Hudson Valley Service Providers Who We Are - HVSP is a group of 22 Mid-Hudson agencies who provide services to people with Developmental Disabilities. While we are separate and distinct organizations we share a commitment to quality services, the right for people with disabilities to have choice in their lives and the need for Mid Hudson agencies to effectively collaborate wherever and whenever possible. Our Goal – To create a Limited Liability Corporation (LLC)dedicated to providing quality care coordination services to individuals with disabilities across the Mid- Hudson region.

Hudson Valley Service Providers Strategic Partnership – HVSP will be dedicated to advocating for the unique needs of organizations who provide services to individuals with developmental disabilities across our region. Our voice will be authentic to our region, recognizing that our needs are different than NYC and Albany based organizations. Advocacy - We will champion the service needs of the people with disabilities in our region providing a strong collaborative network, to ensure that quality planning and access to services are available.

Valley Service Providers Care Coordination Organization Service Area Putnam Niagara Erie Chautauqua Cattaraugus Orleans Genesee Wyoming Allegany Monroe Livingston Steuben Wayne Yates Ontario Seneca Tompkins Cayuga Oswego Onond aga Cortland Schuyler Chemung Tioga Jefferson St. Lawrence Franklin Clinton Essex Lewis Herkimer Oneida Madison Chenango Broome Hamilton Warren Fulton Otsego Delaware Sullivan Washington Saratoga Rensselaer Columbia Dutchess Schoharie Albany Greene Ulster Schenectady Orange Suffolk Westchester Rockland Nassau Queens Richmond Kings Bronx New York Montgomery Hudson - Valley Service Providers Care Coordination Organization Service Area

Hudson Valley Service Providers What We Offer: Regionalized Care Coordination – HVSP will embrace OPWDD’s goal of regionalized care coordination and provide agencies throughout the Mid Hudson Valley with care coordination developed by the organizations who know the region the best. Representation – HVSP offers each agency a voice in the development and design of the Care Coordination organization. Collaboration – Our network of organizations offer a wide range of experience and resources that allow all of us to benefit from our collective expertise.

Hudson Valley Service Providers Access – Through HVSP, we will be able to access decision makers in Albany ensuring that our distinct regional needs are heard on key issues affecting services to individuals with developmental disabilities. Community Based Service Expertise – The 22 agencies currently participating in HVSP cover the entire Mid Hudson Valley region. We have already created a community linkage spreadsheet for medical and mental health organizations providing services to the developmentally disabled and community resources. We are in the process of creating formal linkage agreements with these organizations, as well as Mid-Hudson DSRIP providers.

Hudson Valley Service Providers Why does it make sense to form a regional CCO? Our Region – The Mid Hudson region cannot be easily served by joining in the larger NYC or Albany based marketplace. There are wide differences in costs (salary and rent) and substantially different medical and mental health resources that create very different needs and priorities. Our Vision - We believe that the Mid Hudson Valley should stand as a separate and distinct region, allowing strong advocacy and individualized services for the needs of people with disabilities in our area, including: Regional expertise pulled from the combined experience of over 20 Mid Hudson providers. Level of service tailored to the Individuals’ needs linked to established resources. Similar demographics, cost structures and operational challenges. Families who live in the region want an organization that understands the resources available and how to access services. At this time our MSCs serve over 4,000 people in our region, providing a solid foundation for the transformation to managed care. We anticipate that this number will continue to grow throughout the development process.

Hudson Valley Service Providers Why does it make sense to form such an organization? Linkages - Understanding potential business opportunities, the creation of necessary linkages with a MCO and down-stream providers, the combined experience of over 20 Mid Hudson organizations, this creates an advantage compared to organizations who are primarily based outside of our region. Implementation Costs – HVSP members feel that it is important to have a voice and a vote on development costs for the CCO. By using the vast resources of over 20 agencies throughout our region, the overall cost per agency for development can be kept reasonable allowing organizations of many sizes to join our group. IT Platform— HVSP has formed an IT Committee that is dedicated to researching the infrastructure of our current providers, as well as the methods by which current Managed Care Organizations (MCO) submit claims for services. This will ensure that the CCO can efficiently interface with the MCO billing software while also being compatible to the member agency electronic record keeping systems. Our Workforce – The MSCs and their supervisors, who will be required to become care coordinators face a challenging transition. Each member of HVSP is an employer of MSCs. Working as a group we will ensure that the training and transition is sensitive to the MSCs, giving them the tools and job security that they need, to provide quality services.

Hudson Valley Service Providers Why Now: OPWDDD Transition to Managed Care - In October 2016, OPWDD submitted a transition plan to the Canter for Medicaid Services (CMS) to transition traditional MSC services to a Conflict-Free Case Management (CFCM) model. This transition ensures compliance with the Federal rules for Home and Community Based Services (HCBS). Conflict Free Case Management – Under this model the agency providing services can no longer be the same agency that provides MSC services. At this time over 85% of MSC is provided by the same agency that delivers services. The process by which MSC is transferred to the CCO will be a major part of the CCO application. Timing of the Transition – OPWDD will be accepting “Request for Qualifiers” (RFQ) during the late spring. The RFQ will define which “Care Coordination Networks” (CCO) will be allowed to respond to the “Request for Proposals”(RFP) that will be issued after the RFQ. OPWDD has set 1/1/17 as a the date for CCO services to start transitioning services from the current MSC model.

Hudson Valley Service Providers Current NYS System of Care: Currently individuals with developmental disabilities receive care coordination through several vehicles: Individuals with developmental disabilities living in ICFs and nursing homes have care coordination as part of residential service delivery. Individuals participating in the OPWDD home and community-based services waiver (HCBS), receive targeted Case Management services (delivered by either OPWDD or not-for-profit providers), or as a waiver service. Children enrolled in the OPWDD Care at Home (CAH) Waivers receive care coordination through CAH Case Management Services. OPWDD States: “These different program models have promoted person-centered planning principles in the development of care plans for the individuals served, but may be focused on care in the residential setting or on OPWDD community-based supports without comprehensively addressing both healthcare and long-term care needs.”

Hudson Valley Service Providers Care Coordination - Where we are going Background – From 2002 – 2014 CMS, under a mandate from the Balanced Budget Act of 1997 was authorized to create Care Coordination demonstration projects. The goal of the study was to “to rigorously assess the impacts of care coordination programs for Medicare fee-for-service (FFS) beneficiaries with chronic illnesses. Care Coordination Defined – In the 1115 waiver, OPWDD states, Care Coordination “integrates the health, mental health and specialized developmental disability service needs of enrollees” CMS Goals – CMS goals for Care Coordination were defined as: “reducing Medicare Part A and Part B expenditures and, or, improving care quality and patient and provider satisfaction without raising total expenditures.” It should be noted that out of the 15 organizations that participated in the study only one organization, Health Quality Partners (HQP) completed the 12 year study. (https//innovations.cms.gov/files/reports/mccd-hop-finaleval.pdf) OPWDD Goals - OPWDD added the goal of “conflict free case management” as part of the 1115c waiver amendment application. This goal establishes the need for the MSC to transition to a care-coordinator who can not be employed by the agency providing services to the individual with disabilities.

Hudson Valley Service Providers How HVSP Proposes To Address This Challenge: Our Mission – HVSP has been formed to create a Mid Hudson CCO that will be dedicated to providing quality services to the individuals with disabilities throughout the Mid Hudson region. RFQ and RFP – Upon OPWDD releasing these applications HVSP stands ready to submit an application to become a CCO in New York State. Through this application we will detail how we envision the transformation of MSC to Care Coordination including training for current MSCs, as well as start up for the new CCO organization. Members – Prior to the issuance of the RFQ, HVSP has decided that any organization that opts to become a member will have a seat on the board of directors and a full vote on decisions made by the board.

Flowchart of Care Coordination Organization Eligibility Determination and Funding Enrollment and Referrals: Local Regional Office Assessment, Acuity Level Determination, Determination of Services Funding $ Individual Feedback Quality Improvement, Reporting, Health Information Technology, Referrals Regional Care Coordination Organization / Health Home Plan Development Monitor Service Delivery Care Manager A Plan Development Monitor Service Delivery Care Manager B Plan Development Monitor Service Delivery Care Manager C Access Services from Downstream Community Service Providers Network Providers Behavioral Health Services Primary / Health Care Services HCBS Waiver Service Provision Direct Supports & Services

Hudson Valley Service Providers Going Forward…. Provider Agencies – We will continue to expand our network of both partners and downstream providers with the goal of providing services to 10,000 lives throughout the Hudson Valley. Development and Support – We will continue our weekly meetings dedicated to bring the most current information and strategy to our provider network. Proposal - Respond to the RFQ RFP Development - Work closely with our consultant to write a winning proposal ensuring the Mid Hudson region has a Care Coordination Organization. MSC Transition – Provide training, support, and guidance along with a detailed transition plan, to ensure that our valued MSC professionals have the support they need and the people who participate in our services have choice and quality. IT – Our Information Technology Committee will select billing software that will successfully interface with the MCO, ensuring that provider electronic record systems are ready to interface with billing software, before the provider goes live. Community Awareness – Create an awareness campaign broadcasting MSC service awareness to individuals with disabilities and their circle of support. Operationalize the CCO, beginning in January 2018

Hudson Valley Service Providers For more information, or to arrange to attend a meeting with HVSP please contact: Gerry Dohrenwend CEO Cerebral Palsy of Ulster County gdohrenwend@cpulster.org 845-336 -7235 ex 2259 Jeff Fox, CEO Abilities First jefferyfox@abilitesfirstny.org (845) 485-9803 x200