Gearing Up Your Organizations (or Not) for Implementing HCBS Services

1. Gearing Up Your Organizations (or Not) for Implementing HCBS Services Presenter: Cindy Freidmutter, CLF Consulting for The Supportive Housing Network of New York Sept 21 & 22, 2015

2. Presentation Overview

3. Goals for This Session • Factors to consider in deciding whether or when to proceed with offering HCBS services • Offer an overview of business planning & implementation strategies for launching and sustaining various HCBS services • Identify common challenges and supports needed by SHNNY members to become viable HCBS providers • Flag advocacy issues that are critical to supportive housing providers

4. HCBS Ground Rules • Certification as an HCBS provider doesn’t mean you have to offer the service on 1/1/16 or ever • Certification as an HCBS provider doesn’t mean you will get a viable number of clients for the services you can provide • Health Homes will do the assessment, care plan and offer two provider choices for each approved service, so your own clients many not end up at your agency for HCBS services. • Accepting the OMH/OASAS start-up funding requires a viability plan and at least one MCO contract, but not necessarily that you offer services on 1/1/16.

5. Issues for Residential Providers • Supportive housing contract services overlap with certain HCBS services (e.g. PRS, Habilitation) • NYS and CMS are still negotiating the IMD exclusion list for HCBS. HARP eligibles who live in certain residential settings (e.g. CRs, adult homes) will not be able to access HCBS services Bottom line is that where someone lives will determine whether they can access HCBS

6. Offer HCBS Services or Not: Factors to Consider • Access to eligible population • # of agency clients who are HARP eligible & likely to use HCBS services • Opportunities to engage new clients (not residents of agency housing) in HCBS services (e.g. shelter residents) • Start-up/ongoing administrative costs to become HCBS provider • Is agency already a Medicaid provider or will need to add this capacity? • Additional work to participate and one-time/ongoing administrative costs • Ability to improve outcomes with HCBS • Is quality likely to improve? • Is building HCBS capacity an agency growth opportunity? • Timing of HCBS Start-up to Minimize Operating Losses • Can you implement with low/no additional fixed operating cost for services? • What are your projections for service demand in initial 6 months?

7. Business planning for HCBS services You need a business plan for each service cluster and for core administrative functions • Project volume of services and be conservative • Do you have to build, buy or just adapt Medicaid billing, corporate compliance and QA functions, and at what cost? • Calculate revenues and operating costs to see if offering HCBS services is financially viable at a scale you can achieve Given the low rates, high fixed costs and uncertainty of referrals, HCBS may not be a viable choice, at least not in the first half of 2016.

8. Implementation Strategies: Short Term Crisis Respite • Plus: Can get direct referrals into program & has potential to save MCOs $. • High fixed costs: Site based with 8-10 single rooms & 24/7 staff • Will $306 per diem rate cover fixed costs and at what average occupancy? • Path to sustainability: Will one or several MCOs contract for all or a % of beds and generate referrals.

9. Implementation Strategies:PSR • Goal: optimally restore the individual’s functional level • Flexibly Delivered: Services may be delivered individual/to a group in a home or in the community (e.g. clubhouse) • Health Homes are Gatekeeper: Must be in care plan, activities linked to goal achievement and time limited (500 hours annually) • Service Requirements: Utilize (with documentation) evidence-based rehabilitation and recovery practices (up to 500 hours) • Need supervising licensed practitioner (SLP): Workers who provide PSR services should periodically report to a SLP on participants’ progress/re-acquisition of skills.

10. Implementation Strategies: Habilitation/Residential Supports • Goal: Assist participants acquire, retain and improve skills • Flexibly Delivered: Services may be delivered 1:1 in a home or in the community by the provider of housing services/other certified agency • Health Homes are Gatekeeper: Must be in care plan and time limited (250 hours annually) • Opportunities to serve new clients in community housing without support services and people leaving institutional care • Unclear if it can be used to supplement (and not supplant) supportive housing contract services

11. Common challenges and supports needed by SHNNY members Three suggestions • Administrative Infrastructure: A cost-effective ASO that can help with billing, corporate compliance, QA, IT and more? • Program Clarity: Can HCBS help current residential clients who have housing-related supports fill gaps that are critical to recovery/community stability? • Financial Viability: Which HCBS services (ex. Crisis respite) are not viable to implement without volume payment guarantees by MCO(s)? What else?

12. Advocacy issues critical to supportive housing providers Two suggestions • Final rules that permit supportive housing residents to keep SH contract services and access HCBS supplemental services in their home. • Support for ASO infrastructure for agencies that need it to maximize $s that go for program services What else?

13. Upcoming HCBS Roll-out • Oct 1—Publication of residential exclusion list for HCBS services & revised HCBS manual • Fall 2015--Part 2 of MCTAC training on HCBS service clusters • Coalition--Bringing Recovery Supports to Scale (BRSS) Academy “boot camp” and DOHMH-supported on-site TA for peer support agencies • SHNNY--brief business planning TA to members in Sept/Oct

14. Remember…