Transcript Division of Aging Waiver Enrollment Process MAC Meeting August 2015 Role of Indiana’s Area Agencies on Aging (AAAs) • All 16 AAAs are certified as.

Division of Aging
Waiver Enrollment Process
MAC Meeting
August 2015
Role of Indiana’s Area Agencies on Aging
(AAAs)
• All 16 AAAs are certified as Aging and Disability
Resource Centers (ADRCs)
• The ADRCs are the entry point for our HCBS
programs
• AAAs administer Title III, SSBG, and CHOICE
dollars contracted out by the Division of Aging (all
non-Medicaid)
Role of Indiana’s Area Agencies on Aging
(AAAs)
• AAAs are the gateway to the Aged and Disabled and
Traumatic Brain Injury Medicaid waiver programs
• The AAAs also conduct nursing facility preadmission
screening under current state statute
– Preadmission screening is separate from waiver enrollment
– Nursing facility level of care is required for the Aged and
Disabled Waiver but is not determined through the
preadmission screening process
The Aged and Disabled Medicaid Waiver
• Must be Medicaid eligible
– Special income limited is used
– Spousal impoverishment protection is applied
• Must meet nursing facility level of care
• Currently there is no waiting list for the Aged
and Disabled Waiver
The Enrollment Process
• AAA conducts assessment, includes statement
from physician (or nurse practitioner)
• Eligibility determination made by AAA
• Plan developed with individual and whoever
else they wish to include
• Service plan submitted to the Division of
Aging (DA)
The Enrollment Process
• Service plan is reviewed by DA staff and
either
– Approved;
– Denied; or
– Additional information requested
• If approved, it may be pending certain items, such as
Medicaid approval or discharge from a nursing
facility
The Enrollment Process
• When all pending items are resolved, AAA
case manager confirms the start date of waiver
services
• That also comes to the Division for review
– Some auto approvals
– Some require verification by DA staff
• Then authorizations for services are issued to
providers
Potential Sources of Delay
• AAA capacity issues may delay the time it takes to
complete the assessment
• May be difficult to secure document from physician
• May be difficult to get information or schedule
appointments with consumer or their families
Potential Sources of Delay
• DA staff capacity can be an issue as well
• End of waiver year issues can make slots unavailable
until the new waiver year starts
• Medicaid issues
– Disability determinations
– Miller’s Trust
– Failure to produce documents
A&D Waiver Monthly Participant Count
14000
12769
12000
10000
8000
8951
6000
4000
2000
There are 43% more individuals on
the waiver now then just 3 years ago.
Participants served year to date was
55% higher in SFY 2015 than just two
years earlier.
0
Jul-12
Jan-13
Jul-13
Jan-14
Jul-14
Jan-15
Jul-15
Impact for Rebalancing
• Process needs to be faster, more streamlined
• For hospitals discharges, nursing facility is the faster,
easier option
• Waiver capacity (DA, AAAs, providers) has grown
but not at the same rate as waiver participation
– Need to evaluate rates
– Need to encourage capacity building (fear among AAAs
and providers is that the waiver will wait list again)
Pre Admission Screening
• Required of individuals seeking admission to Medicaidcertified nursing facilities, regardless of payer source.
• Current process conflates CMS-required PASRR process (for
individuals with MH or ID/DD conditions), along with LOC
determinations.
• Process is expensive and inefficient and does not lead to
outcomes required of enabling statute and regulations.
• Legislation last session with a sunset date of June 30, 2016 of
state-mandated PAS. Current redesign process underway.
Potential Solutions
• Pending technology changes will allow the DA to more
effectively track AAA response and processing times to
identify and troubleshoot problem areas more directly.
• PAS/PASRR redesign process is underway. This will allow
more directed targeting of individuals discharging from
hospitals with options counseling and divert or prevent long
term institutionalization.
• Trying to identify funding to support capacity building efforts.
Contact Information
Yonda Snyder
Director, Division of Aging
317-232-7123
[email protected]
Debbie Pierson
Deputy Director, Operations
317-232-0604
[email protected]