Since care management is central to any managed care plan, the transition from Medicaid Service Coordination to comprehensive care management (provided through Care Coordination Organizations or CCOs) has helped to pave the way for managed care. Today, individuals with I/DD who are eligible as determined by OPWDD to be eligible for the Medicaid Home and Community Based Services (HCBS) Waiver select a Care Coordination Organization (CCO) to develop an integrated, comprehensive care plan (known as a “Life Plan”). A Care Manager at the CCO then works with that individual to implement the Life Plan – coordinating all the necessary health, social service, and developmental disability supports and services. Health and disability services are typically paid on a per-service basis, according to established fee or rate schedules.
Under managed care, the OPWDD eligibility and “person-centered” planning approach (based on the Life Plan) will remain unchanged. But the individual will select a Managed Care Organization (MCO) to work with. Then the MCO Care Manager (in many cases, the same Care Manager you have now through your CCO) will coordinate the implementation of his/her Life Plan. Managed care models support more effective coordination and integration of services. The MCO authorizes the supports and services needed by the individual and provides access to its network of providers who can deliver those supports and services. Over time it is expected that the payment for services will shift from the current fee-for-service model to value-based models where providers are rewarded for providing quality services and supporting positive outcomes for MCO members.