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Pamela Mokler, Vice President, LTSS, Care 1 st Vicki Macedo, Program Specialist, HHSA AIS Mark Sellers, Asst. Deputy Director, HHSA AIS.

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Presentation on theme: "Pamela Mokler, Vice President, LTSS, Care 1 st Vicki Macedo, Program Specialist, HHSA AIS Mark Sellers, Asst. Deputy Director, HHSA AIS."— Presentation transcript:

1 Pamela Mokler, Vice President, LTSS, Care 1 st Vicki Macedo, Program Specialist, HHSA AIS Mark Sellers, Asst. Deputy Director, HHSA AIS

2  Health & Human Services Agency  Aging & Independence Services  Behavioral Health Services  Children’s Services  Public Health Services  Self-Sufficiency  Support Divisions

3  Area Agency on Aging/ADRC  Adult Protective Services/Senior Mental Health Team  In Home Supportive Services  Multipurpose Senior Services Program ( & “MSSP-Like”)  Long Term Care Ombudsman  Call Center  PA/PG/PC  Veteran Services  Senior Nutrition  Community Services – IG, CM, RSVP, Health Promotions  Community-Based Care Transitions Program

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5  AB CA Long Term Care Integration Pilot Project (LTCIP) –  Planning Committee formed 1999 with the following mission: “Develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD).”  Began with 50 participants – now over 800 members strong: Multiple Medical, Behavioral Health, Social Service Providers, Consumers, Caregivers and Advocates

6 LTCIP ADRC San Diego Network of Care CCI Advisory Committee Community- based Care Transitions Program

7  Cal MediConnect Health Plans established to provide them recommendations about operations, access to services, outreach & education, etc.  Communications Sub-Group: coordinated outreach to consumers, providers, physicians, pharmacists, hospitals/clinics, etc.  Coordination Guide Sub-Group: coordination between the Health Plans & IHSS/PA & MSSP

8  Cal MediConnect Health Plans  HHSA/AIS  Public Authority  Dual-eligible consumers  Hospital Association  SD Medical Society  Consumer Center  HICAP  CBAS  PACE  Advocates  Community Clinics  HCBS Providers  SNF  Harbage Consulting Firm  Behavioral Health  Disability Rights

9  Workgroup: All 5 Health Plans, AIS IHSS Managers/Program Staff, Public Authority  Commitment: A single protocol  CCI Advisory Committee: review & approval

10  IHSS is a core service that is needed to keep members with ADL/IADL deficiencies living in the community  We need to make it easier for our members to transition from hospital to home with IHSS services, than it is to transition from a hospital to a SNF! – especially on a Friday evening! We need expedited IHSS assessments and extended hours.  All IHSS recipients’ needs are not the same! Programs need to be FLEXIBILE to meet changing needs of members/clients.

11  Application Process flow chart – especially helpful for the Health Plans at the beginning of the process  Call Center and Web Referral processes – giving them the contact information they would need and letting them know what type of information they will need to provide on referrals.  The establishment of “expedited” referral criteria and the development of an “expedited” referral process

12  Differentiating between “expedited referrals” and situations where “urgent service referrals” are appropriate  Explaining form requirements and how the Health Plans may play a key role in assisting the member with this  Providing phone numbers to each district office, as well as a zip code list of which office handled which zip code, so that Health Plans could contact the clerical staff at each office with questions.

13  Expedited applications will be processed within 10 business days of receipt by the IHSS Social Worker. Health Plans will be contacted if there are problems that prevent or delay the process. Examples could include but are not limited to the following:  Refusal of services by the Health Plan Member  Failure to cooperate or provide required information

14 Someone who has critical care needs and:  No one is available to provide in-home care  Is unsafe in his/her own home  Is at risk of hospitalization (or re- hospitalization) without additional assistance Someone who has critical care needs:  That cannot be fully met without additional assistance from IHSS  Is unsafe in his/her own home  Is at risk of hospitalization (or re- hospitalization) without services in place

15 Other indicators for an expedited referral could include:  A diagnosis of a terminal illness.  A rapid decline in health.  Client Is transitioning out of a hospital, and no one is available to provide in-home care or the care needs can’t be fully met. If necessary the IHSS Social Worker may conduct a needs assessment in the hospital. Once the Member transitions home, the IHSS Social Worker must complete an in-home needs assessment within 10 business days from the date of discharge.

16  A Notice of Action (NOA) will be issued providing information on services and the number of hours authorized, or the reason for any denial of services  IHSS will inform the Health Plan of any ineligibility to IHSS services  The client has 90 days from the date of the Notice of Action to file an appeal

17  AIS was willing to be flexible  AIS was willing to expedite referrals for Plan members transitioning from hospital or SNF to home  Agreement from all 5 Health Plans, Public Authority and AIS on a single, core protocol  Shared value for the consumer-driven foundation of the IHSS program

18  Partnerships/relationships are everything!!  Broad coordination is critical!  Training, re-training…and more training!  Slow beginning for IHSS – applications (standard and expedited) and CCT’s – Why?  Continuous efforts at delivering information and resources to consumers & IP’s  HICAP/Consumer Center for Health Education & Advocacy calls – steady, but settling, burst at start of the month


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