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CCO enrollment process

Have questions about the CCO enrollment process?

Provider agencies are one of several referral sources for CCO services. Here is information to share when speaking with potential members.

Begin at the Front Door

All applicants must start by going through the Front Door with OPWDD. Referrals may come from OPWDD or may be made directly to the CCO by the individual or their representative, in which case the CCO will help connect the individual to the Front Door.

The Eligibility, Assessment, and Authorization (EAA) tool completed by Front Door staff serves to help identify the most appropriate services for the individual. The EAA is completed at different times in the process based on the Development Disabilities Regional Office (DDRO). If an identified service requires enrollment into CCO care management, the individual or their representative will contact the enrollee’s preferred CCO to begin this process.

How the enrollment process can vary

The process varies depending on several factors, including but not limited to the following:

  • The individual’s age
  • Their Medicaid status
  • Whether or not they already have OPWDD eligibility

LCED is needed before enrolling

All individuals applying for services must obtain an initial Level of Care Eligibility Determination (LCED) before enrolling in a CCO. The CCO enrollment team can assist with this. To apply for the initial LCED, the individual must have the following:

  • A current medical exam dated within 12 months
  • A psychosocial/social history dated within 12 months, inclusive of developmental milestones
  • A psychological evaluation dated within three years reflecting an intellectual/developmental disability before the age of 22

 

Additional evaluations may be required depending on the primary diagnosis.

It is important to note that the eligibility process is very individualized. The CCO’s enrollment staff will support the individual throughout the application process, including applying for OPWDD eligibility if needed.

Additional steps are needed for enrollment

The individual must have active Medicaid through their local district. If the individual does not have Medicaid, the CCO enrollment staff can assist with the application. If the individual is under 18 and needs Medicaid, they must go through a “Parental Deeming” process with the assistance of CCO enrollment staff.

Once the individual has obtained an initial LCED, OPWDD eligibility, and Medicaid, the CCO enrollment staff will submit a CCO1 form via CHOICES.

OPWDD processes all CCO enrollments on the first of the following month. CCO staff will follow up with OPWDD to resolve any issues if the enrollment cannot be processed.

The CCO staff will complete the necessary DOH consent forms before enrollment. The member should also have had a CAS (18 and older) or CANS (under 18) conducted by Maximus, a subcontractor of OPWDD. The CAS and CANS must be completed before applying for HCBS waiver services.

Challenges or delays to enrollment

They may include:

  • EAA tool by DDRO Front Door
  • Parental Deeming process
  • Medicaid application process
  • DOH consent completion
  • Obtaining required documentation in a remote environment
  • Scheduling required evaluations (psychological, adaptive, physical) needed to submit for eligibility and/or LCED

 

OPWDD may request more information during the eligibility process or require a second or third-step review before deciding.

Special populations

Please note: OPWDD expects the CCO to pre-assign a Care Manager for individuals transitioning from a non-qualified setting to a qualified setting for CCO services. An example would be an individual discharged from a hospital, rehab, or nursing home to the community or into a certified residence. Enrollment cannot be completed until the first of the month following discharge.