Specialized Managed Care Transition for Individuals with Intellectual and Developmental Disabilities (I/DD)

Revised Draft New York State Medicaid Managed Care Organization I/DD System Transformation Requirements and Standards to Serve Individuals with Intellectual and/or Developmental Disabilities in Specialized I/DD Plans – Provider Led (SIPs-PL)

The New York State Department of Health (DOH) and the New York State Office for People With Developmental Disabilities (OPWDD) have undertaken a transition for people with intellectual and developmental disabilities (I/DD) to specialized managed care. Over the past two years, this process has been focused on two distinct areas: (1) improvement in care management processes using a home health model; and (2) creation of a policy framework for the implementation of provider-led managed care. This notice is published in order to update people we support, families, providers and other stake-holders on the progress we have made in these areas.

In July 2018, DOH and OPWDD launched an enhanced care management program to support individuals with developmental disabilities and their families. This program consolidated more than 350 agencies providing Medicaid Service Coordination into 7 regional Care Coordination Organizations (CCOs) providing Health Home Care Management. At the same time, we expanded the role of the new care managers, moving from OPWDD service-centric Individualized Support Plans (ISPs) to integrate and coordinate health and habilitative services through an expanded Life Plan. Approximately 100,000 individuals transitioned to this new model.

In August 2018, DOH and OPWDD released a draft version of the New York State Medicaid Managed Care Organization I/DD System Transformation Requirements and Standards to Serve Individuals with Intellectual and/or Developmental Disabilities in Specialized I/DD Plans – Provider Led (SIPs-PL) (hereafter referred to as the Qualification Document) for stakeholder review and comment.

The draft document was revised based on the feedback received and the revised draft is being released for further public comment. Additional feedback to this revised qualification document received during the second opportunity for public comment will be used to better inform the State on how best to implement a transition to managed care.

A link to the revised draft SIPs-PL qualification document is available below:

Please submit comments electronically to peoplefirstwaiver@opwdd.ny.gov no later than March 27, 2020.

OPWDD will be hosting an online webinar on February 19 at 2 PM to outline the content of the document and changes since August 2018. Follow the link below to register for the webinar: