1. Key Provision of the Ohio Dual Demonstration:
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Larke Recchie
(614)
Key Provision of the Ohio Dual Demonstration:
Ohio Association of
Area Agencies on Aging
Integrated Care Delivery System (ICDS)
Facebook: o4aadvocacy

2. Key Provision of the Ohio Dual Demonstration: ICDS
Enrollment
Voluntary enrollment: September 2013
Passive enrollment: phased in by region Oct.–Dec. 2013
Who will assist with enrollment?
Enrollment broker, OSHIIP, ADRN (AAAs, CILS, other human services) Possible $4 million fund
How to roll out information for current dual eligible individuals? (Enrollment work group)
Regional meetings (providers in morning and consumers/advocates in afternoon
“Tiered messages” to consumers
Branding: My Care Ohio
Notices (CMS vs state)

3. Key Provision of the Ohio Dual Demonstration: ICDS
Care delivery model
Managed Care Plans coordinate services through a person-centered planning process
Plans must contract with AAAs to coordinate HCBS waiver services for enrollees over age 60
Financing
CMS capitated financial alignment model
Benefits
Nearly all Medicare and Medicaid services and plan flexibility to add benefits

4. Key Provision of the Ohio Dual Demonstration: ICDS
Targeted population
Est. 114,00 beneficiaries
Excludes those with developmental disabilities
Only Full duals are included
People with credible 3rd party insurance are excluded
Ombudsman
Existing State Long-term Care Ombudsman will offer:
Individual advocacy
Independent systemic oversight
Each MCO is required to have consumer advisory panels

5. Next Steps
Rates: Participating plans receive capitation rate reflecting the integrated delivery of Medicare and Medicaid benefits based on:
Baseline spending in both programs.
Anticipated savings resulting from integration & improved care.
Readiness Review: Ongoing process to asses plans’ Medicare and Medicaid experience and Demonstration readiness.
Two-step process that includes an onsite and desk review of participating plans.
Massachusetts first state to begin.

6. 7 ICDS Regions

7. Health Plans by Region Northwest: Aetna and Buckeye
Southwest: Aetna and Molina
West Central: Molina and Buckeye
Central: Aetna and Molina
Northeast Central: CareSource and United
East Central: CareSource and United
Northeast: Buckeye, CareSource, United

8. Demonstration status nationally
Overall:
Massachusetts, Ohio, and Illinois have approved capitated Demonstrations
Washington State has an approved managed fee-for-service Demonstration
Continuing to work with over 20 states on initiatives to better integrate care.
Approved Demonstrations

9. Considerations Implementation and Monitoring: Evaluation:
Ongoing milestones that allow CMS and States to monitor demonstration plan as enrollments begin.
CMS and the State have the right to stop enrollment at any time.
Evaluation:
Contracted independent evaluator (RTI); and
State-specific evaluation plans

10. Comparison to another state: Illinois
Illinois got MOU signed February 22, 2013
135,825 eligible beneficiaries in 2 regions
Voluntary enrollment Oct through December 2013, May begin passive enrollment in January 2014
May keep out of network providers 180, special exceptions after
Care team led by care coordinator. Jointly develop care plan, review every 30 days for high risk, 90 days for moderate risk
Ombudsman created outside Medicaid office
Plans must offer contracts to LTSS providers to avoid redundant services

11. ICDS Provisions Affecting AAAs
Front door role remains the same
MCOs must contract with AAAs for waiver service coordination of NF LOC individuals over age 60
Provider rates protected 90 days to 1 year
Consumer chooses LTSS specialists (WSC): PASSPORT care managers are default for people over age 60
ICDS will align with other HHS initiatives (CMS care transitions program)
ICDS may contract with AAAs to do caregiver support, evidenced based disease management, provider network management

12. Successes Annually, AAAs: Answer 300,000 calls
Perform 45,000 assessments
Enroll 9,700 in PASSPORT
Care manage 43,000 frail people
Ohioans 60+ using Medicaid funded NFs down 14.5% in 12 yrs. despite 15% increase in 60+ population
PASSPORT has 99.3% satisfaction rate statewide
25+ years of care management

13. AAAs as Front Door to LTSS

14. AAA Network Menu of Services for ICDS Plans
The Ohio ICDS MOU requires ICDS Plans to default to AAAs as the preferred provider of waiver service coordination for individuals over 60 years old. Required Waiver Service Coordination: Delegated component of ICDS Plan care management. AAAs provide face to face services across all care settings of the ICDS Plan member’s choice, including the following:

15. Required Waiver Service Coordination
Waiver Service Coordination/Care Management
Establish personal goals and plans of care
Address provider management issues
Develop disaster preparedness/back-up plans
Medication review
Provide health and safety review and problem resolution
Assist with transitions between care settings
Work collaboratively with other community-based programs to provide a seamless system of care for the Plan members

16. Required Waiver Service Coordination
Care and Service Plan Review
Face to face, in-home visits to:
Review of physical health systems, medical history, functioning (ADL/IADL), mental and cognitive abilities, social supports, environment, and financial resources (SSI, VA, HEAP, Homestead Exemption)
Provide disease management education
Recommend housing modifications, DME, and service plan updates
Coordinate benefits and confirm eligibility status
Review and revise disaster preparedness plan
Update care plans

17. Required Waiver Service Coordination
Crisis Intervention
Psycho-, social, and environmental problem solving (non-medical)
Provide family and care giver education
Report abuse, neglect, exploitation
Resolve and report service delivery incidents
Event-based Visits
Address changes in home environment, caregiver, physical/mental functional areas
Update care plans to address health and safety issues or areas of non-compliance

18. Required Waiver Service Coordination
Institution-based Visits
Coordinate with payer to identify diagnosis, treatment, and expected length of stay
Advocate for member in discharge planning meetings
Assist with transition home
Service Management
Order and adjust services as needed
Resolve service delivery issues and ensure service plans remain member-centered

19. Required Waiver Service Coordination
Medicaid Resolution
Assist with Medicaid redetermination and food stamp resolution
Assessment of LTSS Need
Including functional needs assessment, environmental assessment, social needs assessment
Managing Member Care Through Independent Providers and Consumer Direction

20. Potential Add-on AAA Services
Technical Assistance:
Care Transitions Services
Evidence-based transition services, such as the Coleman Care Transitions Intervention, are designed to assist MCO members transitioning from any health care facility to home.
These services have been proven to significantly reduce hospital readmissions.
Provider Management Assistance

21. Potential Add-on AAA Services
Evidence-Based Wellness Programs
Matter of Balance
Chronic Disease Self-Management Program with special versions for individuals managing chronic pain and diabetes
Healthy IDEAS
Tai Chi

22. Potential Add-on AAA Services
Caregiver Support
Customized training and education
Health and wellness programs
Personal consultation
Family mediation
Caregiver planning

23. Continuing Issues for AAAs in ICDS
Firewall protections between the Front Door and Care Management/waiver service coordination
Rates
Enrollment process (transition)
Interaction with 2 or 3 Plans and continued administration of Medicaid waiver programs for non-duals and those that are presumptively enrolled in Medicaid (before final Medicaid determination)
Evaluation

24. Budget Advocacy for Aging Issues
Keeping the front door open,
Restoring funds to rebalance Medicaid

25. Budget Priorities
Restore the 10% cuts ($3.6 million) for PASSPORT screening and assessment
Increase all PASSPORT provider rates by 3%
Permit individual care plans that fully support nursing home transition and diversion
Ensure all seniors have access to life-enhancing services no matter where they live both inside and outside the Integrated Care Delivery System
Fully fund Adult Protective Services across the state ($11 million)
Fund the Balancing Incentive Payment Program ($10 million

26. 1. Restore front door funding
PASSPORT assessors are the front door to link older adults to cost-effective in-home and community programs
PASSPORT enrollment has stalled since July 2011 when 10% cuts to front door funding went into effect, forcing AAAs to lay off screeners and assessors
HB 59 proposes only fractional increases to front door funding
Not only is PASSPORT cost-effective, it also has 99.3% consumer satisfaction rate statewide

27. 2. Restore provider rates
While rates for assisted living and adult day care services are increasing, all other PASSPORT providers are flat-funded after sustaining a 3% cut from the last budget
Providers who have earned a Medicare-Medicaid certification get a higher Medicaid reimbursement rate than PASSPORT’s and thus many of them choose not to provide the PASSPORT service
ALL provider rates need to be restored to ensure that seniors receive quality services without delay

28. o4a amendment
o4a has submitted an amendment to the legislature that would restore front door funding and increase PASSPORT provider rates
AAA representatives continue to follow-up with local representatives, especially those of the House Finance & Appropriations Committee
Time to move to the Senate finance committee

29. Budget Advocacy: House Substitute Bill
Good News:
½ of the request for increases in PASSPORT provider rates and PASSPORT front door activities are in the bill ($6 million)
Bad news:
Only ½ of the funding is included…
Funds for the Balancing Incentive payment Program were removed
MEDICAID EXPANSION WAS REMOVED

30. 3. Fund senior care plans
Lower care plan ceilings arbitrarily limit access to necessary services
The previous budget reduced the amount AAAs can spend on an individual’s care plan, from an average of $1,147 in FY 2012 to $1,060 in FY 2013
Lower care plan ceilings have lowered the quality of life for many older Ohioans
Prescribed services are necessary to avoid or delay nursing home placement

31. 4. Treat seniors equally
Rural Ohioans should benefit from the same enhanced services being made available in the ICDS counties
The Integrated Care Delivery System (ICDS) will offer an array of new home care services, but only seniors living in 29 predominantly urban and suburban counties are included in the ICDS
The state is essentially creating two separate but unequal long-term care systems—one for poor communities and a better one for metropolitan areas
Level of service shouldn’t be determined by where you live, but by your needs

32. 5. Fully fund Adult Protective Services
39 counties do not have enough funding to have full-time adult protective workers
Older Ohioans deserve protection from abuse, neglect, and exploitation
o4a has testified in support of the Ohio Elder Justice Act
This bill would expand the definition of “elder abuse” to include financial harm and make permanent the Elder Abuse Commission, among other provisions that strengthen Adult Protective Services Law

33. Extend Medicaid Eligibility
Medicaid expansion makes Ohio stronger by improving the health outcomes of more people of all ages
o4a estimates that not extending Medicaid eligibility would force $30 million in cuts to PASSPORT and other aging services over two years
If such drastic cuts take effect, older Ohioans might have to go to expensive nursing facilities or be left on their own

34. of Area Agencies on Aging
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Thank you
Stay in touch with
Ohio Association
of Area Agencies on Aging
Larke Recchie
(614)
Ohio Association of
Area Agencies on Aging
Facebook: o4aadvocacy