ICDS - Western Reserve Area Agency on Aging

Report
Ohio Association of Area Agencies on Aging
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Key Provision of the
Ohio Dual Demonstration:
Integrated Care Delivery System
(ICDS)
Larke Recchie
[email protected]
(614) 481-3511
Ohio Association of
Area Agencies on Aging
www.ohioaging.org
Facebook: o4aadvocacy
Twitter: @o4aadvocacy
Ohio Association of Area Agencies on Aging
Key Provision of the
Ohio Dual Demonstration: ICDS
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)
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
Key Provision of the
Ohio Dual Demonstration: ICDS
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
Ohio Association of Area Agencies on Aging
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.
Ohio Association of Area Agencies on Aging
7 ICDS Regions
Ohio ICDS Regions
Williams
533
Paulding
238
Van Wert
344
Henry
294
Darke
590
Wyandot
319
Hardin
344
Logan
558
Champaign
512
Miami
1,165
WC
Montgomery
8,467
Butler
3,737
Hamilton
11,363
Huron
705
Clark
2,304
Union
341
Ashland
687
Wayne
1,271
Knox
942
Madison
412
Scioto
2,559
Tuscarawas
1,440
Columbiana
1,670
Carroll
458
Harrison
333
Guernsey
930
Jefferson
1,333
Belmont
1,512
Monroe
277
Morgan
324
Hocking
578
Pike
891
Mahoning
4,475
Stark
5,769
Noble
223
Perry
675
NEC
Portage
1,474
Coshocton
677
Muskingum
1,887
Pickaway
696
Highland
907
Adams
972
EC
Licking
1,811
Fairfield
1,733
Ross
1,413
Clermont
2,219
Summit
7,711
Holmes
452
Morrow
461
Franklin
13,732
Clinton
570
Brown
840
Richland
2,083
Trumbull
3,139
NE
Medina
1,190
Delaware
848
Central
Greene
1,610
SW
Crawford
808
Marion
1,147
Fayette
640
Warren
1,567
Lorain
3,466
Hancock
777
Allen
1,565
Geauga
617
Cuyahoga
24,396
Erie
1,031
Sandusky
858
Seneca
875
Putnam
350
Shelby
491
Preble
472
Wood
1,146
Auglaize
436
Mercer
375
Ottawa
527
NW
Defiance
470
Ashtabula
2,133
Lake
2,043
Lucas
7,793
Fulton
418
Vinton
292
Washington
1,025
Athens
998
Meigs
511
Jackson
913
Gallia
998
Lawrence
1,836
Average Potential ICDS Medicare/
Medicaid eligibles per month, SFY 2011
Non-demonstration counties
ICDS Regions and Demo Counties
Central
NW - Northwest
EC - East Central
SW - Southwest
NE - Northeast
WC - West Central
NEC- Northeast Central
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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-MedicaidCoordination/Medicare-MedicaidCoordinationOffice/FinancialModelstoSupportStatesEffortsinCareCoordination.html
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
AAAs as Front Door to LTSS
Ohio Association of Area Agencies on Aging
AAA Network Menu of Services
for ICDS Plans
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:
Ohio Association of Area Agencies on Aging
Required Waiver Service Coordination
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
Required Waiver Service Coordination
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
Ohio Association of Area Agencies on Aging
Required Waiver Service Coordination
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
Ohio Association of Area Agencies on Aging
Required Waiver Service Coordination
Medicaid Resolution
Assist with Medicaid redetermination and food stamp
resolution
Assessment of LTSS Need
Including functional needs assessment, environmental
assessment, social needs assessment
Managing Member Care Through Independent
Providers and Consumer Direction
Ohio Association of Area Agencies on Aging
Potential Add-on AAA Services
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
Potential Add-on AAA Services
Caregiver Support
• Customized training and education
• Health and wellness programs
• Personal consultation
• Family mediation
• Caregiver planning
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
Budget Advocacy for Aging Issues
Keeping the front door open,
Restoring funds to rebalance
Medicaid
Ohio Association of Area Agencies on Aging
Budget Priorities
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
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
Ohio Association of Area Agencies on Aging
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Thank you
Stay in touch with
Ohio Association
of Area Agencies on Aging
Larke Recchie
[email protected]
(614) 481-3511
Ohio Association of
Area Agencies on Aging
www.ohioaging.org
Facebook: o4aadvocacy
Twitter: @o4aadvocacy

similar documents