Office for People With Developmental Disabilities

Managed Care for Providers

As we continue the evolution of the service delivery system for people with developmental disabilities to one that is more flexible and focuses on achieving outcomes through managed care, we recognize that a successful transition will require collaboration, shared learning and technical assistance for the agencies that deliver services.

As we work towards implementing specialized managed care in our service system, it is time to increase our efforts towards readiness for the future as providers of care.

To this end, the Office for People With Developmental Disabilities has partnered with New York Alliance for Inclusion & Innovation (NY Alliance) and New York University’s McSilver Institute on a Managed Care Community of Practice to provide education and technical support to provider organizations on the transition to managed care.

In addition, the Disability Network Business Acumen Learning Collaborative can provide information on how providers can develop successful strategies to build, implement and participate in integrated care systems.

The Process

Specialized Managed Care Qualification Document

The Office for People With Developmental Disabilities (OPWDD) posted the qualification document which outlines the requirements for the creation of specialized Managed Care Plans in August for public comment. This qualification document included requirements for education and experience for medical and clinical directors, financial reserve requirements and other standards the plan applicants will be required to meet.

OPWDD prepared a presentation to outline the document for easier understanding. 
 View the video. 
 Read the transcript of the video presentation.  

OPWDD is preparing the final document for release this fall.

 The next step in the process will include the release of the Managed Care Policy document for public comment in the Spring of 2019 which will provide further guidance on the details of the delivery of managed care. 

To learn more about the progression of managed care for people with developmental disabilities, visit the Care Management Development page at: https://opwdd.ny.gov/opwdd_services_supports/people_first_waiver/care_management


Questions and Answers:

What is managed care?

Managed care is a term that describes a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members.  Managed care is designed to coordinate care effectively and provide better access to services and supports.

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How does managed care work?

Managed care plans pay health care and service providers directly, so enrollees do not have to pay out-of-pocket for covered services or submit claim forms for care received from the plan's network of doctors and service providers.  When a person chooses to join a managed care plan, the plan has a network of service providers for the person to choose from.  The person gets their care and services through the plan’s network of providers.

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What managed care options are now inviting participation from I/DD service providers?

Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD)

FIDA-IDD is a managed care demonstration program that integrates health and long-term service and support benefits to individuals with Medicare and Medicaid (dual) who are eligible for OPWDD services.  The FIDA-IDD consolidates a number of separate sources of coverage for dual eligible individuals to a single primary source.  Benefits include Medicare and Medicaid services, care management, OPWDD services, long term supports and services, behavioral health, dental, transportation and pharmacy benefits.

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