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    NY Alliance Statewide and Regional Housing Collaboratives 2019-2021

    NY Alliance Statewide and Regional Housing Collaboratives 2019-2021

    Regional Housing Collaboratives (RHCs)

    • Develop 5 RHCs, one in each OPWDD region, comprised of housing stakeholders
      • insure representation by persons from cultural and linguistic minorities
    • Facilitate 2 meetings/year in each of the 5 regions- lead by MHN, Project Director, & Project Manager (30 meetings total- 10 meetings/year for 3 years)

     

    First Year

    • Identify membership
    • Identify 15 persons interested in un-certified housing
      • Schedule planning sessions
    • Establish connection with local and central OPWDD
    • Schedule minimum number of RHC meetings- more if needed
      • Annual learning journey and at least 1 in person meeting
    • Identify, by region, persons interested in participating in training (especially persons with IDD and their families)
    • Identify between 12-15 people regionally who will participate in SLI
    • Identify local resources to post on HRC
    • Create/execute Regional specific workplans within 6 months
    • Project Director will meet monthly with all MHNs and confer with members of RHCs

     

    Advisory Group

    • Create a regional advisory group to oversee grant operations/communications

     

    Master Housing Navigator (MHN)

    • Identify, train (graduate from Master Housing Navigator Curriculum) and contract with one MHN lead per region (5 MHNs) by month 3
    • MHNs will facilitate the RHCs and coordinate with statewide activities
      • Facilitate 2 meetings/year, in month 5 and 10, in each of the 5 regions- lead by MHN, Project Director, & Project Manager (more than two meetings/year if necessary)
      • Identify membership in RHC
      • Identify 15 persons interested in un-certified housing (3 months)
        • Outreach to OPWDD, providers, advocacy and family groups
        • Schedule planning sessions
      • Establish connection with local and central OPWDD
      • Identify, by region, persons interested in participating in training (especially persons with IDD and their families)
      • Identify between 12-15 people regionally who will participate in SLI
      • Identify local resources to post on HRC
      • Project Director will meet monthly with all MHNs and confer with members of RHCs
      • MHN will prepare an interim report for Project Director and NYAII’s CEO 2 times per year (2 per year for 3 years- 6 reports per MHN
      • MHN will prepare one final report at the end of each year (3 total/ 5 MHNs over grant period- 15 total)

     

    • The Project Director will meet monthly with all MHNs to ID best practices, and resolve any issues
    • Each MHN works with 3 individuals, per year, to develop non-certified housing opportunities (15 individuals/year for 3 years)
      • Work directly or as an advisor to create a plan
      • Each housing plan will be evaluated on outcomes for the person and the process
        • Process indicators- time from development to moving; impediments to the process

     

    45 Individuals moving to non-certified homes (15 each year for three years)

    • The NY Alliance will create materials covering several topics to be used by OPWDD to educate potential participants:
      • Why consider uncertified housing
      • Pros and cons- comparing certified with non-certified housing
      • Examples on non-cert housing including Shared Living and Self-Direction
      • How non-cert housing options are developed and financed
      • Safeguards
      • How to find housemates
      • Employing Assistive Tech to insure success
      • And for families- “how to sustain non-certified housing over time” and “what happens when I am gone?”
        • Materials will reflect comprehension level of individuals with IDD
        • Multiple formats for distribution including written, web-cast, presentations etc.
      • Project Director will identify select 3 individuals per year per region who want to move from their current 24-hour/ day settings (based on outreach to OPWDD, provider agencies, advocacy and family groups)
      • Each individual moving to a non-certified home will receive training on tenant rights and responsibilities

     

    Statewide Learning Institute

    • Annual SLI Summit for Regional Housing Coordinators (total of 3)
    • Series (number?) of events throughout the year for RHCs
      • 20 topics over the three-year grant
        • Some core courses offered each year
        • Some content offered only once
        • Housing Resource Center website can translate into over 100 languages
      • Variety of formats- including open-source learning systems
      • Posted on the Housing Resource Center website
    • 60-75 participants/year representing 5 regions
    • Three Learning Tracks
      • Work with developers/use of tax credits
      • Becoming a housing navigator
      • Repurposing cert. sites-Developing uncertified housing
        • ID 3 providers interested in repurposing at least 1 property
        • Develop proposal for the property, submit to OPWDD

     

    Housing Resource Center

    • Augment the Resource Center to include non-cert housing options and resources, replicable tools and best practices
      • With assistance from MHNs, RHCs and Housing Navigators
      • Variety of formats
    • Create a targeted training for landlords re: interactions with persons with disabilities, the OPWDD system and the benefits of leasing to persons with IDD

     

    Evaluation/Dissemination/Sustainability

    • Evaluation
      • Work with an independent evaluator to develop and administer pre/post survey on quality of life indicators and social determinants of health for the individuals moving to a non-certified home- each person in the pilot (15/year)
      • Develop Eval tool for process and outcomes (year 1)
      • HRC website evaluated by 2 of the 5 regions annually
      • Electronic surveys after each educational session
      • Statewide and regional collaborative evals reviewed annually by NY Alliance Advisory Committee
      • Final report reflecting overall process and outcomes posted on HRC and distributed electronically to all RHC members (year 3)
    • Sustainability
      • Toolkit and sustainable culture of collaboration (year 3)
      • Seek funding sources beyond grant
      • Use revenue generated from educational sessions to provide community ed and tech assistance
      • Advocacy for HN services to be reimbursable under the waiver

     

    Miscellaneous

    • Create and administer educational materials, programs and learning opportunities for individuals and family members on the range housing opportunities.
    • Provide strategies to promote conflict resolution surrounding housing through person centered planning
    • ** Education on non-cert options will be developed and provided in multiple formats- webinars, podcasts, in person, written and visual materials and tech support
    • A menu of training will be offered over a three-year period in a variety of modalities. Stakeholders pick and choose- (Is there a number of trainings? Times per year?)

    Statewide and Regional Housing Collaboraitves

     

    The NY State Developmental Disabilities Planning Council (DDPC) awarded a three-year grant to The New York Alliance for Inclusion and Innovation (NY Alliance) to create housing options for People with Intellectual and Developmental Disabilities (I/DD). 

    The grant will fund the New York Alliance Statewide and Regional Housing Collaboratives which will create a pilot program in each of the OPWDD Regions: 

    • Western New York and the Finger Lakes,
    • Central New York, Broome and Sunmount,
    • Capital District, Taconic and the Hudson Valley,
    • New York City,
    • Long Island.

     

    The regional pilots will provide housing plan development services to a total of 15 people with I/DD and continue to recruit and add 15 more people each year from the regions to receive services that will help them transition from their current home to the home they wish to create.

    In addition to the pilots, the New York Alliance Statewide and Regional Housing Collaboratives will enhance the New York Housing Resource Center (HRC), an online resource, into a central hub of accessible information for:

    • Advocates and professionals supporting people in finding housing options, including provider agencies,
    • People seeking to provide housing options, and
    • People seeking housing options.

     

    The HRC will be a valuable resource containing webcasts, podcasts, and other resources to facilitate housing options.

    This grant program will offer trainings for people seeking housing options, as well as trainings for potential landlords.  A Statewide Learning Institute will be held to engage in facilitated conversations to highlight key learnings, successes, barriers and other pertinent information.  They will consist of the following three learning tracks:

    • How to Work with Developers to Create Affordable Housing, including the Use of Tax Credits.
    • Resources and tools to Navigate housing options.
    • How to Repurpose Existing Certified Properties and Leverage their Equity to support the Development of Uncertified Housing.

     

    In addition to people seeking housing options and those seeking to provide opportunities, this grant program will bring together Master Housing Navigators, (MHNs) and Regional Housing Collaborative networks to bring together a full range of stakeholders to be a resource to each other, providing experience and advice to create more options.

    For more information about this program contact Co-Directors, Carol Napierski at [email protected] and John Maltby at [email protected].

    Self-Direction Frequently Asked Questions

    Frequently Asked Questions (FAQs) on FI and Self-Directed Services

    Q: Please explain the liability of Direct provider services on an FI? If the FI does have liability responsibility towards Direct Provider services, please specify how an FI is responsible for the billing actions of another agency and how this should be addressed by FIs with Direct Providers?

    1. What if the Direct Provider fails to provide billing information regarding their services within a self-direction budget to an FI?

    A: FIs have a responsibility to monitor and track any services included in a SD Budget, as a duty described in ADM 2019-07. The HCBS Waiver specifies that FI will not be reimbursed for services and supports that are above the PRA.

    As such, there is a potential FI liability if the DPP services is not reported or if PRA is exceeded due to DPP over utilization. It is important for the FI to establish working relationships with other providers that allow it to monitor and track services delivered by those providers. The person-centered planning process and Life Plan meetings should be primary tools to facilitate the arrangements. Authorization amounts for DPP services are contained in the Life Plan as well.

    Pending a formal review protocol, situations would be reviewed on a case by case basis. If an FI encounters a DPP provider that is resistant to sharing the utilization information they should make attempts to coordinate and obtain the information, document these, ask the OPWD DDRO to intervene, and estimate based on authorization as a last resort.

    Q: Follow up question on the Direct Provider:  If OPWDD is stating that the FI a liable for potential overbilling of a Direct Provider services, is OPWDD communicating to Direct Providers this information?

    1. If not, what is the responsibility of the Fi in relaying this information and what recourse does the FI have for noncompliant Direct Providers? Are Direct Providers being educated on Self-Direction services by OPWDD?

    A: OPWDD is communicating and addressing this as relevant and assessing options for broader communication. Regardless, this topic needs to be covered during the person-centered planning process and discussed as part of that function.

    Q: Is there a way to report formal issues and concerns to Central office regarding independent brokers?
    A: Yes, FIs and directly email the SD Broker Mailbox, [email protected] Upon contact from an FI or DDRO, the mailbox will provide a compliant form. The compliant will be logged and addressed as appropriate. Advocates and other parties should contact the DDRO or FI, who will contact the Broker Mailbox. 

    Q: We are being told by OPWDD that FIs are responsible for Broker services when the broker is nonexistent/unresponsive. We are hoping you can expand on these expectations and provide information on where this information is provided in guidance and /or ADMs for clarification? – Can the FI bill for broker services without a broker agreement on file?
    A: Where Support Brokerage is an HCBS Waiver service, once it is authorized by OPWDD for the person and the Service Provider (FI) agrees to provide it, the FI does have an obligation to provide the person with the service, this relates to the 633.12 Regulation. A broker is either an agent or employee of the FI. If they are no longer available, it would be expected that the FI assists the person in finding a new broker. The DDRO can be contacted to assist with this.

    There are not exceptions to the billing standards. An FI could help a person with broker services from an internal broker. However, if the services are billed as brokerage, they need to be supported as such – including with a broker agreement, even if it is temporary. It would not be expected that an FI must provide brokerage without reimbursement indefinitely. However, it they are unable to help the person access this service, it would need to be handled as a service termination.

    Q: Can a broker terminate a case without another broker found?
    A: As part of a planning team and an agency or employee of the FI, the Broker should be working to prevent gaps in service. However, ultimately a Broker can not be prevented from walking off the job. If the FI/DDRO feels this is being done in a manner to attentionally cause harm, that should be filed as a complaint to the SD Broker mailbox.

    Q: What can brokers do when families/individuals are refusing to find a new broker after providing sufficient notice of no longer providing the service or the need to drop the case/individual?
    A: Brokers can work with the person, their Circle or Support and the DDRO to determine why the person/designee is refusing to find a new broker and work on resolution steps. It should be made clear that to self-direct with Budget authority the person must have either a paid broker, or a qualified person who has agreed to act in the capacity. Also, the person/designee cannot force a broker to work for them against their will. Assistance and reasonable deadlines should be provided, but ultimately a broker can unilaterally terminate a case.

    Q: What are an FIs recourse when a broker fails to distribute a Staff Action Plan within 60 days to all necessary parties?
    A: Where the Broker is either an agent or employee of the FI, this should be primarily addressed as part of contract or employment agreement between the FI and the Broker. The FI is ultimately obligated to meet the billing standard for the habilitation service if billing for the service is submitted. If a Broker is failing to do their job, this can be reported to SD Broker mailbox.

    Q: Respite mileage – is mileage provided to respite staff built into the respite rate? If so, is mileage required to billed out of the staffing line or is respite mileage allowed through IDGS mileage?
    A: Mileage is not built into the respite rate. It is allowed to use IDGS transportation related to self-hired respite, which likely makes sense in most situation given that the rate for this service leaves little cushion above minimum wage for expenses like transportation.

    Q: How does the 90-day billing rule apply to IDGS and OTPS services?
    A: This question comes up frequently, especially during FI transition scenarios.

    IDGS and OTPS have unique considerations for billing as they are reimbursement services, whether reimbursement is being made to the person/designee who made the purchase, or directly to the vendor. In addition, because IDGS is MA funded and OTPS is State funded, there are differences between the two. The good news is that the rules are generally generous in terms of maximizing the FI’s opportunity to bill.

    For IDGS, the 90 clock starts on the Date of Service (DOS). The DOS will be the date the good/service was purchased, or reimbursed by the FI, whichever occurs later. This is because MA requires a service to happen prior to billing. It also means that if the FI has not made the reimbursement, the DOS has not occurred 90-day clock has not started.

    For OTPS, the service month is considered. The 90-day clock start at the end of the service month. The service month is determined based on when the liability is incurred by the contract holder. That is, the FI. So, if someone sends their July phone bill to the FI in September, the service month is September – not July. This allows for ample time for billing.

    This should not be construed to indicate that there is an unlimited “begin” date for reimbursements to be submitted by the FI. Good judgement and business practices should be applied to individual scenarios, but in general a reimbursement should never qualify if the item/service was purchased prior to the approval of the person’s SD budget.

    Q: Does an FI Operating Certificate cover all services in a Self-Direction Budget?
    A: When an OPWDD Provider obtains an Operating Certificate for Fiscal Intermediary Service, it will cover FI, Live-In Caregiver, IDGS, Support Broker, and Self-hired CH, Respite, SEMP. State Paid services are covered by the OSC contract.

    However, it must be noted that non-self-hired CH, Respite and SEMP – both Agency Supported and traditional, are not automatically authorized. It is recommended that additional operating certificates for these services are obtained.

    Q: Must providers of IDGS, FI or broker services have a provider assigned goal in sections 2 or 3 of the Life Plan?
    A: For non-habilitation services (e.g., IDGS), an assigned “My Goal/Valued Outcome” is not mandated. Justification in the Life Plan for non-habilitative services included in a Self-Direction budget can be provided through “My Goal/Valued Outcomes in either section II or III, or by needs described in the narrative section (section 1).

    Each habilitation service in the Self-Direction budget (e.g., Community Habilitation) must have a provider assigned “My Goal/Valued Outcome” in Section II or III of the Life Plan.

    Q: May a person employed by the FI provide self-directed staffing support?
    A:  Only as co-employed self-hired staff. The intent of the restriction is to avoid conflicts of interest. It applies to employees of providers other than the FI or, employed by the FI in roles other than the provision of Self-Hired Community Habilitation, Respite or Supported Employment. It also applies to employees of any not for profit organization, whether or not that organization is involved in the delivery of supports to persons with I/DD.

    Q: This is an update from the first FAQ. A person who provides self-directed staffing support through IDGS may be someone who provides self-hired CH, Respite or SEMP to that person or other people?
    A: Correct, but it would be important that they keep responsibilities distinct and do not overlap times.

    Q: Travel out of state- Can you address the expectations of someone traveling out of state and still needing SD services.
    A: With the April 10, 2019 release of ADM 2019-02, there are now consistent standards for OPWDD services delivered out of state – both SD and not SD. Refer to the current ADM for the standards in specific scenarios (https://opwdd.ny.gov/opwdd_regulations_guidance/adm_2019_02).

    Q: May a person receiving SD living with family members receive Live in Caregiver supports?
    A: A participant who lives with family members in the family home is eligible for Live In Caregiver supports, with caveats.

    First, no family member may provide Live In Caregiver support.

    Secondly, as stated in ADM 2016-3, the participant must “live in his/her own home or leased residence” and must be “directly responsible for the residence”. This might be achieved, for example, if the family leases the residence and the SD participant’s name appears on the lease as a lessee. In this example, the participant may also qualify for a housing subsidy.

    Similarly, if the participant leases an in-law type apartment from his or her parents, the participant could be eligible for Live In Caregiver supports. The apartment must be a legal dwelling according to local law and regulations and otherwise legally rentable to any person in the community.

    Or, if the family home is owned by a trust and the participant’s name appears on a lease between the family and the trust, Live In Caregiver supports may be provided.

    Finally, a participant cannot lease just a room from his or her family. As stated above, the residence must be a legal dwelling.

    Q: Can the costs related to attending a conference be reimbursed through a SD budget?
    A: It depends. A conference could meet the criteria of a community class if it teaches a subject related to the person’s Life Plan goals, is open to the public, has published fees and meets the other requirements.

    If not allowable as a class, it could be explored as OTPS – but would need to pass all for tests. In either case, the reimbursement would be for the conference. Lodging is generally considered an activity fee or related expense and would be outside reimbursement. For bundled conferences, it may be possible to explore non- bundled invoices.

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    Q: How are organizations that offer direct provider supports advised that persons they have supported have started self direction? If they are not advised, they risk losing money as they might provide unauthorized services. What is the mechanism to insure direct providers are utilizing the correct number of authorized hours? 
    A: A variant of this question was addressed previously. FI's have a responsibility to monitor and track any services included in a SD plan. The FI may face liability if the PRA is exceeded or if any particular service, such as Community Habilitation, exceeds authorized levels. It is important for the FI and any partner agencies, including those that provide direct supports, to establish working relationships that allow them to monitor and track services. Care managers, brokers, FI's and providers need to be at the table together and all need to reference the Lifeplan.

    Q: How are self-hired staff paid when they attend required orientation/training?
    A: This issue is addressed in the most recent guidance document: “Employee time spent receiving employer-mandated training typically constitutes "time worked" and should be paid as such. Although employee training time does not represent billable service time, the employment costs (wages + fringe assessment) associated with such training do represent a reimbursable cost of delivering the self-hired service. As such, training-related employment costs may be included in the billed service charges for the service date the employee training is attended. If there were no claimable service units for the person on that particular day (e.g., all of the person's self-hired community habilitation staff attended training that day, there was no substitute staff, and, therefore, the person did not receive any billable community habilitation service units that day), the training-related employment costs may be added to the regular charges on the next day claimable service units were delivered. Training should be scheduled and paced to minimize the potential of exceeding the effective reimbursement rate (ERR) caps.”

    The following example may help to illustrate this guidance:

    Total Employment Cost

    _______ = Effective Reimbursement Rate (ERR)

    Billable Hours
    Total Employment Costs = Direct Employment Costs + Indirect Employment Costs
    Direct Employment Costs = (Billable Work hours X Wage Rate) + (Indirect Service Time* X Wage Rate)
    Indirect Employment Costs = Direct Employment Costs X Fringe Rate OR Direct Account of all costs not associated with Wages
    *Indirect service time constitutes hours a Self?Hired staff was required to work, but billable services (as defined in the relevant Administrative Memorandum) were not delivered. Examples include attendance to a mandatory training, completing documentation, and overnight/asleep.

    Example: 24/7 coverage using Self?Hired Staff delivering Community Habilitation
    One week period.
    5 Staff, 8 hour shifts, including overnights. Assume all awake hours are billable.
    Staff #1: $15/hr – 40 hours
    Staff #2: $13/hr – 40 hours
    Staff #3 (asleep): $11/hr – 40 hours
    Staff #4 (asleep): $9/hr – 16 hours
    Staff #5: $14/hr: 32 hours
    Fringe = 25%
    (15 x 40) + (13 x 40) + (14 x 32) + (11 x 40) + (9 x 16) x 1.25/ 40 + 40 + 32 =
    2690/112 = $24.00 ERR ( Hourly Unit Cost)

    Q: According to the most recent Guidance Document, “The FI will require utilization information for services delivered by other agencies to be reflected in the person’s expenditure reports.” What is the FI’s responsibility to ensure expenditure reports accurately reflect services delivered by other agencies and what is the FI’s liability, if any, if another agency exceeds the authorized expenditure level?
    A:While the FI does not deliver those services, it has a responsibility to monitor and track any services included in a SD plan. The FI may face liability if the PRA is exceeded or if any particular service, such as Community Habilitation, exceeds authorized levels. It is important for the FI to establish working relationships with other providers that allow it to monitor and track services delivered by those providers.

    Q: May a person employed by the Fiscal Intermediary provide Self-Directed Staffing Support?
    A: This is an update from the first FAQ. A person who provides Self-Directed Staffing Support through IDGS may be someone who provides self-hired CH, Respite or SEMP services to that participant or other participants.  However, they cannot be otherwise employed by any not for profit agency.

    Q: Are persons who provide IDGS supports (e.g. clinical supports, paid neighbor supports, staffing supports) limited to contractor status or may a FI directly employ those persons?
    A: OPWDD will not comment upon whether a particular provider of IDGS supports meets the criteria for either an employee or contractor. That question should be referred to the FI’s Human Resource Department and to its human resource counsel. However, there is no prohibition on a provider of IDGS supports being an employee of the FI. So, someone providing paid neighbor supports or clinical services through IDGS may indeed be employed by the FI.

    Q: What are OPWDD's training requirements for self-hired staff?
    A: Please see Attachment E in OPWDD’s most recent guidance document where training requirements are addressed in detail. The key to understanding Attachment E  is to know that mandated training for self hired staff is identical to mandated training for non-self hired staff in more traditional services (with the exception of SEMP. Please see the relevant ADM). More information on OPWDD’s training requirements may be found on its website here.

    Q: The Guidance Document states that a Live In Caregiver may not be related by “blood or marriage” to a SD participant nor may a “family member” provide Paid Neighbor supports. Elsewhere in New York’s waiver, an exception to these exclusions is provided:
    In extraordinary circumstances, the following are exceptions to this policy:
    -The Commissioner or designee may authorize a parent or legal guardian of an adult child (over the age of 18) to be paid to provide waiver services, when it can be clearly documented that the arrangement is in the best interests of the participant.
    -The Commissioner or designee may authorize an otherwise qualified relative who resides in the same residence as the participant to be paid to provide waiver services when it can be clearly demonstrated that the arrangement is pursuant to the participant's choice, is in the best interests of the participant, and does not potentially jeopardize the health, safety, rights and informed choice of the participant.
    Does this process to seek an exception also apply in SD? If not, why are SD participants not offered the same service exceptions as other persons enrolled in the waiver?
    A. These exceptions are not applicable to the Live-In Caregiver and Paid Neighbor services. Family members are explicitly restricted from providing those services.

    Q: The Guidance Document states that a person who provides the IDGS “Staffing Support cannot otherwise be employed by a not for profit agency”.  Please clarify the intent and meaning of this restriction.
    A: The intent of the restriction is to avoid conflicts of interest. It applies to employees of providers other than the FI or, employed by the FI in roles other than the provision of Self-Hired Community Habilitation, Respite or Supported Employment. It also applies to employees of any not for profit organization, whether or not that organization is involved in the delivery of supports to persons with I/DD.

    Q: Are persons who provide Staffing Support considered employees or contractors of the FI?
    A: OPWDD does not generally provide legal guidance on human resource or wage and hour questions. This question should be referred to the FI’s Human Resource Department and to its human resource counsel.

    Q: During a hearing for an employee who provided both Community Habilitation and Paid Neighbor services, the Department of Labor indicated that the person should be treated as an employee when providing either service.
    A: OPWDD does not generally provide legal guidance on human resource or wage and hour questions. This question should be referred to the FI’s Human Resource Department and to its human resource counsel. Another good resource is New York Alliance’s Toolkit for Providing Shared Living in New York

    Q: May a FI contract with a staffing company to serve as the employer of record for direct support workers hired by individuals doing self-direction? It would still manage all other FI tasks (working with the individuals on their budget, etc.).
    A: Such a contract would be permissible. OPWDD would still view the Self-Hired staff as co-employed between the individual and the agency.OPWDD would advise a FI considering such an arrangement to consult with human resource professionals and attorneys to insure compliance with all applicable wage and hour laws and regulations.

    Q: We support a person who attends a rowing class that has been modified for persons with physical disabilities. Are the costs of that class reimbursable?
    A: Yes, as long as the class is not restricted to only persons with I/DD. If the class has been modified for persons with physical disabilities and is not restricted to only persons with I/DD, its costs are eligible within IDGS.

    Q: Why are children under the age of 18 prohibited from accessing the OTPS category of Personal Use Transportation?
    A: There is no explicit restriction on children under the age of 18 accessing Personal Use Transportation. However, in general, OPWDD considers routine transportation unrelated to valued outcomes to be part of a family’s responsibility. If Personal Use Transportation is part of a child’s SD budget, such transportation must be related to a Valued Outcome, as documented in the child’s ISP.

    Q: May a SD participant who still lives in the family home with family members receive Live in Caregiver supports?
    A: A participant who lives with family members in the family home is eligible for Live In Caregiver supports, with caveats.
    First, no family member may provide Live In Caregiver support.
    Secondly, as stated in ADM 2016-3, the participant must “live in his/her own home or leased residence” and must be “directly responsible for the residence”. This might be achieved, for example, if the family leases the residence and the SD participant’s name appears on the lease as a lessee. In this example, the participant may also qualify for a housing subsidy.
    Similarly, if the participant leases an in-law type apartment from his or her parents, the participant could be eligible for Live In Caregiver supports. The apartment must be a legal dwelling according to local law and regulations and otherwise legally rentable to any person in the community.
    Or, if the family home is owned by a trust and the participant’s name appears on a lease between the family and the trust, Live In Caregiver supports may be provided.
    Finally, a participant cannot lease just a room from his or her family. As stated above, the residence must be a legal dwelling.

    Q: Can the costs related to attending a conference be reimbursed through a SD budget?
    A: Yes, a conference may be considered a Community Class within the IDGS category, if it meets the four criteria specified in the Guidance Document. If it meets those criteria, registration fees for a conference may be reimbursed as could travel costs to and from the conference if they meet the Guidance Document criteria. In no instance, however, are separatelodging costs reimbursable as they are considered to be activity fees and therefore are not reimbursable.

    Q: We recently heard from one of our liaisons that a participant is not eligible for Agency Supported Community Habilitation for their day service if he/she has a “residential only” budget. We believe this is institutional bias, because someone who lives in an IRA can have ASCH for their day service. This is how we have been supporting people who need 24/7 supports. How can this be rectified?
    A: A person with a “residential only” budget is indeed eligible for Agency Supported Community Habilitation. See the table on page 51 of the most recent Guidance Documentwhich lists the services available within each type of self-direction budget. The Community Habilitation ADM governs these services.

    Q: Are participants who attend overnight summer camp allowed to have self-hired or provider purchased comm hab staff working with them on or off premises?
    A: Summer camp may be funded as either an IDGS service (if the camp is not already waiver funded) or as a Direct Provider Purchased service (if the camp is funded as a waiver service). In either instance, the funds are used to pay for camp tuition. If the camp is billing Waiver Respite, then self hired staff may not be paid as this would constitute double billing. If the camp is not billing a waiver service, the self hired staff may provide services (such as Community Habilitation) as long as a documented habilitative need has been identified in the person’s ISP and Hab Plan. The same logic applies to self hired staff providing supports to a person while attending a Community Class, health club or other organization funded by IDGS.

    Q: Are self-hired staff permitted to observe a person who administers his/her own medications?
    A: There is no prohibition on simple observation, as long as the self hired staff person does not improperly assist with the administration of the medications.

    Q:  May a Live In Caregiver provide support with physical dependency needs or Activities of Daily Living?
    A: The role of a Live In Caregiver does not include providing support with activities of daily living. However, there is no prohibition on an individual who is a Live In Caregiver also providing other waiver services, such as Community Habilitation.  Live In Caregiver and Community Habilitation are discrete waiver services and may be provided by the same individual to one participant.When exploring these types of dual role situations, it is important that the provider is aware of and complies with the applicable labor laws relating to caregivers living in an individual’s home.

    Q: Can a person providing Paid Neighbor supports also provide Community Habilitation services to the same individual?
    A: Yes, that is core concept of the Paid Neighbor support. Paid Neighbor, within Individual Goods and Services (IDGS), is an on-call stipend. If the paid neighbor is called to duty, they need to be paid for the delivery of self-hired or agency supported community habilitation for the time worked. IDGS and Community Habilitation do not duplicate eachother.

    Q: We would like to not have to collect receipts from restaurants, etc. Does OPWDD require such receipts? If so, are scanned and uploaded electronic receipts permissible?
    A: Receipts are required only for staff related reimbursements, such as for meals and activity fees within OTPS. OPWDD has no specific requirements regarding the form of those receipts although it considers paper originals to be best practice.

    Q: Does the Social Security Administration consider the Housing Subsidy to be income to the person?
    A: As long ago as 1994, then OMRDD reached an agreement with the Social Security Administration and with the then New York Department of Social Services that ISS services will not adversely affect a person’s Social Security eligibility, benefit level or Medicaid eligibility.

    Q: Is there an annual cap on Support Broker services?
    A: There is no annual cap on Support Broker services. However, since their costs count against the participant’s Personal Resource Account, care should be taken when considering how much to budget in this category. And it is important for the FI to beware of potential abuse of this service…if requested hours of SB services appear excessive, the FI should require justification.
    There is an annual cap of $2400 on Start Up broker services. This does not count against the participant’s PRA.

    Q: We have been told that SEMP and Respite rates are determined by the location of the FI and not by the location of the service recipient. Please clarify.
    A: SEMP fees are determined by the program that the individual is enrolled in and which OPWDD region this program falls.  This would mean that if an individual is enrolled in a SEMP program designated as being in NYC, the cap associated with Self-Hired SEMP would be OPWDD Geographical Region 1, even if the FI agency is headquartered in Franklin County in OPWDD Region 3. 
    For Non-Self-Hired Respite fees are determined by where the provider is headquartered and which DOH region this falls.  This would mean that even if an individual lives in NYC, the fee associated would be DOH Region 4 if the individual’s FI agency is located in Franklin County.
    For Self-Hired Respite the billing is based upon the county in which the individual lives.  This would mean that if an individual lives in Queens, the cap associated with Self-Hired Respite would be DOH Region 1, no matter where the FI is located.
    Community Habilitation fees are determined by where the individual lives.  This means that for an individual living in NYC and receiving Self-hired Community Hab, the cap associated would be OPWDD Geographical Region 1, no matter where the FI is located.
    Please note that although OPWDD oversees the services, the development of rates and fees is a function of the Department of Health.  They use various models and methodologies to determine the reimbursement to providers.

    Q: When people go over their budget in a particular category, and it is not an option to try to move money to cover the overage (for example, a full budget amendment is needed and therefore the effective date can’t be retroactive) is the FI expected to pay back the billing if overall, the person is within their PRA? Would the answer be different if the individual is over their total PRA?
    A: FI’s are responsible for tracking expenditures and reporting them in a timely fashion. It is important that FI’s insure adherence to authorized service levels and should institute audit protocols and internal controls to insure such adherence.

    Q: An individual is currently receiving an ISS rental subsidy. She wishes to move to Self-Direction. Does she have to "convert" her ISS rent subsidy to a self-direction rent subsidy or is it just left out of her budget and she continues getting the rent subsidy as she currently does?
    A: In general, the answer is “yes”, the ISS subsidy must be converted to a self-direction housing subsidy. See Attachment B in the most recent Guidance Document. However, there is an exception to this. If for some reason an Other Than Residential Self Directed budget makes sense for a person, than there would be no conversion. The person would keep her ISS subsidy.

    Q: What can be done to make the approval process for brokerage, budgets and budget amendments more transparent and easier to track? For example, can OPWDD require both DDRO’s and FI’s to acknowledge receipt of submissions, with time stamps and provide estimated time to review and approve (or disapprove)?
    A: OPWDD does not govern the business operations of FI’s. Participants and their families are customers of FI’s and can ask them to provide services such as receipts and time stamps. Transparency with participants and their families is a best practice. OPWDD has not considered requiring DDRO’s to provide services suggested in this question and will take it under advisement.

    Q: If circumstances require it, may a Fiscal Intermediary co-sign a lease with a SD participant?
    A: There is no prohibition of a Fiscal Intermediary co-signing a lease with a SD participant as long as it is clear the participant is a tenant, has tenancy rights and has responsibility for the residential arrangement.  There may be other co-signers as well, such as family members.

    Q: Will there be a way to fund housing navigators going forward?
    A: Housing Navigator service could be a reimbursable service under the following parameters:
    1. OTPS: “People who are self-directing their services with Budget Authority may elect to use up to $3,000 in 100% state funding for items that are not Medicaid-fundable. This budget category is called “Other Than Personal Services” or OTPS. Housing Navigation (“HN”) services; housing access start-up services, development of an individual housing action plan and or implementation of the housing action plan are eligible to be funded through OTPS for people with Self-Direction budgets.
    Where HN services could also be delivered by a Broker or Community Habilitation (CH) staff as part of their responsibilities for those services, those Brokers or CH staff may not separately charge for HN services through OTPS.
    To summarize; HN services can be provided by the Broker or the CH staff, if qualified, or be paid separately as OTPS. The Broker or CH staff may not separately charge a person they provide HN services to through OTPS.”
    2. Support Broker: If you are a Support Broker, and HN is part of someone’s plan, you can bill for HN work performed at the Support Broker rate. Housing navigation work is typically work that could be completed within the broker role. Brokers could do housing related tasks and be reimbursed through an SD plan. The billing would be for the broker service – the tasks completed would be housing related.
    3. Community Habilitation Services: If an individual is receiving Community Habilitation (CH), and the ISP includes Housing as a goal and Housing Navigation (HN) as a way to get to it you can pay for that time with Comm. Hab. If direct, then it must be in person and focused on a specific ISP goal. If Indirect, then it must also align with the goals. The methodology for covering the indirect cost would vary based on whether the CH staff support is through agency supported/purchased or through self-hired staffing. The provider or FI would need to manage the indirect elements of the service depending on the method used. Again, the service provided is CH not HN the CH service needs to relate back to a valued outcome and activity under the service to meet that outcome.”
    *Housing Navigators- professionals that have expertise in the development and implementation of an individual housing action plan.

    Supported Decision Making & Alternatives to Guardianship

    Supported Decision- Making & Alternatives to Guardianship

    Click Here to View a Dynamic Webinar Fully Explaining Supported Decision-Making: Presented by Jonathan Martinis on November 4, 2019

    What is supported decision-making?

    Supported decision-making is not a strange, new thing, but rather a process by which a person with an intellectual or developmental disability can be supported in making his or her own decisions. Supported decision-making draws on our common experience of consulting or seeking assistance from others when we make decisions or choices in our own lives. Whether it is renting an apartment, buying a car, or choosing to get married, we do not make decisions in a vacuum, but rather with "support" from friends, family and/or experts of some kind.

    People with intellectual or developmental disabilities also have a right to make their own choices and decisions, but may need more, or different kinds of support to do so. Supports may include helping a person access information that is useful or necessary for a decision, helping her weigh the pros and cons, assisting in communicating the decision to third parties, and /or in carrying it out. But the decision is always the person’s (who we call the "decision-maker") and not the supporter’s.

    One common form of supported decision-making involves the decision-maker identifying and choosing a person or persons whom she wishes to support her in various areas. For example, she might wish one person to support her with regard to finances, another with health care, and a third with intimate relationships. There is no limit to the number of supporters a decision-maker may choose, but usually it is between one and 10. Supporters are frequently family members, and might also include friends, peers, neighbors, or service providers, but the relationship must always be one based on trust.

    Often the arrangement is reduced to writing in what is called a “supported decision- making agreement” which spells out the rights and obligations of the parties, including an understanding by supporters that they are to assist the decision-maker, but never to substitute their own decision in lieu of hers. Although not yet legally binding on third parties (like banks or healthcare providers) in New York, supported decision-making agreements, and the relationships that underlie them may be used as an alternative to guardianship, where, literally all of the rights of persons with disabilities are taken away.

    Supported Decision-Making New York (SDMNY)

    The Supported Decision-Making Project, funded by a five year grant from the NYS Developmental Disability Planning Council, is run by an innovative consortium between Hunter College/Cuny, New York Alliance for Inclusion and Innovation (formerly NYSACRA), Disability Rights New York, and Arc of Westchester.

    The main focus of the project is aimed at increasing awareness of SDM as an alternative to guardianship for persons with I/DD, and to implement two parallel SDM pilot programs designed to divert transition-age youth with I/DD from entering guardianship, and to help restore the rights of adults with I/DD already under guardianship. The project partners will use the results of these pilots, which will begin in NYC and roll-out to several statewide locations, to create educational materials for a variety of stakeholders—including persons with I/DD, their parents and family members, professionals in special education, lawyers, judges and the court system, legislators—and disseminate them through information sessions for interested groups, webinars hosted on sdmny.org, conference presentations, and an active social media awareness-raising campaign.

    By project’s end, the partners hope to have established a viable model for providing access to SDM for persons with I/DD in New York, and to have either prevented a significant number of persons with I/DD from entering into guardianship or helped them remove their guardianship orders, thereby enhancing their opportunities to maximize their autonomy and independence.

    For more information on Supported Decision Making or to get involved go to www.sdmny.org or contact Desiree Loucks Baer at d[email protected].

    New York Housing Resource Center

    NYHRC Logo

    The New York Housing Resource Center (HRC) for People with Intellectual / Developmental Disabilities was developed by NYSACRA with funds received through the Balancing Incentive Program grant (BIP).

    The HRC acts as a clearinghouse for information and resources for the housing professional across the state and will help to foster collaboration between and among the housing industry and related professions, service provider agencies and people with I/DD.

    The HRC provides all housing stakeholders with technical assistance on housing matters and community training for people with Intellectual and Developmental Disabilities and their families.

    Visit the NY HRC Website: www.nyhrc.org

    Shared Living Toolkit

    A toolkit for providing shared living in New York State: Click Here to Download

    UPDATE:
    Our Shared Living Toolkit Now Addresses Tax Treatment of Wages

    In January, 2014, the Internal Revenue Service (IRS) issued Notice 2014-7, which addressed what the IRS has for decades called Difficulty of Care (DoC) Payments. Under Section 131 of the IRS Code, a DoC was (and still is) “compensation to a foster care provider for the additional care required because the qualified foster individual has a physical, mental or emotional handicap.” This compensation is excludable from the taxable wage income of the provider for federal income tax purposes.

    The 2014 Notice expanded the definition of foster care providers and individuals and DoC payments. The result is that wages paid to providers of Shared Living supports who meet certain criteria will be treated as DoC payments. Therefore, they are excludable from providers’ taxable wage income for both federal and New York State income tax purposes. That is, they do not have to pay income taxes on those wages. While it’s unclear what the passage of tax reform legislation will mean to shared living, the New York Alliance is committed to informing our members as to any impact.

    The New York Alliance has recorded a 4-minute webinar which addresses these changes.

    Learning Institute

    Learning Institute on Innovation and Individualized Supports for Persons with Complex Needs - A Learning History Final Report: Click Here to View

    Marist College Partnership

    New York Alliance Academic Partnership with Marist College

    Click Here to Learn More About the Marist Academic Partnership

    In 2018 two amazing organizations, NYSACRA and NYSRA, joined together to form one powerful voice for people with disabilities. The New York Alliance for Inclusion and Innovation envisions a society where individuals with disabilities are contributing citizens with equal rights and the ability to live full, productive and meaningful lives. It is their mission to serve as a catalyst for positive change and be a leading resource for individuals with disabilities, their families, and the organizations supporting them.

    The New York Alliance for Inclusion and Innovation values the communities in which they serve. They inspire creativity and innovation as well as build strong relationships and strategic alliances so that individuals with disabilities can thrive in our community. The New York Alliance is an advocate and voice for all people with disabilities. They shape sound public policies which respond to people’s needs and support initiatives which advance positive, high-quality outcomes.

    As a way of saying "thank you" to New York Alliance for Inclusion and Innovation members who reside in our community, Marist College is offering special tuition pricing for all members and their immediate adult family members.

    Special Tuition Pricing for Members

    New York Alliance for Inclusion and Innovation members and their immediate adult family members will receive the following benefits:

    • A tuition discount on eligible graduate and adult undergraduate degree programs. For our complete list of eligible programs and discounted pricing visit our eligible programs and pricing page.
    • Options for Full-Time and Part-Time Master's and Bachelor's degree programs offered 100% online, in-class or a mix of both.
    • Enjoy state of the art classrooms for our Bachelor’s and Master’s programs offered on our Main Campus in Poughkeepsie, NY.  We also offer a classroom-based MPA option at our satellite locations in Queens, NY, and Albany, NY.

     

    Eligibility

    New York Alliance for Inclusion and Innovation members and their families must show proof of membership in order to qualify for the partnership tuition rate.

    Adult undergraduate students are defined as students who began their Marist academic career at age 22 or older and who are applying through the Office of Adult Undergraduate Admission. Graduate students are those students who are initiating an application for a stand-alone masters degree through the Office of Graduate Admission.

    Final determination of eligibility is made by Marist College.

    Complete our online inquiry form to receive more information. All contact information provided is confidential.

     

    Programs Offered

    Marist College offers students a variety of programs on-site and online for both graduate and adult undergraduate (ages 22+) learners.

    Please visit our eligible programs page for more information.

    College of Direct Support

    New York Alliance for Inclusion and Innovation is pleased to announce the College of Direct Support semesters beginning in March and November each year. NY Alliance has an updated brochure to core competency online learning called Investing in a Professional Workforce. 

    The brochure provides an overview of the College of Direct Support, an outline of how the College of Direct Support works, and a list of the curricula.

    To download a copy of the updated brochureclick here or the picture above.

    The Registration Form can be downloaded by clicking here. Please email the registration form to Stacy at [email protected]. You may also email Stacy with learners name(s), and which module(s) the learner(s) will be taking.

    Questions? Contact Lisa Mount at [email protected] or 518-417-4055.

    More Information: Agencies that provide services and supports in New York State should be particularly pleased with the opportunity to participate in the College of Direct Support, since the content of the CDS training aligns with the state required core competency implementations criteria (OPWDD Administrative Memorandum #2014-03).

    To learn more about this requirement click here for a letter from Ann Hardiman, President and CEO of New York Alliance for Inclusion & Innovation.