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May 2014 Home Care Program Executive Office of Elder Affairs.

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Presentation on theme: "May 2014 Home Care Program Executive Office of Elder Affairs."— Presentation transcript:

1 May 2014 Home Care Program Executive Office of Elder Affairs

2 ELD Home Care Program Team Mary DeRoo – Director of Home and Community Programs Mary DeRoo – Director of Home and Community Programs Susan Tompkins-Hunt – Asst. Director Home and Community Programs Susan Tompkins-Hunt – Asst. Director Home and Community Programs Brenda Correia – Coordinator of Elder Community and Support Programs Brenda Correia – Coordinator of Elder Community and Support Programs Sandy Brown – Clinical Assessment & Eligibility RN Sandy Brown – Clinical Assessment & Eligibility RN CAE & Home Care RN Manager CAE & Home Care RN Manager Devon Garon– Waiver Program Manager Devon Garon– Waiver Program Manager Shannon Philbrick –Home Care Program Coordinator Shannon Philbrick –Home Care Program Coordinator Quality Manager Quality Manager

3 Brief history 27 Home Care Corporations (HCCs) established Home Care Corporations (HCCs) established Each with a unique geographic service area Each with a unique geographic service area Community based non-profits Community based non-profits 51% of board members must be aged % of board members must be aged 60+ ASAP law passed in 1997 – c.19a§4b ASAP law passed in 1997 – c.19a§4b Request for Responses (RFR) issued 2010; designation of 27 Aging Services Access Points (ASAPs) Request for Responses (RFR) issued 2010; designation of 27 Aging Services Access Points (ASAPs) Statutory responsibilities of ASAPs: Statutory responsibilities of ASAPs: –Information & Referral –Clinical eligibility for Medicaid-funded institutional and community based care –Care management and service coordination –Authorization and purchase of services –Protective Services

4 ASAPs perform many functions Information and Referral Information and Referral Nursing facility pre-admission screening Nursing facility pre-admission screening Functional eligibility determinations Functional eligibility determinations Financial eligibility (Home Care Program) Financial eligibility (Home Care Program) Needs assessment Needs assessment Care plan development Care plan development Authorization of services Authorization of services Monitoring of service delivery Monitoring of service delivery Reassessment Reassessment Protective Services Protective Services

5 Home Care Programs Provide interdisciplinary care management and in-home support services to elders in Massachusetts. Provide interdisciplinary care management and in-home support services to elders in Massachusetts. Eligibility is based on age, residence, income, and ability to carry out daily tasks such as bathing, dressing and meal preparation (functional impairment level). Eligibility is based on age, residence, income, and ability to carry out daily tasks such as bathing, dressing and meal preparation (functional impairment level).

6 Eligibility for Home Care Age and residence: Age and residence: –60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder) –Resident of Massachusetts and not living in an institutional setting or Assisted Living Residence. Income: Income: –Based on a sliding scale, monthly co-payments of $9 - $140 are required for individuals/couples with income above the Federal Poverty Level. Respite/Over- Income eligible, monthly cost sharing of 50% - 100% of the service plan cost is required. Functional Impairment Level (FIL): Functional Impairment Level (FIL): –Require assistance with at least 2 Activities of Daily Living (ADLs) or 6-10 ADL/IADLs (Instrumental Activities of Daily Living) and have a critical unmet need (any ADL, meal preparation, food shopping, home health services, Respite, transportation for medical treatments). Exceptions to the Uniform Intake Policy: Exceptions to the Uniform Intake Policy: –At Risk. Elders who are at risk due to a variety of factors, including, but not limited to substance abuse, mental health problems or cultural and linguistic barriers. –Protective Services. Elders who are receiving or are eligible to receive Protective Services… –Congregate Housing. Clients residing in a Congregate Housing Facility. –Waiver Clients. Clients who are eligible for the Home and Community based Waiver Program.

7 State Home Care Programs Home Care Basic - a program for elders who: Home Care Basic - a program for elders who: –meet the Home Care enrollment eligibility –require assistance with I/ADLs. –have an Average service cost per consumer is no more than $266/month. (Not a per person limit.)

8 State Home Care Program Respite Over-Income – a program that supports caregivers in meeting the needs of elders who: Respite Over-Income – a program that supports caregivers in meeting the needs of elders who: –Meet the Home Care Program eligibility criteria of 60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder) 60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder) Residents of Massachusetts Residents of Massachusetts Functional Impairment Level (FIL) Functional Impairment Level (FIL) –have an annual income over $26,562 (single) or $37,584 (couple) and are willing to pay an income-based percentage of the cost of services (50% to 100%) –Are not MassHealth eligible –Are not eligible for other programs

9 State Home Care Programs Enhanced Community Options Program (ECOP) – a subset of Home Care Basic consumers who are: Enhanced Community Options Program (ECOP) – a subset of Home Care Basic consumers who are: –60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder) –State Home Care Program eligible –Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR ) –Not MassHealth Standard eligible –Service plan cost of two times the level of services provided through Home Care Basic Non-Waiver.

10 Home Care Non-Waiver Services Personal Care Personal Care Home Health Aide Home Health Aide Supportive Home Care Aide Supportive Home Care Aide Respite Respite Companion Companion Skilled Nursing Skilled Nursing Adult Day Health Adult Day Health Behavioral Health Behavioral Health Chore Chore Environmental Accessibility Adaptations Environmental Accessibility Adaptations Grocery Shopping/Delivery Services Grocery Shopping/Delivery Services Alzheimer’s/Dementia Coaching Alzheimer’s/Dementia Coaching Home Delivered Meals Home Delivered Meals Homemaker Homemaker Laundry Services Laundry Services Medication Dispensing System Medication Dispensing System Home Delivery of Pre- packaged Medication Home Delivery of Pre- packaged Medication Nutrition Assessment/Counseling Nutrition Assessment/Counseling Personal Care Personal Care PERS/Enhanced PERS PERS/Enhanced PERS Supportive Day Care Programs Supportive Day Care Programs Transitional Assistance Transitional Assistance Transportation Transportation Vision Rehabilitation Vision Rehabilitation Home Based Wandering Response Systems Home Based Wandering Response Systems

11 Home & Community Based Services Waiver Programs Home Care Basic Waiver – a subset of Home Care Basic consumers who are: Home Care Basic Waiver – a subset of Home Care Basic consumers who are: –60 years of age or over –State Home Care Program eligible –Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR ) –MassHealth Standard eligible –In need of and/or receiving a Waiver Service

12 Home and Community Based Services Waiver Programs CHOICES - a subset of waiver consumers who are: CHOICES - a subset of waiver consumers who are: –60 years of age or over –State Home Care Program eligible –Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR ) –MassHealth Standard eligible –In need of and receiving a Waiver Program Service –Service plan cost of two times the level of services provided through Home Care Basic Waiver.

13 Frail Elder Waiver (FEW) Expanded Income Eligibility Frail Elder Waiver (FEW) Expanded Income Eligibility for MassHealth Standard: Frail Elder Waiver (FEW) Expanded Income Eligibility for MassHealth Standard: -Elders who meet all Waiver program eligibility criteria except for MassHealth Standard eligibility: -Elders who meet all Waiver program eligibility criteria except for MassHealth Standard eligibility: With income at or below 300% SSI FBR With income at or below 300% SSI FBR ($2,163/month in 2014) ($2,163/month in 2014) Have countable assets below $2,000 Have countable assets below $2,000 -Can apply for MassHealth Standard using the FEW expanded income eligibility rule

14 Home Care Waiver Services Personal Care Personal Care Home Health Aide Home Health Aide Supportive Home Care Aide Supportive Home Care Aide Homemaker Homemaker Respite Respite Companion Companion Skilled Nursing Skilled Nursing Chore Chore Environmental Accessibility Adaptations Environmental Accessibility Adaptations Grocery Shopping/Delivery Services Grocery Shopping/Delivery Services Home Delivered Meals Home Delivered Meals Laundry Services Laundry Services Supportive Day Program Supportive Day Program Transitional Assistance Transitional Assistance Non- Medical Transportation Non- Medical Transportation Home Based Wandering Response Systems Home Based Wandering Response Systems Alzheimer’s/Dementia Coaching Alzheimer’s/Dementia Coaching Home Delivery of Pre-packaged Medication Home Delivery of Pre-packaged Medication Medication Dispensing System Medication Dispensing System Occupational Therapy Occupational Therapy Services not available through the waiver program, available through the MassHealth State Plan: Services not available through the waiver program, available through the MassHealth State Plan: –PERS –Transportation for medical –ADH

15 Care Planning/Care Management –Care Manager completes an initial on-site assessment (OSA) to determine consumer eligibility –Initial Service Plan is created with consumer to address identified unmet needs. –visit schedule of an OSA at least every six months dependent upon program enrollment and need –Annual re-determination of home care program eligibility –review of care plan/service plan at least annually –Annual re-determination of personal care needs, as well as clinical eligibility for waiver and ECOP by ASAP RN

16 Service delivery options Traditional service providers Traditional service providers –ASAP contracted service providers Consumer Directed Care – a service delivery option for non-waiver enrolled consumers in accordance with EOEA PI Consumer Directed Care – a service delivery option for non-waiver enrolled consumers in accordance with EOEA PI –Consumer can choose to recruit, train and hire their own worker for personal assistance services –ASAP authorizes an average number of hours per week and is responsible for the overall management of program service costs within the limits for HCB-NW and ECOP program –Services Offered Homemaking Homemaking Personal Care Personal Care Home Health Aide Home Health Aide Transportation Transportation Chore Chore Companion Companion Other assistance with I/ADLs Other assistance with I/ADLs –Services provided must meet needs identified in the assessment process or otherwise identified as necessary for the health, welfare and community independence of the consumer.

17 Wait Lists Currently, there are no wait lists for: Currently, there are no wait lists for: –Home Care Programs –ECOP (Enhanced Community Options Program) No Expectation for a wait list through Fiscal Year 2014 No Expectation for a wait list through Fiscal Year 2014

18 Wait Lists and Exceptions Effective September 8, 2009, ASAPs were required to establish a Home Care Program waiting list. Applicants are screened at intake to determine whether the applicant meets one of the following exceptions: Effective September 8, 2009, ASAPs were required to establish a Home Care Program waiting list. Applicants are screened at intake to determine whether the applicant meets one of the following exceptions: –Eligible for Enhanced Community Options Program (ECOP) or Medical Frail Elder Home and Community Based Services Waiver; –Active or triaged Protective Services consumers in need of Home Care Program Services –Elders being discharged from nursing facilities and hospitals, including chronic and rehabilitation hospitals who need Home Care Program Services in order to return to the community; –Elders enrolled in hospice care who require Home Care Program Services. All eligible applicants who meet one of the exception criteria described above shall be enrolled in the Home Care Program. All other applicants must be placed on the Home Care Program waiting list. All eligible applicants who meet one of the exception criteria described above shall be enrolled in the Home Care Program. All other applicants must be placed on the Home Care Program waiting list. Referral sources must be informed at the time of referral that the applicant may be enrolled in a program or placed on the waiting list, as appropriate. Referral sources must be informed at the time of referral that the applicant may be enrolled in a program or placed on the waiting list, as appropriate. ASAPs should offer information regarding other community sources of assistance that may be available to the applicant. ASAPs should offer information regarding other community sources of assistance that may be available to the applicant.

19 Wait List Priority Levels Criteria for the assignment of priority levels. Priority levels are based on the need for services. Criteria for the assignment of priority levels. Priority levels are based on the need for services. –Priority Level 1: The applicant has no informal support or other formal support and has at least one of the following Critical Unmet Needs: Personal Care Personal Care Home health services Home health services Transportation to medical treatments Transportation to medical treatments Grocery shopping Grocery shopping –Priority Level 2: The applicant has limited formal and/or informal supports (inadequate to meet demonstrated need) or the caregiver requires respite to continue involvement and the applicant has at least one of the following Critical Unmet Needs: Personal Care Personal Care Home health services Home health services Transportation to medical treatments Transportation to medical treatments –Priority Level 3: The applicant has limited formal/informal supports and a Critical Unmet Need of grocery shopping. –Priority Level 4: The applicant has a Critical Unmet Need of meal preparation.

20 Family Caregiver Support Program National Program implemented by Elder Affairs through ASAPs National Program implemented by Elder Affairs through ASAPs Funded primarily with Federal Title III-E funds; with limited state and local agency funds Funded primarily with Federal Title III-E funds; with limited state and local agency funds Program with a multi-faceted approach that supports the Caregiver. Program with a multi-faceted approach that supports the Caregiver.

21 Caregiver Specialist Caregiver Specialist focuses on supporting the Caregiver Caregiver Specialist focuses on supporting the Caregiver –Conducts caregiver assessments –Develops a caregiver action plan –Provides personal assistance in connecting caregivers with resources and services which may include Respite care options Respite care options Supplemental Services Supplemental Services –One-on-one counseling & coaching –Identified training in group settings or for individuals –Facilitates family meetings

22 Who is eligible to be a Caregiver A family or informal caregiver who is A family or informal caregiver who is –caring for an elder 60 or older, or someone with Alzheimer’s –a grandparent aged 55 or older caring for a child age 18 or younger –over the age of 55 caring for a disabled individual between the ages of 18-59; cannot be the parent Contact the Massachusetts Family Caregiver Support Program: Local ASAP AGE-INFO or Contact the Massachusetts Family Caregiver Support Program: Local ASAP AGE-INFO or

23 Other Community Options Veteran’s Independence Plus (VIP) Veteran’s Independence Plus (VIP) Certified Home Health Agency Certified Home Health Agency –Optional for consumers with Medicare A coverage, as well as other insurers Private Pay Home Care Private Pay Home Care –Optional for all consumers

24 Veteran’s Independence Plus Program (VIP) VIP Program serves – –veterans of any age – –at risk of nursing home admission – –Supports family Caregivers VIP Program qualifications – –receive primary care at Bedford or Boston VAMC (Veteran’s Administration Medical Center) – –have a VA primary care team – –meet the eligibility criteria for home and community based services as determined by VA – –Receive a referral to VIP Program from the VA Medical Center ASAP Case Manage (Care Advisor) VIP enrollees

25 Certified Home Health Agency CHHA’s are home care providers certified by Federal Medicare Program CHHA’s are home care providers certified by Federal Medicare Program –Provide and bill for services –Meet requirements for patient care and management –CHHA’s provide: In-home assessment In-home assessment Developed plan of care Developed plan of care Skilled care health services for 60 day increments Skilled care health services for 60 day increments

26 Qualifying for Certified Home Health Care (CHHA) To qualify for Medicare home health coverage, a person must: To qualify for Medicare home health coverage, a person must: –Need skilled care (SN, OT, PT) –Have a physician’s order for care and have seen by the physician ordering care either within 90 days before care or 30 days after starting care –Be homebound, i.e. unable to seek medical attention without “severe taxing effort” Discharge from an acute or rehabilitation/hospital is not necessary Discharge from an acute or rehabilitation/hospital is not necessary Family members or others can refer to CHHA – –Physician’s order for care is required (see above)

27 Private Home Care Private pay home care services can be purchased in hourly blocks of time or as overnight or live in services Private pay home care services can be purchased in hourly blocks of time or as overnight or live in services Private pay home care companies provide a broad range of services Private pay home care companies provide a broad range of services Private pay home care services are not subject to eligibility rules and restrictions, or ASAP/EOEA monitoring requirements Private pay home care services are not subject to eligibility rules and restrictions, or ASAP/EOEA monitoring requirements Private pay home care companies can be a company within a Certified Home Health Agency, but not always Private pay home care companies can be a company within a Certified Home Health Agency, but not always For more information contact local ASAP or ILC For more information contact local ASAP or ILC

28 Information and Referral Contact the local ASAP or ILC AGE-INFO AGE-INFOwww.800ageinfo.com


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