What is OPWDD Self-Direction Series: Everything you need to know about Community Classes

Ok let's talk community classes in self-direction! "Community Classes" is a specific line item in a self-direction budget. It is one of the most valuable and popular line items in the budget because it allows a self-directing person to be able learn skills from providers in their local community. These "Community Classes" can be everything from horseback riding, computer coding, gaming, and in our case VR technology" ;) As long as it's a subject matter being taught to the public, it's fair game to use.

Community classes are all around you. For example you can take non-credit classes at a local community college or maybe there is a local cooking class in your town that you can sign up for. Once you locate an organization that you are interested in taking a class from, you can share this with your Fiscal Intermediary for approval. To get approved, you would need to provide some sort of marketing material of that class and email this to the Self-Direction Coordinator. Things like flyers and websites are usually the two most common ways.

Once approved, the fiscal intermediary will do one of two things. Either the fiscal intermediary will reimburse you for the cost of the class after you make a payment, or they may use the "direct pay" method. The direct pay method offers a significant advantage, as the initial cost does not not be provided upfront by the participant/family and will be paid for directly from the budget, unlike the reimbursement method. Unfortunately not all FI's allow for direct pay method though. It would best best to follow up with your self-direction coordinator to find out what their policy is. If the Fiscal Intermediary is going to reimburse you for the cost, make sure to get a receipt of the class and send it to the FI. It may take a month or longer before the reimbursement comes to you.

What happens if my class get rejected and not approved? This can be a frustrating experience for sure. The approval process by an FI is subjective to each individual FI, as they must "interpret" the class to see if it's meets the criteria for a community class via the "Self Direction Guidance for Providers" https://opwdd.ny.gov/system/files/documents/2022/03/sd_guidance-final_march2022.pdf

If you scroll down to page 24, you'll find that according to OPWDD, community classes " teach a subject, are open to the public, and result in active engagement and participation in integrated community settings". There you have it.

Also, as an additional measure they offer a box of bullet points of what DISQUALFIES a class from being a reimbursable community class according to their guide. Here is what OPWDD has to say about exclusions:

"Each of the following are excluded from being funded with the IDGS as a Community Class:

• Classes that duplicate any Medicaid State Plan or HCBS Waiver service or are conducted by an entity that delivers such services;

• Classes where participation is restricted solely to people with intellectual/developmental disabilities (I/DD);

• Classes where there are not established published fees; • Classes that are credit bearing for matriculating students;

• Classes in a setting accessed only by people with I/DD (not including paid staff support), including all certified settings; and

• Classes that do not adhere to the standards identified in the broader IDGS rules and standards (e.g. experimental therapies)"

Let's look at each in turn:

• "Classes that duplicate any Medicaid State Plan or HCBS Waiver service or are conducted by an entity that delivers such services"

An agency that offer OPWDD services, think day programs, WOW programs, community habilitation programs. Basically if they work directly for or recieve funding from OPWDD in any capacity to deliver services, they're basically ruled out. Many FI's have interpreted this bullet point to disqualify classes that offer social skills and vocational skills.... Why?

Well... in the "interpretation" process an FI may assume a social skills class is no different than what a community habilitation provider does, since social skills is assumed to be the domain of community habilitation. Community habilitation is an HCBS waiver service, so the FI will reject the class based on ""Classes that duplicate any Medicaid State Plan or HCBS Waiver service" key word being "duplicate". Vocational skills will suffer the same fate of rejection as well because this is to be the domain of ACCES-VR and to a certain extent OPWDD as well. The key to approval would be to provide evidence and justification that the class is NOT similar to what is already being offered by OPWDD. Are they right? Maybe, Maybe not. Again it is a subjective "interpretation". It will be up to you to give the FI every detail and nuance about the class possible so that they can make an informed decision. If you give them little information, you are leaving it up to them to base their judgement of it, leading to a higher likelihood of potential rejection.

• Classes where participation is restricted solely to people with intellectual/developmental disabilities (I/DD);

This is very understandable, and is probably one of the key factors of what differentiates community classes from just any other HCBS waiver program. In my opinion, OPWDD is basically saying that the class should be open to everyone, and everyone should have equal access to utilize the program. If you're program only offer access to a person with a disability, well that's not really a community class and you're basically just another OPWDD-like program.

• Classes where there are not established published fees; • Classes that are credit bearing for matriculating students;

Classes have to make their costs public, either through a flyer, or a website most commonly. Classes must be for learning a topic or skill and not attached to a credit bearing program. I'm assuming this is because their are other programs out there that can do this.

• Classes in a setting accessed only by people with I/DD (not including paid staff support), including all certified settings; and

Again it looks like OPWDD is making sure that the classes really are "public" not programs housed within agencies that only the participants within these agencies would have access to or knowledge about. I'm glad OPWDD decided to add "(not including paid staff support)" . This is important because sometimes a person attending a community class may need support from a comm hab worker or other support provider during a class to get the most out of it. OPWDD understands this. Certified settings are just organizations and environments that OPWDD regulates and keep tabs on. Think Group Homes (IRA's) and Day Programs as examples. Everything else that OPWDD does not direct account for and regulate is considered uncertified settings.

Classes that do not adhere to the standards identified in the broader IDGS rules and standards (e.g. experimental therapies)"

I believe this last one is OPWDD's way of saying any other program or class that does not fit nicely within the bounds of IDGS or sounds odd is off limits. They offer "experimental therapies" as an example. Seems fair.

So know you know how Fiscal Intermediaries think, and what they use to assess whatever class it is that you're trying to approve.

Ok so let's say you're class is rejected, and you're thinking what now?

First I might try to call up you're FI and explain the class in more depth and detail. This can make a world of a difference. Just giving them a flyer or website may not be enough and they may have incomplete information. Many FI's are good about this and should ask clarifying questions to you when you submit for approval. But if they do not and automatically reject it, it's time to call. Call, find out why the class was rejected, and if you're reasoning is sufficient they may reverse the decision.

Next, you can try a more formal procedure, what's known as an appeal process. There is a wonderful organization called the "Coalition for Self Direction" that is a massive resource for everything related to rights and appeal for self direction community classes. This organization has put a lot of time and effort to learning about all the nuances of how this process works. They are a force to reckon with and they almost have it down to a science. I really love what they do. You can check them out here:

https://www.coalition4sdf.org/know-your-rights

Also another tip, always keep on top of your budget! Self-Direction Brokers are the primary support providers to assist with this. Community Classes fall within IDGS (individual Goods and Services) and there is a cap of $32,000 per year. If you go through this budget allotment too fast, you will have to wait until the budget reset date to get more. Of course, the broker can also perform what is called an "CNBA" (cost-neutral budget amendment) to play some funds from a non utilized line item to this item, but again the cap still exists and families and participants should be mindful.