Transcript Slide 1

Nursing Facility Level of Care
Initiative: An Update
Minnesota Department of Human
Services
Continuing Care Administration
Aging and Disabilities Odyssey
Duluth, MN
June 17, 2013
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Presenters
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Douglas Silverman
– MN DHS, Aging and Adult Services Division
– Program Administrator
– Policy Integration Unit
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Jolene Kohn
– MN DHS, Aging and Adult Services Division
– State Programs Coordinator
– Policy Integration Unit
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Outline
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Background
NF LOC Criteria
Estimated impact
Implementation work plan
Available supports for individuals
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Background
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Nursing Facility Level of Care (NF LOC)
changes
Essential Community Supports (ECS)
Enacted in the 2009 Legislative session
Part of a larger strategy aimed at
sustainable long term care
Ensure availability for those with greatest
need
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NF LOC Delay
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Due to Federal Legislation (ACA)
States signed Maintenance of Effort
(MOE) agreements
Delayed implementation
– 2014 for adults
– 2019 for people under age 21
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Nursing Facility Level of Care
Legislation
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Current NF LOC criteria are relatively low
compared to other states
Legislation strengthens NF LOC criteria to
direct people with lower care needs to
other supports, including new program
under ECS
Meet increasing demand for services
Improves equity and access statewide
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Nursing Facility Level of Care
Legislation
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For Medicaid payment for NF services
Eligibility for certain long-term care
waivers (EW, CADI, BI-NF)
State-funded Alternative Care (AC)
Doesn’t affect other payor criteria
(Medicare, e.g.)
Criteria is found at Minnesota Statutes,
section 144.0724, subdivision 11
Effective January 1, 2014 for ages 21 and
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older
Nursing Facility Level of Care
Legislation
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Applies to all new applicants 21+ with an
eligibility start date on or after 1/1/14
Applies to current HCBS participants at
their next reassessment on or after 1/1/14
– Person was previously opened to EW, AC, CADI or
BI-NF, and eligibility span overlaps with 1/1/14.
– Transition for current HCBS participants will occur
over 12 months as reassessments are completed.
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NF LOC Criteria
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Reasonable operationalization of current
criteria, decision-making by LTCC staff
A person must demonstrate at least one of
the following:
1. Need for assistance with ADLs
2. Need for ongoing clinical monitoring
3. Significant cognitive, memory, or behavioral
needs
4. Risk of institutionalization
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NF LOC Criteria: ADLs
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Activities of Daily Living: Bathing, dressing,
grooming, walking, toileting, positioning,
transfer, eating.
An individual meets LOC criteria based on
ADL if they:
– Need assistance in 4 or more ADLs, OR
– Need assistance with toileting, or transferring, or
positioning that can’t be scheduled.
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Assistance = dependency as defined
for case mix classification
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NF LOC Criteria: Clinical Monitoring
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Clinical monitoring meets the description
and requirements used for case mix
classification
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Clinical monitoring must be needed at
least once every 24 hours
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NF LOC Criteria: Cognitive-Behavioral
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This criteria reflects needs that are
assessed in several ways:
– Mental Status Exam (memory)
– Self-preservation (capacity to respond to
changes in the environment)
– Need for staff response to “behavior”
– Orientation
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NF LOC Criteria: Institutional Risk
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The individual lives alone (or will alive
alone) AND
– Has had a fall resulting in a fracture within
the last 12 months OR
– Has vision or hearing impairment that affects
ability to maintain community life OR
– Is at risk of maltreatment by others or at risk
of self-neglect
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NF LOC Determination
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NF level of care can be determined by a
face-to-face LTCC assessment
(MnCHOICES)
Telephone screening as part of PAS for
NF admission
The criteria based on institutional risk must
be determined in a face-to-face
assessment
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NF LOC and Nursing Facilities
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LOC determined at admission via PAS
LOC must be re-established at the first
MDS quarterly that occurs after admission
for continuing MA eligibility for payment of
NF services
RUGs categories, MDS and LOC: all
categories except PA1 and PA2 contain
information that establishes LOC
PA1, PA2: complete LTCC
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Nursing Facilities
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For MA payment for NFs, must meet
criteria at both:
– Admission into facility
– 90 days after admission into facility
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Admissions on or after 10/1/13 may be
affected if criteria not met at MDS quarterly
Admissions prior to 10/1/13 are NOT
affected by revised LOC
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Nursing Facilities
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For private pay, PAS must be completed
regardless of payor source for all
admissions
Private pay will be reevaluated using last
MDS quarterly assessment before MA
eligibility start date
NF staff will need to be aware of and begin
timely discharge planning for all residents
not likely to qualify at 90 days
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Home and Community Based
Programs
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May affect access to public programs that
require NF LOC:
– EW
– CADI
– BI
– AC
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Rolling assessments for current
participants, not all on 1/1/14
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Estimated Impact – HCBS Sample
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Based on 2011 analysis of all individuals
in EW, AC, CADI, BI-NF in the programs
July, 2011
Total numbers of enrollees evaluated
– EW – 23,000
– AC – 3,100
– CADI – 16,960
– BI – 987
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Estimated Impact - EW
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EW: 3,068 (13%) would not meet revised
criteria
– Of those, 2,822 (92%) live in own home or
apartment
– Of the 3,068, 337 (11%) were receiving CL or
24-hr CL
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Estimated Impact – AC, CADI, BI
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AC: 268 (8.5%) would not meet modified
criteria
– All AC lived in own home or apt
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CADI: 501 participants would not meet
modified NF LOC criteria
BI: All participants remained eligible
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Estimated Impact - NF
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May affect MA payment for NF services for
lowest two RUG categories
– PA1
– PA2
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About 1.5% of all NF admissions fall into
one of these groups
– 986 people out of 68,547 admission
assessments that occurred 4/1/12 - 3/31/13
– These individuals can still be assessed to
meet LOC with LTCC assessment
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Available Supports
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93% of EW sample participants would
remain eligible for MA basic health care
– State Plan services
– PCA
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7% will lose eligibility for MA (SIS)
Essential Community Supports: strategy to
provide support to the “transition” group
who lose program eligibility due to revised
LOC (must be on a program 1-1-14)
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Available Supports
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AC: 268 individuals will not meet modified
NF LOC criteria
– 100% are eligible for Essential Community
Supports
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CADI: 501 participants will not meet
modified NF LOC criteria
– 100% remain eligible for MA State plan, PCA
– Essential Community Supports: strategy to
provide support to the “transition” group who
lose program eligibility due to revised LOC
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(must be on a program 1-1-14)
Lead Agency Notification
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Notifications
– For HCBS, notice to lead agencies that
includes individuals, who based on their last
assessment in MMIS, may not meet revised
criteria at their next reassessment
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Essential Community Supports
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New program will provide specific
services
People who do not meet NF LOC
criteria
Based on analysis of needs and
services of original sample group that
did not meet revised criteria
– What services were they most likely to be
receiving?
– Address emerging needs
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Essential Community Supports
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To be run like AC with allocations to
counties
$400/month budget
Must live in own home or apartment
Case management - $600/year for
transition group
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Essential Community Supports
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Must live in own apartment or single family
home
Cannot be provided in
– Board and lodge
– Non-certified boarding care
– Corporate/family foster care
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Essential Community SupportsNew Program for Seniors
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“Legacy” group
– Not eligible for MA
– Age 65 or older
– Meets Alternative Care financial criteria
– Have been assessed to need and can benefit
from services available under ECS
– Does NOT meet LOC criteria
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Essential Community SupportsTransition Group
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Transition group: 12 month group
– Must have been on waiver on 1-1-14 and
immediately prior to eligibility for ECS (i.e. still
on the program at reassessment)
– Loses eligibility at reassessment due to
changes in LOC criteria
– Any age
– Continue to be financially eligible for MA or AC
– Can benefit from ECS services available
– One-time case management benefit
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Essential Community Supports
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Service coordination
Homemaker
Chore
Caregiver training and education
PERS
Home-delivered meals
Service definitions identical to AC/EW
New service: Community Living
Assistance
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Essential Community Supports
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Service Coordination
– Reimbursement up to $600 in a service
year
– Performed by case manager, case aide
employed by or under contract with the
lead agency
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For the transition group only, $600 for
service coordination is outside of $400
per month budget
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Essential Community Supports
Service Definitions
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Homemaker may include:
– Meal preparation
– Routine household tasks
– Assistance with arranging transportation
– Companionship
– Informal emotional support
– Social stimulation
– Monitoring the safety and well being of the
client
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Essential Community Supports
Service Definitions
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Chore Services
Support or assist individual or primary
caregiver to maintain home
– Heavy household chores
– Moving or removal of heavy items
– Shoveling snow and lawn maintenance
– Customary service charges
– Extermination and pest control
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Essential Community Supports
Service Definitions
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Caregiver Training and Education
Family and informal caregivers who
provide direct services
– Parent
– Spouse
– Adult child
– Other relative
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Not paid, not employed by provider
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Caregiver Training and Education
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Caregiver training: Instruction about
– Treatment regimens
– Disease management
– Nutrition
– Personal/physical care
– Behavior management
– Family dynamics
– Caregiver roles
– Use of equipment
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Caregiver Training and Education
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Caregiver Education includes:
– Coaching
– Guidance
– Instructions
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Directly related to providing care to the
person receiving services
Must be documented in support plan
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Essential Community Supports
Service Definitions
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Personal Emergency Response Device or
System (PERS)
– Summon help in an emergency without
dialing the telephone
– Press an alert or panic button worn on a
pendant or bracelet in event of fall or other
emergency
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Strategies to Support NF LOC
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Streamline Preadmission Screening (PAS)
Senior Linkage Line will conduct PAS
– October 1, 2013
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Return to Community
MDS Section Q
Face-to-face assessments for <65
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Strategies to Support NF LOC
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Relocation Services Coordination
Care Coordination in MCOs
Moving Home Minnesota
ECS
MA State Plan, PCA
NF discharge planning
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What Doesn’t Change
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Appeal rights for individuals
Lead agency notification requirements
Provider discharge requirements
Provider notification requirements
Other eligibility criteria for HCBS
Other criteria for NF payment (MA LTC
eligibility, claims edits, e.g.)
Health plan requirements for provider
authorization and billing
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Implementation Plan
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External stakeholder workgroup
Internal workgroups
Referral protocols
Training
Communications: bulletins, legislative
notices to recipients, e.g.
Systems improvements
Evaluation
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Evaluation
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Contractors will evaluate these initiatives:
NF Level of Care
Essential Community Supports
Return to Community Initiative
PCA and Home Care Reform
DHS Evaluation of NF LOC as required by
legislature
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Training
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The following groups will be trained on NF LOC
changes and ECS program:
– Lead Agencies
– Financial Workers
– Area Agencies on Aging
– Title III Nutrition Service Providers
– Provider Network
– Other stakeholders
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Training Opportunities
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Roadshows: First Contact/PAS/NF LOC
(NF and Lead Agency Staff)
– St Cloud – 8/7/13
– Brainerd – 8/8/13
– Arrowhead – 8/12/13
– Mankato – 8/13/13
– Rochester – 8/14/13
– Marshall – 8/19/13
– Fergus Falls – 8/20/13
– Crookston – 8/21/13
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Training Opportunities
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Conferences (Providers)
– Care Providers Billing Institute – 7/17/13
– Aging Services Billing “University” – 8/15/13
– Care Providers Convention – 11/18-20/13
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Videoconferences (Lead Agency Staff)
– 10/24/13
– 11/14/13
– 12/12/13
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More to be added!
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Legislative Resources
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NF LOC Legislation
– Criteria: MN Statutes 144.0724, subd. 11
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Essential Community Supports
– Minnesota Session Laws
– Chapter 108, Article 7, Section 13
– MN Statutes 256B.0922 (later in summer)
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Contact Information
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Email: [email protected]
Doug Silverman
– [email protected]
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Jolene Kohn
– [email protected]
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Website: http://www.dhs.state.mn.us
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Thank You!
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Questions?
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