Indiana Area Agencies on Aging (AAA s) CHANGE

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1 Indiana Area Agencies on Aging (AAA s) CHANGE How do we increase access to Home and Community Based Services (HCBS) 1

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4 Build HCBS Provider Capacity Build HCBS Provider Capacity Focus on Outcomes Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign 4

5 Integrated Case Management Software Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign Integrated Case Supported Management Decision Software Making Tools Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign Integrated Case Supported Statewide Management Decision Resource Software Making Tools Database Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign 5

6 No Wrong Door System Integrated Case Supported Statewide Management Decision Resource Software Making Tools Database Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign Transition No Wrong (MFP) and Door Diversion System (PASRR) Integrated Case Supported Statewide Management Decision Resource Software Making Tools Database Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign Improved Access to HCBS Transition No Wrong (MFP) and Door Diversion System (PASRR) Integrated Case Supported Statewide Management Decision Resource Software Making Tools Database Build HCBS Provider Capacity Focus on Outcomes Waiver Redesign 6

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8 The same team, a new Alliance! INconnect Alliance is comprised of the sixteen Aging and Disability Resource Centers (s) throughout Indiana. This new alliance connects facets of information and resources to create a strong collaborative environment. Our new brand builds awareness of the services and resources our agency offers. The goal of the INconnect Alliance is to create a widely recognizable brand that unifies all sixteen centers. Putting the care puzzle together It s no secret the need has increased for long-term services and supports for our aging and disabled populations. They and their caregivers need easy access to reliable information and resources that link them to a better quality of life. The INconnect Alliance helps piece together the care puzzle. The Alliance members will offer information to older and disabled Hoosiers on available options to support them in making decisions that are right for them. Building wider community recognition of s through the INconnect Alliance will increase awareness of options and promote integration of available resources. Option Counseling 8

9 Currently, Indiana is one of the lowest ranked states/territories (49 th out of 51) in regards to the amount of money invested into case management services per qualified resident. The State has requested input from all the stakeholders on what triggers should be implemented to require that options counseling take place throughout the entire system. 9

10 The money being saved from streamlining the PAS program is being planned to be reinvested in Option Counseling. The AAA s are currently working with the Division of Aging to create an agreed upon definition of what Options Counseling means Identify Options Counseling trigger points Establish quality assurance criteria to be sure Counseling is consistent Develop tools/resources to ensure all options are explored No Wrong Door The State recognizes the need for streamlined access to Long-term Support Services (LTSS) information regardless of age, disability type, or income. Town Hall meetings were conducted throughout the State with providers and consumers to help develop a vision the vision of what the No Wrong Door system in Indiana will look like. 10

11 Single Entry Point (SEP) can be defined as: A system that enables consumers to access long term and supportive services through one agency or organization. In their broadest form, SEP s perform a range of activities that may include: Information and assistance Referral Initial screening Nursing facility preadmission screening Assessment of functional capacity and service needs Care planning Service authorization Monitoring and Periodic reassessment Money Follows the Person (MFP) 11

12 What exactly is MFP? The MFP program is funded through a grant from the federal agency, Centers for Medicare and Medicaid Services (CMS). The MFP program was developed to help states move individuals from institutional settings to home and community-based settings. The program helps transition people with housing, services and supplies. The AAA s (SWIRCA & More) are the third entity to hold the contract. Unofficially performing MFP since January 1 st. With AAA s involved will be able to effectively cover all 92 counties. Effective Transitions In a high-performing LTSS system, LTSS services are integrated effectively with health care and social services, minimizing disruptions such as hospitalizations, institutionalizations, and transitions between care settings. Effective Transitions includes: Nursing home residents with low care needs; Nursing home residents who are unlikely to leave an institutional setting; Nursing home and home health hospitalizations; Burdensome hospital transitions at the end of life; and Transitions from nursing homes back to the community. Effective Transitions: Indiana Ranked 33 Low care needs 17 HH hospitalizations 43 NH hospitalizations 32 Burdensome transitions 21 Long nursing home stays 45 Transitions to the community 16 12

13 Percent of people with 90+ day nursing home stays successfully transitioning back to the community 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 15.80% 6.00% 4.00% 8.80% 7.90% 2.00% 0.00% 4.80% Indiana Iowa Utah Median 13

14 PreAdmission Screening Residential Review (PASRR) 14

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16 Ascend will be the software solution All follow the same process All stakeholders have access to the system Nursing facilities will submit request for continued stay, Medicaid related notifications, and transfers between facilities through Ascend. The Ascend system will connect to the state s Medicaid Management Information System for automated recording of level of care start and stop dates and Medicaid notifications Level 1 s Per PASRR regulations, Level 1 s must be completed on all applicants to nursing facilities The Ascend algorithm will make approximately 70% of the Level 1 without additional review. Additional quality reviews will be conducted by DA staff on those reviews The remaining 30% will be subject to a desk review at a minimum Level of Care determinations Level of Care (LOC) determinations, at a minimum, must be made on all applicants utilizing Medicaid as their payor All LOC information will be subject to desk review at a minimum Request for continued stay will be treated as a LOC determination If a case requires independent, onsite verification of LOC, the AAA will complete that assessment along with the provision of option counseling Some roles will be the same in certain admission types. 16

17 Level 1 Entry Level 1 Review LOC entry LOC Desk Review LOC independent, onsite verification From Home Non Emergency AAA AAA AAA AAA n/a Out of State Receiving NF Ascend Receiving NF Ascend n/a Emergency Admits 30 Day Exemptions Respite Admits NF Ascend NF Ascend AAA & APS Hospital discharge planner Ascend Per course of action Per course of action NF Ascend n/a n/a n/a Per course of action Common Questions How long will it take to receive the results of my submitted Level 1 and or LOC? If there are no indicators that additional review is required, you should receive an immediate web reviewed approval. If a clinical review is required, you will receive an approval within 6 business hours of your referral, if or once all information is received What is the process for someone coming from home and not from an acute care setting? If the individual is truly seeking nursing facility admission, the nursing facility would make the referral to the local AAA for the at home assessment/review Does this replace the 450b process? Yes, the 450b system is expected to shut down around July 1, 2016 Will we still have contact with our local PAS office? There will not be a local PAS office per se. The /AAA will continue to have a role in assessments for admissions from home and review of any level of care denials. They will also act on referrals for options counseling to assist individuals in returning to the community as appropriate

18 Impact of Improved Performance: Indicator If Indiana improved its performance to the level of the highest performing state: Low-Income PWD with Medicaid 32,563 More low-or moderate-income (250% poverty) adults age 21+ with activity of daily living disabilities would be covered by Medicaid Medicaid LTSS Balance: New Users 6,358 More new users of Medicaid LTSS would first receive services in home- and community-based settings Nursing Home Low Care Needs 3,550 Nursing home residents with low care needs would instead be able to receive LTSS in the community Long Nursing Home Stays 2,794 More people entering nursing homes would be able to return to the community within 100 days Transitions Back to the Community 2,803 More people with 90+ day nursing home stays would be able to leave a nursing home for a more home-like setting. Thank you!! Rhonda Zuber President SWIRCA & More rzuber@swirca.org 18