For more than a decade OPWDD has been contemplating shifting OPWDD supports and services to a managed care service delivery model. OPWDD recently hired Guidehouse to hold Managed Care Town Halls scheduled October 2023. Guidehouse will be reporting information gleaned to OPWDD to inform their decision: What is the best service delivery model for OPWDD?
Click here for information at OPWDD website: https://opwdd.ny.gov/strategic-planning/managed-care-assessment
WHAT IS MANAGED CARE?
A medical delivery system that attempts to manage the quality and cost of medical services that individuals receive. Most managed care systems use a network design, limiting to varying degrees the number of providers a patient can choose, whether the patient has to use a primary care physician, and whether out-of-network care is covered under the plan. Some managed care plans attempt to improve health quality by emphasizing prevention of disease.
Source: https://www.healthinsurance.org/glossary/managed-care/
Be prepared to ask questions at the Managed Care Town Halls
RED FLAGS:
- We believe no state has been successful using Managed Care for home and community-based services without reducing services and supports.
- Developmental Disability is a life-long condition with no cure and no prevention.
- OPWDD services and supports are to help people with I/DD ‘live richer lives’ in the community of their choice.
- Managed Care means someone else makes decisions about the person’s life.
- Managed Care means person chooses supports and services from a specific network of providers.
- It is not clear how Managed Care Organizations will make money and provide supports and services so that OPWDD eligible children, teens and adults will receive the supports and services to ‘live richer lives’.
HOW WILL MANAGED CARE CHANGE THE SELF-DIRECTION BUDGET PROCESS?
We do not know! We understand:
- OPWDD will continue to determine a person’s eligibility.
- OPWDD will fund the Managed Care Organization (MCO) to provide each participant with supports and services.
- MCO will receive a capitated amount (per-person per-month) determined by a formula that includes scores from DDP2 and CAS and information collected by ‘I AM’ and ‘Life Plan’.
HOW WILL THE MANAGED CARE ORGANIZATION AUTHORIZE SUPPORTS & SERVICES?
We do not really know! We believe:
- MCOs will authorize services and supports deemed necessary for home and community integration and well-being.
- MCOs will make authorization decisions based on collected information (data) about the types of services a person is eligible to receive and how much service each person is ‘authorized’ or ‘allowed’. This will be compared to how much a service or support is ‘used’. This data will be compared to data collected for all people with I/DD with similar conditions or profiles.
- Achieving goals or not making progress is typically used to determine if the support or service will continue to be authorized or discontinued.
WHAT GOALS? WHAT PROGRESS?
Life Plan and the resulting Staff Action Plans will provide data on progress to MCO and OPWDD.