Consumer Directed Attendant Support Services. The Delivery Option for Long-Term Care for the 21 st Century

Transcription

1 Consumer Directed Attendant Support Services The Delivery Option for Long-Term Care for the 21 st Century

2 Why are we here CDASS is the CROWN JEWEL of long term care according to Director Sue Birch. (We agree) CDASS must be stabilized so that compliance with HB and other legislative requirements can be fulfilled. We believe as clients it is our responsibility to be part of the solution and are here to offer specific ways we can help.

3 What is CDASS CDASS is a service delivery option, currently available to some clients in the LTC system. In CDASS clients can hire, fire, schedule, and otherwise manage their personal care instead of using a provider agency. Client satisfaction and outcomes are outstanding. You have a handout showing how someone from each of your districts benefits from this program.

4 FACTS about CDASS It is a service delivery option, not a distinct service or waiver CDASS services more than 2000 clients and has created more than 6000 NEW jobs. Many CDASS employees have been able to get off of public benefits such as food stamps because they are paid a living wage because all funds go to services. CDASS is the ONLY option for clients who are very severely disabled, such as ventilator clients. There are no nursing facilities or home health agencies that take long term vent dependent clients

5 Facts about financing All money goes to services, not administration. Clients pay for all administrative overhead out of their allocation. Administrative overhead in this program is the cost paid to the fiscal agent. This covers payroll services, training of client, and also includes normal employee costs (unemployment, works compensation, FICA, SUTA, etc.) Clients currently pay 10.75% of their allocation and their budget must consider ALL employee related costs. When done properly, the allocation should be equal to the amount that would have been spent on a home health or personal care agency. Clients who qualify for private duty nursing or other nursing have much lower costs (even if the clients are expensive) because CDASS does not have a nursing rate.

6 Facts about Long Term Care Community based long term care is here to stay and will grow. If you live long enough, you will need it-and only the very wealthy can sustain private pay. Middle class Coloradoans will want this model as it fits with the Colorado culture of independence and self determination.

7 CDASS enables us to comply with federal requirements: The federal government (CMS) requires that the state have a care plan for each HCBS client. The state must be able to show that they provide all of the services on the care plan. The federal government also requires that services be sufficient in amount, duration and scope to reasonably achieve their purpose. The Olmstead decision requires services to be provided in the most integrated setting appropriate to the needs of the individual. This includes the ability to provide services in a manner that would enable clients to work, and take other positions of responsibility in the community. Because CDASS is not regulated by the Department of Health and is exempt from the Nurse Practice Act, CDASS enables the state to follow the law without having to do reasonable modifications of policy for numerous clients on a case by case basis, something that would be difficult to administer.

8 As leaders in the community with extensive knowledge about the client base we believe Clients on CDASS have better health outcomes like fewer pressure sores Clients on CDASS have almost no preventable hospitalizations Clients on CDASS are more independent in their daily lives and use fewer ancillary services Clients on CDASS rarely experience no shows and last minute call offs because the client is the employer Quality of care is superb and is frequently noted by physicians caring for this clientele

9 Goal We have been involved with this program since the beginning and have studied similar programs around the country. We understand HCPF is short staffed and suffers turnover. We are not blaming anyone. In the process of numerous program and division managers, the understanding of this program has been lost. We are here to make the JBC aware of concerns, and the need to protect and improve this program. This program is necessary not only as a lifeline for clients, but to keep us in compliance with federal requirements and to give people with disabilities the independence, self determination and control over our lives that we all believe is necessary. We are here to partner with you and the department to bring this program to it s full potential, which is to be the Gold Standard of responsible high quality long term care.

10 History CDASS began as a pilot and was vigorously studied at all phases of implementation. It was only made a permanent part of Medicaid after evaluations approved by CMS proved that it was both cost effective and high quality. It has been consistently supported by the General Assembly, as well as Democratic and Republican administrations.

11 Timeline 1996 Pilot authorized by legislature in 1996 SB Extended Pilot SB Program Operational 2003 First expansion, removed 150 client limit HB CDASS made permanent program AND service delivery option in all long term care programs HB CDASS mentioned as cost effective high quality program in Owens State of State 2007 (January) CDASS moves from pilot program to permanent program after studies show fiscal and quality excellence CDASS (December) identified as one of the three most effective HCPF programs by Ritter Administration at the JBC hearing 12/13/ Medicaid Buy In Authorized-States like CO that received a Medicaid Infrastructure Grant were required to have a consumer directed attendant program 2010 HB changed home care allowance program, had CDASS been operational in all waivers the problems you will hear about later would never have occurred.

12 Today s Situation Long term care is the most expensive part of Medicaid. The LTC clients are not going anywhere. People who require others to assist with basic everyday living skills will likely always need some level of Medicaid support. Overall LTC reform is imperative. The CDASS model is the answer for fiscally responsible high quality care for our most vulnerable citizen. Community First Choice Option is complementary to CDASS and would not replace it. If we go in that direction, and preliminary information suggests that we should, CDASS may help Colorado qualify for federal incentives. At each juncture when the program clients, employees and family members have had true partnership with HCPF the program has been efficient and effective. Every time those with the on the ground expertise and institutional knowledge (clients/family/employees) have not been equal and active partners problems have developed. (handout) Every time we have been involved we have been able to come up with cost effective solutions. We believe that these problems can be solved with proper intervention.

13 Rumor Versus Reality We need to make decisions based on real data. There are a lot of rumors about CDASS. For example, we heard there was out of control fraud. When we asked for data to help craft policy to fix the problem, we learned that out of more than 2000 clients the fiscal agent had 13 reports of fraud. At the time of this report (Summer 2011) no one had been convicted of fraud.

14 Data is imperative Decisions about this program should be evidence based using sound data Data is imperative for accountable decisions, but it is critical that people who understand the program can be partners with HCPF to set the parameters of data collection. Any data collected must be done using nationally recognized data collection methods.

15 Questions to Consider How to do we compare this to other programs without a control group? The highest need clients are not served elsewhere? Can we review medical outcomes and look at cost avoidance? If there are cost overruns what are the specifics? How does acute care fit into this program? How long does it take to make an allocation change? Is the current process of making clients micromanage the minutes driving costs, rather than containing costs?

16 Measurement of Cost Effectiveness For many clients it is easy the cost of CDASS is the same as it would be for a home health agency but the client has more freedom, is healthier, and is less dependent on other services. For the most disabled clients the difference is more dramatic. According to HCPF high cost clients on average have more hospitalizations, saw 4 more doctors and had 30 more prescriptions than other people. We are confident that the data will show that for high cost CDASS clients you will notice a lower hospitalization rate than people with similar or even less severe disabilities. While they may have more doctors due to requirements to see specialists, the visits will be less frequent.

17 Solution The fastest growing demographic are women over the age of 85 and this program needs to be able to serve the citizenry of Colorado. We need to solve the administrative problems so that it can be expanded, as it the only way to meet the capacity demand without building numerous new expensive programs. This model must be expanded not only in personal care but to all long term care waivers and services. The beauty of this model is there is no need for a huge capacity building project or more layers of bureaucracy. Quality control is natural. The program foundation must be solid, communication must be transparent and there must be accountability on all sides, including the clients. At different points in history there was a small policy work group that helped HCPF develop and implement workable solutions to address program issues. There is a correlation demonstrating that when this group is an actively engaged partner problems are solved or prevented.

18 We Request that the JBC Strongly Recommend Reinstitution of the Policy Committee Must be at least 60% clients/family members/employees and those representatives must be chosen by the community. Committee will develop and implement policy changes Committee will create parameters for data collection. Committee will include case managers. Committee will serve without compensation. If necessary CCDC will find resources to cover expenses of client participants. If committee cannot agree on any specific issue, the department will present a minority report written by the dissenting parties to the JBC.

19 History is great teacher This model worked well during original implementation. This model was in place throughout the pilot when by all accounts everything ran smoothly and savings were achieved. This model helped the state solve problems during a fiscal agent transition. This model developed rule changes and policies that worked well. The only problem points occurred during implementation, and this model was NOT used for the implementation.

20 Follow Up We are confident that HCPF will accept our offer of partnership and ask for the JBC to give a vote of confidence or otherwise endorse this idea. We propose that we report back in 90 days with a work plan and timeline. We will provide a memo outlining progress at day 45 with HCPF. The following questions will be addressed in the report:

21 First 90 days What data needs to be collected, how and from whom? What barriers, if any, exist to collection of said data? When can data be collected? What policies, if any, need to be modified? Prioritize policy modification with most to least urgent. Prioritize data collection tasks. Timeline for making said modifications to include rule promulgation process if necessary.

22 Any questions this panel and the disability community remain available as a resource for this and any other disability related issues Thank you for your time and attention