Updates on NHTD and TBI Transition to Managed Care

This past week, the Department of Health (DOH) held another Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver subcommittee meeting on “Services and Workforce Qualifications Update,” "UAS-NY” and the new state plan amendment, “Community First Choice Option (CFCO).”  

Highlights on the transition of waiver services were:

• The function of the Regional Resource Development Center (RRDC), absent the waiver in 2017.
• The role of the Service Coordinator and defining the conditions that must be met to use service coordination, in addition to care coordination with a managed care plan. The two conditions under discussion are a nursing home level of care (NH-LOC) and being diagnosed with a moderate cognitive impairment.
• The entity responsible for obtaining the physician order for a moderate cognitive impairment under discussion would be the RRDC.
• Services that would be outside the managed care benefit package are Service Coordination (SC), Positive Behavioral Interventions and Supports Services (PBIS), Community Integration Counseling (CIC) and Independent Living Skills Training (ILST).

Several concerns were raised regarding the UAS-NY tool and its reliability for measuring cognitive and behavioral impairments, especially as it relates to NH-LOC. Several suggestions were offered to have refresher courses and make certain courses mandatory.

Some of the highlights included in the CFCO discussion were:

• Three eligibility conditions that must be met to use CFCO include 1)  be eligible for Medicaid, 2) meet an institutional level of care, and 3) live in your own home, not in an congregate setting.
• Establishing a cross-walk of services under CFCO to waiver services, FIDA and the benefits in a managed care plan.  Some services will be the same under the CFCO umbrella and others will be “like services” that may have a different name. One example would be a Structured Day, and could be referred to as Community Habilitation. Much of the discussion on services centered on Service Coordination (SC) and Home and Community Support Services (HCSS).
• The CFCO services will be available to Medicaid eligible participants in three state agencies DOH, NYS Office of Mental Health (OMH), and NYS Office of People with Developmental Disabilities (OPWDD).

DOH has requested that we continue to submit questions regarding implementing CFCO to CFCO@health.ny.gov.

For more information about CFCO, visit the State Plan Amendment link SPA 13-0035.

Another subcommittee meeting was requested prior to drafting the transition plan in January 2016.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871