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5/5/20211Overview of CareCoordination Organization(CCO) Care ManagementApril 2021

5/5/20212Welcome Choice of OPWDD Service Care Coordination Organizations(CCO)/IDD Health Home Choice of CCO & Enrollment Process Overview of the CCO Health HomeServiceAmanda Harper, Assistant Statewide Care Management CoordinatorBecki Lifford, Assistant Director of Care Management

5/5/20213Overview of Office for People WithDevelopmental Disabilities OPWDD The New York State agency that authorizes services forpeople in NYS who have intellectual or developmentaldisabilities. Helps people with developmental disabilities live richerlives in the most integrated community settingspossible. Services are provided not only by OPWDD but also byhundreds of nonprofit agencies across NYS thatOPWDD certifies and regulates. Care Coordination Organizations (CCOs) assist mostpeople with the coordination of their services.

5/5/20214Who Does OPWDD Serve?Individuals with a developmental disability:1. A condition that occurs anytime from birth until the age of22, including: Intellectual Disability, Cerebral Palsy, Epilepsy, Neurological Impairment, Autism, Familial Dysautonomia, Prader-Willi Syndrome2. The condition is expected to be permanent.3. The condition affects the person’s ability to function insociety.

5/5/2021Referral for Children’s Services If a child is either served by a Children’sHeath Home and/or is enrolled in theChildren’s Waiver, then the initial point ofcontact for OPWDD services is the DDROChildren’s Liaison. For all other children, the initial point ofcontact is the DDRO Front Door.5

6OPWDD Children’s LiaisonsRegion/CountiesRegion 1: Chemung, Livingston, Monroe,Ontario, Schuyler, Seneca, Steuben,Wayne, Wyoming, Yates, Allegany,Cattaraugus, Chautauqua, Erie, Genesee,Niagara, OrleansContact ion 2: Broome, Chenango, o, Tioga, Tompkins, Cayuga, Cortland,Onondaga, Oswego, Herkimer, Lewis,Madison, Oneida, Clinton, Essex, Franklin,Hamilton, Jefferson, St. LawrenceRegion 3: Fulton, Montgomery, Saratoga,Schenectady, Schoharie, Warren,Washington, Albany, Rensselaer, Orange,Sullivan, Rockland, Westchester, Columbia,Dutchess, Greene, Putnam, Ulsterchildrensliaisonregion3@opwdd.ny.govRegion 4: Queens, Kings, New York, Bronx, childrensliaisonregion4@opwdd.ny.govRichmondRegion 5: Nassau, SuffolkChildrensliaisonregion5@opwdd.ny.gov

5/5/20217What is the Front Door?OPWDD’s Front Door is: The way OPWDD connects people to the services they wantand need. Based on the idea that people with developmental disabilitieshave the right to: Enjoy meaningful relationships, Experience personal growth, Participate in their community, and Live as independently as possible with supportiveservices. A way to help people make choices about their services andhow they are provided.

5/5/20218The Front Door Process Helps WithMany Choices an Individual and TheirFamily Will Need to MakeChoices about: The Care Coordination Organization (CCO)they will work with, and The type of care coordination they want, The types of services they need, Whether to self-direct their services, or not, and Which available agencies they would like todeliver your services.

5/5/202195 Developmental Disabilities RegionalOfficesVoluntary Agency Coordination & Oversight(1) Western NY & Finger Lakes(2) Broome, Sunmount & Central(3) Capital District, Hudson Valley& Taconic(4) Queens, Brooklyn, Metro &Staten Island(5) Long Island

5/5/2021Enrollment in DOH Children’sWaiver & OPWDDComprehensive Waiver A child CANNOT be enrolled in both theDOH Children’s Waiver and the OPWDDComprehensive Waiver. If a child meets the eligibility criteria forboth waivers they must decide whichwaiver best meets their needs.10

5/5/202111DOH Children’s Waiver Services vs.OPWDD HCBS Waiver ServicesDOH Children’s Waiver Habilitation (Community and Day)Prevocational ServicesSupported EmploymentRespite (Planned and Crisis)Adaptive and Assistive EquipmentVehicle ModificationsEnvironmental ModificationsCaregiver/Family Supports andServicesCommunity Self-Advocacy Training andSupportPalliative CareCustomized Goods and ServicesNon-Medical TransportationOPWDD Comp Waiver Habilitation (Residential, Day, Community) Prevocational Services Supported Employment Pathway to Employment Respite Assistive Technology – Adaptive Devices Environmental Modifications Vehicle Modifications Family Education and Training Services to Support Self-Direction Fiscal Intermediary (FI) Support Brokerage Individual Directed Goods and Services Community Transition Services Live-In Caregiver Intensive Behavioral Support

5/5/202112CCO Care Management Care Management:1. Is required in order to get some OPWDD services,2. Is required to ensure individuals who enroll inOPWDD’s HCBS waiver receive the appropriateservices and supports,3. Is a good idea to make sure you get the supportsand services you need. Care managers work for Care CoordinationOrganizations (CCOs). Care managers are professionals whoprovide care management and coordinateservices.

5/5/202113Care Coordination Organizations Beginning on July 1, 2018, OPWDD embraced a newera of People First Care Coordination which has itsfoundation in the creation of CCOs. CCOs areresponsible for the provision of conflict-free caremanagement services. CCO care management services were designed toprovide comprehensive person-centered care planningusing a network of care manager and providers (teamapproach). Enhanced care coordination and integration ofprimary, acute and behavioral health services and, Connections to community services and supports,housing, social services and family services.

5/5/202114What Are CCOs? Organizations formed by providers ofdevelopmental disability services to provideOPWDD care management services. An individual and their family can choose theCCO they want from at least two CCOs intheir county. In the OPWDD system, they can choose thetype of care management they want:– Health Home Care Management Services, or– Basic HCBS Plan Support

5/5/202115The 7 CCOs Advance Care AllianceCare DesignLIFEPlanPerson Centered ServicesPrime Care CoordinationSouthern Tier ConnectTri-County CareCoverage 20/06/cco coverage chart.pdf

5/5/202116CCOs and Coverage Area

5/5/202117CCOs and Coverage Area

5/5/202118Health Home Care Management and BasicHCBS Plan Support ServicesHealth Home Care Management Coordinates OPWDD supportsand services, Coordinates access tobehavioral health services, Coordinates access to medical,and dental services, Identifies community-basedresources, Uses technology to linkservices, Connects care providers, Takes the burden of navigatingsystems from families.Basic HCBS Plan Support Coordinates OPWDDsupports and services;assessment of needs,development of a Care Plan,referral to services, andmonitoring activities.

5/5/202119Enrollment Criteria CCO enrollment can occur when: OPWDD eligibility is confirmed Level of Care eligibility is determined Medicaid is obtained CCO enrollment is always the 1st day ofthe month following the enrollment criteriabeing met

5/5/202120OPWDD LCEDEvaluates: Evidence of a developmental disability Disabilities manifested before age 22 Evidence of a severe behavior problem (not required) Health care need (not required) Adaptive behavior deficit in one ore more of thefollowing t livingSelf-Direction

21Health Homes Provide Six Core CareManagement on idual& HHCareManagerReferral toCommunity &Social al &Family Support21

5/5/202122Six Core Health Home Services1. Comprehensive care management -- initial & ongoingassessment and care management services – tosupport individual outcomes & integration ofhabilitation, primary, behavioral and specialty healthcare and community support services, using acomprehensive person-centered care plan called a LifePlan2. Care coordination and health promotion —education and engagement in making decision thatpromotes independence and wellbeing through theimplementation of the Life Plan and its continuousmonitoring3. Comprehensive transitional care from inpatient toother settings, including appropriate follow-up

5/5/202123Six Core Health Home Services4. Individual and family and caregivers supportCoordination of information and services to supp- orteach individual and their family and/or representative tomaintain quality of life, with a focus on community livingoptions5. Referral to community and social supportservices, to ensure that community resources areutilized, as individuals pursue meaningful activitiesconsistent with their Life Plans and6. The use of health information technology CCOs arerequired to meet the HIT standards in the delivery ofthe Health Home core services. This includes anelectronic Life Plan

5/5/202124Review of the Life Planning Process CycleThe Person and Person-Centered Planning isAlways the Driving ating andRevisingLife PlanPerson- Centered andIT-Integrated throughHealth InformationTechnology (HITS)ServiceDeliveryStaffActionPlanThe Life Plan defines the Person’sgoals/valued outcomes andindividual safeguards and how theserelate to what is most meaningful tothe person.The Life Planning process isdesigned to create consistency atthe point of service delivery byorganizing goals within the 21Personal Outcome Areas. This isone of the major reasons for the useof new technology.

5/5/2021What areHabilitationServices? Habilitation Services aredesigned to assist inacquiring, retaining, andimproving self-helpsocialization and adaptiveskills necessary to residesuccessfully in home andcommunity-basedsettings.25Providers DevelopStaff Action Plans toImplementHabilitation Services A Staff Action Plan is requiredfor each Habilitation servicereceived by the person. The Staff Action Plandescribes how habilitation staffwill assist the individual toachieve his/her definedhabilitation goals/valuedoutcomes from the Life Plan.

5/5/20218/30/201826ComprehensiveAssessment Process Care Management enrolleesmust be comprehensivelyassessed (within 60 days ofenrollment and annuallythereafter), using one or moretools to identify Developmental disability Medical Mental health Behavioral health Chemical dependency Social and emotional needsCAS4CCOToolDDP2Tools Included in the ComprehensiveAssessment Process

5/5/20218/30/201827Person-Centered Life PlanDevelopment:Goals and DesiredOutcomesSafeguards includingindividual back-up plansand strategiesHabilitation GoalsServices and ProvidersStrengths andPreferencesClinical and SupportNeeds (including paid andunpaid) identifiedthrough the Assessment9 Collaborative and recurring processdriven by the person Describes who the person is and whathe/she wants to accomplish andwho/what will help the individualaccomplish their goals/valued outcomes Integrates all services and naturalsupports Understandable to the person Must be finalized and agreed to with theThe Life Plan is person-driven and a living document person’s informed consentsubject to continuous updating and monitoring by theCare Manager

5/5/202128Person-Centered Planning and HealthInformation Technology (HIT) is Integral8/30/20188Life PlanCASGoals andDesiredOutcomesCCOToolDDP2Comprehensive AssessmentProcessAssessmentProcessPopulatesand Informsthe Life PlanSafeguardsincludingindividualback-up plansand strategiesServices andProvidersHITHabilitationGoalsStrengths andPreferencesClinical and SupportNeeds (including paidand unpaid) identifiedthrough the Assessment

5/5/202129Life Plan Sections8/30/2018III. Health & SafetySupports/IPOPII. PersonalOutcomesI. ProfileThePersonIV. Home andCommunity Based(HCBS) Waiver andMedicaidAuthorized ServicesV. Supports10