Dear Friends and Colleagues,

In November 2022, OPWDD contracted with Guidehouse, Inc. to independently assess New York’s current developmental disabilities service delivery system. The assessment evaluated whether utilizing managed care to pay for OPWDD services could benefit the system and improve outcomes for people. This examination of managed care was based on OPWDD’s Strategic Plan objective to explore ways to provide equitable access to high quality, person-centered, needs-based services.

In conducting their examination of managed care, Guidehouse engaged extensively with stakeholders – both within New York and beyond – to understand current supports for people with developmental disabilities, their concerns, and what they, their family members, and service providers think about moving to a managed care payment model for services. This included:

• Participating in eight town hall and focus group sessions, including six with people with developmental disabilities, families and natural supports, and two with providers and Care Coordination Organizations;
• Issuing two separate surveys to broaden Guidehouse’s feedback from people and their loved ones, as well as the provider community;
• Presenting at six stakeholder and advisory board meetings to share and receive information;
• Closely communicating with leadership within OPWDD and other NYS agencies to gain understanding and perspective of expertise; and
• Conducting a robust literature scan, and national review of services and supports; and
• Interviewing other states with managed care systems and national managed care experts.

Today, with the work of Guidehouse complete, OPWDD is pleased to release the Final Report and Recommendations that resulted from this extensive assessment process.

No decision on the managed care recommendations of Guidehouse will be made today.

I encourage you to read the full Guidehouse Final report, along with the plain language report summary now contained on our managed care webpage.  Any additional thoughts or feedback on the Report can be submitted to ARPA.Inquiry@opwdd.ny.gov.

I thank everyone who contributed to this important milestone in the development and advancement of the service system that is so important to all of us. Your contributions to this conversation were essential and appreciated.

Sincerely,

Willow Baer
Acting Commissioner

As the state eyes eliminating over 600 home care agencies, citing fraud, one lawmaker pitched a bill to reverse the planned overhaul.

By Raga Justin

Capitol Bureau, Albany Times Union

Sep 5, 2024

State Sen. Gustavo Rivera, a Bronx Democrat, introduced legislation this week that he said offers a compromise between Gov. Kathy Hochul’s plan to overhaul a popular home care program and the middlemen agencies who are fighting to keep their lucrative businesses operating. Will Waldron/Times Union

ALBANY — A Democratic lawmaker unhappy with the proposed changes to a widely popular home care program is pitching a last-minute legislative fix he contends would offer a compromise between Gov. Kathy Hochul’s budget leaders, who are concerned with increased Medicaid costs, and the industry that could be wiped out by its overhaul. 

The bill set to be introduced by state Sen. Gustavo Rivera on Friday comes less than a month before an Oct. 1 deadline for the state Department of Health to choose a vendor to replace over 600 businesses who serve as middlemen in the popular Consumer Directed Personal Assistance Program. 

That program has been the focus of mounting pressure campaigns this summer since Hochul said she intended to completely restructure it within a year in an attempt to rein in what she has characterized as rampant fraud. That controversial shakeup would involve eliminating the role of hundreds of “fiscal intermediaries,” or companies that act as brokers between Medicaid and patients with long-term medical conditions or disabilities who can choose their own caregivers, including family members. 

Instead, Hochul said New York would contract with a single vendor to streamline and administer CDPAP services to over a quarter million New Yorkers. 

That didn’t go over well with the over 600 fiscal intermediaries scattered across the state. Over the summer, a group called Alliance to Protect Home Care spent millions of dollars attempting to get state lawmakers to halt the shakeup or reverse it entirely. They also filed a lawsuit in August to try and thwart the proposed changes. 

Now, the lawmaker chairing the state Senate’s Health Committee has introduced a bill that would halt the transition to a single fiscal intermediary while implementing new guardrails to protect against some of the overspending Hochul has decried. 

Rivera, a progressive Democrat from the Bronx, called Hochul’s plan an “unreasonable” attempt to fix the CDPAP program and said his legislation would create a licensing process to better regulate the cottage industry of fiscal intermediaries that has sprung up around the program in recent years. 

Under the proposed bill, more power would be given to the commissioner of the Department of Health to require annual reporting from the home care agencies involved in the program, as well as require them to be licensed after April 1, 2026 through a new licensing process the department would also be tasked with creating. State officials have complained they do not have an exact number of fiscal intermediaries operating across the state. 

It would also require each business operating as a fiscal intermediary to pay a one-time licensing fee of $10,000, as well as require that the businesses be prohibited from advertising their services. Both clauses come in response to complaints that the program has in some cases encouraged unscrupulous behavior.

“I recognize that there are changes that are necessary, that there have been bad actors,” Rivera said. “But instead of throwing out the baby with the bathwater, it’s electrifying the baby in the damn tub. Let’s not do that. Let’s actually think through how this could be done more efficiently.”

Other provisions in the bill include: requiring the health commissioner to make regulations and issue guidance for shuttering fiscal intermediaries; establishing a process to discipline fiscal intermediaries that do not comply; setting up a registry for caregivers who are enrolled under the program, and creating minimum training requirements for caregivers. 

It’s unclear whether the bill will pacify both businesses who are angered that their services may soon be on the chopping block and Hochul, who has stood firm on the policy. Rivera said he’s spoken to stakeholders for months and is confident it would find favor among both Democrats and Republicans during the next legislative season. 

The program is beloved by numerous consumers but has also been criticized for its rapidly ballooning growth in recent years, at a time when Hochul and budget officials have attempted to control exorbitant health care costs.

After the change was unveiled during last-minute budget talks earlier this year, Rivera said he had been unhappy with its potential ramifications on Medicaid enrollees who receive services through the program. Advocates of the program have argued that funneling all of the paperwork and administrative requirements through a single company could be disruptive for the nearly 250,000 thousand clients.

n August, several Democrats in the Legislature protested the forthcoming changes in a letter to federal administrators with the Centers for Medicaid and Medicare, urging them to weigh in or halt the planned switch. 

Also in August, home care agencies who would be affected by the switch filed a lawsuit in state Supreme Court in Albany asking a judge to issue a temporary restraining order to halt the massive contract for a single fiscal intermediary. 

Whether Hochul will adjust the Oct. 1 deadline for the state to announce which vendor will receive the multi-billion-dollar contract remains to be seen.

Bryan O’Malley, who represents many of the fiscal intermediaries and has been spearheading the interest group lobbying to stop the overhaul, said in a statement he is pleased with Rivera’s bill.

“We applaud Sen. Rivera for introducing this bill and taking a stand against Gov. Hochul’s plan to gut New York’s home care program that allows 250,000 elderly and disabled to receive the health care they need from the comfort of their homes,” O’Malley said. “Handing over this critical program to one big company isn’t the answer and will potentially force thousands into expensive and overwhelmed nursing homes.”

Raga Justin is an investigative reporter covering politics and policy with the Capitol Bureau, where she was previously a Hearst fellow. She is a native Texan and University of Texas at Austin graduate and has worked for the Hearst Connecticut Media Group, the Dallas Morning News in Washington, D.C., and the Texas Tribune. Send tips, feedback or rants to raga.justin@hearst.com.

OPWDD has filed two new proposed regulations that both appear in the July 31^st edition of the State Register.

The proposed regulatory updates enable OPWDD to further meet the goals in our 2023-2027 Strategic Plan. They include key elements and changes related to both supported decision-making and employment services, which will further support people in their independence. Both were also drafted in response to, and informed by, stakeholders. 

Supported Decision-Making

OPWDD is adding regulation Part 634, which includes rules necessary to implement New York Mental Hygiene Law Article 82, to ensure the appropriate adoption of supported decision-making practices within the OPWDD service system.

This new regulation does several things, including:

• outline the supported decision-making process
• set criteria for both formal and informal supported decision-making agreements
• prescribe the authority of a formal supported decision-making agreement and a third party’s obligation to honor it
• define the Care Coordination Organization’s role in the supported decision-making process
• update notice requirements in existing OPWDD regulations

A full copy of the text can be found at the following link: https://opwdd.ny.gov/system/files/documents/2024/07/supported-decision-making-regulation-text_acc.pdf

Pathway to Employment Services

OPWDD is also replacing subdivision 635-10.4(h) with new language. Language was replaced to define what Pathway to Employment Services are, expand the types of allowable services, re-order the language to match other employment and vocational services to make the regulation clearer, require community-based vocational experiences for the person to assist in building a career path and set requirement for billing, training and documentation.

A full copy of the text can be found at the following link: https://opwdd.ny.gov/system/files/documents/2024/08/pathway-to-employment-reg-text-7.16.pdf

Thank you.

Office of Counsel

Bureau of Policy & Regulatory Affairs

NYS Office for People With Developmental Disabilities
44 Holland Avenue, Albany, NY 12229

OFFICE: (518) 474-7700  l  www.opwdd.ny.gov

Dear Friends and Colleagues,   

Commissioner Neifeld has departed OPWDD to focus on her growing family and I am honored to have been asked to serve as your next Acting Commissioner. I am grateful to Commissioner Neifeld for her years of service to our community and am humbled to continue to work with the amazing team at OPWDD in this new role, as well as our incredible community of self-advocates, parents, providers, and Care Coordination Organizations, as we continue to advance the agency’s mission of providing person-centered and quality services for people with developmental disabilities.  

My history with the agency as Executive Deputy Commissioner and, before that, as Deputy Commissioner and General Counsel has allowed me to be deeply involved in the operations and oversight of the agency.  I also have a very personal connection to our work, as a family member of a person with a developmental disability.  

I am grateful that, under Governor Hochul’s leadership, New York State has restored its status as a national leader in providing services to people with developmental disabilities with policies that prioritize greater independence, innovative housing options, and community integration.  I am so excited to continue to elevate this work and advocate with this community. 

When I think about how far our service system has come over the last 50 years, from one of institutionalization to one that prioritizes community inclusion, I’m encouraged  while remaining aware that there is much more to be done. Successful service systems must continue to evolve to meet changing needs and maximize new opportunities.  

Some of the areas within our strategic plan that I am particularly interested in prioritizing include: the use of emerging technology to support people to live more independently; cross systems work to ensure people with developmental disabilities have better access to appropriate healthcare; stabilizing OPWDD’s network of providers; and ensuring a more responsive, equitable, and accessible service system through data-driven decision-making which is also informed more directly by the experiences of those using our services.    

There are many hurdles that we still face, including the need for enough staff to support people, generations of caregivers who are aging and wondering what will happen to their loved ones when they are gone, a growing number of young families who have recently found out their child may need additional supports, and the turnover of care managers and direct support professionals. Please know I realize that none of these initiatives will succeed without continued investments in our workforce, additional cross-agency collaborations, improved communication, and new approaches to the critical work that we do.   

I look forward to partnering with and getting to know all of you in my new role. Together, we will keep working to ensure that New York is a state that is inclusive, supportive, and one where those with disabilities live with meaningful choice and are proud to call home.   

Sincerely, 

Willow Baer,
Acting Commissioner

As of July 1, Executive Deputy Commissioner Willow Baer has assumed the role of Acting Commissioner of OPWDD. Having served as the second in command at the agency for the last year after returning to OPWDD from an interim position as Assistant Counsel to the Governor and from her role as Deputy Commissioner and General Counsel at the New York State Office of Children and Family Services, Willow Baer is well prepared to lead the agency as it meets the stated goals of its Strategic Plan. Prior to working with OCFS, Willow spent six years at OPWDD, most recently serving as Deputy Commissioner and General Counsel. 

Willow initially joined OPWDD in 2015 as an Associate Counsel after serving as General Counsel at the NYS Justice Center.

Willow has spent much of her career working to ensure that people with developmental disabilities and their families are afforded the best service system possible. Welcome, Acting Commissioner Baer!

Dear Friends and Colleagues,

Today, we celebrate the 25^th Anniversary of the Supreme Court’s Olmstead Decision. This law enshrines the rights of people with disabilities to receive services in their communities rather than in institutions. It is a day also to celebrate and acknowledge the many years of advocacy that came before this landmark decision by those who refused to believe that society was not designed to be inclusive for people with disabilities. Instead, they fought for the right for people with disabilities to live, work and receive their healthcare in communities of their choice. I am proud to work for an administration that prioritizes the needs of people of all abilities, and OPWDD looks forward to thoroughly examining New York’s Olmstead Plan for ways to make even more meaningful change for those it impacts the most.

The spirit of the Olmstead Decision has always been at the heart of the developmental disabilities service delivery system and everything OPWDD does. By continuing to support and strive for increased independence and choice for people with developmental disabilities, we have transformed from a system of institutionalization to one that prioritizes community integration and recognizes the inherent autonomy and dignity of each person.

I am so grateful that OPWDD’s guiding policies have evolved and transformed to best meet the needs of people with developmental disabilities over the last 50 years. And I know that we will continue to work side-by-side with self-advocates, their loved ones, and our provider partners to effectuate even more positive change in the future. In the last few years alone, New York State and OPWDD have put into motion several initiatives to improve the lives of people with disabilities and foster independence. These include the creation of the Office of the Chief Disability Officer, a new supported decision-making option that enables people with developmental disabilities to direct their own lives with the help of a circle of trusted people instead of through traditional guardianship arrangements, expanding supportive housing models, increasing vocational training opportunities, and encouraging businesses to employ people with developmental disabilities, to name just a few.

As we reflect on the progress people with disabilities have made since Olmstead, we must not lose sight that the very things we continue to advocate for are the fundamental rights of all human beings, regardless of their disability status.  These include the right to enjoy meaningful relationships with friends, family, and other people, the right to experience personal health and growth, and to fully participate in their community. Let this year’s milestone anniversary remind each of you of the power of advocacy and strengthen your individual efforts towards achieving full inclusion.

Sincerely,


Kerri E. Neifeld
Commissioner