time, we anticipate substantial fiscal and operational pressures in the future as we continue to support more and more individuals. During the first 12 months of operation, 7,000 new individuals qualified for Health Home Care Management services provided by Care Coordination Organizations, an annual increase of 7% over the prior Medicaid Service Coordination program. In addition, participation in Self-Direction increased by 30% to more than 17,000 individuals. We continue to experience challenges related to the recruitment of all types of personnel, especially direct support professionals, but also health professionals including nurses, primary care providers, behavioral health providers and other licensed professionals.
In recognition of these ongoing and future challenges, OPWDD has examined our current operations and how we might make improvements to prepare us for the future. With a new Executive Deputy Commissioner, a restructured Leadership Team, and increased public access and participation in our advisory committees, OPWDD is poised to take on the challenges that future system enhancements will bring. We have made great progress which has positioned the agency to create a future that ensures access, equity and sustainability while addressing the needs of the individuals we support.
Please allow me to describe some of our initiatives and their preliminary success:
In addition to restructuring the Leadership Team and improving engagement with our Advisory Committees, OPWDD also reviewed its current organizational structure and the functions of some 20,000 employees. We strengthened Central Office oversight of policy, budgeting and program operations. We began planning a complete reorganization of OPWDD’s Regional Office structure to streamline operations, including the restoration of budget control in order to better accommodate the needs of the individuals, families, and organizations we support. In State Operations, the operational structure will be strengthened by the implementation of consistent policy and practice.
With a new and improved website slated to launch this spring and an ever-expanding social media footprint, OPWDD hopes to provide a new face and better communication with our stakeholders. In addition, we continue to look for new avenues, methods and opportunities for outreach to the people we support.
In early 2019, several hundred children, who are eligible for OPWDD services, transitioned from the OPWDD Care at Home Waiver into the Comprehensive Children’s Waiver (CCW) which helped to improve their services and supports. The CCW is operated by the NYS Department of Health and care planning for these children is now provided through the Health Home Serving Children. In addition, OPWDD’s Home and Community-Based Services (HCBS) Waiver was renewed for a five-year period, allowing us to provide supports to more than 90,000 people with intellectual and developmental disabilities in their own home or community.
Building a Continuum of Care
We seek to support all individuals, regardless of need, in their local communities, particularly in their own home. To that end, we are making investments to expand the range of services we provide. In 2019, we received approval to provide Crisis Services for Individuals with Intellectual and Developmental Disabilities (CSIDD). This Medicaid State Plan amendment allows us to capture federal financial participation for crisis response services. In addition, we have identified opportunities to obtain federal financial participation for behavioral services previously funded with state-only support. We are collaborating with the Office of Mental Health to create new in-patient and post-hospitalization step-down programs to support individuals with severe challenging behaviors. A new Extended Treatment Unit in Queens will open in January to provide short-term stabilization for individuals with dual-diagnoses. Finally, building on OMH’s experience in supporting community health care providers, we are exploring avenues for increasing the skills of primary care and behavioral health providers.
Workforce Development and Recruitment
To address the need for more Direct Support Professionals, OPWDD has worked with provider organizations to support curriculum development, training and credentialing through BOCES and SUNY. In addition, we have focused our hiring efforts on veterans leaving military service through public service announcements. We are particularly optimistic about this opportunity because it allows us to leverage military benefits which enhance salary and access to public benefits including the Supplemental Nutrition Assistance Program offered by the NYS Office of Temporary and Disability Assistance. We will continue to expand on our workforce development efforts in the coming year.
Data Management and Strategy
Like any large organization, OPWDD requires data to understand where we are and steer us to where we want to be. OPWDD has created a new Division of Data Management and Strategy which provides consultation and support in program evaluation, organizational change management, acuity measurement, information technology and strategy development and implementation. In addition, OPWDD continued its multi-year survey redesign which streamlined 19 independent survey protocols into just 3 protocols, that are also digitized. As a result of the survey redesign, OPWDD will be able to quickly identify if entities are underperforming. Finally, we have developed a data roadmap and reporting strategy. Beginning with Care Coordination Organization (CCO) metrics, OPWDD will be working towards more transparency by publishing annual data on our website. We will also be looking at security issues and enhanced oversight.
Ensuring equity in service access necessitates an accurate assessment. The Coordinated Assessment System (CAS) is a person-centered assessment tool used to assess the strengths, needs and interests of each person. The CAS looks at a person’s decision-making, routine daily activities, communication skills and behavior. The information shared helps the person and care manager to develop the Life Plan for person-centered services and supports. Since the inception of CAS implementation, nearly 50,000 CAS assessments have been completed. OPWDD, in partnership with providers and CCOs, will continue to educate families and individuals regarding how the CAS is used and how it is administered. In addition, OPWDD continues to work with CCOs to make sure Care Managers are following the defined protocols for CAS completion, communicating the results of assessments in a timely manner, and facilitating the use of the CAS to inform person-centered planning.
Care Coordination Organizations (CCOs) launched our I/DD Health Home program in 2018. As of early 2019 or CCOs were still grappling with the transition of more than 100,000 individuals from Individual Service Plans (ISPs) developed with Medicaid Service Coordination (MSC) to a new model of Life Plans which integrate and coordinate health and habilitative services. We are pleased that CCOs now deliver Life Plans to 98% of eligible individuals. In 2020, we will focus on ensuring that all Life Plans are truly person-centered and conflict-free in order to meet the needs of individuals and their families. We will also examine the means of using the CCO platform to engage in the service access process.
In August 2018, OPWDD published for public comment the Draft Specialized I/DD Plans-Provider Led (SIPs-PL) Qualification Document, which outlined how specialized managed care organizations can appropriately provide managed care to people with developmental disabilities. We have reviewed the comments provided and have been working with both internal and external stakeholders to determine the next steps forward. At this point, we do not have a specific timeline for specialized managed care implementation. At the same time, we are encouraged that more than 28,000 OPWDD-eligible individuals have voluntarily enrolled in mainstream plans in order to gain access to necessary Medicaid State Plan services.
OPWDD State Operations
Through our State Operations, OPWDD continues to be the largest direct service provider in NYS. In 2019 we completed preliminary implementation of a statewide Electronic Health Records (EHR) system for all services delivered directly through OPWDD. This will better track access and quality of health and habilitative care across our entire delivery system.
The achievements of 2019 and the deliverables we propose for 2020 will position OPWDD to create a system which ensures accessibility, equity and sustainability. We welcome your contribution to these efforts and look forward to working together with the individuals we support, their families and our providers to build a service delivery system that addresses the needs of those we support now and will support in the future.
Theodore Kastner, MD, MS