Overview General Information Regulatory Response ACA/NY Response - - PowerPoint PPT Presentation

Overview

• General Information
• Regulatory Response
• ACA/NY Response
• Supporting Our Members

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General Information

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General Information

As you know, the COVID-19 pandemic has changed how we all live our lives. ACA/NY is committed to supporting our members, their families, and our workforce. This forum is an opportunity to discuss the effects of COVID-19 on our country, our government, and ACA/NY operations as a Care Coordination Organization Health Home.

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General Information

Per the President of the United States, the following guidance was extended through 4/30/2020:

• Work or engage in schooling from home whenever possible.
• Avoid social gatherings in groups of more than 10 people.
• Avoid discretionary travel, shopping trips, and social visits.
• Practice good hygiene.

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Federal Guidance

General Information

Recovery Rebate Under the 2020 CARES Act

• Automatically sent to anyone in the income limit who filed taxes in 2018 or 2019,

received Social Security payments, or veterans' benefits.

• To check on the status of this payment: https://www.irs.gov/coronavirus/get-my-payment
• SSI recipients who did not file taxes will not need to do so.
• SNAP

, SSI, & Medicaid will not consider this income/resource for the year.

Sources: 4/13/2020 OPWDD “Advisory: Medicaid Eligibility Processes During Emergency Period”, 4/21/2020 OPWDD Care Coordination E-Visory Issue #7-20

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Federal Guidance

General Information

The Governor of NY issued a Statewide Executive Order extended through 5/15/2020 which provides the following guidance for New Yorkers:

• Everyone in New York should wear masks or face coverings in public,

including when taking public or private transportation.

• Remain indoors, however you can go outside for solitary exercise.
• Pre-screen all visitors by taking their temperature.
• Do not visit households with multiple people.
• Vulnerable people and anyone in their presence should wear a mask.
• Always stay at least 6 feet away from other people.
• Do not take public transportation unless urgent and necessary.

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New York State Guidance

General Information

• Business and entities that provide essential services must implement rules that

help facilitate social distancing of at least 6 feet.

• Employers must provide essential workers with masks free of charge to wear

when interacting with the public.

• Sick individuals should not leave their home unless to receive medical care and
• nly after telehealth visits to determine if leaving the home is in the best

interest of their health.

New York State Resources

• Novel Coronavirus Hotline: 1-888-364-3065
• COVID-19 Emotional Support Hotline: 844-863-9314, 8am-7pm every day
• For more information: https://coronavirus.health.ny.gov/home

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New York State Guidance

General Information

The 7 Care Coordination Organization Health Homes in New York State came together to develop consistent tools and processes to help facilitate the health and safety of members during this crisis.

• The emphasis is advocacy for our collective membership, keeping OPWDD and

providers aware of the needs of our members.

• An assessment tool was created to determine health and safety needs.
• A monitoring tool was created to allow for the continued monitoring of

member’s needs as a follow up, for continuity of care and continued coordination of support and needs.

• The 7 CCOs are collectively providing statewide data regarding members that

are more vulnerable.

• This collaboration and unification would not have been possible before

7/1/2018, with hundreds of Medicaid Service Coordination providers.

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General Information

• ACA/NY was one of the first CCOs to implement a policy on working

from home, dramatically reducing the risk of exposure for everyone. In this environment, staff are still able to provide effective support to our members.

• We have daily contact with OPWDD, the Department of Health and

provider associations to remain up-to-date on regulatory changes.

• We provide regular updates and guidance to ACA/NY staff through twice

weekly webinars that are fully attended by our workforce.

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ACA/NY Response to Federal and State Guidance

Regulatory Response

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Regulatory Relief

• The New York State Department of Health waived face-to-face

requirements for Care Management effective 3/14/2020.

• In lieu of face-to-face contact, Care Managers utilize telephonic
• r telehealth capabilities.
• In certain situations, face-to-face may still prove to be clinically
• indicated. Agencies must have policies and protocols in place to

assess the necessity and process for any in person contact.

Source: 3/14/2020 New York State Department of Health “COVID-19 Guidance for Health Homes”

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Face-to-Face Requirements

Regulatory Relief

• OPWDD and the New York State Department of Health have agreed

to provide relief to Life Plan deadlines retroactively to 3/7/2020.

• Care Managers are not required to hold Life Plan meetings or

develop new annual Life Plans during this time.

• In some circumstances, when able to do so, Care Managers are

making every effort to hold the meeting as scheduled. If we can make it work in a virtual environment, we will.

Source: 4/17/2020 OPWDD “Interim Guidance Regarding Care Planning Activities”

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Life Plan Meetings

Regulatory Relief

• Medicaid coverage will not stop for anyone during the COVID-19 pandemic.
• If you received a notice that your Medicaid was discontinued after 3/18/2020 it

should have been reinstated so there is no gap in coverage.

• Individual's in the Medicaid Buy-In program who lose their job will have a grace

period of 6 months.

• New Applications: Districts must allow self-attestation on eligibility criteria.
• Care Managers can sign on behalf of individuals and must submit DOH-5147 form

(or MAP-3044 form).

• There remains no changes to fair hearings currently.
• Questions can be directed to your local Medicaid district.

Sources: 3/18/2020 New York State Department of Health “New York State Medicaid Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID–19)”, 4/13/2020 Office of People with Developmental Disabilities “Advisory: Medicaid Eligibility Processes During Emergency Period” 14

Medicaid Coverage

Regulatory Relief

• OPWDD suspended in person services at all Day Habilitation, Day Treatment, and

Prevocational Services locations across the state.

• Providers evaluate if an individual may benefit from Community Habilitation,

Respite and Day Habilitation services by alternative means.

• If face-to-face interactions must happen, social distancing measures should be in

effect between individual and worker.

• Care Managers in conjunction with providers will evaluate the need to create a

LP addendum based on service changes

Source: 3/19/2020 “Message from OPWDD Commissioner Kastner Regarding Day Program Services”

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OPWDD Guidance to Providers

Regulatory Relief

• Community Habilitation may be delivered to children during

school hours as of 4/13/2020.

• Community Habilitation must be within authorized levels in order

to be delivered during the day.

• Care Management can advocate around coordination of services

with other providers and should keep this information in mind.

Source: 4/13/2020 Office of People with Developmental Disabilities COVID-19 Update Meeting

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OPWDD Update: Community Habilitation

Regulatory Relief

• All community outings and home visits for certified residential

settings suspended effective 3/25/2020.

• Individuals on home visits can return to their residence.
• A health screening is required, and precautionary quarantine

is possible.

• Goals and services related to community outings should be met by

alternative means whenever possible.

Source: 3/24/2020 OPWDD Guidance “COVID-19 Suspension of Community Outings and Home Visits”

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Suspension of Community Outings and Home Visits

Regulatory Relief

• Service Authorization Requests do not need to be accompanied by a Life Plan or

in-process Life Plan during the COVID-19 emergency.

• Front Door staff can use documents previously considered, including documents

needed to establish OPWDD eligibility and Level of Care Determinations.

• Virtual Front Door Information Sessions will be held on Thursday 4/23/2020

(Spanish) and Thursday 4/30/2020 (English) from 10am – 12pm.

• Pre-registration is required. Registration should be sent by email to Soreth

Mitchell: Soreth.X.Mitchell@opwdd.ny.gov

• Email should include the individual’s name, DOB, parent/advocate name,

home address, email address, and phone number.

Source: 3/27/2020 “Important Updates for Front Door Staff” e-mail from OPWDD.SM.CCOProjectManagement

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OPWDD Front Door

Regulatory Relief

OPWDD has welcomed vacant Day Hab, Respite and other sites to be developed as temporary housing for people impacted by COVID-19.

• First priority will be given for those returning from hospital stays and

recovering from COVID-19.

• Second priority is for those who tested positive for COVID-19 but are

not in need of hospitalization.

• Third priority is for those needing emergency respite placement.
• If emergency respite is needed contact your Care Manager.

Source: 3/30/2020 OPWDD Memorandum “Temporary Emergency Respite Capacity in Response to COVID-19”

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Emergency Respite

Regulatory Relief

Hospitals must permit a support person at the bedside for patients that require additional support for their care.

• This includes individuals with intellectual and/or developmental disabilities and

cognitive impairments including dementia.

• The patient or family/caregiver may designate two support people; but only one

support person may be present at a time.

• Hospital staff must screen the support person for symptoms and conduct a

temperature check prior to entering the clinical area and every twelve hours.

• If a support person accompanying members is denied, Care Managers will advocate

with Care Management leadership.

Source: 4/10/2020 New York State Department of Health “Health Advisory:COVID-19 Updated Guidance for Hospital Operators Regarding Visitation”

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NYS DOH Hospital Visitation Guidance

Regulatory Relief

All Certified Residential Facilities must have a process to expedite the return of asymptomatic residents from hospitals.

• This includes individuals that have been determined medically stable for return

by a hospital physician or designee.

• No individual shall be denied re-admission or admission to a Certified Residential

Facility based solely on a confirmed or suspected diagnosis of COVID-19.

• Providers of Certified Residential Facilities are prohibited from requiring a

hospitalized individual to be tested for COVID-19 prior to admission or re- admission.

Source: 4/11/2020 Office of People with Developmental Disabilities “Advisory: Hospital Discharges and Admissions to Certified Residential Facilities”

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OPWDD Update: Hospital Discharges

Regulatory Relief

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COVID-19 Disability Form

ACA/NY Response

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ACA/NY Response

The expectation is for Care Managers to increase

• utreach to our members during this time and

assess and support the member’s health and wellbeing; especially those members that may have increased vulnerability and in need of additional support during this time of public health crisis.

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Care Management Expectations

ACA/NY Response

ACA/NY employees are “Essential” in New York State.

• ACA/NY remains committed to employee and member health.
• ACA/NY staff may not report to work sites or conduct any visits in

person without approval from the CEO.

• All ACA/NY staff have a cell phone and access to Microsoft Teams and

WhatsApp for web conferencing and video calls.

• ACA/NY is committed to following all updated regulations to allow us

to support our members.

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Essential Worker Status

ACA/NY Response

• In lieu of contact in person, ACA/NY is maximizing technology.
• Video conferencing, Teleconferencing, Phone calls
• Care Managers may be asking you to use Microsoft Teams, this is the most secure

method for us to contact you. We will provide information on how to use Microsoft Teams.

• If you are not able to use Microsoft Teams, let us know what works for you.
• We are in constant communication across systems. ACA/NY has daily calls with

the other CCOs, DOH, and provider associations.

• We need to prepare for the future while identifying concerns and providing
• ngoing support.

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Maintaining Contact

ACA/NY Response

• We have completed 24,861 initial assessments.
• We have completed 9,249 monitoring assessments.
• The person-centered planning process continues to guide us in

making decisions about service planning.

• Although regulatory relief has been granted, ACA/NY is working

with our government partners to balance the regulatory service documentation needs with the most critical needs as it relates to COVID-19.

• As per the person-centered planning process, if it is determined by

the IDT team that the I AM, Life Plan and DDP2 can be completed, they will be.

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ACA/NY Response

All existing incident reporting requirements remain in place. ACA/NY is also required to report the following to OPWDD: 1. A member has tested positive for COVID-19. 2. A member has had direct exposure to someone that has tested positive to COVID-19 (within 14 days of the person testing positive). 3. A member has been placed on quarantine or isolation by the Local Health Department medical provider.

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Incident Reporting

Supporting Our Members

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Supporting Our Members

Care Management Priorities

• Identifying concrete needs and connecting families to

resources for food, medicine, etc.

• ACA/NY is working to maintain accurate contact

information to share updates with members.

• ACA/NY assists as a bridge to services and providers.
• Care Managers make continued contact based on

individual preference and assessed risk or need.

• Care Managers act as advocates for members that have

been hospitalized.

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Supporting Our Members

Success Stories

Care Management and the Clinical Team have been working closely with NY START and the OPWDD Crisis Unit to support a member and their family in navigating an extremely complex situation, which impacts our members health and safety as well as his family’s living situation. Just prior to this COVID-19 pandemic, a meeting had been held with all parties and as a result of that meeting, some positive changes were being made to day program, the development of a NY START Crisis Plan & staff training. The pandemic has halted these plans but Care Management, the Clinical Team, NY START & the OPWDD Crisis Unit have been working together to identify ways to best support this individual and his mother at this time. The Care Manager has been in consistent contact with the family via phone and NY START has been reaching out intermittently to continue building trust and rapport with the member’s mother. The collaboration & open communication of all parties led by the Care Manager has been instrumental in maintaining the relationship with the mother, ensuring the members safety and the small but mighty victories that have been accomplished thus far.

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Supporting Our Members

Success Stories

This CM is going above and beyond their job responsibilities during the COVID-19

• emergency. This CM felt like they needed to do more for members in their region.

Last week, this CM used some of the money they earned from the ACA/NY incentive program to purchase highly in-demand supplies at stores, such as toilet paper, paper towels, cleaning supplies, tissues and hand soap, while at the same time received donations from other ACA staff members, as well as friends and relatives of theirs. This CM purchased a large bottle of hand sanitizer, along with small empty travel bottles to fill up. This CM and their family began making cloth face masks. This CM made up bags that they could quickly drop off at the front door of our members’ homes. The CM reached out their office peers office to help identify members in need of items and then delivered items to members served by other teams as well. This CM travelled to the other side of their region to deliver items. One particular member is an older gentleman living

• n his own in the community. He has been experiencing severe anxiety regarding

this pandemic. This CM dropped off a home-made mask at his doorstep in hopes that this would help with his anxiety. The CM hopes to make this weekly

• ccurrence, as long as they can find these items and keeps getting donations.

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Supporting Our Members

Advocacy ACA/NY will continue to:

• address the needs of self direction;
• identify emergency housing resources;
• connect people to telehealth;
• using data to identify needs of members

throughout the state and;

• work with providers to figure out how to do

waiver services in this environment.

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Supporting Our Members

Planning for the Future We are committed to supporting our members during and after the crisis. The person-centered planning process continues to guide us in making decisions about service planning. We will do what makes sense for each of our members.

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Supporting Our Members

Q&A Thank you for submitting your questions.

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Supporting Our Members

If You Have Additional Questions We are here for you 24 hours a day.

(833) 692-2269 memberInformation@myacany.org https://acany.org

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Thank You