Colorado Choice Transitions Advisory Council Meeting Thursday, January 30, 2014 Draft Minutes Present: Dawn Russell, ADAPT Tamra Moore, Ombudsman Chris Roe, DOLA Marijo Rymer, Arc of Colorado Jenny Smith, SEP Lori Thompson, DDD Kevin Smith, AOI Nora Brahe, HCPF Nicole Storm, HCPF Ed Milewski, Consumer Kathy Cebuhar, HCPF Natalie Komp, Colorado Health Care Association Tracy Martinez, HCBS Provider Tim Cortez, HCPF Mike, Colorado Blue Sky Toni Manjarrez, Housing Taren Cunningham, HCPF Jose Torres, CCDC Representative Anaya Robinson, ILC and TCA Rene Hickman, HCPF Mike Atlas-Acuna, CCB Sara Dent, Nursing Facility Taylor Larsen, HCPF Pat Doyle, Legal Center Michele Craig, CDHS DDD Jennifer Reeves, DRCOG Leah McMahon, Colorado Access Excused: None Old Business and New Business Kathy Cebuhar Kathy started the meeting with introductions, and thanks to those who participated in the survey. The packets for the meeting included the top 10 results of the survey. Kathy went on to review the top 10 guiding principles that have been agreed upon for the conduct of the meetings. All in agreement on: listen to understand; be hard on the issues and easy on people; respect the views on others; suspend judgment; be present - put distractions away (everyone is aware of when to take a phone call, please step out when doing so); one person talks at a time; introduce yourself when speaking; differentiate when stating your personal opinion or that of your constituency; share the air; and say it once, don t feel the need to repeat what others have said, just simply agree. The CCT team will be analyzing the results of the data survey internally and preparing information to distribute at the next meeting. In the meeting materials packet, Kathy included a list of committee members and contact information, in addition to this is a list of definitions that were provided for the data survey, keep these on hand to use as a referral tool. Proposal Jose Torres Managing the phone - when there is a discussion where there are two or three people talking, we need to stop and ask for input from those on the phone before continuing on.
Community Transition Information Rene Hickman and Nora Brahe Rene: In 2010, the MDS was revised and Section Q was introduced. This question asks residents if they would like to speak to someone about receiving information about the possibility of leaving the facility or returning to live and receive services in the community. If the resident says yes to the MDS Section Q question, the facility makes a referral to the local ARCH (now called ADRC in Colorado) or local contact agency. That agency is then responsible for providing the resident with options counseling. After the referral has been sent, there is a monthly report that is submitted by the local contact agency that is received by HCPF. Rene receives an additional report tracking yes responses on MDS section Q (question 500) assessments. Rene receives this report monthly and compares the two to see which nursing facilities are in compliance with the requirement and are referring residents for option counseling. Developer Flow Chart Section Q Question: #490 A council member asked if there is something documented where question 500 is not asked. Concerns about family or guardian making that decision and residents not being offered the choice. Answer: There are times where the resident does not feel competent enough to answer that question, therefore their guardian can answer on their behalf. The question must be asked on an annual basis or if condition has changed. Question: Where does this directive come from that this has been allowed? Answer: CMS has provided extensive training to nursing facilities. Nursing facilities should never second guess the residents about whether or not they can answer the questions. There are parameters they use to determine if the question should be asked. Not too many cases like this. Link with criteria that shows the CMS directive. Question: Concerns about clinician making those decisions for the resident. Answer: Nursing facilities should be asking the question and making appropriate referral and going forward with the requirements of the assessment. Question: Would it be possible to get the percentage of clinical records that have the skip pattern? Answer: Please refer to the hand out that explains skip patterns. Nursing facility has the option to not refer a resident if the box is checked suggesting a referral is not needed. Resident has choice to not be asked on every interview; only annually. Question: Will this be a part of the tracking (number of days between yes and referral)? Answer: Problem with the referral; some clients do not want to wait 90 days for CCT, so nursing facility may do a discharge plan. Clients do not have to wait 90 days to transition through the EBD waiver.
MDS Section Q Data Report Numbers from December: 629 people responded to section 500 meaning, yes, they want options counseling, or no they did not. 208 individuals responded yes to section 500. 184 individuals that could possibly have a referral for options counseling. The exception is if the question Does a referral need to be made at this time? is checked no although the resident say yes the nursing facility does not proceed with the referral. Of the 184 individuals 25 needed to be referred but were not. CTS - Community Transition Services Nora Brahe CTS is the services available to nursing facility residents to help them relocate back into the community. This service is provided by Transition Coordinators (TC). CTS has been benefit of the EBD waiver since 2006. Between 2006 and 2013 CTS was available under EBD, but had limited state coverage. Only three to four counties had TCs that provided the services. Also there was limited participant eligibility for those who met the criteria of the EBD waiver. Eight TCs across the state transitioned 188 participants between 2006 and 2013. In 2013, the decision was made to make CTS a demonstration service through the CCT Program. This allows for expanding state coverage. As of now, all counties except for six or seven have a Transition Coordination agency (TCA). Seven nursing facilities do not have a TCs agency available to support client transitions. Currently, there are 43 TCAs, and 52 TCs enrolled as CCT approved providers. Coverage has expanded because CTS is now available to individuals who have brain injuries, mental health issues and intellectual disabilities. The difference between CTS under EBD and CTS through CCT are pretty significant; most basic being the change in concept about what makes a client ready for a transition. How do we determine that a transition is feasible? Historically, it was based on the client readiness, which is a term used by professionals, clinicians and medical teams. The clinical team determined it by looking at various things and decided if the client was ready or not ready. Now, the decision for a transition is based on whether or not the supports and services that the client needs in the community are available at the level he or she needs. The CTS process is client driven, the client is involved as an active participant, and it is a team-based process. Supports and services in the community need to be available in order to have that individual stay in the community. Nora Brahe stated, We have to have communities prepared to support our individuals. We also provide technical assistance, trainings, and meet with TCs once a month, to review client transitions. Transition Data Transition data points are collected weekly and monthly. CCT tracks referrals, the status of the referrals, identified barriers, and housing needs. Much time is spent problem solving and developing responses to transition challenges and successful practices are identified. CCT Community Transition Services - From 03/20/13-01/27/14 In CCT pipeline -49 clients in CCT Have not yet chosen CCT - 101 clients have not decided or have chosen another Not a transition candidate - 118 not yet to be a transition candidate Successful Transition -35
CMS Site Visit Tim Cortez In December, some of you participated in the CMS site visit. The representatives from CMS liked that the CCT program has not been idle while waiting to get systems in place. Colorado is one of the few states to go to an outside agency to work on housing partnerships and establish housing options for individuals. CMS also liked CCT s level of stakeholder involvement as demonstrated by listening to what stakeholders were saying, and the active CCT advisory council. They liked that we are setting up Regional Transition Committees and linking them to this council, in an effort to be clear on local and common issues throughout the state with the understanding that transitions are a community responsibility. CMS has seen a disconnect on this topic in other MFP states. CMS is looking into the issue of individuals that may be in a nursing facility but not may not be eligible for HCBS. The state plan looks at it as a medical necessity, not a level of care. In Colorado s, state plan medical necessity equals level of care, for us, that is an issue. Unfortunately, there is an annual reassessment process for HCBS and there is not an annual reassessment process for level of care for a nursing facility. Question: What if they took away the nursing facility support? What would that look like in the community? Answer: There is a conference call with the Central and Regional CMS offices including a few other states to discuss how we might address this issue. Another issue CMS heard loud and clear, was home modifications, and the barriers it creates for transitions. This is due to the way Medicaid reimburses work for home modifications. There has been a lot discussion about this issue. It is reinforced by CMS, that they re expecting people to work together in different ways that they haven t worked together before. That means change for people, which creates tension and sometimes conflict. Every MFP state has gone through these growing pains when they launched a program. Housing Update Chris Roe Chris stated he wants to do his best to help groups and organizations to do their jobs. His job is to be an advocate and provide resources. He wants feedback about the housing issues and problems people are encountering around housing in the community. 30 Denver Housing Authority (DHA) vouchers are currently available for CCT participants, so those of you working on applications please get them in quickly. The client must live in a Denver nursing facility for 90 days or if they are outside the Denver area they can transfer to a Denver nursing facility. Funding was secured for bridge housing, which is two years with the housing program, for people who are in CCT program. Chris is running through local agencies, in Denver County, Boulder County, Larimer County, Weld County, El Paso County and Pueblo County. Home Modifications is a barrier keeping clients from moving out of nursing facilities. Understanding of the rule is that a person can t use the home modification services through Medicaid until they move into the community, but many need the modifications completed to move into the community. The Division of Housing (DOH) is working on a budget request that will move the administration of the home modification program from Medicaid to DOH. The process is being piloted in Colorado Springs.
Services Updates and Redesign Nicole Storm When the service package was put together for MFP it involved three months of people meeting weekly to talk about what services to include in the program. This group identified 14 different demonstration services to include in the program. However, some may drop off due to not being feasible. There are two that are really important, but need help in terms of redesign. See benefits worksheet handout for the Caregiver Education and Peer Mentorship services. Peer Mentorship is one of the most used services in the MFP programs and has proven to be a valuable benefit in other states. Julie Reiskin asked the department to do a pilot program for Peer Mentorship so it can be look at it more broadly for MFP. MFP provides a great place to pilot a program. One thing that we would like the committee to do is think about a program or a curriculum that includes consistent training to be provided to all agencies enrolled to provide the service. Volunteers are need to form a workgroup who can come up with a strong program to push out to the agencies. We would like to see Peer Mentorship become a benefit of HCBS in general. Volunteers: Dawn Russell, Jose Torres, Anaya Robinson, Marijo Rymer and Pat Doyle would like to nominate someone. Caregiver Education is about preparing the families to become caregivers after their family member transitions into the community. We have looked at education curriculums, such as Share the Care for Seniors, to help families ask for help and organize the help that they may need. We are seeking volunteers to participate in a workgroup for this benefit as well. Volunteers: Tracy Martinez and Tamera Moore would like to nominate someone. Please ask your teams for volunteers. Future Agenda Items Housing discussion and Services (Providers and explanations) Meeting adjourned