ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
General Information
Q: Will this webinar be recorded?
A: Yes, the recording is available on both organizations’ websites.
• ACA/NY:
• LIFEPlan CCO NY
Q: Do we receive a certificate for our attendance today?
A: No, this webinar is not an official OPWDD training.
Q: Are ACA/NY and LIFEPlan CCO NY the same organization?
A: 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.
Q: What is your definition of “Provider”?
A: For the purposes of this presentation, when we say "provider" we are referring to agencies who
provide one or more OPWDD-funded services.
Q: What is the Federal Public Health Emergency (PHE)?
A: 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.
Q: How are you supporting the Direct Support Professional (DSP) workforce crisis?
A: 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.
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
Enrollment & Eligibility
Q: Do ACA/NY and LIFEPlan CCO NY have a department separate from Care Management that assists
families with obtaining OPWDD eligibility? Is there an age limit for who they will assist?
A: 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.
Q: Who reviews and approves enrollment into the Home and Community Based Services (HCBS) waiver?
A: OPWDD reviews the application for the HCBS waiver and makes the final determination.
Q: What is the process for someone who wants to transfer to a CCO from Partners Health Plan (PHP)?
A: 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.
Care Manager Responsibilities
Q: What is the expectation for notifying providers and caretakers when there is a change in Care
Manager assignment?
A: 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 NY and you are unsure of Care Manager assignment, you can call the Customer Service
Center here.
Q: What is the procedure for inviting providers to Life Plan meetings?
A: 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
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
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.
Q: Are Care Managers required to attend pre-planning/budget development meetings for Self-
Direction?
A: 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.
Q: Does the Care Manager complete the Request for Service Authorization (RSA) and Service
Authorization Request Form (SARF)? Is the Notice of Decision (NOD.09) OPWDD's approval response?
A: Yes. The Request for Service Authorization (RSA) is used when first applying for services as part of the
HCBS waiver application. The Service Authorization Request Form (SARF) is used to make changes to
existing services or to add a new service after the person has been enrolled in CCO services and the
HCBS waiver. The OPWDD forms are completed by the Care Manager. The NOD.09 lists the services and
amounts that are authorized. If a service was not authorized, reduced, or terminated, then the Regional
Office will list this on the NOD.09 and provide information on how to appeal the decision. Please refer to
this OPWDD memorandum for more information here.
Q: If a member is in a behavioral or health crisis, does the Care Manager take the lead on managing the
crisis? How does the Care Manager work with a certified residential provider on these issues?
A: Member health and safety is of the utmost priority and care management services help to ensure a
strong plan is in place so that crisis can be avoided. Care management is not itself a crisis service. When
a crisis is identified, the Care Manager will work with providers to develop an action plan and may take
the lead in coordinating a response. In a community setting, the Care Manager will work to ensure
health and safety by identifying appropriate supports and services and connecting the member to those
services. In a certified setting, the Care Manager will work with the provider’s internal teams, including
behavior and nursing services, to ensure a comprehensive response. In the event of an immediate
emergency, 911 should be contacted.
Q: If a member is enrolled in Basic HCBS Plan Support, has already had their two annual meetings, and a
crisis arises, will a Care Manager address the issue, communicate, and support the member and provider
if needed?
A: The regulations for the Basic Plan allow for two additional contacts per year. A member enrolled in
Basic can receive assistance from the Care Manager for crisis situations if they have already had two
annual meetings. However, depending on the situation and the issue, the Care Management team may
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
recommend that a member moves from Basic to Comprehensive Health Home Care Management to
ensure necessary services are in place.
Assessments & Documentation
Q: Will Coordinated Assessment System/Child and Adolescent Needs and Strengths (CAS/CANS)
assessments that were done virtually be re-done for accuracy?
A: The CCOs do not oversee the CAS/CANS process. CAS/CANs assessments are conducted by OPWDD. A
Care Manager may reach out to notify a member of an upcoming CAS/CANS assessments and can
provide documentation and feedback to OPWDD to help ensure the accuracy of an assessment. In the
event that the review of the CAS/CANS summary contains inaccuracies or errors, Care Managers follow a
specific written process as instructed by OPWDD. Members and families may also reach out to OPWDD
directly for assistance if they feel a CAS/CANS is inaccurate.
Q: How do we obtain DDP2 (Developmental Disability Profile) updates and LCED (Level of Care Eligibility
Determination) updates?
A: All waiver service providers are required to complete their own DDP2 for every member at least once
every 2 years. This is done independently of the DDP2 completed by the Care Manager and should be
based on observations that have been made in that specific program. The DDP2 should be reviewed and
discussed with the member, family, and Care Manager annually during the comprehensive assessment
process. This is important as the results may impact the member’s tier level, Personal Resource
Allowance (PRA) for Self-Direction, and Individual Service Planning Model (ISPM) score, which may affect
service authorization. There is no requirement for Care Managers to distribute DDP2s.
Q: How do we obtain LCED (Level of Care Eligibility Determination) updates? What if we are not listed on
the DOH-5055 or DOH-5201 consent form?
A: LCEDs are now completed and stored in CHOICES. Providers can find the updated LCED under
Supporting Documents in the member’s record. If the provider cannot locate the LCED in Supporting
Documents, they should contact the Care Manager. All active service providers must be listed on the
consent form. If they are not listed, the Care Manager must obtain the consent of the
member/representative.
Q: Were the Life Plans in CX360 reconciled to the last finalized Life Plan distributed before the Electronic
Health Record (EHR) transfer? How can we receive copies of Life Plans that took place prior to the EHR
transfer?
A: All documents including finalized Life Plans were migrated to CX360 as part of the EHR transfer.
Please contact the Care Manager for a copy of historical Life Plans. If the member has received services
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
from ACA/NY in the past but is no longer enrolled, document requests must be made by contacting the
Customer Service Center here.
Q: How can providers document a missing Life Plan review when a member is hospitalized or refuses to
meet?
A: When a Life Plan review cannot be held as scheduled, the Care Manager will communicate changes to
the member’s Interdisciplinary Team (IDT). If the member is hospitalized, the review will be rescheduled
after the member is discharged. If a member refuses to meet, the Care Manager will assess the
member’s needs to determine why they are refusing and help address the barrier to scheduling the
review. The provider should document all communication from the Care Manager to show good faith in
attempting to hold the meeting as required. The Care Manager can also reflect the reason for delay and
efforts to reschedule in the IDT summary once the Life Plan has been held.
Life Plans
Q: What is the process of developing the Life Plan?
A: Every member participates in an annual comprehensive assessment process which informs the
development of the Life Plan. In preparation for the Life Plan meeting, the Care Manager sends the
current draft Life Plan to the member/representative and all invited attendees of meeting,
approximately two weeks before the meeting. Once the meeting is held, the Care Manager completes
the remaining necessary updates to the Life Plan as discussed at the meeting, led by the member. The
Care Manager then submits the Life Plan to their supervisor for review and initial approval. The Care
Manager must send the approved plan to the member/representative for review and signature in order
for the plan to be considered finalized within 45 days of the Life Plan meeting. Providers responsible for
delivering services documented in sections II and/or III of the Life Plan must sign the Life Plan to
acknowledge and agree to provide the provider-assigned goals, supports, and safeguards associated
with those services, per the finalized plan. The Life Plan is then distributed to all applicable parties no
later than 60 days following the Life Plan meeting date.
Q: In Section IV of the Life Plan, should the effective date of the service match the original approval date
listed in CHOICES, or the date of the Life Plan review?
A: When services are newly added to the individual’s Life Plan after the initial Life Plan is finalized, the
effective date of each new service should correspond to the Life Plan review date on which the new
service was added to the Life Plan. For example, The Life Plan was finalized on 2/1/19. The individual
requests a new service, and a Life Plan review meeting is held on 5/15/19 to discuss this request. Day
Habilitation is added to the individual’s Life Plan during the Life Plan review meeting. The effective date
for Day Habilitation is 5/15/19. For subsequent plans, the effective date of the service will show as the
original effective date in CHOICES on the CR4. Please refer to the 6/2018 ADM “Transition to People First
CCO” here. Due to the data migration to CX360, providers may see a blend of this in Section IV until a
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
brand new plan is created in the system for the member.
Q: When changes are needed to the Life Plan, is it appropriate to wait for the next review, and when is it
necessary to complete an addendum? If someone is requesting to be discharged from a provider, how
soon should the Care Manager send the addendum?
A: It is best practice for the Care Manager to complete and distribute an addendum as soon as possible
after a change of service. On occasions where a Life Plan review has already been scheduled and is
occurring within a short timeframe, it may be more appropriate to wait until that date (ex: new service
is authorized on 11/8/22 and a Life Plan review was previously scheduled for 11/14/22).
Q: Can a member create their own Personal Outcome Measures (POM) that are not available in the
drop-down list? Is it possible to get a list of the Personal Outcome Measures (POM) drop-down options
available for a Life Plan?
A: No, members cannot create their own Personal Outcome Measures. Personal Outcome Measures are
set by the Council on Quality and Leadership (CQL) and cannot be altered. A complete list of Personal
Outcome Measures can be found on the CQL website here.
Q: Will there be a presentation to teach the families about the different sections of the Life Plan?
A: We will explore offering a Member & Family Forum on this topic in the coming months.
Staff Action Plans
Q: Does the Life Plan need to match the Staff Action Plan word-for-word?
A: The Staff Action Plan must be derived from and align with the member’s Life Plan but does not need
to match word-for-word. The habilitative goals/valued outcomes and safeguards/Individual Plan of
Protection (IPOP) are derived from the member’s Life Plan. The habilitation service must relate to the
individual’s habilitative goals/valued outcomes. Using the habilitative goals/valued outcomes as the
starting point, the details of the Staff Action Plan must describe the actions that will enable the
individual to reach his/her specific habilitative goals/valued outcomes. Please see the following Staff
Action Plan ADM here.
Q: Should we use the individual’s name in Staff Action Plan? Whose responsibility is it to share with
members, representatives, and other providers?
A: HCBS waiver service providers should refer to the Staff Action Plan ADM, which contains regulations
outlining the required content and distribution timelines.
ACA/NY | LIFEPlan CCO NY Provider Webinar
Q&A: Understanding CCO Care Management & the Role of the Care Manager
Q: We have been told by Care Managers that we must have 3 or more valued outcomes for the service
in the Life Plan and on the Staff Action Plan. What are the minimum number of goals and supports
required?
A: The minimum requirements are 3 goals and 2 Personal Outcome Measures (POMs). Please refer to
the CCO Provider Manual for more information, click here.
Q: What can be done to help a member quantify whether a goal/objective in their Life Plan has been
achieved? A presentation about the data driven resolution between achieving a Life Plan Personal
Outcome Measure/goal and agency Staff Action Plan would be helpful.
A: The goal/objective is identified by the member and the Interdisciplinary Team. The Staff Action Plan
developed by the Provider should be utilized to describe specifically what actions the staff will do to
assist the member in achieving the goal and what metrics that will be used to determine the member’s
progress in achieving the goal. We will explore offering a webinar on Life Plans & Staff Action Plans in
the coming months.
