Department of Aging Office of the State Long-term Care Ombudsman - - PowerPoint PPT Presentation

• Department of

Aging

Office of the State Long-term Care Ombudsman

Ombudsman Demonstration

Karla Warren, Ombudsman System Liaison (project manager for demo)

• Department of

Aging

• As mandated by the federal Older Americans Act

and Ohio law, the mission of the Long-Term Care Ombudsman Program is to seek resolution of problems and advocate for the rights of home care consumers and residents of long-term care facilities with the goal of enhancing the quality of life and care of consumers.

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• Department of

Aging

• Federal Older Americans Act

State Law Enhancement

Nursing Home Adult Day Care Residential Care Facility Home-delivered Meals Hospital-based SNF Personal Care Long-Term Acute Care Hospital Therapies County Home Transportation Residential Facility (“Adult Care Facility”) Respite Case Management Home Health Care Homemaker Services Respite Chore Services Any other health and social services provided to persons that allow them to retain their independence in their own homes or in community care settings. 3

• Department of

Aging

• State office

12 regional ombudsman Programs Some in AAAs, some not SLTCO designation and certification of staff 80 paid staff 275 volunteers

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• Department of

Aging

• Consumer

Complaint Handling 54.73% Regular Presence 20.1% Counseling

• n Benefits,

Rights, & Regulations 3.5% Community & Provider Education 2.3% Systems & Other Advocacy 5% Participate in Survey Process 0.4% Provider Consultation 1.8% Selection Assistance 0.6% Work with Resident & Famly Councils 1.2%

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• Department of

Aging

• Ombudsman: The Ohio Office of the State Long-term

Care Ombudsman Program is statutorily authorized to advocate and investigate on behalf of Ohio’s home- and community-based care and nursing facility-based recipients to safeguard due process, and serve as the early and consistent means of identifying systematic

• problems. Capitalizing on the function of Ohio’s Office of

the State Long-Term Care Ombudsman, the State will create MyCare Ohio Ombudsman to support the

• bjectives of Ohio’s newly integrated care delivery

system.

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• Department of

Aging

• The MyCare Ohio Ombudsman program will expand the

State Long-Term Care Ombudsman’s current accessibility to serve the needs of all beneficiaries participating in the Demonstration. The Ombudsman shall provide core ombudsman services to beneficiaries including outreach, consumer empowerment through education, complaint investigation, person-centered complaint resolution, and shall collect and report casework data to CMS on a quarterly basis. The Ombudsman shall be accessible to consumer advisory boards, and shall participate in all statewide stakeholder and oversight activities. The Ombudsman shall maintain access to and will coordinate with the CMT.

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• Department of

Aging

• CMS Funding Award:

Year 1: $272,354 Likely Year 2 and 3: $317,716 About 61 percent of original request, and thus our work

will be regionalized.

Our partners: ODM, CMS and ACL. Other states awarded: California, Illinois and Virginia.

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• Department of

Aging

• NE MyCare – Ombudsman

Program 10A (not in AAA)

• EC and NEC MyCare –

Ombudsman Program 10B (in AAA)

• Central and WC MyCare –

Ombudsman Program 6 (not in AAA)

• SW MyCare – Ombudsman

program 1 (not in AAA)

• NW MyCare – Likely integrated

into RP 4 (not in AAA)

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• Department of

Aging

• CMS funding to support services.

3 FTE, 1 PTE regionalized across state. Regional approach based on “community-well” population: 10A, Cle – full-time MyCare Ohio ombudsman who would cover

NE

10B, Akron – full-time MyCare Ohio ombudsman who would

cover EC and NEC

6 – full-time MyCare Ohio ombudsman who would cover central

and WC

1 – part-time MyCare Ohio ombudsman who would cover SW 4 – Likely integrated into current work Most minimal approach we’ll have. Possible additional $ pending

could allow for expansion.

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• Department of

Aging

• Many of these beneficiaries have already been our

clients.

Community-well is new population. Ombudsmen will continue with normal role with long-

term care consumers and will get assistance from MyCare Ohio ombudsman as needed, for example, if case involves complicated managed care issue.

MyCare Ohio ombudsmen will handle acute care cases.

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• Department of

Aging

• ACL’s Office of Duals Demonstration Ombudsman

Technical Assistance Program:

Plan and launch the program Meet data collection and reporting requirements Collaborate with other grantees to share ideas and

experiences

Develop training materials

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• Department of

Aging

• Provides Ombudsman Core Services (information, advocacy and

complaint investigation) for dual-eligible members of MyCare Ohio and the “community-well.” Provides expert technical assistance to Ombudsmen in the North-Eastern Ohio region or as directed. Functions as a liaison to MyCare Plans and managers.

Provides information regarding rights and benefits to members,

families and providers within the MyCare Ohio service delivery system.

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• Department of

Aging

• Promotes positive relationships within the MyCare Ohio network of

providers including those providing acute care services, as well as

• ffering case management and community-based long term care

services.

Enhances the presence of rights advocates within the MyCare

service system by providing rights-related information to MCOs, case management organizations, acute care providers LTC facilities and other community venues.

Investigates and resolves complaints regarding MyCare Ohio

enrollees and other LTC consumers receiving care from Managed Care Organizations. Assist and represent MyCare members and families in administrative hearings and appeal situations in accordance with Ombudsman policy.

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• Department of

Aging

• Hire regional ombudsman staff.

Create written protocols, including a MOU between

ODM and SLTCO, for the MyCare Ohio Ombudsman Program.

Implement first training for staff. Establish regular meeting schedule with MyCare

Ohio managed care plans and means for sharing of non-confidential data with ODM, CMS and plans.

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• Department of

Aging

• Stakeholder advocacy outreach:

ADRN Centers for Independent Living Ohio Hospital Association Ohio Association of County Behavioral Health

Authorities

Ohio Consumer Voices for Integrated Care Ohio Department of Mental Health and Addiction

Services

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• Department of

Aging

• Create ombudsman promotional materials and increase

consumer awareness of the ombudsman program.

Present at community education events. Deliver ombudsman services and investigate MyCare

Ohio complaints.

Analyze data and make recommendations to CMS, ODM

and any other entities on how to improve the final alignment initiative for individuals with Medicare and Medicaid.

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• Department of

Aging

• !

Contact us about quality concerns with all

providers.

MyCare Ohio ombudsman involvement

with membership advisory committees.

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• Department of

Aging

• !"

MyCare Ohio abuse identification and screening

• nline training.

HCBS ombudsman associates. Volunteers provide regular presence New training Public service announcement campaign

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• Department of

Aging

• Demand is unknown.

Nursing home complaints may actually

decrease.

Questions?

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• Department of

Aging

• Karla Warren

614-466-1242 kwarren@age.ohio.gov MyCare Ohio Ombudsman Contact Info: NE – Long-term Care Ombudsman: 1-800-365-3112 EC & NEC – Area Agency on Aging: 10B

1-800-421-7277

NW – ABLE: 1-800-542-1874 Central & WC – Easter Seals Central and Southeast

Ohio: 1-800-536-5891

SW – Pro Seniors: 1-800-488-6070