FAQ

FAQ

Questions & Answers Regarding Tri-County CCO:
A Care Coordination Organization

Tri-County Care Coordination, LLC (Tri-County Care) has developed this document to help yourorganization understand New York State’s (NYS) transition to conflict free service coordinationfor individuals with intellectual and developmental disabilities (IDD). Tri-County Care is aninclusive organization accepting of individuals and MSC agencies from all backgrounds. We havean extensive background in care coordination across a diverse set of programs, care settings,and communities.

  1. What is the transition from Medicaid Service Coordination (MSC) to conflict free caremanagement (CFCM) about?

    NYS is expected to require MSC service providers to partner with a Care CoordinationOrganization (CCO) and transition to a conflict free model for serving individuals with IDD.OPWDD is requiring this transition in response to federal rules requiring referrals to waiverbased Medicaid services be made in a manner which is conflict free.

    Current MSC service coordination providers will be required to join a Care CoordinationOrganization (CCO) and transition to providing Conflict Free Care Management (CFCM) services.

    Under the CFCM model, the same organization developing the plan of care cannot also beproviding treatment called for under the plan of care.

    This is intended to limit self-referrals andempower individuals and families in direction of their care.

    During the transition, MSC service coordination staff will be reorganized within their currentservice coordination agencies and begin using the CFCM model. Staff will ultimatelytransitioned to the CCO, where the CFCM model will continue to be used.

  2. Where can I see the Office for People with Developmental Disabilities (OPWDD) proposal?

    The recently released NYS Executive Budget states the following:

    Support OPWDD’s Transition to Managed Care. The OPWDD system will transitionto managed care in phases, beginning with an enhanced care coordination model throughthe development of regional Care Coordination Organizations (CCOs) before a transitionto a fully capitated rate structure. Beginning in late 2017, CCOs are expected to beginoperations and will be rolled-out on a regional basis. Enrollment on a voluntary basis inmanaged care is expected to begin in 2019, and the transition to managed care is plannedto be completed within a five-year period.

    The Executive Budget is available at the following URL:
    https://www.budget.ny.gov/pubs/executive/eBudget1718/financialPlan/FinPlan.pdf

  3. How will managed care work for individuals with IDD?

    NYS is in the process of transitioning individuals with IDD from fee-for-service to managed care.While the structure for delivering managed care to this population has not been finalized,OPWDD has put out materials in the past and has launched a demonstration program for dualinsured individuals (Medicare and Medicaid) in downstate counties.

    It is anticipated that care coordination and service planning will be provided by CCOs and thatenrollment of individuals with IDD will eventually be mandatory. As OPWDD moves to managedcare, insurance entities will receive a monthly payment from NYS to cover the cost of IDD andmedical services. Some services, like residential, may be excluded and remain in fee for service.The insurance entities will then contract with providers to pay for services and those providerswill submit claims to the insurers. CCOs will not be insurance entities but will coordinateindividuals’ care and receive insurer payments.

    It is also anticipated that NYS will require insurance entities covering individuals with IDD benon-profit organizations with experience providing IDD services in NYS, or for-profitcorporations that are governed by such non-profits. Approved insurance entities will berequired to post significant statutory reserves.

    Tri-County Care will update its partners as the State’s plans for managing IDD and waiver-basedservices become more definitive.

  4. What is a Care Coordination Organization (CCO)?

    CCOs are organizations approved by OPWDD that will initially contract to provide conflict freecare management services, and will ultimately provide these services directly. This includesprovision of independent treatment plans that support individuals’ own choices and needs.CCOs will eventually support the managed care transition by also coordinating physical healthcare needs.

    NYS will be requiring CCOs to be regional in scope, serve a large number of individuals with IDDand to be experienced providers of IDD services. Experience providing care to members of aManaged Long Term Care (MLTC) plan would supplement the required IDD experience.

  5. What is a Care Coordination Organization (CCO)?

    Tri-County Care Coordination LLC (Tri-County CCO) is an established organization in the processof obtaining OPWDD approval to become a CCO. This entity will be a subsidiary companycontrolled by the New York State Hamaspik Association (NYSHA, Inc.) Tri-County Care intends toprovide care in a manner that is accepting of all individuals from all backgrounds. As such, Tri-County plans to contract with a diverse set of MSC agencies during and after the transition toconflict free care coordination.

    Tri-County Care Coordination will meet the new CMS regulations of providing conflict-free carecoordination, so there should be no conflict-of-interest between the case manager and theservice provider agencies. Tri-County Care Coordination will allow people to take any of theirapproved OPWDD services through the agency they are most comfortable with and will benefitthem the most, without compromising their coordination of services by being limited to theone agency that provides the coordination. The new model will provide consumers freedom,more choice and better options.

    Tri-County CCO is sponsored by the New York State Hamaspik Association (NYSHA), an inclusiveorganization consisting of experienced providers who operate in New York City and the HudsonValley. NYSHA provides:

    • Services for individuals with IDD, including but notlimited to: MSC, residential and respite care, communityhabilitation, family supports, Article 16 and self-directedcare services, day services, environmental modifications,and ABA;
    • Department of Health supported services, including butnot limited to: home care, personal care, earlyintervention, health home care management, rehabilitation and social day services,weatherization, access to the home, and senior dining;
    • Managed Long Term Care (MLTC) services; and,
    • Vocational and job coaching services.

    IMPORTANT: OPWDD has not specified all details for how the conflict free transition will takeplace. By executing a Letter of Intent with Tri-County CCO now, your organization will be able totransition service coordination staff and space to Tri-County CCO as required under the conflictfree model. Staff could be leased for a period of up to one year, and leased space can beongoing. This allows continuity for service coordination staff, service locations, individuals andfamilies.

  6. How will this change affect my non-profit organization?

    NYS is expected to require MSC agencies to contract with a CCO like Tri-County in order toprovide care coordination services during the transition period.

  7. What will happen to my staff that currently provide MSC services when they contract withTri-County Care?

    Staff currently providing MSC services will be transitioned to the CFCM program within yourMSC agency and transition plans will be developed to move staff and individuals to Tri-CountyCare. Tri-County can help your organization navigate this transition, minimizing disruption tostaff and individuals. This will allow maintaining the relationships between current servicecoordination staff and the individuals they serve.

  8. What are the timeframes for the transition and what will happen to agencies and theirstaff that do not contract with a CCO?

    It is anticipated that OPWDD will require all MSC agencies to partner with a CCO and developworkforce transition plans. CCOs are expected to begin rolling-out on a regional basis in late2017. OPWDD is expected to release a request for applications (RFA) in Spring 2017 that isexpected to lead to organizations like Tri-County Care being designated as regional CCOs.

  9. Will there be a transition period where current MSC service coordination staff remain ontheir current provider’s payroll?

    Tri-County CCO will help MSC agencies transition their service coordination staff to Tri-County CCO and allow for a 1-year lease or contract for those same staff. This means individuals cancontinue receiving services in the same location and setting.

  10. Where will CFCM staff (former MSC agency employees) be located?

    The CFCM staff will be located at your agency, but will be transitioned to the payroll of Tri-County CCO pending approval of this arrangement by CMS and OPWDD. Once the transition tothe CCO payroll is complete, it is the intent of Tri-County CCO to keep as many staff as possiblein their current locations and to lease space from current MSC agencies.

  11. What will the relationship be between Tri-County CCO and its partners?

    Tri-County CCO will initially enter a 180-day Letter of Intent where Tri-County agrees to be theprimary CCO your organization works with. Based on additional guidance and the expected RFA,the contractual relationships may evolve. As mentioned above, Tri-County CCO will help yourorganization maintain its service coordination staff in their current location and will not bedisrupting relationships between staff and individuals served. Tri-County Care is an inclusiveorganization and respects all individuals from a diverse set of communities.

  12. Will my organization have input into Tri-County CCO’s policies?

    Tri-County CCO will establish an Advisory Board comprised of representatives from NYSHA andCFCM providers. The Advisory Board will meet regularly and have a direct line ofcommunication with Tri-County leadership. It will provide advice on areas including:

    theassignment of individuals to CFCM providers, development and expansion of service networks,partnerships with health care providers, information technology and finances.The Advisory Board will ensure MSC staff, individuals and families are transitioned from theircurrent MSC agency to the payroll of Tri-County CCO, consistent with criteria that emphasizequality and continuity of care.

  13. Will individuals that currently receive MSC services from my organization continue toreceive services from staff they are familiar with in current locations?

    Yes. Staff will be allowed for a one-year transition period to continue in their current locations.Beyond the first year, every effort will be made to continue the use of these service locations.Nobody wants to disrupt the relationships between individuals and their service planners andproviders. Tri-County Care will offer to lease space from former MSC agencies so servicescontinue in the current locations.

  14. How will individuals newly enrolled in the CCO be assigned to CFCM services?

    Individuals that currently receive MSC services will continue to be served by the staff that theyare working with. With the input from its Advisory Board, Tri-County CCO will work with thenewly enrolled individuals to match them with the best CFCM provider possible to meet theircare coordination needs. Tri-County will consider factors including geography, type of service,language, and provider capacity.

  15. How many CCOs will there be in a region?

    It is anticipated that there will be a limited number of CCOs in each region with significantminimum size requirements. Two CCOs in a region would provide choice for families.

  16. Can my organization work with multiple CCOs?

    Right now, OPWDD is expected to require your agency to work exclusively with a single CCO ingiven region.

  17. Why should I choose Tri-County CCO?

    Tri-County CCO is ideally positioned to help your organization transition to the conflict freemodel. We are sponsored by the New York State Hamaspik Association (NYSHA), an agencywith extensive experience service including provision of services to persons with IDD, includingMSC services, residential and respite care, community habilitation, family supports, Article 16and self-directed care services, day services, environmental modifications and ABA.

    NYSHA provides home care, personal care, early intervention, health home care management,rehabilitation and social day services, weatherization, access to home, and senior dining. NYSHAalso sponsors a Managed Long Term Care (MLTC) plan.

    Eighty-five percent of the people served by the Hamaspik MLTC are from outside the Hamaspikcommunity. We have strong experience coordinating care across a wide range of programs. Assuch, Tri-County Care is open to serve all individuals, families and providers equally based ontheir background and needs.

    More information about Tri-County CCO is available in the accompanying brochure. Informationabout NYSHA is available on their website: http://www.nyshainc.org/

  18. What counties does Tri-County CCO anticipate working in?

    Tri-County expects to work in counties covering the Hudson Valley, New York City, and LongIsland.

  19. What are the timeframes?

    As mentioned above, OPWDD is expected to release an RFA this Spring where organizations likeTri-County will seek designation as regional CCO providers. CCOs will play a key role in NewYork’s transitioning of the IDD population to managed care for all health care services, with thatenrollment beginning in 2019.

  20. As mentioned above, OPWDD is expected to release an RFA this Spring where organizations likeTri-County will seek designation as regional CCO providers. CCOs will play a key role in NewYork’s transitioning of the IDD population to managed care for all health care services, with thatenrollment beginning in 2019.

    Tri-County CCO will help your organization maintain these relationships during and after thetransition period by allowing organizations to lease their staff back from the CCO’s payroll forup to one year and lease service locations on an ongoing basis. Tri-County CCO will help yourorganization ensure continuity and quality for individuals and families throughout the transitionand on an ongoing basis.

    As an inclusive service provider, Tri-County Care is committed to working with families andMSCs during this process. We have a history of working across a variety of communities and areseek to work with providers, individuals and families from different communities andbackgrounds.

  21. What are the next steps?

    The next step is to sign a 180-day agreement to work primarily with Tri-County Care. MSCagencies and service coordination staff will then have access to ongoing technical assistance forthe transition. Agencies and staff will have an important voice in the direction of Tri-CountyCare and the decisions made by its Advisory Board. This ensures your agency is part of theplanning process for this new program. At the end of the 180-day period, MSC agencies will beoffered a contract with reasonable terms for leasing staff and space.

    Please contact Jacklyn Spring (JSpring@tricountycare.org) at Tri-County CCO with any additionalquestions. For more information about NYSHA, Tri-County CCO, and our background, pleasevisit our website at: www.tricountycare.org

  22. Additional Questions and Answers about NYSHA

  23. Who is NYSHA Inc.?

    NYSHA, Inc. (New York State Hamaspik Association) is a 501(c)(3), nonprofit organization filedwith the New York Department Charities Bureau. NYSHA was established in 2009 and is astatewide non-profit organization representing a network of member agencies that provideessential health and human services for people in need and their families.

  24. Who are the NYSHA Member Agencies?

    Currently, NYSHA comprises of five Hamaspik member agencies: Hamaspik of Rockland County Inc., Hamaspik of Orange County Inc., Hamaspik of Kings County Inc., Hamaspik Choice, andHamaspikCare.

    NYSHA members operate as independent nonprofit agencies that provide support services intheir local area. All agencies are joined together under the Hamaspik umbrella association,reflecting one basic ideal of supporting people with compassionate and personalized care.

  25. Who comprises the NYSHA Inc. Board of Directors?

    Each member agency appoints one of their own Board Members to serve on the Board ofDirectors. Two thirds of the board members are parents of individuals with IDD and receiving services through OPWDD.

  26. What is the function and goal of NYSHA, Inc.?

    As the association for Hamaspik agencies, NYSHA is the foundation upon which members relyon for organizational stability, effective advocacy, community outreach, training curriculum,medical research, family support initiatives and more. Member agencies greatly benefit frombeing a part of this consortium, including saving money on large projects which can be sharedwith other member agencies. Professional staff and project coordinators can be hired by NYSHAand shared by the members. Purchases like office equipment and seasonal gifts can be boughtin bulk and distributed to the members

    Members also benefit from the world known law firm Moritt, Hock &Hamroff LLP and we haverecently added on the reputable consulting firm Sachs Policy Group.

  27. What are the details of the NYSHA Article 16 Clinic?

    The only direct service that NYSHA itself provides is the Article 16 OPWDD clinical services. Thearray of clinical services includes Physical Therapy, Occupational Therapy, Speech Therapy,Psychology, Social work, Psychiatry, Nutrition, and more.

    The only direct service that NYSHA itself provides is the Article 16 OPWDD clinical services. Thearray of clinical services includes Physical Therapy, Occupational Therapy, Speech Therapy,Psychology, Social work, Psychiatry, Nutrition, and more.

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