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Key Provision of the Ohio Dual Demonstration:

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Presentation on theme: "Key Provision of the Ohio Dual Demonstration:"— Presentation transcript:

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

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