rewards and challenges of oklahoma medicaid assisted living feb 2010
DESCRIPTION
General info and review of challenges and rewards to offering Medicaid assisted living in Oklahoma. This is a new program that began in 2010 in Oklahoma.TRANSCRIPT
REWARDS AND
CHALLENGES OF
PROVIDING MEDICAID
ASSISTED LIVING IN OK
OKAHSA
March 2010
Presented By Joyce Clark
405.812.9089
ADvantage PROGRAM
1915(c) Home & Community Based Medicaid Waiver that Serves Medicaid Eligible Persons Who Meet NF Level of Care.
Resident must also meet other qualification criteria to be eligible for assisted living services.
ADvantage ASSISTED LIVING
Assisted Living Providers Must Be OSDH Licensed.
And Then
Assisted Living Providers Must Be ADvantage Program Certified by OKDHS.
REWARDS
Much easier for Medicaid
certified nursing home to
implement than private pay
assisted living community.
REWARDS
Intrinsic
New service option that
promotes independence,
avoids early institution, and
slows health decline.
Expands continuum of care.
REWARDS
Enlarges target market.
Diversifies resident and
revenue base.
Increases opportunity to
maintain 100% occupancy.
REWARDS
Assists with supplements
and supplies.
Independent case
management.
CHALLENGES
Industry and community wide lack
of awareness & understanding.
Bureaucracy.
Increases staff cost and operation
expenses – especially for private
pay assisted living provider.
CHALLENGES
No reimbursement when resident is
out of building (hospital, travel, rehab).
No pending or retroactive
reimbursements.
Tier of Care is determined by OKDHS
prior to IDT. Necessary modifications
can be time consuming process that
delays resident from move-in.
CHALLENGES
Additional regulations and
survey.
Threats of funding cuts.
Interagency differences.
Physical plant requirements.
Qualification process.
FYI…
OKDHS & OSDH Partnership
Physical Requirements
Lockable Doors
Private Rooms
Private Bathroom
Kitchenette
Minimum Square Footage:
Built Prior to 1/1/08 = 250 sq. ft.
Built After 1/1/08 = 360 sq. ft.
ROOM & BOARD PAYMENT
The member is responsible forroom and board costs. TheADvantage Assisted LivingServices provider is allowed tocharge a maximum for room andboard that is no more than 90%of the SSI Federal Benefit Rate(Currently $606.60).
REIMBURSEMENT RATE
Three tiered based on eachconsumer’s assessed need viaindependent UCAT assessmentnot associated with the AL butbased on ADL-IADL need.
Does Not Pay For Room and Board.
PER DIEM RATE STRUCTURE
Standard = $42.24(estimated 20% ADv AL consumers)
Intermediate = $57.00(estimated 50% ADv AL consumers)
High = $79.73(estimated 30% ADv AL consumers)
DEFINITION OF ADvantage
ASSISTED LIVING
Assisted living services are personal care & supportive services furnished in a homelike, non-institutional setting including 24-hour on-site response capability to meet needs & provide supervision, safety and security.
SERVICES TO MEET CONSUMERS
NEEDS MAY INCLUDE:
Personal Care
Housekeeping
Laundry
Meal Preparation
SERVICES TO MEET CONSUMERS
NEEDS MAY INCLUDE:
Nursing Evaluations and Supervision.
Nursing Care.
Medication Administration.
Assist with Transfer or Ambulation.
THANK YOU!
•DEVELOPMENT
•PROJECT MANAGEMENT
•FEASIBILITY ANALYSIS
•MARKETING & MANAGEMENT
Achievis Services Include:
