IL Department of Healthcare & Family Services
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Transcript IL Department of Healthcare & Family Services
Balancing Incentive Program
Governor’s Conference on Aging &
Disability
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What is the Balancing Incentive Program?
The BIP was authorized under the Affordable Care Act
(Section 10202) to assist states with improving access to
Medicaid-funded home and community-based long-term
services and supports (LTSS), and streamline program
eligibility and service delivery to consumers between
state agency programs.
Participating states receive enhanced federal match
through September 2015 to further rebalance long-term
care delivery towards home- and community-based
services.
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Why BIP? Illinois’ Vision
The BIP structural requirements support Illinois’
ongoing efforts to break down existing
bureaucratic silos to better address individuals
who have complex needs
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Why BIP? Illinois’ Vision
Illinois is embracing a number of federal
opportunities to improve the coordination and
integration of LTSS
BIP is one opportunity under the Affordable Care Act
(ACA) that promotes enhanced coordination.
Illinois is participating in the Medicare/Medicaid
Alignment Initiative.
Illinois is a recipient of federal funding under the CMMI
Model Design Grant – State Healthcare Innovation
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Why BIP? Illinois’ Vision
Illinois was already considering the adoption of a
Uniform Assessment Process as a result of
Legislative and Administrative Initiative
The SMART act (PA 097-0689 and SB 2840)
Illinois currently uses several assessment tools, depending
on the consumer’s presenting issue.
Existing tools do not capture all of the dataset domains
required under the BIP.
Illinois, like many states, is moving towards breaking down
the silos and assessing consumers in a holistic manner.
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Why BIP? Illinois’ Vision
BIP – Benefits at the Ground Level
Access to services will be streamlined and more efficient
through the creation of numerous access points –
web portal; 1-800 line; and physical agency access.
Consumers will only have to tell “their story” one time –
data will be shared across agencies to reduce duplication
of effort and ensure that providers have necessary
information to support consumers.
Holistic approach to assessment process will enhance the
linkage of consumers to services and supports and result in
better health outcomes.
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Key Elements of the BIP
Required Structural Changes
1.
2.
3.
No Wrong Door
Conflict-Free Case Management
Core Standardized Assessment (aka Uniform Assessment Tool)
Additional Work Plan Requirements
Information Technology coordination
Data & Reporting
Service data
Quality measures
Outcomes data
Funding plan for structural changes
Stakeholder Engagement
Sustainability plan for the use of funds
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Required BIP Structural Changes
No Wrong Door / Coordinated Entry Process
Develop a statewide system to enable consumers to access LTSS
through a coordinated network or portal that will reduce existing
fragmentation and duplication, improve coordination, and:
Provide a streamlined/standardized intake process into the state
‘system’
Provide application assistance
Provide referrals for services and supports available in the
community
Enable functional eligibility assessments
Numerous Streamlined Entry Points:
New LTSS website
New 1-800 number
Existing network of community-based agency offices
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Conflict-Free Case Management
Federal definition of “conflict-free”
Separation of case management from direct service provision
Separation of program eligibility determination from direct
services provision
Case managers cannot establish funding levels for the beneficiary
Case managers cannot be related to the beneficiary or their
caregivers
Where conflict risk exists, states must establish firewalls
and appropriate safeguards that assure consumer choice
and protect consumer rights.
Analysis of our current systems reveal that only some of our LTSS
systems are compliant with CFCM.
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Conflict-Free Case Management
Conflict-Free Case Management
Additional Design Elements
Grievances, complaints, appeals, and the resulting decisions
are adequately tracked and monitored.
State agencies retain functional LTSS program eligibility
determination and service provision business practices to
ensure that consumer choice and control are not
compromised.
Consumer experiences are tracked and documented with
measures that capture the quality of care coordination and
case management services.
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Uniform Assessment Process
Uniform Assessment Tool (UAT)
The UAT will, in a uniform and automated manner
across the state:
Assess functional eligibility for LTSS applicants
Identify support needs
Inform service planning
Meet the Core Standardized Assessment BIP requirement
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Uniform Assessment Process
Uniform Assessment Process
BIP requires assessment of consumers across a number
of domains.
Activities of daily living
Instrumental activities of daily living
Medical conditions
Cognitive functioning
Behavioral concerns
BIP supports a holistic approach to the assessment
process and service planning.
The Determination of Needs (DON) tool focused on ADLs and IADLs
with limited focus on behavioral health and other clinical domains.
We will now see an improved assessment process that views
consumers holistically which will lead to the development of
comprehensive service plan.
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Additional BIP Requirements
Information Technology Coordination
States must make an effort to coordinate their
NWD system with other health IT initiatives.
The IT System will be interoperable and will allow
sharing of data across agencies to better support
consumers.
The Illinois Framework Project is committed to assisting
the BIP team with planning the necessary IT
improvements given the alignment of the mission of
the Illinois Framework Project and the goals of the
Balancing Incentive Program.
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BIP Funding
Sustainability
Funding Plan
Illinois is projected to receive approximately $90 million
in enhanced FMAP under BIP. The $90 million is a
calculated percentage of community LTSS expenditures.
States must use the BIP funds in a manner that can be
sustained after the program ends September 30, 2015
States should identify funding sources that will allow
them to build and maintain the required structural
changes
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Funding Dos and Don’ts
BIP funding is restricted to specific uses:
Allowable Uses of BIP Funds
Threshold tests for IL BIP spending:
Does the activity increase offerings of or access
to non-institutional LTSS?
Does it contribute directly to increasing
access to and utilization of LTSS in home
and community settings?
Does it provide a community alternative
to immediate institutional placement?
Does it expand community capacity that
lengthens community tenure?
Does the activity expand/enhance
offerings/access that benefit Medicaid
recipients?
Is the activity something that Medicaid funds
can typically be spent on (i.e. not prohibited
use of Medicaid funding)?
Prohibited Uses of BIP Funds
Under federal law, BIP funds
may not be used:
X To match any other Federal funds.
X To provide services, equipment, or
supports that are the legal responsibility of
another party under Federal or State law.
X To supplant existing Federal, State, local,
or private funding of infrastructure services.
Sustainability:
All activities must have a sustainable source
of funds after BIP ends, unless they are onetime, non-recurring expenses.
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Illinois’ BIP Timeline
March 29, 2013: IL submitted BIP
application
June 12, 2013: IL received CMS
approval to participate
October 18, 2013: Initial work plan due
to CMS
October 2013-September 2015:
Implement required structural changes
September 30, 2015: BIP funding ends
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IL BIP Contact Information
Questions?
Lora McCurdy
BIP Project Director
Illinois Department of Healthcare & Family Services
Phone: 217-557-0997
Email: [email protected]
http://mfp.illinois.gov/bip.html
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