Family Forums

Report
Family Forums:
Designing the Future
Title of Presentation
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Agenda
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NYIN.org
Value-based Business Model
Care Coordination Model
Response to the NYS Transformation
Agenda
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NYIN.org
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NYIN: Value-based Managed Care
NYIN is driven by a simple idea that
providers listening to and working with
individuals & families can create and
design a viable business model that works
for everyone.
We hold to the ideals of choice, access, and
quality of life
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A picture of the new world
NYS Medicaid $$$
NYIN DISCO* with Insurance License
Network of Providers (Agencies you know)
Medicaid Recipients = Enrollees (Persons
Served and Families)
Access and Choice of Service
* DISCO - Developmental Disabilities Individual Supports and Care Organization
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DISCO Benefit Package
OPWDD Auspice Services
 OPWDD Comprehensive
Waiver Services
 Day Treatment
 ICF/IID
 Art 16 Clinic Svcs: OT, PT,
SLP, Clinical Social Work,
Psychology, Nutrition,
Rehab Counseling,
Podiatry, and Dentistry.
 Care Coordination
provided by the DISCO
DOH Auspice Services
 Adult Day Health Care
 Dentistry
 DME and Hearing AIDS
 Home Care (offered under any auspice:
hospital-based, nursing home-based,
and free-standing programs)
 Non Emergency Transportation
 Optometry/Eyeglasses
 OT, PT, SLP
 Personal Care
 Personal Emergency Response System
 Private Duty Nursing
 Psychology and Clinical Social Work
 Respiratory Therapy
 Skilled Nursing Facility
 Podiatry
OMH/OASAS Auspice
Services
 OASAS Inpatient
 OMH Institutional
Program (PC/RTF) &
private psychiatric
hospitalizations
 Personal Recovery
Oriented Services
(PROS)
 Outpatient – OMH,
OASAS
 Psychology and
Clinical Social Work
 OMH day
treatment
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Care Coordination Model
Current
Anticipated
Community
Linkages and
Referrals
MSC (Case
management)
Advocacy/
Life
Planning
Designated Care
Coordinator:
Central point of
contact
Eligibility and
Benefits
Management/
Assessment
Coordination
with
Providers
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What is Care Coordination?
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Provides a person-centered, integrated system for medical, health and
social support services
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Creates an individual care plan
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Connects individuals with all their providers
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Ensures timely communication with providers and community supports
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Measures, monitors and improves quality informed by individual outcomes
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Utilizes electronic information to support integrated and coordinated care
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Responses to NYS Transformation
Agenda
NYIN will continue to take a leadership role in:
• Individual Services and Supports (Self-Direction)
• Employment Opportunities: Cleaning with Meaning
a “green” home cleaning business run by people
with disabilities.
• Community Integration: Our Place a new day
services model using neighborhood spaces and selfdirected activities.
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What you can do going forward
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Take advantage of these Family Forums. Ask questions.
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Stay connected to NYIN – NYIN.org
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Ensure eligibility for services is formally established through
the local DDRO
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Stick with or get connect to an agency you know - to maintain
continuity of services
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Keep informed
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Be an advocate
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Contact the NYIN Agency You Know
UCP of NYC
212.683.6700 ext 202
[email protected]
www.ucpnyc.org
HeartShare
718-422-3204
[email protected]
www.heartshare.org
CBHS
[email protected]
1-888-750-2266
http://www.occupations.org/pdf/CBHS
_brochure.pdf
YAI LINK
212.273.6182
[email protected]
www.yai.org
SUS
212.633.6900
[email protected]
www.sus.org
Lifespire
212-741-0100
[email protected]
www.lifespire.org
IAHD
718-741-0100
[email protected]
www.iahdny.org
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Agencies You Know
Governing Agency
Communities Served
Coordinated Behavioral Health Services
(CBHS)*
Westchester, Mid-Hudson Region
HeartShare Human Services of New York
New York City
The Institutes for Applied Human
Dynamics (IAHD)
New York City, Westchester
Lifespire
New York City, Lower-Hudson Region
Services for the UnderServed (SUS)
New York City
United Cerebral Palsy of NYC (UCP/NYC)
New York City
The Young Adult Institute (YAI)
New York City, New Jersey, Long Island,
Mid-Hudson Region
* CBHS is a consortium which includes Abilities First, Crystal Run Village Inc., New
Hope Community, Occupations Inc., and Westchester Jewish Community Services
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Business Council members
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Ability Beyond Disability
Birch Family Services
Camp Venture, Inc.
CP Associations of New
York State
Children’s Village
Community Based
Services, Inc.
Edwin Gould Services
Epilepsy Foundation of
Metro NY
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F.R.E.E., Inc.
Hawthorne Foundation
Head Injury Association
Opengate, Inc.
Richmond Community
Servies
• The Rose F. Kennedy
Center
• St. Vincent’s Services
• A Very Special Place
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Business Partnership
Business Partnership
UAM Bd.
Observer
UCP of
NYC
Heart
Share
IAHD
YAI
SUS
CBHS
Lifespire
Owners
Loans
Reinsurance Agreement
Business Plan
DISCO Application
NYIN
OPWDD
UAM
$
Costs of Application split 50/50 by
NYIN and UAM
$
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Acronyms
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ADA – American with Disabilities Act
AT – Assistive technology
CASA – Community Alternative Systems Agency
CDPAP – Consumer Directed Personal Assistance Program
CDS – Consumer Directed Services
CMS – Centers for Medicare and Medicaid
CR – Community Residence
CSS – Consolidated Supports and Services
DC – Developmental Center
DD – Developmental Disabilities
DDRO – Developmental Disabilities Regional Office
DISCO - Developmental Disability Individual Support
and Care Coordination Organizations
DOH – Department of Health
DQA – Division of Quality Assurance
EI – Early Intervention
FIDA – Fully Integrated Dual Advantage Programs
FSS – Family Support Services
HCBS – Home and Community Based Services
HIPAA – Health Insurance Portability and Accountability Act
HUD – Housing and Urban Development
ICF – Intermediate Care Facility
ICS – Individual and Community Supports
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IEP – Individual Education Plan
ILC - Independent Living Center
IRA – Individualized Residential Alternative
ISE – Individualized Service Environment
ISP – Individualized Service Plan
ISS – Individualized Support Services
IWRP – Individual Work Related Plan
LCED – Level of Care Eligibility Determination
MA – Medicaid
MLTCP – Managed Long Term Care Plan
MSC – Medicaid Service Coordination
NCI – National Core Indicators
OPWDD - Office for People with Developmental Disabilities
PCP – Person Centered Planning
PCP – Primary Care Physician
PCSS – Plan of Care Support Services
POM – Personal Outcome Measures
SA – Self Advocacy
SCAP – Service Coordination Activity Plan
SCBA – Service Coordination Basic Agreement
SD – Self Determination
SE – Supported Employment
SSDI - Social Security Disability Insurance
SSI – Supplemental Security Income
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Developmental Disabilities Individual Support
and Care Coordination Organization (DISCO)
NYIN, as a DISCO, has developed plans to:
• Enroll individuals who voluntarily opt to enroll in 2014-15
• Provide person-centered planning for all individuals enrolled
• Handle the flows of funds (per member, per month)
• Promote living and active engagement in the most integrated
setting
• Ensure that each individual who chooses to do so can selfdirect his or her services
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