1. The Affordable Care Act and Weatherization – Healthy Homes Programs: Is there a Connection? Carrie Smith, FSL, Chief Operating Officer

2. The Affordable Care Act Signed on 3/23/2010 to “expand coverage, control health care costs and improve the health care delivery system”

3. Individual mandates for insuranceEmployer requirementsExpansion of public programsPremium and cost sharing subsidies Tax related changes Formation of health insurance exchanges Changes to private insurance State’s Roles Cost Containment within current program models (Medicare, Medicaid, Drugs, Waste/Fraud and Abuse) Improving quality and performancePrevention and wellnessLong-Term CareOther investments The Affordable Care Act established…

4. Where are the opportunities in ACA for healthy homes initiatives Cost Containment –Provider ACO’s are forming –Test and evaluate different payment structures, payment reform models –Reduce Medicare payments to hospitals for readmissions Quality –Pilot programs to evaluate bundled payment models in Medicare and Medicaid programs –Independence at Home demonstration programs to prevent hospitalization and improve outcomes Prevention and Wellness –Govt to establish a grant program to support the delivery of evidence based and community based prevention and wellness, address health disparities LTC –New options for home and community based services Other –Impose additional requirements on non-profit hospitals to conduct a community needs assessment every 3 years and adopt implementation strategy to meet the needs.

5. The # 1 key to Survival is….. Diversification of….. –Revenue –Partners –Services

6. FSL’s Program and Services  Medicare Certified Home Health Agency  Home Care/Personal Care services division  A full service Home Improvement Division (weatherization, minor/major home repair program and handicap accessibility modifications programs)  4-Adult Day Health Care Centers  Pathways Social Work/Care Management Clinical Team  17-Licensed Residential Behavioral Health Group Homes  Credentialed Caregiver and Health Care Worker Training Program  Hospital Care Transition Program  HUD and Low-Income and Affordable Senior Apartment Housing Developer and Property Owner/Manager  Community Living Resources division (monitoring agent for DHS licensure division for all Assisted Living homes in AZ)

7. Potential Activities –Consider adding services such as Handicap Accessibility Modifications to your portfolio –Consider using your intake workers to help enroll people into health exchanges/health plans or help them navigate the system. –Demonstrate to providers you can manage Health and Safety issues in the home (remove hazards such as indoor air quality issues, trip/fall hazards, electrical or plumbing hazards) which may impact the persons ability to live at home and or prevent a hospitalization –Make connections with new partners to your current WAP program for energy efficiency modifications If their electric bill is less, maybe they can afford their prescriptions?

8. ACA Partners and Opportunities Look to partner with newly forming Accountable Care Organizations (ACO’s) –ACO’s take responsibility for cost and quality received by patients and will receive a share of savings they achieve for Medicare. A hospital readmission can cost on average $12,000 -15,000 per episode. Think of all the things that can be done to prevent this? Sell yourself to these new organizations.

9. Other Potential Partners HUD CDBG, HOME funds State and local municipalities Veterans Administration Grants for environmental home modifications Division of Developmental Disabilities Medicaid Programs Environmental Modifications Potential for Health and Safety modifications Area Agency on Aging Durable medical equipment and emergency home repairs Private Pay

10. Challenges - Areas for Change Application processes –Not uniform –Not one database system for ease of eligibility –Locations and application processes vary by funder, services Coordination is challenging –Agencies don’t work together / silo system at the federal, state and local levels

11. What works? Use current resources to expand services to meet community needs –Dedicated staff –With key knowledge/experience –program space –administration –reputation “Success is when… Preparation, meets opportunity” Zig Zigler Review city/county and state plans Learn more about Medicaid health plans in your community Do some research on ACO’s forming in your area Make the connections to potential partners Start talking to people Go out and get it!

12. Resources Department of Veteran Affairs – Home Modification Programs Area Agency on Aging Division of Aging Services Medicaid health plans with home and community based programs in your community HUD programs operated by –State Department of Housing programs –City and County government offices where CDBG funds are used www.healthcare.gov

13. Carrie Smith Chief Operating Officer Foundation for Senior Living (FSL) 1201 E. Thomas Rd. Phoenix, AZ 85014 602-285-1800 ext. 142 csmith@fsl.org