OPWDD Self-Direction · Port Jefferson Station, NY
OPWDD Self-Direction & Adaptive Fitness
Using Self-Direction? Let's Help Your Team Understand the Fitness Options.
Fusion Adaptive Fitness works with children, teens and adults who may need a more individualized approach to exercise.
For people using OPWDD Self-Direction with Budget Authority, certain qualifying fitness expenses may be included in an approved Self-Direction budget.
Depending on the participant, budget and funding category, this may include certain fitness memberships, publicly available exercise classes or individual exercise training.
Fusion can provide program descriptions, pricing and business information for your Support Broker and Fiscal Intermediary to review.
We do not determine whether an expense is approved and cannot guarantee Self-Direction funding.
How Does OPWDD Self-Direction Work With Fitness?
OPWDD Self-Direction gives eligible participants more control over how certain approved supports and services are arranged within their Self-Direction plan and budget.
When someone uses Budget Authority, their Self-Direction team may include people such as:
The Participant & Family
The participant and their family or representative help identify goals, preferences and the supports they want to pursue.
Support Broker
A Support Broker helps the participant develop and manage the Self-Direction budget and works with the participant's Circle of Support.
Fiscal Intermediary
The Fiscal Intermediary, often called the FI, handles administrative functions such as reviewing approved budget expenses, billing and payment.
Fusion Adaptive Fitness
Fusion provides the fitness service and can provide the business, pricing and program information the participant's Self-Direction team may need.
Your Self-Direction team determines how an expense fits into the participant's approved plan. Fusion provides the fitness service and supporting documentation.
How Can Fitness Fit Into Self-Direction?
OPWDD's Individual Directed Goods and Services, commonly called IDGS, includes several categories that can be relevant to fitness. The exact category and approval depend on the participant's plan.
Health Club or Gym Membership
OPWDD guidance allows qualifying health club or community-organization memberships to be included in a Self-Direction plan when they relate to the participant's health, fitness or community-integration goals.
Membership funding is subject to OPWDD rules, the participant's approved budget and FI review.
Community Exercise Classes
Exercise is one example of a subject that may qualify under the IDGS Community Class category.
To qualify through the Community Class pathway, the class generally must occur in an integrated community setting, be available to people with and without disabilities, teach a subject related to the participant's goals and not duplicate another Medicaid State Plan or Waiver service.
Individual Exercise Training
OPWDD's IDGS guidance also identifies sessions with a private exercise trainer as potentially allowable when the service relates to a participant's valued outcome and meets applicable Self-Direction requirements.
Fusion Adaptive Personal Training may therefore be something a participant can discuss with their Support Broker and FI.
A Note About Community Classes
Not every adaptive fitness class automatically qualifies as an OPWDD Community Class.
OPWDD's Community Class category is specifically intended to support participation in publicly available, integrated community classes.
For that funding pathway, the class generally needs to:
Be Open to the Public
Enrollment should be available to people with and without disabilities.
Take Place in an Integrated Community Setting
The purpose is to support community inclusion rather than create a separate disability-only setting.
Teach a Specific Subject
Exercise can qualify when the class provides instruction related to the participant's identified goals.
Avoid Duplicating Medicaid Services
The class cannot simply replace another Medicaid State Plan or Waiver service.
Important: A class offered exclusively to people with developmental disabilities may not qualify through the IDGS Community Class category.
That does not mean the fitness program itself is inappropriate.
It means the participant's Support Broker and Fiscal Intermediary may need to determine whether another allowable funding category applies.
Fusion does not make that determination.
What About Fusion Adaptive Group Fitness?
Adaptive Group Fitness and an OPWDD-funded Community Class are not automatically the same thing.
Fusion may offer adaptive group programming designed around different abilities and support needs.
Whether a specific class qualifies for IDGS Community Class funding depends on how that class is structured and whether it meets current OPWDD requirements.
If the class is being considered through Self-Direction, we can provide:
- class description
- enrollment information
- public availability information
- pricing
- schedule
- business information
Your FI and Support Broker can then determine whether the class fits the participant's plan and the applicable funding requirements.
Group Fitness & IDGS
A qualifying Community Class must be publicly available and integrated. Your Self-Direction team decides whether a specific Fusion class fits that pathway.
Can Self-Direction Be Used for Personal Training?
OPWDD guidance for Individual Directed Goods and Services includes private physical-education or exercise training as a potentially allowable expense when it relates to a participant's valued outcome and meets the applicable requirements.
That means Adaptive Personal Training may be worth discussing with the participant's Support Broker and Fiscal Intermediary.
Fusion can provide:
- service description
- session pricing
- trainer/business information
- invoices
- program schedule
- reasonable supporting documentation
Whether the expense is approved depends on the participant's Self-Direction plan and FI review.
IDGS & Training
Private exercise training is identified in OPWDD's IDGS guidance as potentially allowable. Your broker and FI confirm whether it fits the approved plan.
Can Self-Direction Help Pay for a Gym Membership?
OPWDD's IDGS guidance includes a Health Club / Organizational Membership category.
A qualifying gym or health-club membership may be included in a participant's Self-Direction plan when it supports identified health, fitness or community-integration goals.
Current OPWDD guidance places an annual funding cap on this specific IDGS membership category.
The participant's actual available budget may be lower, and all expenses remain subject to the participant's approved plan and FI requirements.
What Does the Fiscal Intermediary Do?
A Fiscal Intermediary helps administer a participant's Self-Direction budget.
For Budget Authority participants, the FI performs functions that can include reviewing budgeted expenses, handling billing and making payments for approved goods and services.
For a fitness expense, the FI may ask Fusion for information such as:
- legal business name
- business address
- contact information
- W-9
- program description
- pricing
- schedule
- invoices
- proof of attendance or service where applicable
- other documentation required by that FI
Different Fiscal Intermediaries may have different internal procedures.
Fusion can work with the participant and their team to provide reasonable documentation.
The FI's Role
The Fiscal Intermediary reviews expenses, handles billing and makes payments for approved goods and services within the participant's Self-Direction budget.
Does the Family Have to Pay First?
Not always.
OPWDD guidance allows qualifying IDGS goods and services to be purchased directly from a vendor by the Fiscal Intermediary in some circumstances.
An FI may also have procedures for reimbursing a participant or family for approved expenses.
The exact payment process varies by FI and by the type of expense.
Before paying out of pocket, ask your Fiscal Intermediary how it wants the expense handled.
If your FI wants to pay Fusion directly, have your broker or FI contact us and tell us what documentation they need.
Your Support Broker Can Help You Navigate the Budget
Support Brokers help participants with Budget Authority develop and manage their Self-Direction budgets.
If you're interested in adaptive fitness, your broker can help determine:
- which Self-Direction category may apply
- whether the expense relates to the participant's goals
- whether funding is available in the approved budget
- what information the FI needs
- whether a budget amendment may be necessary
Fusion does not replace the participant's broker or FI.
Our role is to explain the fitness program clearly and provide the information the team needs to evaluate it.
Broker's Role
Your Support Broker develops and manages the Self-Direction budget and helps determine how a fitness expense fits the approved plan.
Information for Your Self-Direction Team
We want to make it easier for families, brokers and Fiscal Intermediaries to understand exactly what Fusion provides.
Depending on what your team requests, we may be able to provide:
If your FI uses a specific vendor form or documentation process, send it to us and we can review what is required.
What Fusion Cannot Determine
Fusion Cannot Determine OPWDD Eligibility
Eligibility for OPWDD services is determined through OPWDD's process.
Fusion Cannot Approve Your Budget
Your Self-Direction plan and budget are handled by the participant and their Self-Direction team.
Fusion Cannot Guarantee Reimbursement
An expense must meet applicable rules and be accepted through the participant's approved budget and FI process.
Fusion Is Not a Community Habilitation Provider
A participant may attend Fusion with their own support staff where appropriate, but Fusion's fitness services should not be described as Community Habilitation.
What we can do is clearly explain our programs and work with you to provide the information your Self-Direction team requests.
Explore Fusion Adaptive Fitness Programs
Adaptive Personal Training
One-on-one fitness coaching built around the athlete's abilities, goals and current fitness level.
Personal TrainingAdaptive Group Fitness
Small-group fitness with individualized modifications and flexible coaching.
Group FitnessAdaptive Boxing & Kickboxing
Bag work, striking, movement and conditioning adapted around the athlete.
Boxing & KickboxingOPWDD Self-Direction Fitness on Long Island
Fusion Adaptive Fitness is located in Port Jefferson Station and serves children, teens and adults from communities throughout the Town of Brookhaven, Suffolk County and surrounding Long Island areas.
Families may travel from communities such as Port Jefferson, Mount Sinai, Miller Place, Stony Brook, East Setauket, Centereach, Selden, Coram, Sound Beach, Rocky Point, Middle Island and surrounding areas.
Because Self-Direction fitness options can be specialized, families may choose to travel beyond their immediate town to find the right program.
Communities We Serve
- Port Jefferson
- Mount Sinai
- Miller Place
- Stony Brook
- East Setauket
- Centereach
- Selden
- Coram
- Sound Beach
- Rocky Point
- Middle Island
- Surrounding areas
OPWDD Self-Direction & Fitness FAQs
Have Self-Direction? Start With a Conversation.
You do not need to understand every OPWDD funding category before contacting us.
Tell us about the athlete, the Fusion program you're interested in and whether you're already working with a Support Broker or Fiscal Intermediary.
We can provide the fitness-program information your team needs to determine the next step.