Division of Aging Waiver Enrollment Process MAC Meeting August 2015

Role of Indiana’s Area Agencies on Aging (AAAs) All 16 AAAs are certified as Aging and Disability Resource Centers (ADRCs) The ADRCs are the entry point for our HCBS programs AAAs administer Title III, SSBG, and CHOICE dollars contracted out by the Division of Aging (all non-Medicaid)

Role of Indiana’s Area Agencies on Aging (AAAs) AAAs are the gateway to the Aged and Disabled and Traumatic Brain Injury Medicaid waiver programs The AAAs also conduct nursing facility preadmission screening under current state statute –Preadmission screening is separate from waiver enrollment –Nursing facility level of care is required for the Aged and Disabled Waiver but is not determined through the preadmission screening process

The Aged and Disabled Medicaid Waiver Must be Medicaid eligible –Special income limited is used –Spousal impoverishment protection is applied Must meet nursing facility level of care Currently there is no waiting list for the Aged and Disabled Waiver

The Enrollment Process AAA conducts assessment, includes statement from physician (or nurse practitioner) Eligibility determination made by AAA Plan developed with individual and whoever else they wish to include Service plan submitted to the Division of Aging (DA)

The Enrollment Process Service plan is reviewed by DA staff and either –Approved; –Denied; or –Additional information requested If approved, it may be pending certain items, such as Medicaid approval or discharge from a nursing facility

The Enrollment Process When all pending items are resolved, AAA case manager confirms the start date of waiver services That also comes to the Division for review –Some auto approvals –Some require verification by DA staff Then authorizations for services are issued to providers

Potential Sources of Delay AAA capacity issues may delay the time it takes to complete the assessment May be difficult to secure document from physician May be difficult to get information or schedule appointments with consumer or their families

Potential Sources of Delay DA staff capacity can be an issue as well End of waiver year issues can make slots unavailable until the new waiver year starts Medicaid issues –Disability determinations –Miller’s Trust –Failure to produce documents

A&D Waiver Monthly Participant Count Jul-15

Impact for Rebalancing Process needs to be faster, more streamlined For hospitals discharges, nursing facility is the faster, easier option Waiver capacity (DA, AAAs, providers) has grown but not at the same rate as waiver participation –Need to evaluate rates –Need to encourage capacity building (fear among AAAs and providers is that the waiver will wait list again)

Pre Admission Screening Required of individuals seeking admission to Medicaid- certified nursing facilities, regardless of payer source. Current process conflates CMS-required PASRR process (for individuals with MH or ID/DD conditions), along with LOC determinations. Process is expensive and inefficient and does not lead to outcomes required of enabling statute and regulations. Legislation last session with a sunset date of June 30, 2016 of state-mandated PAS. Current redesign process underway.

Potential Solutions Pending technology changes will allow the DA to more effectively track AAA response and processing times to identify and troubleshoot problem areas more directly. PAS/PASRR redesign process is underway. This will allow more directed targeting of individuals discharging from hospitals with options counseling and divert or prevent long term institutionalization. Trying to identify funding to support capacity building efforts.

Contact Information Yonda Snyder Director, Division of Aging Debbie Pierson Deputy Director, Operations