Transcript Slide 1

Medicaid Home and Community
Based Care Resources
Mary Beth Ribar
Technical Director in Division of Community Systems Transformation
Centers for Medicare & Medicaid Services (CMS)
Bob Connolly
CMS Consultant
Presentation Topics
• MDS 3.0 Section Q Context
o
Importance to State Veterans Homes (SVH) and Veterans in Community
nursing homes
• Overview: Medicaid & AoA Transitions and
Community Resources
• MDS 3.0 Content and How it Works
• Case Discussion using Veterans Directed Home and
Community Based Services (VDHCBS)
• AoA/CMS/VA Federal Transition Workgroup
• Transition Resources Guide
• SVH Resident Employment Resources
Minimum Data Set (MDS) 3.0
Section Q
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Progress Is Being Made By States To
Balance Long Term Care Service Delivery
• In 2003, 67% of Medicaid LTC expenditures
were for institutional services and 33% were
for community based services.
• In 2008, 57.3% of Medicaid LTC
expenditures were for institutional services
(NF and ICF-MR), and 42.7% were for
community-based services.
• In 2012, the Veterans Administration has a
80% to 20% Institution to community service
expenditures
Minimum Data Set (MDS) 3.0
Section Q
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ADA and Olmstead Decision
Important progress has been made in the last 20 years so that
individuals have more choices, care options, and available
supports to meet care preferences and needs in the least
restrictive setting possible.
o Legislation such as the Americans with Disabilities Act
(1990) and the Olmstead Supreme Court Decision
(1999).
 “Individuals have a right to receive care in the least
restrictive (most integrated) setting and that
governments have a responsibility to enforce and
support these choices.
 An individual in a nursing home can choose to
leave the facility at any time.”
Minimum Data Set (MDS) 3.0
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Overview: Medicaid & AoA Transitions
and Community Resources
• Balancing Incentive Payment Program
• Money follows the Person (MFP)
• Aging and Disability Resource Centers
(ADRC)
• Collaborations AoA, CMS, and Veteran’s
administration (VA)
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Money Follows the Person
(MFP)
 Transition individuals to the community From
Institutional Long-Term Care Settings
 Rebalance the long-term care system by:
 Eliminating barriers to HCBS and
transitioning from Institutional settings
 Increasing availability of and access to Home
& Community Based Services
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MFP: Extended through 2019, 43 States and
DC, new Solicitation in February, 2012
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MFP/ADRC Supplemental
Funding
• 2010, (25 States) up to $400,000 for MFP and
ADRC to MFP Grantees to work with ADRCs,
build processes & partnership & utilize MDS 3.0
Section Q
• States eligible for the 2012 ADRC Supplemental
Funding Opportunity: CO, FL, GE, HI, ID, IL, ME,
MA, MISS, MN,NV, NJ, NM, OH, RI, SC, TN, VT,
WV
• MFP States will submit with budget in early 2012,
approved by April of 2012
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ADRCs – Six Domains: VA is contracting with some
Information & Referral
• Outreach and
marketing to all ages
and income levels,
web-based
searchable database,
systematic I&R, followup
Care Transitions
• Formal agreements
and protocols with
hospitals, nursing
homes and other
health providers to
facilitate transitions,
serve as Local
Contact Agency for
MDS 3.0 Section Q
Options Counseling
• Standards and
protocols, short-term
crisis support to
prevent
institutionalization,
planning for future
needs, follow-up
Targeting/Partnerships
• Capacity to serve all
ages and types of
disabilities, formal
partnerships with key
agencies, regular
consumer input and
involvement
Minimum Data Set (MDS) 3.0
Section Q
Streamline Eligibility
• Uniform intake and
screening processes,
financial and functional
elig. determined on-site
or through seamless
referral, tracking and
follow-up on all
applications
Quality Assurance
• Adequate staffing
and IT to support all
program functions,
CQI plan and
procedures, state and
local level tracking of
performance and
outcomes
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ADRC Location and Service Areas,
February 2012
Indicates ADRC Service Area
States and Territories with Open ADRCs = 50
(Note: ID, MI, NE are planning/redeveloping ADRC
programs)
% of population covered by ADRCs 61.5%
Total number of ADRC sites 414
Minimum Data Set (MDS) 3.0
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MDS 3.0 Section Q
How it works?
MFP & Community Care Referrals: Nursing
Home (NH) Minimum Data Set (MDS)
• MDS 3.0: functional assessment instrument
administered to all residents of all
Medicare/Medicaid certified US nursing homes (already Implemented in Most SVHs)
Minimum Data Set (MDS) 3.0
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April 2012 Revised Q0500B
Return To Community Question
For Admission, Quarterly, and Annual Assessments.
Q0500. Return to Community
B. Ask the resident (or family or significant other if
resident is unable to respond): “Do you want to talk to
someone about the possibility of leaving this facility
and returning to live and receive services in the
Enter
community?”
Code
0.
No
1.
Yes
9.
Unknown or uncertain
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Nursing Home Minimum Data Set
(MDS) Section Q:
•
•
•
•
Section Q asks resident if they would like to talk with
someone about the possibility of returning to live in the
community
If resident says yes-they are referred to local contact
agency (LCA); LCA provides information and works with
resident and NH to determine if community supports and
services are available
NH is still responsible for traditional discharge planning
LCA assists with: housing, personal care assistance, employment,
community integration, transportation, and/or assistive technology
•
Gap in knowledge between VA and nursing home staffs as
far as eligibility and availability of services
Minimum Data Set (MDS) 3.0
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Section Q: New Opportunities for
Discharge Planning Collaboration
 Meaningfully engages residents in their discharge
planning goals.
 Directly asks the resident if they want information about
long-term care community options.
 Promotes linkages and information exchange between
nursing homes, local contact agencies, and communitybased long-term care providers.
 Promotes discharge planning collaboration between
nursing homes and LCAs for residents who may require
medical and supportive services to return to the
community: SVHs,CLCs, can work with LCAs
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MDS-Section Q and Local Contact Agencies
(LCAs)
• Section Q provides resources to resident and NH
from local contact agencies (LCAs) for information
and transition planning
• Each State develops own process and designates
a LCAs for every NH to process transition referrals
• LCAs assist resident and NH with transition
planning: housing, personal care assistance,
transportation, employment, formal and informal
supports
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Local Contact Agencies
LCAs can be:
• Center for Independent Living (CIL)
• Area Agency on Aging (AAA)
• Aging & Disability Resource Center
(ADRC)
• Money Follows the Person program (MFP)
• Developmental Disabilities Administration
• Mental Health Administration
• Mix of these
• State’s Department of Aging
• Other
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Transition Referral Process
NH
Resident
MDS 3.0
Request
Community
Discharge
following
Transition
Plan
LCA
Speaks
With Resident,
Family & NH
staff
Community
Referrals
with
Medicaid
Payment
If yes, initiates
transition plan
If Medicaid
eligible , uses
MFP & HCBS
Resources
If Non-Medicaid,
uses No Wrong
Door ADRC or
Community
Resources
Community
Referrals
with Private
or
Alternaive
Payment
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Emerging Step-by-Step Transition
Models - MFP
Emerging Step-by-Step Transition
Models - MFP
PLACEHOLDER for MFP Step by Step Flow –
Emerging Step-by-Step Transition
Models - MFP
PLACEHOLDER for MFP Step by Step Flow –
AoA, CMS & VA Community
Transition Partnership History
• Feb. 2011: Speeches by Dr. Jim Burris and Dan
Scheops at the CMS and AoA National Grantee
Meeting highlighted Federal mutual interests and
goal
• June 30, 2011: AoA/CMS/VA Workgroup
teleconference initiated
• October 2011: VA implements MDS 3.0 and many
State Veterans Homes (SVHs) already use MDS
3.0 & Section Q return to community requirements
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Why is the AoA/VA/CMS
Partnership Important?
• Uses Person –Centered Transition Planning
for Veterans in NHs and SVHs who say that
they would like to talk to someone about the
possibility of returning to the community
• Aligns communication channels, resources and
eligibility determinations
• Seeks solutions for Veterans different with
different eligibility
o VA & Medicaid, Partial VA & Medicaid, private/selfpay, homeless, etc.
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AoA, CMS, & VA Workgroup Goals
• Use MDS 3.0 Section Q to provide Veterans
information and assistance with available
community resources to transition back to the
community
• Provide wrap-around services for a Veteran in
conjunction with their full, partial, or no VA
benefits
• Coordinate roles for State and local community
supports and services to assist Veterans.
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VA/AoA/CMS Transitions Workgroup Members
Agency Representatives
VA
Dan Schoeps, Nancy Quest, & Patrick O’Keefe
Representatives:
Steve Matune, National Association of State Veterans Homes
President
Linda Schwartz, National Association of State Directors of
Veterans Affairs President
CMS
Alice Hogan, Mary Beth Ribar & John Sorensen and MFP
Terry Moore OH;
CMS Consultants: Bob Connolly and Dann Milne
AoA
Joseph Lugo
VA Directed Care Representatives: Steve Thovson MN CIL
Thomas Wilson & Richard McGhee AoA TX
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AoA/CMS/VA Outcomes
• VA is creating a Points of Contact (POC) List to share
with LCAs, MFPs, ADRCs, SVHs, etc. staffs
• VA/CMS/ADRC Workgroup developed Section Q
Resource List for VA and LCA staffs describing MFP,
LCA, ADRC, SVH and Veterans Extended Care Services
roles, POCs and key resource websites.
• VA is partnering with AoA through ADRCs to provide
services to veterans paying privately or without VA and
Medicaid benefits (i.e., housing, part-time job or other
community supports)
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SVH Local Partnerships
Are Critical!
• Person centered care and Veteran and
Resident choice values are shared by all
agencies, payers and providers
• Siloed care doesn’t work so SVHs must
utilize your Medicaid, MFP, LCA, ADRC, AAA
and other community partners
• SVHs must duplicate the federal
partnership locally to better serve
Veterans
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Case Examples
Veterans Directed
Home and Community Based Services
NH Prevention Case Example 1
Darvin - 83 year old naval veteran from WW II in late stage Alzheimer’s
Disease and had several other medical issues facing nursing home
admission because his 75 year old wife could not care for him
• SDHCBS Plan
o 65 hours per week personal care attendants
o Medical equipment supplied and paid by VA and Medicare
o “Care for the Person with Dementia” and “Family
Caregiver: Physical Skills” for Family members
o Hospice care paying not only attendants but family
members.
Darvin died at home surrounded by his loved
ones as he wished.
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NH Prevention Case Example 2
Joe - 69 year old Staff Sargent with ALS (Amyotrophic lateral sclerosis) also known as
Lou Gehrig's disease. The disease and his dependence on others was robbing him of
his independence.
•
SDHCBS Plan
o 45.9 hours personal care attendants per week, which is his budget
o
Home modifications and a lift, and electric wheelchair
o
Computer devices to “talk” and turn on the TV or appliances with his eyes
o
VA Nurse visits weekly and by VA nurse practitioner as needed.
o
Telemedicine Connection to VA Clinic regarding vitals take by attendants
o
InteractiveTV at VA Clinic Sioux Falls counselor for depression
The case manager said Joe took her hand in his weakened hand and with tears in his eyes
said:
“Thank you. You have no idea”
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In-Process NH Transition Case Example 3
Phil is a 30 year old Operation Iraqi Freedom resides in a VA hospital after IED injuries
including shrapnel piecing the frontal lobe of his brain and an amputation of one of his
legs. His wife divorced him. He has a cognitive impairment however that manifests itself
by late payment of bills, forgetting to buy groceries, complete personal hygiene, cook
meals or eat.
Transition Steps
o Since SDHCBS funds are exhausted, Phil is afraid he will have to be placed
in a Nursing facility or assisted living facility with “old people.”
o
Seeking ADRC resources for his IADL, ADL, and financial management
needs
o
Communicating with Texas Community Living Programs to be proactive
o
Encouraging Brain Trauma team to think outside the box to locate VA paid
resources
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NH Transition Case Example 4
Anna - 93 year old WW II Army Nurse with Alzheimer's required
transition services after skilled nursing facility stay for a broken hip and a
hip replacement. Her niece wanted her to live with her but works full
time.
SDHCBS Plan
o 35 hours a week of personal care attendant with her niece
providing care on weekends
o “Care for the Person with Dementia” and “Family Caregiver:
Physical Skills” training for niece and paid caregiver through Central
Texas Center for Caregiver Excellence
“Anna remains in that home and is now 93 years old and not in a
nursing home.”
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Ohio Medicaid & SVH
Transition Partnership
Initial Steps and Strategies
Ways Ohio SVH & Medicaid Can
Partner
• Ohio is one of 23 SVH states without Medicaid payment for their
nursing home care and are not eligible for MPF funding
• Ohio is considering the following ways to partner without MFP
o Use Ohio MDS 3.0 data to help the SVH and VA profile and
understand transition candidates
o Link MDS data to Statewide Ohio/VA PARIS (Public Assistance
Reporting Information System) to determine their community living
o Utilize OH’s LCA for SVH and community VA transition referrals
o Provide MFP and LCA education to VA and SVH staffs
o Explore mental health resources for the homeless and mentally ill
revolving door Veterans in SVHs and community NHs.
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MFP & Employment
Additional Resources to Veterans
MFP and Employment
• Each state is set up differently
• Check with your local One Stop Centers operated by Dept
of Labor
http://www.careeronestop.org/reemployment/jobsearchhel
p/changecareers/findcareeronestopcenter.aspx
• MFP Technical Assistance Website www.mfp-tac.com for
employment resources
• Medicaid Employment Supports –Medicaid recipients only
http://aspe.hhs.gov/daltcp/reports/2011/supempFR.htm
• Check with your local Vocational Rehabilitation (VR )
agency www.rsa.gov for contact info in your state
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Veterans who want to work: Vocational Rehabilitation
(VR) Role?
• If an individual is not Medicaid eligible and not eligible for VA
employment services due to disability rating, then refer yourself
to a local VR agency and or to a local One Stop Center
• VR can provide employment expertise, guidance, and TA to
MFP Project Director(s) and MFP employment specialists. VR
can assist MFP states in bridging community workforce
partners on availability and access to VR services, job training,
job supports, accommodations and other employment related
needs and services-comparable benefits
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Employment Resources
(Continued)
• If the Veteran receives SSA/SSDI, check with Local SSA/VR
agencies regarding Ticket to Work Incentives
http://www.socialsecurity.gov/pubs/10061.html
• CMS MFP Website
www.cms.gov/CommunityServices/20_MFP.asp
• CMS Employment subject matter experts:
o
o
[email protected]
[email protected]
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Section Q Information and Comments
 E-mail questions or comments
to:[email protected]
 http://www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/Long-TermServices-and-Support/Balancing/MoneyFollows-the-Person.html Section Q webpage
o Amended Questions and Answers
o MDS Section Q Pilot Test report (June 2011)
o State LCA Point of Contact List
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