Issue:
OPWDD is developing a new rate methodology, which will have significant and long-lasting implications for voluntary provider agencies for years to come. Throughout this process, providers have been engaging with OPWDD and other stakeholders on the technical aspects of the rate redesign. The overall objective is to reform the reimbursement rate from a cost-based methodology to an acuity-based methodology.
However, provider agencies have expressed serious concerns about the potential outcome of the final rate methodology, which may result in significant long-term revenue losses for provider agencies statewide. Agencies that have already invested in direct care wages above the regional average will be penalized due to the proposed regional cost approach.
The Coordinated Assessment System (CAS) will be used to determine the relative acuity of a person, which in turn determines how much an agency is reimbursed to support that person. However, questions and concerns remain whether the CAS has the functionality, reliability or validity to appropriately identify the level of support required for a person. Inconsistency or errors in CAS outcomes will lead to inaccurate acuity levels and result in insufficient funding.
A decade ago, the state shifted rate-setting authority for IDD services from the Office for People with Developmental Disabilities (OPWDD) to the Department of Health (DOH). This change has resulted in a rate-setting process that is slow, unpredictable, and inefficient, leaving many non-profit agencies in precarious financial positions. For example, rates effective on July 1, 2024, were not finalized until December 31, 2024, and not paid until February 2025, 8 months after the effective date. This has caused hardships for providers who rely on the rates to set their budgets, provide much needed salary adjustments for their workforce, and cover other operating costs.
The January 2025 NYS Comptroller’s report, The Critical Role of Nonprofits in New York, underscored these concerns:
“When contracts are not timely executed and/or payments for services are delayed, nonprofits may face difficult choices: decrease the services they provide, defer paying or hiring staff, or even laying off staff. They may also be subject to cash flow burdens—relying on loans or lines of credit to make existing payroll or other expenses, incurring costs for which they are not reimbursed delayed state contracts and payments hinder nonprofit operations and disrupt services to New Yorkers that rely on them.”[1] Therefore, any new rates or cost-of-living increases must be applied in a timely manner to ensure the stability of providers.
[1] https://www.osc.ny.gov/files/reports/pdf/critical-role-of-nonprofits-in-new-york.pdf?utm_medium=email&utm_source=govDelivery
Call to Action: Tell OPWDD to Reform Rate Methodology that Works with Providers and for People with I/DD
- The new reimbursement methodology must not harm providers that have appropriately invested in their workforce.
- Restore rate-setting authority back to OPWDD from DOH, which would help streamline the process by placing responsibility back with the agency that has the most expertise in IDD services.
- Changes to rates, including the implementation of any investments made in the state budget, must be completed in a timely manner within 90 days from the enacted budget or final rate approval.
- Develop new payment methodology for the capital component of rates that reimburse providers at their full approved capital reimbursement rate.
- Continuing education, training, and opportunities for the direct care and other frontline workforce must be taken into consideration when determining rates to retain valuable talent and expand the ability for voluntary providers to support people with complex higher needs.
- Access to the methodology used by CAS to determine acuity assessments must be made available to providers. Greater transparency will lead to a continually refined and more equitable system that providers trust and support. This would be consistent with Governor Hochul’s directive that New York State agencies increase transparency and accessibility in their work.
- CAS assessments must accurately reflect the current acuity of a person and be completed within a reasonable timeframe to ensure an appropriate placement and proper provider reimbursement.
- There must be a mechanism for timely CAS reassessments for individuals that experience a significant change in their service level needs.
The Arc promotes and protects the human rights of people with intellectual and developmental disabilities and actively supports their full inclusion and participation in the community throughout their lifetimes.
