Office for People With Developmental Disabilities

Managed Care for Providers

The Governor’s 2017-18 budget charts a course for OPWDD to join all other service systems in managed care.  The Transformation Panel stressed the importance of exploring ways to better coordinate Intellectual and Developmental Disability (I/DD) services and quality health care.  By engaging with existing managed care opportunities, providers will join the managed care program to offer people with I/DD supports that are tailored to their needs and allow them to live in the communities of their choice.

Through these programs, OPWDD and service providers will learn more about evaluating service delivery and care coordination in a managed care environment.  Service providers participating in these programs can improve the overall experience and outcomes for people with I/DD by working closely and collaboratively within the individual’s network of service providers.

Specialized Managed Care Qualification Document

The Office for People With Developmental Disabilities (OPWDD) is extending the timeframe for public comment on the qualification document posted in late August which outlines the requirements for the creation of specialized Managed Care Plans. This qualification document includes requirements for education and experience for medical and clinical directors, financial reserve requirements and other standards the plan applicants will be required to meet. We would like to encourage you to provide your comments on this document to [email protected] prior to the extended October 17 deadline.

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

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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