Managed care may provide states and the federal government with the opportunity to reduce healthcare expenditures and better manage utilization, while improving quality and outcomes. Understanding what New York state intends to achieve by transitioning people with intellectual and other development disabilities to managed care is key to informing design decisions. Meaningful stakeholder engagement and education are vital for the program success.
The overarching goal for people with intellectual and other developmental disabilities supported in a managed care system must be quality driven and person/family centered. The supports offered must be integrated and coordinated, blending needed medical services with habilitation services in all life domains, without barriers for opportunity or access. Managed care payment models must provide sufficient resources and flexibility to both the person and the larger population, and must also allocate adequate administration payments to providers.
Regardless of the service delivery/payment strategy developed, a seamless “no wrong door” philosophy and practice, coupled with person-centered outcome measures aimed at enhancing quality of life, must be actionable in every life domain.
It is the Position of The Arc New York that managed care will best serve the health and habilitation needs of people with I/DD when:
- There are meaningful opportunities for stakeholder feedback during the design phase of the program.
- Care management roles are clearly defined.
- Funding for the implementation and operation of managed care cannot come from the operating budgets of providers delivering supports and services to people with intellectual and other developmental disabilities or from the existing resources of the OPWDD system. Any attempt to do so would exacerbate the financial crisis faced by all voluntary providers already facing hardship.
- I/DD providers receive dedicated training and communication resources before, during, and after transition to managed care.
- Educational materials and notices relating to the transition to managed care are written in a way that people with I/DD and their families can easily understand, so as to ensure people understand what is changing, what is staying the same, that they have choices and rights, how to exercise their rights, and where to go for help.
- Once managed care is operational, ongoing engagement is key to ensuring Managed Care Organizations (MCOs)are complying with program standards delivering on the promise of managed care.
- Services and supports are delivered in a quality manner that maximizes personal well-being.
- Protections, health and safety, and rights are addressed in the determination of supports offered.
- Financial constraints are not the prevailing fact or driving the system.
- Quality metrics are meaningful and reflect the unique needs of the I/DD population, including personal outcome measures, and need to reflect long-term care, as well as acute healthcare needs of people with intellectual and other developmental disabilities.
- No one is denied access to needed supports and services and everyone receives them in a timely fashion.
- Services and supports are offered and coordinated within the person’s community.
- MCOs have significant expertise in serving the I/DD population and their needs
- Provider networks account for longstanding relationships between members and their providers.
- State oversight of MCOs is strong in order to ensure continued access to services and compliance with consumer and provider protections.
- The payer agencies and the agencies delivering supports, work together for the common good of the person being supported.
- Independent Ombudsman programs are in place to ensure that enrollees can both navigate the system and have continued access to the services they need.