ohio association of area agencies on aging wraaa annual luncheon cleveland, oh april 16, 2013 larke...

Ohio Association of Area Agencies on Aging

WRAAA Annual Luncheon Cleveland, OH

April 16, 2013

Larke [email protected]

(614) 481-3511


www.ohioaging.org

Key Provision of the Ohio Dual Demonstration:

Integrated Care Delivery System

(ICDS) Facebook: o4aadvocacyTwitter: @o4aadvocacy


Enrollment• Voluntary enrollment: September 2013 • Passive enrollment: phased in by region Oct.–Dec. 2013• Who will assist with enrollment?

• Enrollment broker, OSHIIP, ADRN (AAAs, CILS, other human services) Possible $4 million fund

• How to roll out information for current dual eligible individuals? (Enrollment work group)

• Regional meetings (providers in morning and consumers/advocates in afternoon

• “Tiered messages” to consumers• Branding: My Care Ohio• Notices (CMS vs state)

Key Provision of the Ohio Dual Demonstration: ICDS


Care delivery model• Managed Care Plans coordinate services through a

person-centered planning process• Plans must contract with AAAs to coordinate HCBS

waiver services for enrollees over age 60

Financing

CMS capitated financial alignment model

Benefits

Nearly all Medicare and Medicaid services and plan flexibility to add benefits



Targeted population• Est. 114,00 beneficiaries• Excludes those with developmental disabilities • Only Full duals are included • People with credible 3rd party insurance are excluded

Ombudsman

Existing State Long-term Care Ombudsman will offer:• Individual advocacy• Independent systemic oversight

• Each MCO is required to have consumer advisory panels



Next Steps

• Rates: Participating plans receive capitation rate reflecting the integrated delivery of Medicare and Medicaid benefits based on:

• Baseline spending in both programs.

• Anticipated savings resulting from integration & improved care.

• Readiness Review: Ongoing process to asses plans’ Medicare and Medicaid experience and Demonstration readiness.

• Two-step process that includes an onsite and desk review of participating plans.

• Massachusetts first state to begin.


7 ICDS Regions

Ross1,413

Wood1,146

Stark5,769

Licking1,811

Knox942

Darke590

Scioto2,559

Pike891

Adams972

Wayne1,271

Gallia998

Huron705

Butler3,737

Lorain3,466

Brown840

Trumbull3,139

Ashtabula2,133

Seneca875

Perry675

Logan558

Athens998

Union341

Hardin344

Meigs511

Allen1,565

Franklin13,732Clark

2,304

Henry294

Mercer375

Belmont1,512

Noble223

Miami1,165

Portage1,474

Highland907

Preble472

Fairfield1,733

Vinton292

Fulton418

Putnam350 Hancock

777

Muskingum1,887

Monroe277

Carroll458

Shelby491

Richland2,083

Clinton570

Marion1,147

Medina1,190

Guernsey930

Madison412

Lucas7,793

Holmes452

Warren1,567

Greene1,610

Morgan324

Summit7,711

Coshocton677

Pickaway696

Morrow461

Fayette640

Ashland687

Hocking578

Jackson913

Geauga617

Williams533

Tuscarawas1,440

Delaware848

Harrison333

Paulding238

Lawrence1,836

Defiance470

Hamilton11,363

Auglaize436

Columbiana1,670

Wyandot319

Van Wert344

Crawford808

Mahoning4,475

Sandusky858

Champaign512

Ottawa527

Washington1,025

Clermont2,219

Cuyahoga24,396

Jefferson1,333

Erie1,031

Montgomery8,467

Lake2,043

Ohio ICDS Regions

Central

NW

WC

SW

NE

EC

NEC

Average Potential ICDS Medicare/Medicaid eligibles per month, SFY 2011

Non-demonstration counties

ICDS Regions and Demo Counties

Central

EC - East Central

NE - Northeast

NEC- Northeast Central

NW - Northwest

SW - Southwest

WC - West Central


Health Plans by Region

• Northwest: Aetna and Buckeye• Southwest: Aetna and Molina• West Central: Molina and Buckeye• Central: Aetna and Molina• Northeast Central: CareSource and United• East Central: CareSource and United• Northeast: Buckeye, CareSource, United


Demonstration status nationally

• Overall:

• Massachusetts, Ohio, and Illinois have approved capitated Demonstrations

• Washington State has an approved managed fee-for-service Demonstration

• Continuing to work with over 20 states on initiatives to better integrate care.

• Approved Demonstrations www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-CoordinationOffice/FinancialModelstoSupportStatesEffortsinCareCoordination.html

http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-CoordinationOffice/FinancialModelstoSupportStatesEffortsinCareCoordination.html




Considerations

• Implementation and Monitoring:

• Ongoing milestones that allow CMS and States to monitor demonstration plan as enrollments begin.

• CMS and the State have the right to stop enrollment at any time.

• Evaluation:

• Contracted independent evaluator (RTI); and

• State-specific evaluation plans


Comparison to another state: Illinois• Illinois got MOU signed February 22, 2013

• 135,825 eligible beneficiaries in 2 regions• Voluntary enrollment Oct through December 2013, May

begin passive enrollment in January 2014• May keep out of network providers 180, special exceptions

after• Care team led by care coordinator. Jointly develop care

plan, review every 30 days for high risk, 90 days for moderate risk

• Ombudsman created outside Medicaid office• Plans must offer contracts to LTSS providers to avoid

redundant services


ICDS Provisions Affecting AAAs

• Front door role remains the same• MCOs must contract with AAAs for waiver service coordination of

NF LOC individuals over age 60• Provider rates protected 90 days to 1 year• Consumer chooses LTSS specialists (WSC): PASSPORT care

managers are default for people over age 60• ICDS will align with other HHS initiatives (CMS care transitions

program)• ICDS may contract with AAAs to do caregiver support, evidenced

based disease management, provider network management


Successes

• Annually, AAAs:• Answer 300,000 calls • Perform 45,000 assessments• Enroll 9,700 in PASSPORT• Care manage 43,000 frail people

• Ohioans 60+ using Medicaid funded NFs down 14.5% in 12 yrs. despite 15% increase in 60+ population

• PASSPORT has 99.3% satisfaction rate statewide

• 25+ years of care management


AAAs as Front Door to LTSS


The Ohio ICDS MOU requires ICDS Plans to default to AAAs as the preferred provider of waiver service coordination for individuals over 60 years old.

Required Waiver Service Coordination:

Delegated component of ICDS Plan care management.

AAAs provide face to face services across all care settings of the ICDS Plan member’s choice, including the following:

AAA Network Menu of Servicesfor ICDS Plans


Waiver Service Coordination/Care Management • Establish personal goals and plans of care• Address provider management issues• Develop disaster preparedness/back-up plans • Medication review • Provide health and safety review and problem

resolution • Assist with transitions between care settings• Work collaboratively with other community-based

programs to provide a seamless system of care for the Plan members

Required Waiver Service Coordination


Care and Service Plan Review Face to face, in-home visits to:

• Review of physical health systems, medical history, functioning (ADL/IADL), mental and cognitive abilities, social supports, environment, and financial resources (SSI, VA, HEAP, Homestead Exemption)

• Provide disease management education• Recommend housing modifications, DME, and service plan

updates• Coordinate benefits and confirm eligibility status• Review and revise disaster preparedness plan• Update care plans



Crisis Intervention• Psycho-, social, and environmental problem solving (non-

medical)• Provide family and care giver education• Report abuse, neglect, exploitation• Resolve and report service delivery incidents

Event-based Visits• Address changes in home environment, caregiver,

physical/mental functional areas• Update care plans to address health and safety issues or areas

of non-compliance



Institution-based Visits• Coordinate with payer to identify diagnosis, treatment, and

expected length of stay• Advocate for member in discharge planning meetings • Assist with transition home

Service Management• Order and adjust services as needed• Resolve service delivery issues and ensure service plans

remain member-centered



Medicaid Resolution Assist with Medicaid redetermination and food stamp resolution

Assessment of LTSS NeedIncluding functional needs assessment, environmental assessment, social needs assessment

Managing Member Care Through Independent Providers and Consumer Direction



Technical Assistance:

Care Transitions Services

Evidence-based transition services, such as the Coleman Care Transitions Intervention, are designed to assist MCO members transitioning from any health care facility to home.

These services have been proven to significantly reduce hospital readmissions.

Provider Management Assistance

Potential Add-on AAA Services


Evidence-Based Wellness Programs

• Matter of Balance• Chronic Disease Self-Management Program with special

versions for individuals managing chronic pain and diabetes

• Healthy IDEAS • Tai Chi



Caregiver Support

• Customized training and education• Health and wellness programs• Personal consultation• Family mediation• Caregiver planning



Continuing Issues for AAAs in ICDS

• Firewall protections between the Front Door and Care Management/waiver service coordination

• Rates

• Enrollment process (transition)

• Interaction with 2 or 3 Plans and continued administration of Medicaid waiver programs for non-duals and those that are presumptively enrolled in Medicaid (before final Medicaid determination)

• Evaluation


Budget Advocacy for Aging Issues

Keeping the front door open,

Restoring funds to rebalance Medicaid


1. Restore the 10% cuts ($3.6 million) for PASSPORT screening and assessment

2. Increase all PASSPORT provider rates by 3%

3. Permit individual care plans that fully support nursing home transition and diversion

4. Ensure all seniors have access to life-enhancing services no matter where they live both inside and outside the Integrated Care Delivery System

5. Fully fund Adult Protective Services across the state ($11 million)

6. Fund the Balancing Incentive Payment Program ($10 million

Budget Priorities


1. Restore front door funding

• PASSPORT assessors are the front door to link older adults to cost-effective in-home and community programs

• PASSPORT enrollment has stalled since July 2011 when 10% cuts to front door funding went into effect, forcing AAAs to lay off screeners and assessors

• HB 59 proposes only fractional increases to front door funding

• Not only is PASSPORT cost-effective, it also has 99.3% consumer satisfaction rate statewide


2. Restore provider rates

• While rates for assisted living and adult day care services are increasing, all other PASSPORT providers are flat-funded after sustaining a 3% cut from the last budget

• Providers who have earned a Medicare-Medicaid certification get a higher Medicaid reimbursement rate than PASSPORT’s and thus many of them choose not to provide the PASSPORT service

• ALL provider rates need to be restored to ensure that seniors receive quality services without delay


o4a amendment

• o4a has submitted an amendment to the legislature that would restore front door funding and increase PASSPORT provider rates

• AAA representatives continue to follow-up with local representatives, especially those of the House Finance & Appropriations Committee

• Time to move to the Senate finance committee


Budget Advocacy: House Substitute Bill

• Good News:• ½ of the request for increases in PASSPORT provider rates and

PASSPORT front door activities are in the bill ($6 million)

• Bad news:• Only ½ of the funding is included…• Funds for the Balancing Incentive payment Program were

removed• MEDICAID EXPANSION WAS REMOVED


3. Fund senior care plans

• Lower care plan ceilings arbitrarily limit access to necessary services

• The previous budget reduced the amount AAAs can spend on an individual’s care plan, from an average of $1,147 in FY 2012 to $1,060 in FY 2013

• Lower care plan ceilings have lowered the quality of life for many older Ohioans

• Prescribed services are necessary to avoid or delay nursing home placement


4. Treat seniors equally

• Rural Ohioans should benefit from the same enhanced services being made available in the ICDS counties

• The Integrated Care Delivery System (ICDS) will offer an array of new home care services, but only seniors living in 29 predominantly urban and suburban counties are included in the ICDS

• The state is essentially creating two separate but unequal long-term care systems—one for poor communities and a better one for metropolitan areas

• Level of service shouldn’t be determined by where you live, but by your needs


5. Fully fund Adult Protective Services

• 39 counties do not have enough funding to have full-time adult protective workers

• Older Ohioans deserve protection from abuse, neglect, and exploitation

• o4a has testified in support of the Ohio Elder Justice Act• This bill would expand the definition of “elder abuse” to include financial

harm and make permanent the Elder Abuse Commission, among other provisions that strengthen Adult Protective Services Law


Extend Medicaid Eligibility

• Medicaid expansion makes Ohio stronger by improving the health outcomes of more people of all ages

• o4a estimates that not extending Medicaid eligibility would force $30 million in cuts to PASSPORT and other aging services over two years

• If such drastic cuts take effect, older Ohioans might have to go to expensive nursing facilities or be left on their own


Thank youStay in touch with

Ohio Association

of Area Agencies on AgingFacebook: o4aadvocacyTwitter: @o4aadvocacy

WRAAA Annual Luncheon Cleveland, OH

April 16, 2013

Larke [email protected]

(614) 481-3511


www.ohioaging.org

ohio association of area agencies on aging wraaa annual luncheon cleveland, oh april 16, 2013 larke...

Documents

ohio dual demonstration

icds slide

aging aaas

united slide

ltss slide

years of care management

o4aadvocacy slide

aging icds provisions