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Preparing for 2014: Where have we been and where are we going. November 22, 2013 Manatt, Phelps & Phillips, LLP. Overview of Environmental Scan. Where we are: Continued federal scrutiny of New York’s Medicaid program Medicaid Redesign Implementation OPWDD Transformation

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Preparing for 2014:

Where have we been and where are we going

November 22, 2013

Manatt, Phelps & Phillips, LLP

Overview of environmental scan
Overview of Environmental Scan

  • Where we are:

    • Continued federal scrutiny of New York’s Medicaid program

    • Medicaid Redesign Implementation

    • OPWDD Transformation

  • Where we may be headed

  • What this all means to NYSACRA and its members

  • Where we are
    Where We Are

    In 2014, the attention will be on implementation, not new policy directions:

    • ACA/MRT Status

    • OPWDD Transformation/Waiver/DISCO

    • Justice Center

    • Olmstead

    • E.O. 38/Executive Compensation Regulations


    • New York’s health exchange began enrolling 10/1/13

    • Rocky start, but at least 50,000 obtained coverage/200,000 on their way to coverage

    • In-Person Assistors (IPAs)/Navigators providing enrollment assistance

    Medicaid redesign team
    Medicaid Redesign Team

    • Global Spending Cap

    • Initiation of Health Homes

    • MRT Waiver Amendment

    • Duals Initiative: FIDA

    • Care Coordination Imperative: End of fee-for-service

    • Behavioral Health Initiatives

    May 3 2013 disco letters of intent
    May 3, 2013DISCO Letters of Intent

    Advance Care Alliance

    Advocates for the Disabled

    Affinity Health Plan

    Alpha Care


    AmeriHealth Caritas


    A-Z Representative Payee

    Care Management of New York

    CHDFS Inc.

    EIHAB Human Services


    Excellent Home Care Services

    Extended Manged Long Term Care

    Fidelis Care

    General Human Outreach in the Community, Inc.

    Hamaspik Choice

    HASC Center Inc.


    Human Care Services


    Kee to Independent Growth


    Living Resources Inc.

    Lower Westside Household Services

    Magellen Health Services

    NYIN New York Integrated Network

    NYSARC Inc.

    Olympia MLTCP

    Partners Health Plan Inc.

    Person Centered Services WNY

    Residential Resources

    Staten Island Opportunities Alliance

    United Healthcare

    VNSNY Choice


    Young Adults with Special Abilities


    • New partnership between State of New York and CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.  

    • An estimated 170,000 Medicare-Medicaid enrollees in New York will have an opportunity for more coordinated care.  

    • New York and CMS will contract with health plans known as “FIDA Plans” that will oversee the delivery of covered Medicare and Medicaid services for Medicare-Medicaid enrollees in New York City, Long Island, and Westchester County.

    • Specially designated OPWDD FIDA Plans Authorized

    • MOU with CMS finalized this fall

    • Rate development underway

    *Fully Integrated Duals Advantage



    • Assist in transitioning people with disabilities into the community from developmental centers, ICFs, sheltered workshops and nursing homes;

    • Reform the assessment of the needs/choices of clients;

    • Adopt new Olmstead outcome measures;

    • Enhance integrated housing, employment, and transportation services;

    • Improve services to children, seniors, and people with disabilities involved with the criminal justice system;

    • Remove legal barriers to community integration; and

    • Assure continuing accountability for serving people with disabilities in the most integrated setting.


    Justice Center

    • Substantial new obligation on all affected providers

    • Still a work in progress—on which NYSACRA’s input continues to be very much welcome

    • As rules become clear, important to identify what needs to be done to make the implementation of the new requirements manageable


    OPWDD Transformation and Rate Rationalization

    • Principles of Overall OPWDD Reform and Restructuring

    • Rate Methodology Reform

      • Timing

      • Key Issues

      • Status

    Executive Compensation and Administrative Expense Caps: Update

    • Regulations finalized in late May, effective July 1

    • Latest regulations exclude clinical/program executive leadership

    • Guidance documents released in early July: Clarify key provisions, including comparability for 75th percentile test

    • Reporting obligations commence within 6 months of close of first reporting year

    • Litigation commenced to challenge regulations—although most cases are directed at DOH regulations

    Where are we headed
    Where are we headed Update

    • 2013 off-year elections – potential impact on state politics

    • The Impact of 2013 OPWDD Crisis

    • Transitions in Executive Branch

    • Potential Legislative Leadership Changes

    • Open seats in the Legislature

    Status of cms congressional inquiry
    Status of CMS/Congressional Inquiry Update

    • OIG scrutiny and Congressman Issa’s investigation

    • Broadened scrutiny of New York’s Medicaid Program

    • Consequences for pending waivers and other CMS-NYS issues on developmental disability field

    2014 political outlook
    2014 Political Outlook Update

    • National political influence on state elections

    • Statewide offices up for election – Governor, Lt. Governor, Attorney General, and Comptroller

    • All 213 seats in NYS Legislature

    • Moreland Act, Criminal Investigations, Sexual Harassment Issues

    • Current relationship between Governor and Legislature

    2014 session preview
    2014 Session Preview Update

    • Fiscal status of New York State

    • Tax reform, tax cuts, tax increases

    • MRT/ACA implementation issues

      • Global cap

      • Wage parity for home care workers

    • Political/governmental reform

    • Women’s equality

    • Economic development

    • Education reform (pre-K/common core)

    What we need to do
    What we need to do Update

    • Remind policymakers of what you do every day for your clients and their families

    • Remind policymakers of the historic role you have played

    • Remind policymakers that a humane society should be judged by how it serves people with the most severe disabilities

    • Inform policymakers of the economic impact of not-for-profit organizations in their communities

    • Avoid providing any excuse for policymakers to adopt any additional adverse actions against the field

    • Strongly resist policies that ultimately punish the individuals and families you serve

    • Remember the caregivers

    Questions or Thoughts? Update

    Jim Lytle

    Sandra Rivera

    Manatt, Phelps & Phillips LLP

    30 South Pearl Street

    Albany, NY 12203

    (518) 431-6700

    [email protected]

    [email protected]