Office for People with Developmental Disabilities (OPWDD) and the People First Waiver. OPWDD and the Department of Health are working with CMS on an agreement called the People First Waiver, a 1915 (b)/(c) concurrent Comprehensive Home and Community Based Services (HCBS) waiver. This agreement will renew the OPWDD 1915(c) Comprehensive HCBS Medicaid Waiver for People with Developmental Disabilities and will also be the vehicle OPWDD uses to authorize the creation of a managed care delivery system for individuals with disabilities. The managed care delivery system will allow individuals to enroll on a voluntary basis in a Developmental Disability Individual Support and Care Coordination Organization (DISCO). Originally planned for October 2014, the state now expects that DISCOs will begin providing service in October 2015. DISCOs will be voluntary for both enrollees and providers and will be implemented in select geographic regions across the state. While the state hopes to create a mandatory managed care program for Medicaid beneficiaries with developmental disabilities, they expect that full implementation will take several years as DISCOs are established and approved. DISCOs will be prohibited from doing direct marketing, and all education and enrollment activities will be conducted by Maximus. The DISCO will be responsible for providing care management to its enrollees, based on the HCBS standards of the current 1915-c waiver, including the use of a care coordination team and coordination of care across waiver providers, specialists, behavioral health providers, and long-term care providers. OPWDD is reviewing Medicaid managed care standards regarding network adequacy to assess their relevance for the I/DD population. The state typically requires a minimum of two of each type of provider in a region, but the concern is that this standard may not be sufficient given the variety of needs of the population and the range of services included in the benefit package. OPWDD is also reviewing credentialing requirements for the DISCO, trying to determine the division of responsibility between plans and providers. DISCOS will be required to verify the license of all individual practitioners as well as ensuring that all Direct Care Support professionals are evaluated for core competencies. A self-directed program will be required of all plans. Finally, OPWDD must establish an independent ombudsman program, provide consumer education and advocacy services, and maintain a state-wide database on consumer concerns and complaints.
