AccessAbility

People First, Integration Last?

In October OPWDD published a draft five-year plan for 2011-2015. It mostly focuses on the proposed new "People First" 1115 Medicaid waiver, but also describes what will happen in the 2 to 3 years before that waiver begins to roll out. The plan repeats, frequently, many buzzwords that are near and dear to advocates: "choice", "integration", "individualized supports", "self direction", "self determination", and "performance based outcomes". The plan says all of these things will be more available under the new waiver. It says that "real person centered planning" will drive everything.

However, the nitty-gritty details of the plan don't support the birth of this brave new world.

An 1115 Medicaid waiver is a demonstration project that is supposed to test innovative policies and practices. OPWDD's 1115 waiver will be a managed care system that allegedly will include every service OPWDD now provides through its Home and Community Based Services (HCBS) waiver and other funding mechanisms, as well as all acute medical services, such as dentistry and primary physician services, that OPWDD- eligible people receive via Medicaid.

OPWDD will create "Developmental Disabilities Individual Support and Care Coordination Organizations" (DISCOs) as local managed care entities, a concept that has advocates envisioning white-leisure- suited John Travolta, hand upraised, feet apart, introducing himself as your Service—oops, "Care"—Coordinator. Unfortunately, this isn't as funny as all that.

The plan has a detailed section on quality measurement. Quality measures rule the DD world; these are the checklists that auditors use to evaluate programs. If it's not required to pass an audit, most administrators don't take it seriously. Virtually none of these new ideas appear in the plan's checklist. The only mandates there are "health and safety" and fiscal governance—just like the old OPWDD. Continue reading...

Autism Insurance a Reality

At long last, New York State has a law requiring private insurance companies to cover autism-related services. On November 1, 2012, NY will become the 29th. state to have such a law.

The law is a compromise; it only requires insurance plans to pay for a maximum of $45,000 per year for "applied behavior analysis". This runs against the spirit of recent health insurance reforms on the federal and state levels that require "parity" between mental health and physical health services. However, this is a rather narrow limitation.

The bill requires coverage of screening, diagnostic, and treatment services for conditions on the "autism spectrum", and prohibits insurers from terminating plans or denying coverage for other services because the recipient has an autism spectrum disorder. The treatment services include assistive communication devices; "behavioral health treatment" and psychiatric and psychological care; medications; and ordinary medical care. It also requires coverage of speech therapy, OT, and PT, if the plan covers those services generally. Continue reading...

Commissioner Burke Visits STIC

In response to an invitation from Southern Tier ADAPT and STIC, OPWDD Commissioner Courtney Burke visited STIC in October.

Consumers invited her because they wanted to tell their stories, convey their wishes, and ask for her help in achieving their dreams.

The Commissioner opened the meeting by describing her vision for the new People First managed care Medicaid waiver. She said that the new waiver would be flexible enough to cross systems and provide the services consumers wanted and needed. She said that because the new waiver was managed care, it would save money so that funding would be available to offer the services consumers want and need to help them fulfill their goals. She then said that the reason she was at STIC was to hear consumers tell their stories. And tell their stories they did.

Consumers were extremely articulate and very passionate about their personal experiences, as well as their goals for the future. Continue reading...

Courts Watch

Joseph S. v Michael Hogan settled

This case, filed in 2006 by New York Lawyers in the Public Interest (NYLPI) and Disability Advocates, Inc. (DAI), against New York's Office of Mental Health (OMH), concerned New York State's confinement of people with mental illness in nursing facilities. In September, the state agreed to a settlement.

We were unable to view actual court documents in the case. According to the NY Times, the plaintiffs alleged that state psychiatric centers had "turnaround agreements" with nursing facilities in NY and surrounding states that allowed them to transfer inmates back and forth.

We reported on this in AccessAbility, Summer 2006. At that time the state had discharged about 1000 people from psychiatric centers directly to nursing facilities, and frequently to locked wards within those facilities, even though the people were not dangerous to themselves or others and therefore did not meet legal criteria for being locked up. The inmates did not receive any mental health treatment except medication, and did not receive any rehabilitation or recovery services. They spent their time mostly sitting around and watching TV. Continue reading...

Winter 2012 Issue No. 105