Presentation on theme: "Options for Home and Community- Based Care Educational Video for Discharge Planners Rhode Island Executive Office of Health and Human Services Presented."— Presentation transcript:
Options for Home and Community- Based Care Educational Video for Discharge Planners Rhode Island Executive Office of Health and Human Services Presented by Ellen Mauro, RN, MPH, Administrator, Office of Institution and Community Services & Supports, Rhode Island Department of Human Services
Purpose The options available to help Rhode Island’s elders and adults with disabilities live safely at home The needs-assessment process and the roles involved This presentation will provide discharge planners with an understanding of:
Topics Importance of the discharge planner’s role Rhode Island’s long-term care goals Overview of the new needs-assessment process Description of home and community- based services available to help elders and adults with disabilities Resources Evaluation of this presentation
Why the Discharge Planner is Important You come into contact with patients and their families at a crucial time. You provide support and sound advice. You help patients and caregivers establish follow-up care arrangements. You talk to patients and caregivers about the available options that help them live at home safely.
Began in 2009 through the Global Waiver Creates a sustainable, cost-effective, person-centered and opportunity-driven Medicaid program Helps people live where they want to live by providing safe options Rhode Island’s New Long-Term Care System
Changes Levels of care Highest High Preventive Discharge planner no longer determines the level of care The most significant changes that affect you as a discharge planner have to do with:
Patients qualify for either a nursing facility or home and community-based services. Replaces the former Nursing Facility Institutional level of care. This is the only group that qualifies for a nursing facility. Highest Level of Care
High Level of Care Patients qualify for home and community-based services. Includes what used to be called waiver programs, such as: A&D Waiver DEA Waiver DEA Assisted Living Waiver RI Housing Assisted Living Personal Choice PACE Program
Preventive Level of Care Patients qualify for limited CNA, homemaker services Current Title XX recipients (SSI) will continue to receive services managed by the Department of Human Services Community Medical Assistance patients and non-SSI patients will be referred to the Office of Community Programs
Nursing Facility Grandfather Clause Individuals eligible for nursing facility institutional care as of June 30, 2009, maintain that level of care (grandfathered). After July 1, 2009, individuals are assessed with the new needs- assessment criteria.
Office of Medical Review Determines All Levels of Care Discharge planners no longer have delegated authority to make level of care determinations. One exception: If an individual is admitted to an emergency room on a weekend or a holiday, the discharge planner has the authority to transfer the person to a nursing home if appropriate.
New Process for Determining the Level of Care The Office of Medical Review (OMR) receives referrals from long-term care field offices, discharge planners, and nursing homes. The OMR identifies eligibility status and evaluates supporting documents. The OMR determines the appropriate level of care. The OMR faxes the determination/authorization to the DHS field office and the referral source. If the case is medically complex, the OMR refers it to the Office of Community Programs for monitoring and oversight. If level of care criteria is not met, the DHS field office sends written notice to the applicant, who can appeal the decision.
Functions of the OMR & OCP The Office of Medical Review (OMR): Processes and makes determinations of the levels of care The Office of Community Programs (OCP): Monitors medically complex cases who are at home and use home and community based services
Discharge Planners Make Referrals to the OMR Your fax to the Office of Medical Review should include: Nursing home search forms PT/OT notes Pharmacy profile Clinical notes on wound management Completed four-page continuity of care forms MDS from nursing facilities Physician’s form (former CP-1)
For Referrals to Nursing Homes Four-page continuity of care form Signed physician form (former CO-1) Completed PASSR and ID screen DHS Level of Care Authorization form Please fax this Form ASAP. Fax the following to the nursing home if you are making a referral there:
Home & Community-Based Services All three new levels of care give individuals the option of using some or all of these services. Home health aides: Personal care assistance for a few hours each week or every day Skilled nursing services Homemaker services: Help with household tasks, such as grocery shopping, meal preparation, and laundry Adult day services: Care and companionship for individuals who need supervision during the day
Home & Community-Based Services (cont’d) Environmental modifications: Installation of home safety equipment, such as grab bars in the bathroom Special medical equipment: Such as wheelchairs or walkers Meals on Wheels: Delivery of lunches SNAP: Extra money to buy food Personal emergency response system: Connects individuals to trained professionals who can send help quickly
Case management: Helps individuals manage medical issues Senior companions: Volunteers who visit individuals Assisted living: Apartment living for individuals whose current home is not suitable Shared living: Individuals live with a relative, friend or neighbor Respite care: Provides caregiver with time off while their loved one is cared for Home & Community-Based Services (cont’d)
What Has Not Changed DEA Co-Pay Program SSI Enhanced Assisted Living Senior Companion MR/DD Waiver Habilitation Waiver RI Housing Assisted Living Waiver Personal Choice Program RIte Care RIte Share Rhody Health Partners Connect Care Choice DCYF Programs & Services MHRH Programs & Services Our commitment to giving Rhode Island elders and adults with disabilities the best possible care remains firm and constant.
Resources For information about these and other services, call: The POINT at (401) or (401) TTY. Find updated information about the Global Waiver initiative at: Rhode Island Executive Office of Health and Human Services, Other websites: Rhode Island Department of Elderly Affairs, Rhode Island Department of Human Services,
Evaluation First, do you believe you understand the new levels of care? Second, do you believe you understand your role in the process of determining the level of care? Third, do you believe you understand the home and community- based services that you have to recommend? Fourth, do you believe you understand the role of the Office of Medical Review? Fifth, do you have any comments about this presentation or the subject in general? Your feedback is important in helping us provide you with the best information possible. Please answer the first four questions with: much better, a little better, no change, less well, not at all.
If you have any questions, please contact me at Thank you for helping us help Rhode Island’s elders and adults with disabilities live safely and as independently as possible in their homes and in their communities. Please click on the survey button below. Thank you.