In this blog, we’ll focus on the introduction of managed Medicaid called Managed Long Term Care (MLTC) and its counterpart for persons with developmentally disabled persons, OPWDD’s (Office of Persons with Developmental Disabilities) People First Waiver.
While MLTC has been introduced in New York City and its boroughs (with mandatory enrollment currently in operation unless the consumer meets the exclusion criteria), and will be introduced on Long Island in early 2013, the introduction of the People First Waiver is a work in progress. Its pilot program currently is only open, for voluntary enrollment, limited to consumers in specific categories who must be approved through OPWDD.
In September, a draft of the RFP (request for proposal) was released by OPWDD so that nonprofit and for-profit entities can apply to be DISCO’s – Developmental Disabilities Individual Services and Care Coordination Organizations. The DISCO – a coordinating contract agency that will serve as the fiscal intermediary – will enroll consumers, moving them from fee-for-service to a “one-size-fits-all” monetary rate. Advocates and OPWDD emphasize that a DISCO must have contract services and companies which can address the developmentally disabled consumer’s needs and services from community-based programming, medical care and treatment, through nursing home care at the end of life. Watch for my discussion of the latter in a future blog.
Once the DISCO’s are selected, the process, very basically, will require the entity to establish a ‘rate’ for approval. A DISCO is charged with retaining providers – similar to HMO’s for medical care, and the existing voluntary agencies for other OPWDD services, and nursing homes to contract with the DISCO. These sub-agencies and entities will be paid through the DISCO for each consumer who enrolls.
The draft of the RFP contains a chart which outlines the DISCO’s minimum services for its contract network of providers and represents a range of services:
- from OPWDD waivered services (home and community-based services) to day treatment, clinical services for residents of group homes, and care coordination; and
- more traditional Medicaid services such as adult day care, home care, home delivered meals, social work through nursing home care; and
- for persons under Office of Mental Hygiene with mental illness, services such as psychiatric and psychological treatment and OMH day treatment programs.
The DISCO must be able to offer at least two providers within each category of services on the chart contained in the draft RFP.
The challenge for the DISCO lies within the funds it receives for each enrollee; it will be required to meet the full needs of each consumer, as an individual, to promote and achieve the state agency’s goals for person-centered planning.
The draft RFP also includes mandatory DISCO board participation in ‘abuse and incidents training’ by OPWDD, and inclusion of advocates on either the DISCO’s governing board or an advisory council to the DISCO.
If you need more information at this time, please contact my office.
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