CDPAANYS 2013 ANNUAL REPORT

2013 – Expanding Influence

2013 proved another very successful year for the Consumer Directed Personal Assistance Association of New York State (CDPAANYS), as well as for fiscal intermediaries (FIs), consumers and the program as a whole. However, despite the many successes, we are faced with new challenges as well, on both the Federal and State level – challenges that CDPAANYS is committed to addressing.

2013 saw the State continue its expansion to “care management for all”, or mandatory managed care or managed long term care for all Medicaid recipients and CDPAANYS engaged directly on a number of fronts to ensure that this transition occurred in a way that complemented consumer direction and the protected the integrity of CDPA.

CDPAANYS successfully fought for inclusion in the prompt-pay law. This protects FIs by requiring timely payment, and the payment of interest if such timely payment is not received. It also protects FIs in the event of a plan bankruptcy by making sure that they are on the same legal level as all other providers in bankruptcy proceedings.

The State continued its recognition of the important role CDPA plays, and took steps to expand that role. Governor Cuomo’s Olmstead Cabinet greatly expanded the role that CDPA will play in the future. Primarily, at the urging of CDPAANYS, the Cabinet concluded that CDPA will become the primary mechanism through which long-term community-based supports and services are delivered. This dramatic change in policy will alter the landscape of services for decades to come, and CDPAANYS will continue to fight to make sure it is implemented correctly.

CDPAANYS increased its policy presence, working with coalitions to increase our presence in major policy discussions. CDPAANYS joined the Steering Committee of the Coalition to Protect the Rights of Dual Eligibles in New York (CPRDENY), a coalition looking at MLTC and the Fully Integrated Dual Advantage (FIDA) program from a consumer perspective to ensure that consumer’s rights are protected.

 CDPAANYS also became dramatically more involved in the Medicaid Matters New York coalition, in part through our efforts leading the campaign to restore fair hearing and aid continuing rights for consumers. Our role in both of these coalitions has ensured that CDPA is considered as policy decisions are made, with more focus paid to access to CDPA and the steps necessary to ensure consumer success in the program and the community.

One critical policy challenge we saw this year was the implementation of the Companionship Rule changes at the Federal level. This rule will dramatically alter the landscape of consumer direction moving forward by indirectly limiting a consumer’s ability to hire workers for more than 40 hours in a week by creating a currently unfunded mandate requiring the worker to receive time and a half for hours in excess of that. CDPAANYS will work in 2014 and beyond to minimize the impact of this rule both nationally and on the State level.

Another challenge remains the examination of the Affordable Care Act and its impact of FIs, consumers and personal assistants. We will continue to examine IRS rules as they are issued to determine what role the FIs have as employers under this law and keep members appraised.

Overall, 2013 proved a successful year for CDPAANYS where we were able to again expand our reach and influence, growing the organization further and further establishing ourselves as the “go to” resource for consumer directed personal assistance.

Thank you,

2013 Notable Achievements

Secured inclusion of Fiscal Intermediaries under Prompt Pay law.

Established CDPAANYS as a leader in multiple statewide coalitions.

Worked closely with DOH and the Governor’s Olmstead Cabinet, resulting in CDPA being a critical component of all new managed care products and the default community-based care service moving forward.

Brought a New York specific approach to the companionship rule changes, meeting with the Office for Management and Budget, Senator Schumer and participating in a roundtable at the National Council on Disability.

Served as a major voice for consumers and personal assistants through the creation of a Consumer Advisory Committee and advocacy on fair hearings, aid continuing and wages.

Expanded support from fiscal intermediaries, managed care and other organizations for the 11th Annual Conference.

Secured inclusion of Fiscal Intermediaries under Prompt Pay law

The standard contract specifically exempted FIs from prompt-pay because we were not in the law. This led CDPAANYS to identify the addition of FIs to the prompt-pay law as a top priority for its 2013 Legislative agenda.

CDPAANYS was able to secure the inclusion of Fiscal Intermediaries in Prompt Pay insurance law §3224-a in less than 6 months.

As of April 1, managed care plans and MLTCs must reimburse a clean claim within 30 days or pay interest.

Leadership in Statewide Coalitions

CDPAANYS ensured that consumer directed personal assistance emerged as a contemplative factor in multiple statewide coalitions.

Coalition to Protect the Rights of Dual Eligibles in New York New coalition which focuses on the upcoming transition to the Fully

Integrated Dual Advantage program, or FIDA, for people eligible for Medicare and Medicaid.

Serve currently on Steering Committee, providing guidance to Centers for Medicare & Medicaid Services, New York Medicaid Choice (Maximus), NYSDOH, and Medicare Rights Center.

Medicaid Matters of New York Statewide coalition of over 140 organizations representing diverse interests

of Medicaid beneficiaries. Ensures strong consumer-driven policy and advocacy voice in Albany as state

government seeks Medicaid reform.

Olmstead CabinetCDPAANYS drafted recommendations for the Governor’s Olmstead Cabinet, participated in hearings held by the Cabinet and continues to work monitoring implementation. This led to a final report that dramatically increased the role CDPA plays in the State.

Olmstead Cabinet - Results

CDPAANYS efforts led the Olmstead Cabinet’s report to include: Including CDPA as the first option for people

accessing Community-based long term supports and services;

Including nursing homes in managed long term care to incentivize community-based services through cost;

Transferring 10,000 people from permanent placement in a nursing home to care in the community; and

Develop rate structures that will allow incentivize community-based care, even for highest cost consumers.

Implementing Managed Care Correctly

In 2013, CDPAANYS took the lead on communicating with members, plans and the Department of Health to resolve issues with the transition to managed care. Weekly calls were held for all members to inform

CDPAANYS and other members of issues. CDPAANYS has maintained regular contact with staff in

DOH in both the managed long-term care and mainstream managed care units.

CDPAANYS has worked with individual plans and the different plan associations to resolve individual issues where appropriate or necessary.

Implementing Managed Care Correctly

Issues identified by CDPAANYS have resulted in or contributed to the development of several policy documents that seek to protect consumers: Managed Long Term Care Policy 13.10 (issued May 8),

Communication with Recipients Seeking Enrollment and Continuity of Care

Managed Long Term Care Policy 13.17 (issued June 14), Care Management Administrative Services Agreement Guidance

Updated CDPAS Guidelines, detailing the rights and responsibilities of both plans and FIs in the managed care environment. (June 6)

Fighting for Consumers and Attendants

Led an effort to mobilize consumers around the issue of protecting due process rights within managed long term care.

Coordinated six press conferences and rallies around the state on due process, prompt-pay and the guarantee of adequate reimbursement for personal assistants.

Created an internal Consumer Advisory Committee to better serve and represent needs and priorities of consumers and their personal assistants.

Representing New York at Federal Level

CDPAANYS continued its advocacy against the United States Department of Labor’s (DOL) proposed revisions to the Fair Labor Standards Act: In April, CDPAANYS was one of approximately 25 organizations

that participated in a national forum coordinated by the National Council on Disability. This meeting allowed CDPAANYS to provide the impact these regulations would have on CDPA in New York.

CDPAANYS convened a group of consumers that met with Senator Charles Schumer to discuss the impact the proposed changes would have on seniors and people with disabilities, securing his support and putting him in contact with key allies to move toward a resolution that protects those who rely on consumer direction.

CDPAANYS met with the Office of Management and Budget with Concepts of Independence consumer and advocate T.K. Small to advocate for exclusion of consumer direction in the final regulations.

Affordable Care Act Companionship Rules

CDPAANYS is looking at many issues that will impact members: Is the FI the employer

for the employer mandate?

What is the benefit package?

Are there things that can change the impact on FIs?

CDPAANYS is still examining prior to January 1, 2015 implementation: Are FIs employers? How does the travel

pay get implemented? How does the overtime

rule correspond with role of FI?

Analyzing Federal Rules

11th Annual Conference

11th Annual Conference

The conference hosted a range of expert presenters in the fields of Medicaid, Managed Care, OMIG, Plan/FI Roles, Appeals and Due Process, and Changes to the Medicaid System.

CDPAANYS Annual Conference continued to grow in 2013, receiving unprecedented support from managed care organizations and technology companies.

The Annual Conference had seven vendors and six sponsors in 2013, providing attendees with information about a diverse range of industries: insurance, telephony software, accessible transportation, safety group options and more.

Margaret O. Willard and NYSDOH were awarded with the Sally Johnston Award for Advocacy and Constance Laymon Excellence in Leadership Award, respectively. Ms. Willard for her career long work to better CDPA and NYSDOH for advancing CDPA as part of the Medicaid Redesign Team.

Membership Growth

CDPAANYS members operate in all but five counties.

CDPAANYS members represent about 6,500 consumers, approximately 60% of all consumers using the program statewide.

Consumers working with CDPAANYS members employ approximately 11,000 personal assistants.

2012 Member Map 2013 Member Map

Membership Growth

Consumer Directed Personal Association of New York State272 Broadway

Albany, NY 12204

For more information about CDPAANYS or for information on joining as an Individual, Affiliate or Provider Member, please

contact us at 518-813-9537 or info@cdpaanys.org.

www.cdpaanys.org

QUARTER 1 - 2014

ADDENDUM

2014 Budget Victories

CDPAANYS had a very productive budget season:Successfully fought for inclusion in the Vital

Access Providers’ Program (VAPP), with specific language to address the Companionship rule changes.

Restored the ability of consumers to receive aid continuing in MLTC when services are reduced or terminated.

Played a large role in securing agreement on Community First Choice (CFC), to likely pass in first weeks after budget.

Unprecedented Support

CDPAANYS worked with NYAIL and brought over 100 people to Albany for a Lobby Day.

Community, Work and Independence (CWI) joined to bring CDPAANYS to its highest level of membership in years, and expand the organization to all but five counties.

CDPAANYS continued to be recognized as the expert in CDPA, providing educational sessions on maximizing use of CDPA to more managed care plans, including Agewell, Emblem and United.