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 &
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
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
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
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.
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.
Key Elements of the BIP
 Required Structural Changes
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
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
 Provide application assistance
 Provide referrals for services and supports available in the
 Enable functional eligibility assessments
 Numerous Streamlined Entry Points:
 New LTSS website
 New 1-800 number
 Existing network of community-based agency offices
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
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.
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
Consumer experiences are tracked and documented with
measures that capture the quality of care coordination and
case management services.
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
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.
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
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.
BIP Funding
 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
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
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.
All activities must have a sustainable source
of funds after BIP ends, unless they are onetime, non-recurring expenses.
Illinois’ BIP Timeline
March 29, 2013: IL submitted BIP
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
IL BIP Contact Information
Lora McCurdy
BIP Project Director
Illinois Department of Healthcare & Family Services
Phone: 217-557-0997
Email: [email protected]