The Care Manager must submit a DDP-1 to update the demographics when a member moves. The service provider is always responsible for completing and submitting the DDP-1 into CHOICES to enroll a member in a particular program, regardless of the program type, including residential providers.

Each member enrolled in Health Home/Care Management must complete a comprehensive assessment before the member’s life plan. The CCOs that utilize the CORE Solutions electronic health record (EHR) use PATHS, and CCOs that utilize Medisked for the EHR use the I AM assessment. While different, both assessments capture essential information needed to ensure person-centered Life Plans. 

Yes, the change in assessment tools occurred last year. Since ACA/NY and LIFEPlan CCO have changed to CORE Solutions for an EHR, all members enrolled in Health Home/Care Management should complete a PATHS assessment before the next annual life plan. 

Yes, members enrolled in Health Home Care Management need the PATHS assessment to inform the life plan. The Care Manager completes the PATHS by reviewing information in supporting documents, observation, and conversations with the member and their circle of support. The PATHS is not required for members enrolled in Basic HCBS Plan Support. 

The PATHS is completed to develop the member’s draft Life Plan since it identifies a member’s goals and safeguards. A member’s PATHS can be updated if requested by the member or if there are significant changes. 

No, our Care Managers do not complete psychosocial evaluations. Instead, Care Managers can help provide support and link you to clinical staff to complete a psychosocial evaluation.

An addendum would be needed when there are significant changes to warrant one. For example, when there is an identified health or safety issue or when there is an error that would impact a provider’s ability to be reimbursed for their services, then an addendum would be completed. If it’s a minor change (for example, a change in a medication, non-waiver service provider, or community resource), the Care Manager may wait to make the changes until the next Life Plan review. Please remember that even if an addendum is requested, providers must acknowledge a finalized life plan before an addendum can be completed.   

The program is responsible for scheduling and coordinating the 30-day meeting. The Care Manager will attend, and if changes to goals or safeguards are needed, the Care Manager will complete an addendum. 

It is the responsibility of the current residential provider to complete Due Process by informing the member and/or representative of the member’s rights.

Please speak with your employer about requesting CHOICES access.

No, they are two separate organizations. Last fall, ACA/NY and LIFEPlan CCO NY announced a strategic partnership with the goal of enhancing the quality of our Care Management service. We continue to operate as two separate organizations with two separate governing boards. It is important to note that there are no changes to how either Coordinate Care Organization (CCO) provides Care Management services. Provider agency staff should continue to work with the CCO Care Management staff and leadership in their regions on day-to-day care coordination/care planning matters.

For the purposes of this presentation, when we say “provider” we are referring to agencies who provide one or more OPWDD-funded services.

The Federal Public Health Emergency (PHE) is an emergency declaration in effect because of the COVID-19 pandemic. The PHE outlines specific areas of regulatory relief to allow for flexibility in service delivery throughout the pandemic.

ACA/NY and LIFEPlan CCO NY have worked and will continue to work closely with provider, family, and self-advocacy groups across the state to petition for a permanent wage increase for Direct Support Professionals.

All initial OPWDD eligibility requests must now go through one of the 7 CCOs in New York State. Both ACA/NY and LIFEPlan CCO NY have dedicated teams who help people in pre-enrollment obtain OPWDD eligibility. We will assist anyone with obtaining eligibility regardless of age. We also assist with applying for Medicaid.

OPWDD reviews the application for the HCBS waiver and makes the final determination.

Once the CCO is made aware of the person’s intent to transfer from PHP, a member of the CCO’s enrollment team will contact them or their representative to complete the appropriate consent form. The CCO enrollment staff will also verify Medicaid eligibility and will contact the team at PHP to obtain copies of all required documents. Once the consent and required documents have been received, the CCO enrollment staff will submit the enrollment form to OPWDD via CHOICES. Upon enrollment into the CCO, the Care Manager will complete the necessary comprehensive assessment and Life Plan process. If the member was not previously enrolled in the HCBS Waiver, the Care Manager will work with the member to complete all necessary components of the HCBS Waiver application and supporting documents to submit to OPWDD for review.

For planned changes to Care Manager assignment, such as a member request or resignation with notice, the outgoing Care Manager is expected to notify members, families, and providers of the change. For unplanned changes due to unavoidable circumstances, the outgoing Care Manager’s immediate supervisor is expected to notify members, families, and providers. If the member is enrolled with LIFEPlan CCO and you are unsure of Care Manager assignment, you can call the Customer Care Center at 1-833-692-2269 or click here. They will direct you to the appropriate person. If the member is enrolled with ACA/NY, please contact the Care Manager Supervisor or Director for the new Care Manager’s contact information.

Life Plan meetings should be scheduled well in advance with the time, place, and attendees led by the member’s preference. The Care Manager is ultimately responsible for coordinating and scheduling the meeting with all parties. Once a meeting date is confirmed, the Care Manager is to send an invitation to all requested attendees. Approximately 2 to 4 weeks before the Life Plan meeting, the Care Manager will send a confirmation email or letter with the draft Life Plan and meeting reminder. Please let the Care Manager know if there is a change in staff to ensure the correct people are being invited.

Care Managers are a part of the circle of support and should attend pre-planning meetings when possible, unless the member requests otherwise. However, the Care Manager is not required to attend pre-planning meetings, and not having them in attendance should not prevent the meeting from proceeding.