t140624 - 06-24-14 the clinical business and regulatory ...the clinical, business and regulatory...
TRANSCRIPT
6/11/2014
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THE CLINICAL, BUSINESS AND REGULATORY CLIMATE OF DISCHARGE PLANNING
Toni G. Cesta, Ph.D., RN, FAANPartner and Consultant
Case Management Concepts, LLC
East Coast Office
North Bellmore, New York
Bev Cunningham, MS, RNVice President Clinical Performance ImprovementMedical City Dallas HospitalAndPartner and ConsultantCase Management Concepts, LLCDallas, Texas
The information provided in AHC Media Webinars does not, and is not intended to constitute medical or legal advice. Opinions, references and links provided by our speakers are provided for your convenience and do not represent our endorsement of such opinions, products or services.
Tuesday, June 24th, 2014
FACULTY
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Bev Cunningham, RN, MS is Vice President, Resource
Management at Medical City Dallas Hospital. Her areas of
responsibility include Case Management, Health Information
Management, Clinical Documentation Integrity, Patient Access
and Transplant Financial Services. Bev is a well‐known speaker
in the Case Management field. Involved in the development of
case management for over twenty five years, her areas of
expertise include denials management, patient flow and the
role of the Case Manager and Social Worker in the Case
Management process. She has served as a Commissioner on
the Commission for Case Management Certification. Bev is also
a partner and consultant in Case Management Concepts, a
company that provides support to hospitals regarding effective
Case Management model development and evaluation. Bev's
publications include a chapter in CMSA's Core Curriculum for
Case Management Certification and most recently, co‐author of
the book, Core Skills for Hospital Case Management. She is
also on the advisory board for Hospital Case Management.
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Healthcare
Consultant in Case Management Concepts, LLC, a consulting
company that assists institutions in designing, implementing
and evaluating acute care and community case management
models, new documentation systems, and other strategies for
improving care and reducing cost. The author of eight books,
and a frequently sought after speaker, lecturer and consultant,
Dr. Cesta is considered one of the primary thought leaders in
the field of case management. Dr. Cesta writes a monthly
column called “Case Management Insider” in the Hospital Case
Management journal in which she shares insights and
information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr.
Cesta was Senior Vice President – Operational Efficiency and
Capacity Management at Lutheran Medical Center in Brooklyn,
New York.
LEARNING OBJECTIVES
• Identify key strategies for timely and effective discharge planning.
• Explain delays in patient transitions to the case management department scorecard.
• Explain new and revised case management standards, regulations, and laws put forth by CMS, TJC and the federal government.
• Evaluate case management protocols and penalties.
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TRANSITION
• State or passage from state or stage to another
• Alteration of a physical system from state, or condition, to another
• Shifting gears
• Passage from one phase to another
DEFINITION OF DISCHARGE PLANNING
Medicare defines discharge planning as “a process used to decide what a patient needs
for a smooth move from one level to another”
www.cms.gov/cfcandcop/
TRANSITION
THE WHY OF TRANSITION PLANNING
Through a situation
From one provider to the next
To the community
Through the community
Through the hospital
Through a disease process
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DISCHARGE PLANNING IS A PROCESS‐NOT AN EVENT
Patients and families may say: “Sometimes it seems as though discharge from the hospital happens all at once, and in a hurry.”
But discharge planning is a process, not a single event.
As a result of that process, the discharge plan may be to send
your relative to her own home or someone else’s, a rehabilitation facility, a nursing home, or some other place outside the hospital. Discharge from a hospital does not mean that your relative is fully recovered. It simply
means that a physician has determined that her condition is stable and that she does not need hospital‐level care. If you disagree, you can appeal the decision.
From “A Family Caregiver’s Guide to Hospital Discharge Planning”
www.caregiving.org
IT’S ALL ABOUT TRANSITIONS. . . . . . . .
And effective transitions are the core business of hospitals—and a core
responsibility of the case management department
CASE MANAGEMENT TRANSITIONS• Case finding• Patient assessment
– Functional ability– Co‐morbidities and complications– Environmental barriers to post‐discharge care– Services needed by patient
• Resource assessment• Goal setting
– What needs to be accomplished– Time frame for accomplishment
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CASE MANAGEMENT TRANSITIONS
• Planning – Coordination with all disciplines– Coordination with all levels of care
• Implementation• Notification of discharge appeal rights• Monitoring/reassessment; continued
interdisciplinary coordination• Documentation
DISCHARGE PLANNING EVALUATION (ADMISSION ASSESSMENT)
STANDARD• The hospital must provide a discharge planning evaluation to the patients, to other patients upon their request, the request of another person acting on their behalf, or the physician.
• The discharge planning evaluation must include an evaluation of the likelihood of a patient needing post‐hospital services and the availability of those services.
• The evaluation must include an evaluation of a patient’s capacity for self‐care or of the possibility of the patient being cared for in the environment from which he or she entered the hospital.
CATEGORIES TO BE INCLUDED IN THE EVALUATION
• Patient information
• Admission information
• Financial information
• Spoken language(s)
• Source of admission
• Significant prior medical history
• Mental status prior to admission
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• Ability to make needs known
• Living arrangements
• Activities of daily living
• Prior resource use
• Primary care provider
• Social work triggers
• Home care triggers
SOCIAL WORK TRIGGERS
– Abuse – Domestic violence
– Abuse and/or neglect of a child
– Abuse and/or neglect of elder / Adult
– Abuse – sexual assault
– Adjustment to illness/ Difficulty coping
– Behavioral management problems
– Crime victim
– Cultural and/or language issues
– Drug abuse
– Ethical concerns
– ETOH abuse
– Family concerns and/or conflicts
– Guardianship– Homeless requesting
intervention– Hospice placement– Inadequate social support– Inadequate financial support– Long term care placement– Major illness causing lifestyle
change– Multi‐system trauma– Name of patient unknown– Non‐compliance issues– Poor prognosis– Shelter placement– Uninsured– Undocumented– Other– None
HOME CARE TRIGGERS
• Patients requiring assessments/education relating to:• New diagnosis• New medications or change in medications• Change in patient’s physical environment and/or new assistive device.• Patients with unstable disease process; cardio/pulmonary, diabetes, neurological, neuromuscular,
metabolic, cerebrovascular, cardiovascular, renal, cancer, pediatric/including asthma, premature infants, psychiatric
• Patients with open wounds, VAC wound care, pressure ulcers• Patients with ostomies, trachs, feeding tubes• Patients with drainage tubes and catheters• Patients requiring I.V. and injectable drug therapies• Patients with recent change in functional status including but not limited to; falls, paralysis,
fractures, amputation or other physical impairment, change in custodial needs, ortho, neuro and or deconditioned diagnosis
• Patients with pain control management• Patients with end stage disease and palliative care needs• Patients with new oxygen and/or nebulizer treatments • Patients receiving any type of home care services, i.e., CHHA, LTHHCP, PCA, private care, at time of
hospital admission• Patients re‐hospitalized within 60 days and/or known history of repeated hospital readmissions.
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INFLUENCES ON THE PATIENT’S TRANSITION PLAN
PATIENT
PHYSICIAN
FAMILY
CASE MANAGEMENT DEPARTMENT
NEXT LEVEL OF CARE DELAYS
HOSPITAL ISSUES
PAYERS AND REGULATIONS
INFLUENCES ON THE PATIENT’S TRANSITION: Patient/ Family
• Agreement with plan – CMS requirement!• Perception of word “discharge”• Timeliness in decisions• Decision making process, including end of life decisions• Family dynamics• Geography• Family types*
• The Ghost; Difficult to track down and evasive in making decisions• The Sitter: Frequently makes visits to hospital, may have difficulty making decisions
• The Peacock: Doesn’t visit often, but makes big deal when involved• The White Knight: Present often, acts aggressively toward staff
From Brazelton and Bellamy presentation, NICM Conference 2004
INFLUENCES ON THE PATIENT’S
TRANSITION: PHYSICIAN
• Planning• Perception of the word “discharge”• Critical thinking skills• Financial incentives for timely transitions• End of life communication with family• Delays (consultants)• Hospitalist impact• Investment in post acute care facility/provider
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INFLUENCES ON THE PATIENT’S
TRANSITION: PAYER AND REGULATIONS
PAYER
• Managed care– Choice of vendors for next level of care
– Delays, especially with DRG reimbursed patients
– Timeliness of next level of care approvals
– Timeliness of on‐site reviewers– Contractual agreement or requirements
• Type of reimbursement, i.e. DRG/Per Diem
• Delegated review to facility• Self pay/flat rate ‘gone bad”• Choice: patient or payer
REGULATIONS
• Balanced Budget Act of 1999: The hospital, as part of the discharge planning process must inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of post hospital care services and must, when possible, respect patient and family preferences when they are expressed
• Medicare Discharge Notification Appeal
• 1‐2 day stays• QIO areas of focus
CMS CONDITIONS OF PARTICIPATION: DISCHARGE PLANNING 482.43
The hospital must have in effect a dischargeplanning process that applies to all patients.
The hospital’s policies and procedures must bespecified in writing.
http://edocket.access.gpo.gov/cfr_2004/octqtr/pdf/42cfr482.43.pdf
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(a) Standard: Identification of patients in need of discharge planning.
The hospital must identify at an early stage of hospitalization all patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.
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(b) Standard: Discharge planning evaluation.(1) The hospital must provide a discharge planning evaluation to the patients identified in paragraph (a) of this section, and to other patients upon the patient’s request, the request of a person acting
on the patient’s behalf, or the request of the physician.
(2) A registered nurse, social worker, or other appropriately qualified personnel must develop, or supervise the development of, the evaluation.
NEW ADDITIONS TO THE INTERPRETIVE GUIDELINES for CFR 482.3
• Discharge planning processes should now be in place for:
– Acute care
– Ambulatory Surgery
– Observation
– Other (similar) patients treated at an out‐patient level of care
READMISSIONS FINALLY MENTIONED!
• CMS says that:– “when discharge planning is well executed” the patient proceeds toward the goal of their plan of care after discharge”
– acknowledgement that some patients may be readmitted within 30 days even under the best of circumstances
– Hospitals are “well‐advised” to assume that every in‐patient requires a discharge plan to reduce the risk of adverse events in the community, including readmissions
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INFLUENCES ON THE PATIENT’S TRANSITION: CASE MANAGEMENT DEPARTMENT
• Processes, including delays• Staffing Model• Case Manager/Social Worker Relationships• Case Manager or Social Worker ▫ Case management intelligence▫ Skill sets▫ Work load
• Manager/Director▫ Outcomes focused▫ Data driven/influenced
RECOMMENDED PROCEDURES TO ENSURE THAT YOUR DEPARTMENT IS COMPLIANT
• If every patient is not evaluated, is there a timely screening to determine if a discharge planning evaluation is needed?
• Was the screening done?• Can staff demonstrate that the hospital’s criteria for screening is applied properly?
• Is there a process for updating the patient’s post‐discharge needs?
• Are inpatient staff aware of who and how to notify if the patient’s condition changes in a way that may result in a change in the discharge plan?
CMS CONDITIONS OF PARTICIPATIONSTANDARD 482.43 (e)
“The hospital must reassess its discharge planning process on an on‐going basis. The reassessment must include a review of discharge plans to ensure that they are responsive to discharge needs”
• Reassess daily
• Round daily
• Document daily
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INFLUENCES ON THE PATIENT’S TRANSITION: HOSPITAL ISSUES
▫ Scheduling of services
▫ Delays in services
▫ Hospital acquired conditions
▫ Patient safety events
▫ Communication among team▫ Incomplete documentation Physicians Nurses Other team members
▫ Collaboration and collaboration delays by not having: Huddles Interdisciplinary care conferences Interdisciplinary team conferences
Effectiveness of hospitalist and intensivist services
INFLUENCES ON THE PATIENT’S TRANSITION: NEXT LEVEL OF CARE ISSUES
• Appropriate use of next level of care (i.e. LTAC, hospice, palliative care)• Physicians
• Family
• Patient
• Payer
• Next level of care providers • Nursing home use of SNF days
• Not accepting patients on the weekends
• HH delays in seeing patient
• Delay in DME delivered to patient
CASE MANAGERS MUST EVALUATE AND PROVIDE COMMUNITY‐BASED SERVICES THAT THE PATIENT MAY NEED TO REMAIN AT HOME
• Home health, attendant care• Hospice or palliative care• Respiratory care• Rehabilitation services including physical, speech and occupational therapy
• End stage renal dialysis services• Pharmaceuticals and related supplies• Nutritional consultation and/or supplemental diets
• Medical equipment and related supplies
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LESS COMMON COMMUNITY SERVICES
• Home and physical environment modifications
• Transportation services
• Meal services
• Household services such as housekeeping or shopping
Include all of these in your evaluation form!!!
CMS CONDITIONS OF PARTICIPATIONSTANDARD 482.43 (c)(6)
• Applies to patients transitioning to home health agency (HHA) or skilled nursing facility (SNF). Known as the “choice list”.
• Hospital can develop their own list or print lists from the CMS website.
“The hospital must include in the discharge plan a list of HHAs or SNFs that are available to the patient that are participating in the Medicare program, that service the geographic area in which the patient resides (for HHA), or in the case of SNF, in the geographic area requested by the patient”.
CMS CONDITIONS OF PARTICIPATIONSTANDARD 482.43 (c)(7)
• The hospital must be sure to explain to the patient or their representative their right to choose among participating Medicare providers of post‐hospital services.
• Whenever possible, the hospital must respect the preferences of the patient and family.
• The hospital must not specify or limit the qualified providers that are available to the patient.
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CMS CONDITIONS OF PARTICIPATIONSTANDARD 482.43 (c)(8)
• If a HHA or SNF has a financial interest in your hospital, or the hospital has a financial interest in the HHA or SNF………………
• This must be disclosed to the patient and family.
Pre‐admission
AdmissionPost –
Discharge
Case Management
ALIGNING BEST PRACTICE TRANSITION PLANNING
STRATEGIES ALONG THE CONTINUUM
Patient and/or Family
ELECTRONIC DISCHARGE PLANNING SOFTWARE
• Interface with EHR• Integrate with post‐acute care colleagues
• Template for assessments, with assessments populated with demographics from EHR
• Electronic notification of discharge planning consults– By physicians– By staff– By patients
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INTERDISCIPLINARY AND COLLABORATIVE IMPACT ON TRANSITIONAL PLANNING
• Bedside rounds
• Effective multidisciplinary discharge planning rounds
• Long stay care conferences– Identify ALOS for last 6‐12 months
– Discuss all patients with LOS > than ALOS
– Focus on clinical case, plan of stay, payer, social issues, other relevant issues, barriers to discharge
– Frequency: 2‐3 x/week
– Attendees: Appropriate care providers, as well as government program liaisons and/or financial counselors
– Goal: Identify and resolve barriers to care coordination and discharge
INTERDISCIPLINARY AND COLLABORATIVE IMPACT ON TRANSITIONAL PLANNING
• Unfunded/underfunded care conferences▫ LOS
▫ Discharge planning
▫ Focus on compromised funding Poor paying insurance policies
Medicare patients close to, or in LTR days
Medicaid patients exceeding their span of illness days
Medicare patients with SNF days close to end or gone
Flat rate patients with procedure complications
• Patient/family care conferences
• Connect patients to OP services to decrease readmissions
• Discharge lounge
FLOW CHART YOUR TRANSITIONAL PLANNING PROCESS
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ROLE OF THE TEAM IN DISCHARGE PLANNING
• Identify the team• Ensure that each team member understands their critical role
“The National Health Service in the United Kingdom
has shown that patient death rates are
negatively related to the percentage
of staff working in teams, regardless of hospital size”
Borril, et al., 1999
Findings from the Team Effectiveness Project
TRIAGE PLAN FOR THE DISCHARGE PLAN
NursingAssessment
PtRequiresDP?
CM Assessment
Clinical Complexity
Only?
SocialComplexity
Only?
Clinical &Social
Complexity?
RN Case
Manager
SocialWork Case Mgr
RN and Social Work Case Managers
All patients need discharge planning, but not all have discharge planning problems
DOES YOUR STAFF WORK AS A TEAM IN PATIENT TRANSITIONS?
FAMILIES
MIDLEVEL CARE PROVIDERS
NURSING
QUALITYMANAGEMENT
ANCILLARY SERVICES
PHYSICIANS
POST ACUTE CARE PROVIDERS
PAYERS
CASE MANAGER
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DISCHARGE PLANNING TEAM RESPONSIBILITY GRID
PREADM. ASSESS.
ADM. ASSESS.
FAMILY ASSESS.
CORE MEASURES
HOSPITAL ACQUIRED CONDITIONS
CARE COORD. ROUNDS
PT/FAM. CONF.
EDUC.PLAN
READM. REDUCTIONSTRATEGIES
CASE MANAGER
SOCIAL WORKER
NURSING
QUALITY MGMT
PHYSICIAN
APN or PA
EDUCATOR
PATIENTNAVIGATOR
CLINICAL NURSE LEADER
DISCHARGEPLANNING SPECIALIST
ANCILLARY STAFF
CORE MEASURECOORD.
NEXT LEVEL OF CARE PROVIDERS
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DISCHARGE PLANNING SWOT*
• Unit‐based rapid discharge planning team• Discharge SWAT** social work case manager (for complex discharge planning)
*Strengths Weaknesses Opportunities Threats**Special Weapons and Tactics
TRANSITION TIME‐OUT
▫ From one hospital level of care to another—i.e. medical unit to ICU
▫ From one practitioner to another
Intensivist to hospitalist
Case manager to case manager
Social worker to social worker
Nurse to nurse
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▫ Transition time‐out topics: Discharge plan Barriers to wellness and barriers discharge Clinical challenges Family challenges Economic challenges Psychiatric challenges Patient challenges Avoidable/delay days
▫ Team meeting for transition time out of challenging patient: sending team and receiving team; patient and/or family if possible
▫ Document transition time out
DISCHARGE TIME OUT
▫ Discharge time out topics
Discharge plan
Challenges with effective discharge plan
Education
Core measures
Time for follow‐up conversation
Medication reconciliation
Diet
DME needs
Code status
Readmission indicators
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OTHER HARD‐WIRED NEEDS
• Follow‐up appointment with the patient’s primary care provider and specialist if appropriate.
• Series of appointments for physical or occupational therapy.
• Definite transportation to community appointments.
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CARE DELIVERY MODELS: TRANSITIONAL MODELS WITH PRIMARY CARE PROVIDERS
Community Health Centers
• Uninsured• Homeless
Hospital‐Employed Primary Care
• Patient Centered Medical Homes
Indian Health Services
Other PCP& SpecialtyPractices
Post Hospital ClinicsPost Hospital & ED Navigation Programs
Transitional Care Models
CARE DELIVERY MODELS: PREFERRED PROVIDERS FOR LOS AND READMISSION STRATEGY
Skilled Nursing
Hospice
Chronic Disease Mgt.
• Diabetes • Heart Failure• AMI• Pneumonia
Traditional & Non
Traditional Home Health
Transitional Care
• Transitional Care Programs
• Post Hospital & ED Navigation Programs
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Case Management
COMMUNITYHEALTH CLINICSCONTINUING CARE SERVICESTHIRD PARTY PAYERSCOMMUNITY‐BASED PHYSICIANS
CASE MANAGEMENT
Patient/Family
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SOME DAYS DISCHARGE CHALLENGES MAKE YOU FEEL LIKE THIS!
ASSESS YOUR DEPARTMENT’S EFFECTIVENESS
HOW ARE YOU DOING?
• Know your entry points
• How effective are your transitional elements?– Risk assessment– Patient assessment– Planning– Implementation of plan– Follow up
• How effective are your supportive processes?
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IDENTIFY THE LEVEL OF YOUR CASE MANAGEMENT DEPARTMENT’S EFFECTIVENESS
I Basic Case Management (focus on UR and discharge planning)
II Case Management with focus on LOS and readmission
III Case Management with LOS, readmission focus andinterdisciplinary team interventions
IV Case Management with interdisciplinary collaboration with open, continuous communication and physician champion(s)
V Level IV Case Management with outcomes management used to develop strategies
IDENTIFY THE LEVEL OF YOUR DEPARTMENT’S TRANSITIONAL PLANNING EXPERTISE
Level 1: Information provided to patient
Level 2: Advice (sit‐down discussion with patient and/or family)
Level 3: Professional assessment without intervention
Level 4: Professional assessment with interventionInterventions for compliant
Interventions for noncompliant
Level 5: Professional assessment with intervention based on patient’s ongoing needs and potential readmission strategy plan
Level 6: Professional assessment with collaborative intervention based on patient’s ongoing needs and potential readmission strategy plan
Level 7: Level 5 with integrated ACO‐type plan
EVALUATE YOURSELF IN BEST PRACTICE STRATEGY IMPLEMENTATION
STRATEGY IT’S WORKING WELL FOR US
HAVEN’T TRIED IT NEED TO TRY IT TRIED IT AND IT DIDN’T WORK
Advanced levels of case management
Electronic case management documentation
Case management care plans
Admission and/or ED case management
Discharge planning FAQs on hospital website
Patient care conferences
Care coordination rounds
Effective patient flow processes
Discharge lounge
Effective communication handoff practices
APNs involved in transition planning
Networked discharge planning teams
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EVALUATE YOURSELF IN BEST PRACTICE STRATEGY IMPLEMENTATION
STRATEGY IT’S WORKING WELL FOR US
HAVEN’T TRIED IT NEED TO TRY IT TRIED IT AND IT DIDN’T WORK
Unit based rapid discharge planning team/discharge SWOT nurse
Readmission strategy team
Discharge planning specialist
Discharge time out
Community case management
ACO plan
Outcomes
Predictive modeling
Identification of responsibilities
Effective physician relationships
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ULTIMATE GOAL
• Right Service
• Right Time
• Right Cost
• Right Place
WEB RESOURCES
• Administration on Aging www.aoa.gov/caregivers Caregiver resources from the Administration on Aging (also see Eldercare Locator below)
• Caregiving.com www.caregiving.com Online support groups and numerous articles on care giving
• Care Planner www2.careplanner.org Online decision support tool for seniors, individuals with physical impairments, and their caregivers
• Children of Aging Parents 800‐227‐7294 www.caps4caregivers.org Information, referrals, and support for caregivers of the elderly and chronically ill
• Eldercare Locator 800‐677‐1116 www.eldercare.gov Help with locating aging services in every community throughout the United States
• Family Caregiver Alliance 800‐445‐8106 www.caregiver.org Information on care giving, and online support groups; California‐focused
• Healthfinder www.healthfinder.gov Free Internet guide to consumer health information from the U.S. Department of Health and Human Services
• Better Outcomes for Older adults through Safe Transitions (BOOST) From the Society of Hospital Medicine; http://www.hospitalmedicine.org/resourceRoomRedesign/RR_CareTransitions/CT_Home.cfm
• Re‐engineered Hospital Discharge Project ( Project RED); from AHRQ; http://www.ahrq.gov/news/kt/red/redfaq.htm; http://www.bu.edu/fammed/projectred/index.html
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WEB RESOURCES• Medicare.gov 800‐MEDICARE The official U.S. government site for people with Medicare
• National Alliance for Care giving www.caregiving.org Support for family caregivers and the professionals who serve them
• National Association of Professional Geriatric Care Managers 520‐881‐8008 www.caremanager.orgInformation on geriatric care management, and a free online care manager search tool
• National Family Caregivers Association 800‐896‐3650 www.nfcacares.org Support for those who care for chronically ill, aged, or disabled loved ones
• Society for Social Work Leadership in Health Care 866‐237‐9542 www.sswlhc.org Dedicated to promoting the principles of social work within the health care system
• United Hospital Fund 212‐494‐0700 www.uhfnyc.org Publisher of Always on Call: When Illness Turns Families into Caregivers
• Federal Register, April 7, 2011 Update of provisions in Section 302 of Affordable Care Act
• National Transitions Of Care Coalition www.ntocc.org
• Partnership for Patients http://www.healthcare.gov/partnershipforpatients
• Transitional Care Model http://www.transitionalcare.info/
WEB RESOURCES
• Area Agencies on Aging (AAAs) Help adults age 60 and older and their caregivers. To find the AAA in your area, call The Eldercare Locator at 1‐800‐677‐1116 weekdays from 9:00 a.m. to 8:00 p.m. (EST), or visit www.eldercare.gov.
• Long‐Term Care (LTC) Ombudsman Program Advocate for, and promote the rights of, residents in LTC facilities. Visit www.Ltcombudsman.org.
• Aging and Disability Resource Centers (ADRCs): Offer resources to help people of all incomes and ages stay independent. Visit www.adrc‐tae.org.
• Centers for Independent Living (CILs): Help people with disabilities live independently. For a state‐by‐state directory of CILs, visit www.ilru.org/html/publications/directory/index.html.
• State Technology Assistance Project: Has information on medical equipment and other assistive technology. Call 1‐703‐524‐6686 to get the contact information for your state, or visit www.resna.org.
• National Long‐Term Care Clearinghouse: Provides information and resources to plan for your long‐term care needs. Visit www.longtermcare.gov.
• National Council on Aging: Provides information about programs that help pay for prescription drugs, utility bills, meals, health care, and more. Visit www.benefitscheckup.org.
• State Health Insurance Assistance Programs (SHIP): Offer counseling on health insurance and programs for people with limited income. Also help with claims, billing, and appeals. Visit www.medicare.gov/contacts/Default.aspx, or call 1‐800‐MEDICARE (1‐800‐633‐4227) to get your SHIP’s number. TTY users should call 1‐877‐486‐2048.
• State Medical Assistance (Medicaid) office: Provides information about Medicaid. To find your local office, call 1‐800‐MEDICARE and say, “Medicaid.” You can also visit www.medicare.gov.
This presentation is intended solely to provide general information and does not constitute legal advice. Attendance at the presentation or later review of these printed materials does not create an attorney‐client
relationship with the presenter(s). You should not take any action based upon any information in this presentation without first consulting legal
counsel familiar with your particular circumstances.
