Office for People With Developmental Disabilities

Care Coordination Organizations FAQs for Providers

Questions and Answers:

How does the CCO/HH affect my agency?

OPWDD encourages provider agencies to come together to form partnerships as CCO/HHs or to make contact with a CCO/HH to arrange for the provision of care management services. All MSC agencies will join CCO/HHs, and current MSCs will be offered the opportunity to apply to work in CCO/HHs as Care Managers.   

In addition, to ensure a smooth transition, during the first year of operations, with appropriate firewalls and supervisory structures in place, former MSC agencies may provide I/DD Health Home care management services through a contract with a CCO/HH as a CMA if the CCO/HH chooses.

Back to Top

What if a provider does not to join a CCO/HH? What will happen to smaller agencies or agencies that only provide Medicaid Service Coordination?

The OPWDD encourages organizations to join together in CCO/HH conversations and explore the various opportunities to partner and align with these emerging entities. The CCO/HH is expected to develop and maintain a network of partnerships with cross-system services providers, including I/DD service providers, to meet the requirements of the Health Home care coordination model and support effective Health Home care coordination for all enrollees. The CCO/HH is required to work with prior MSC providers to employ the MSC’s directly or through subcontract for a one-year period to allow for continuity of care for the individuals served.

OPWDD will convene a workgroup representing small agencies and those that only provide Medicaid Service Coordination to discuss how best to work together and navigate the transition to CCO/HHs.

 

Back to Top

What will happen if Applicants are not successful in being designated as a CCO/HH?

Given the regional scope of CCO/HH operations it will not be possible for a single OPWDD provider agency to independently operate as a CCO/HH.  Successful applicants will be formed by regional cooperatives that represent many current OPWDD providers.  We encourage providers to build on existing relationships and partner with community- based resources when developing an application to be a CCO/HH.  If a provider agency does not participate in the formation and leadership of a CCO/HH it can contract with an CCO/HH to deliver Care Coordination services for a one-year period. OPWDD’s Regional Offices are available to assist in connecting CCO/HHs with emerging CCO/HHs and addressing issues with the transition as they arise.

Back to Top

What contracting agreements will be allowed under CCO/HHs for MSCs?

CCO/HH applicants will be responsible for describing in their applications how they will transition the current MSC’s new CCO/HH Care Manager roles as employees of a CCO.  CCOs/HHs may subcontract with existing I/DD MSC provider agencies for a one-year period, and then those subcontracted Care Manager positions must transition to direct employment with the CCO/HH.

Back to Top

Will there be exceptions made when there are a limited number of providers in a region?

After one year of operation, all care managers (including former MSC Service Coordinators) providing care management under a designated CCO/HH must be directly employed by the CCO/HH and may not provide HCBS, except for agencies that are operated by a federally recognized Tribe. A CCO/HH may transition Care Managers to become direct employees of the CCO at any time during that first year.

Back to Top

How will CCO/HH responsibilities interface with the Front Door? How will enrollment and authorization for services occur?

The Front Door will continue to be the means by which OPWDD connects people to the OPWDD HCBS services they need and want by providing assistance in navigating the steps involved in determining OPWDD eligibility and referring eligible individuals to a CCO/HH to provide care management services.  Just like it happens today, CCO/HHs will work with individuals and their advocates and request OPWDD HCBS service authorization through the OPWDD Regional Offices.   

Back to Top

How often will a CCO/HH enrollee be seen face- to- face? Are there specific timeframes that must be adhered to?

The draft application states that within ten business days of a member being enrolled in a CCO/HH (i.e., the member has signed the appropriate Health Home consent forms), the care manager shall conduct a face-to-face-meeting with the individual.  Within 90 business days of enrollment into a CCO/HH, the enrollee’s Life Plan must be completed using a person-centered planning process.  The Developmental Disabilities Profile (DDP)/Coordinated Assessment System (CAS) must be conducted at least annually, or more frequently if the person experiences a significant change.  No less than annually, a person-centered planning review meeting must occur face-to-face, and all members of the interdisciplinary team must participate.

In addition to the monthly documentation of at least one Health Home core service, care managers must also adhere to the following face-to-face meeting requirements:

  • For HH enrollees in Tiers 1-3, the CCO/HH Care Manager must have at least one face-to-face meeting with HH member on a quarterly basis (January – March; April – June; July – August and September – December). 
  • For HH enrollees in Tier 4, the Care Manager must have a monthly face-to-face meeting with the HH enrollee.

 

Back to Top

What funds will be available for start-up expenses?

The State anticipates providing start-up funds for entities that are successful in being designated as CCO/HHs.  An announcement is expected to be made in late 2017 with more details.

Back to Top

What will be the level of monthly payment to CCO/HH for care coordination services?

The preliminary care management per member per month (PMPM) rates for CCO/HHs and the proposed methodology for a tiered PMPM rate structure are draft and subject to review and approval by CMS and the State. The draft rates, published in the draft application, will include rates for the first month of enrollment and rates applicable to each month of enrollment thereafter. Due to the nature of the Health Home enrollment process for I/DD members, there will be no outreach PMPM for members with I/DD enrolled in CCO/HHs.

The tiered rate structure for CCO/HH service is based upon the acuity/functional capability status of the individual, whether the individual lives in a certified residential setting or in their own or family home, or is a member of a ‘special group status’ that includes the individual’s status as a Willowbrook class member.

 

Back to Top

How will Medicaid Service Coordination Providers be reimbursed for supporting an individual’s eligibility activities during the months of May and June if the person doesn’t enroll until after June 30, 2018? In particular, will the MSC effective date be back-dated so that the MSC provider can be reimbursed for the work?

 

 

 The effective date of a person’s Care Management will not be backdated following July 1, 2018 implementation of CCOs.  If the person is newly enrolled into Care Management services after June 30, 2018, for the first time, the CCO’s reimbursement will include transition funds to reimburse enrollment activities.   Medicaid Service Coordination affiliated providers should work with their CCO to coordinate the transition of the individual to the new Care Management model.   

 


Back to Top