Families

Questions & Answers for Families:In The Here and Now

Change is here. As OPWDD transitions from MSC services to a Care Coordination model, it is no surprise that you have questions and concerns. Whether you are a person receiving services, a family member, or part of a support team, Tri County Care is committed to

supporting you throughout this transition As your partner, we will inform and engage you with quality resources, options, and a Life Plan. Facing the future with a familiar face makes the horizon that
much brighter.

You - First, Your Needs - Foremost, Moving-forward.

Your peace of mind is our charge.

1 . What is a Care Coordination Organization / Health Home (CCO/HH)?

A Care Coordination Organization / Health Home (CCO/HH) is a Health Home that is tailored to meet the needs of individuals with intellectual and/or developmental disabilities (I/DD). CCO/HHs will be designated by the NYS Department of Health (DOH) in collaboration with the NYS Office for People With Developmental Disabilities (OPWDD) under an Application process. Health Homes and Health Home care managers provide person-centered care management, planning and coordination. (Please note that the term health homes has nothing to do with the home that your loved one lives in currently. That does not change).

The CCO/HH will provide care management and coordination services that are tailored specifically to help people with I/DD and their families coordinate all services.

CCOs/HHs work with individuals with I/DD and their families to bring together health care and developmental disabilities service providers to develop an integrated, comprehensive care plan (known as a “Life Plan”) that includes health and behavioral health services, community and social supports, and other services. CCO/HHs will assist individuals and families with accessing services that support well-rounded and fulfilling lives.

2 . Why are we transitioning to CCOs/HHs?

CCO/HH care coordination will provide a more robust, integrated system of care management that not only includes the existing OPWDD services, but brings together medical, behavioral health services and other long term support and services in a single coordinated care plan.

3 . What services will be coordinated by a CCO/HH?

CCOs/HHs will coordinate all of your I/DD HCBS services and, in addition, will coordinate other health-related supports and services with community providers such as personal care, mental health, home health aides or medical services. It also allows people receiving supports and services better continuity of care between all providers, whether they are providers of I/DD services or community providers of other health-related services.

4 . Is joining a CCO/HH mandatory? How does individual choice play a role?

Enrollment in a Health Home is optional, but CCO/HHs will be the primary way that people with I/DD will receive access to:

• Comprehensive Care Management, Care Coordination and Health Promotion, Comprehensive Transitional Care, Individual and Family Support, Referral to Community and Social Support Services, Use of Health Information Technology to Link Services

Once the CCO/HH is designated, Care Managers will begin to work with the individual and their family members, caregivers and advocates to help them understand the importance of the Health Home Program in accessing the supports and services that they need.

5 . Will I lose my Medicaid Service Coordinator (MSC)?

The MSC will now become a Care Manager. The CCO/HH model is intended to allow for enhanced care coordination to you. Within the CCO/HH you will not lose any of the benefits of MSC but will experience enhanced service coordination. Every effort will be made to ensure continuity of relationships, so you should be able to keep your MSC as long as they choose to continue working in the field and stays within the CCO.

6 . Who will have access to my plan and how will my personal information be protected?

CCO/HHs will be required to have an electronic health record system that links the various service providers involved in your care together and allows your health information and Life Plan to be accessible to you and your interdisciplinary care team. All CCOs/HHs must ensure security protocols and precautions are in place to protect your Personal Health Information (PHI). CCO/HHs will work with you and your family to ensure you agree to share your information with the care team.

7 . What happens if I want to leave the CCO/HH?

The State’s goal is to provide CCO/HH services statewide, including your choice of CCO/HH in the region where you live. If you are dissatisfied with the CCO/HH in which you are currently receiving services, you may opt to join a different CCO/HH within your region.

8 . Will I be able to get a choice of more doctors or dentists in my area?

To provide comprehensive, timely and high quality Health Home services, CCO/HH providers are expected to develop and maintain a network of partnerships with cross-system service providers. The CCO/HH enrollee is not limited to receiving services only from network providers. Instead, the CCO/HH and its network providers agree to participate in care planning and information sharing to better meet the cross-system needs of the enrollee. CCO/HHs must partner with medical care providers; I/DD service providers; long- term supports and service providers; dentists; behavioral health care providers; regional START teams, community-based organizations; and social services providers; and others.

9 . What will happen if the CCO/HH decides to change my services or give me fewer services?

The CCO/HH will not authorize services and therefore will not change or take away your services. You, in partnership with your interdisciplinary team, will identify the supports and services you receive based on your wants and needs. The Front Door will continue to be the means by which OPWDD connects people to the OPWDD HCBS services they need and want by providing assistance in navigating the steps involved in determining OPWDD eligibility, and referring eligible individuals to a CCO/HH to provide care management services.

10 . What Do I Need to Do?

You can expect your MSC to contact you to review information about the transition and ask you to sign consent forms for this new level of service.

11 . How can I get more information?

You can log on to our website at www.tricountycare.org or OPWDD’S website at https://opwdd.ny.gov/opwdd_services_supports/care_coordination_organizations . You can also reach out to us via email at info@tricountycare.org or by calling us at (844) 504-8400. We will also by hosting parent sessions in a variety of locations throughout New York State. We will posts that information on our website and your MSC will be able to direct you to the next session.

We look forward to working with you. Welcome to the Tri County Care family.

We look forward to working with you.Welcome to the Tri County Care family.