Enacts the "people first act of 2016"

Section three of the bill amends section 13.15 of the Mental Hygiene Law, in order to require the Commissioner of OPWDD to conduct a geographic analysis of the supports and services in community settings available for individuals, with developmental disabilities and to identify gaps between required supports and services by region of the state. In addition, the Commissioner is directed to develop a web-based database which will permit the prioritization of the urgency of needs (P.D.N.S.) for supports and services for those facing emergency or immediate need, those facing critical need, defined as additional services and supports with one year and planning need, for those who will require additional services and supports within five years or where the Individual's caregiver is over sixty years old. Annual reporting requirements will allow the Executive and the Legislature make informed Policy choices in the delivery of supports and services to people with developmental disabilities.

Section four, of the bill makes technical, amendments. Section five is the effective date of the bill.

Justification

The New York State Department of Health (DOH) in partnership with the Office of People with Developmental Disabilities (OPWDD) proposed a new model for the financing of services for individuals with developmental disabilities to the federal government. The federal government no longer supports NY's current model for financing services and supports for people with developmental disabilities, The current model is based, in significant part, upon allowed costs for institutional placement, which are substantially in excess of actual costs of institutional placement, as institutional capacity has been reduced over the past 30 years, The state and the federal government had previously agreed that as institutional capacity was reduced, the funds otherwise used for institutional placement could follow the individual into the community. The use of these funds allowed NYS to create the current community-based service structure.

The state was authorized in the 2011-12 Enacted. Budget to submit a Medicaid waiver application, which OPWDD has called the "People First Waiver", in order to transition the current Medicaid "fee for service" longterm care services for individuals with developmental disabilities to a case management model.

The state is seeking authority to transition individuals served by the current service delivery system into mandatory enrollment in managed long-term care services. The core concept behind the "People First Waiver" application is an individual budget allocation built on a standardized assessment of individual support needs. Recognizing that people with developmental disabilities want to live their lives in the community, just like everyone else, OPWDD is racing to embrace the concept of a "self-directed person-cantered system, where individuals and their circle of support have considerable authority over what supports they receive, how they are received and from whom.

At the center of any system promoting self-direction is a personal budget allocation that the individual and his circle of support may apply within the bounds of an approved service plan to secure needed supports. The Center for Medicare and Medicaid Services (CMS) requires any "individual budget amount" to be "a prospectively determined amount of funds that the state makes available for the provision of federally funded services to an (individual)". Implicit in this definition are two key concepts: the state determines the budget amount for each individual, and the individual and/or his or her circle of support is provided this information before developing a service plan.

Legislative history

S.6420/A.9402 of 2011-12; Reported and Committed to Finance S1109D vetoed

Fiscal impact

To be determined.

Effective date

Immediately.