Missouris LOC Transforma1on Final Stakeholder Mee1ng November 27, - PowerPoint PPT Presentation

Missouri’s LOC Transforma1on Final Stakeholder Mee1ng November 27, 2018

Session’s Agenda 1. Refresh memory of journey thus far 2. Share feedback results collected from stakeholder groups 3. Offer revised model of the framework 4. Outline next steps including opportuniCes for input

Begin With The End In Mind Overarching Goal : Create a new Level of Care (LOC) model that: 1. Ensure access to care for most in need of HCBS providing least restric1ve community seMng as long as safely possible 2. Use limited state resources on those most in need of HCBS compared to more costly facility placement. 3. Ensure individuals able to live in the community are not inappropriately placed in a more restricCve seMng.

Why Now? • No substanCve updates since 1982 • Inherent problems with current model • Exacerbated when moved from 21 to 24 points • Missouri’s aging demographic • State Auditor’s Office recommendaCon

Technical Assistance (TA) Grant • Robert Wood Johnson funding through Princeton University’s State Health & Value Strategies • Funded to perform following acCviCes: 1. NaConal landscape scan • Deeper dives into specific states of interest 2. Stakeholder engagement 3. Co-create the new model 4. Summarize key learnings and best pracCces

1982 NF Level of Care Eligibility Criteria Added to Missouri Regula1ons

2001 1982 NF Level of Care Eligibility Criteria 1 st Significant Change to LOC Added to Missouri Move from 18 to 21 points Regula1ons

2 nd Significant Change to LOC – Move from 21 to 24 points Awarded Robert Wood Johnson Founda1on Grant 2017 2001 1982 NF Level of Care Eligibility Criteria 1 st Significant Change to LOC Added to Missouri Move from 18 to 21 points Regula1ons

January to June 2 nd Significant Change to Research and Discovery LOC – Move from 21 to 24 points July to December Stakeholder Engagement Awarded Robert Wood and Model Forma1on Johnson Founda1on Grant 2017 2018 2001 1982 NF Level of Care Eligibility Criteria 1 st Significant Change to LOC Added to Missouri Move from 18 to 21 points Regula1ons

Stakeholder Engagement Sessions June 25, 2018 • 161 HCBS Providers, 52 SNF Providers, and 78 Staff July 13, 2018 • 197 HCBS Providers, 88 SNF Providers, and 84 Staff November 27, 2018 • 298 HCBS Providers, 111 SNF Providers, and 94 Staff

U%.7(>W(!771.:(X":83":85#( • ! fNJ3gR<O)h)W($/)0(?/7?/9)15+.0)0($)6.&&$/0)G<F)6&?0$&?1) 1/4):&+6$''b)@(10)1&$)0($)0(&$$)0+)^>$)*+'0)'?9/?^61/0) 6(188$/9$')+&)?''.$')$B:$&?$/6$4)5,)0($):+:.81C+/'),+.) '$&>$i) ) • ! W&?0$)+/$)?4$1):$&)/+0$61&4) • ! O+)8$'')0(1/);)61&4') • ! O+)*+&$)0(1/)a)61&4') • ! Y8$1'$)@&?0$)8$9?58,)

June 25 Mee1ng Highlights • NaConal landscape findings • LOC eligibility criteria • FuncConal assessment tools used • Assessor/Determinators of services and supports • Scoring systems

U%.7(>W(!771.:(X":83":85#( R%),+.)6+.84)@?998$) ,+.&)/+'$)1/4)*17$)?0) *19?6188,)(1::$/b) @(10)6(1/9$')@+.84) ,+.)8?7$)0+)'$$) ?*:8$*$/0$4)?/)0($) G<F):&+6$'')?/) S?''+.&?i)

U%3F(BY(!771.:(X":83":85#( • ! #$:+&0$4)+/):&+6$'')1/4)%&1*$@+&7)%$$45167) • ! 3(1&$4)^&'0)4&1k)+%)/$@)G<F)6&?0$&?1) • ! \?>$)4++&@1,')l):+?/0')

( V$$&L-F(BZ(2&-"3(J397&3F( ( V7S."1$. E)R/4?>?4.18')19$)Qc)1/4)+>$&)@?0()1) 4$6&$1'$4)15?8?0,)%+&)?/4$:$/4$/0)8?>?/9)4.$)0+) 6(&+/?6)($180():&+58$*' b):(,'?618)8?*?01C+/'b)1/4j+&) ?*:1?&$4)*$/018)15?8?C$'") ) +&"57&"-(J3":"="3"5F( • ! U]GT')HU6C>?0,)+%)]1?8,)G?>?/9I)$"9")L10(?/9b) S+5?8?0,b)g&1/'%$&'b)]&$''?/9b)D&++*?/9b) g+?8$C/9b)J1C/9) • ! RU]G')HR/'0&.*$/018)U6C>?C$')+%)]1?8,)G?>?/9I_ S$18):&$:) • ! 31%$0,_U]G')?*:16C/9)($180(b)\188)&?'7) H510(?/9b)0&1/'%$&'I)

( ( V$$&L-F(>Z([8F#"E-3()"0"5-1$.#( ( ( V7S."1$. E)U/)?/4?>?4.18)@?0()1):(,'?618)8?*?01C+/b) *$4?618)4?19/+'?'b)1/4j+&)6(&+/?6)6+/4?C+/)0(10) 8$14')0+)0($)/$$4)%+&):(,'?618)(1/4'_+/)61&$") ) +&"57&"- ) J3":"="3"5F( • ! U]G'_L10(?/9b)S+5?8?0,b)g&1/'%$&'b)]&$''?/9b) D&++*?/9b)g+?8$C/9b)J1C/9) • ! RU]G'_S$18):&$:) • ! 31%$0,_U]G')?*:16C/9)($180(b)\188)&?'7) H510(?/9b)0&1/'%$&'I)

( ( V$$&L-F(YZ(V707.1-( ( ( V7S."1$. E)Y&+%$''?+/18)]$*$/C1)]?19/+'?') &$m.?&$4") ) ) +&"57&"- ) J3":"="3"5F( • ! U]G'_J1C/9b)S+5?8?0,b)]&$''?/9b)D&++*?/9b) L10(?/9b)g+?8$C/9) • ! RU]G')

( ( V$$&L-F(TZ(!7.5-33F(K33( ( ( V7S."1$. E)Y&+%$''?+/18)S$/018)K$180() ]?19/+'?')&$m.?&$4") ) ) +&"57&"- ) J3":"="3"5F( • ! RU]G'_3$8%)61&$) • ! 31%$0,_W1/4$&?/9jJB?0)'$$7?/9b) L$(1>?+&18b)\188)&?'7)

( ( V$$&L-F(WZ(K\VV(NK.57337E5%-3($&(V7<73$G07.5-3( V"#-="3"5FO($&(DHK(ND9%35(H&-".(K.]%&FO( ( ( V7S."1$. E)Y&+%$''?+/18)]?19/+'?')+%)Rj]]b) U6m.?&$4)L&1?/)R/-.&,)+&)g&1.*1C6)L&1?/)R/-.&,) 1')4$^/$4)?/)#3S<_!P2"e;a") ) +&"57&"- ) J3":"="3"5F( • ! RU]G'_3$8%)61&$) • ! 31%$0,_W1/4$&?/9jJB?0)'$$7?/9b) L$(1>?+&18b)\188)&?'7)

U%3F(BY(!771.:(DE1<"17#( ( Y816$4)4+0')5,).:)0+)'?B)?0$*')@(?6()'(+.84) '01,)0($)'1*$)?/)0($)^/18)%&1*$@+&7) ( ) ( Y816$4).:)0+)0(&$$):+'0_?0)/+0$')@?0()?4$1')%+&) ?*:&+>$*$/0)H144?C+/'b)4$8$C+/'b)6(1/9$'I) ) ) <=$&$4)'.99$'C+/')%+&)'6+&?/9)1/4):&+>?4$4) *+&$)?/%+&*1C+/)?/)+/8?/$)'.&>$, )

Frail Elderly Doorway Feedback Staff HCBS SNFs Definition Change age , could be tiered age: 65-70, 70-79, 80 and up; maybe start at � � � age 75, start at age 70 since many are in poor health, start at age 65, no age limit because discriminatory Add short-term rehab door � Indicators Add ADLs including personal care, supervision, transfers � � Add IADLs including grocery shopping, laundry, med prep, med � � management, money management, scheduling medical appointments, light housework, using phone to accomplish tasks, using phone apps, � � personal hygiene, household chores, bill paying, other shopping tasks, guardian, carrying 10 lbs., reading labels, and transportation Add to Safety : A/N/E, memory, living conditions � � Add Medication: specifically availability and administration �

Physical Limita1on Doorway Feedback Staff HCBS SNFs Definition Add to wording : HIV, end stage disease, kidney, liver, cancer � Add to wording : morbidly obese and diabetes; identify timeframe � Add to wording : rehab and hospice; How account for individuals with � limb/muscle constriction or amputee who no longer need clinical? Indicators Add ADLs including personal care, grooming, bathing, dressing, all ADLs � � � Add IADLs including transportation, meal prep, medication prep, money �� �� � management, household chores, laundry, shopping (for MS or ALS clients) Add to Safety : A/N/E � � � Add to Safety : fall risk, transfers � Add to Clinical : catheters, ostomies, etc. �

Demen1a Doorway Feedback Staff HCBS SNFs Definition Change wording : HIV/AIDS could be in this doorway or what kind of dx? � Specifically, Dementia word only? Change wording to identify timeframe; is an MD a specialist, no true test � Dementia (indicators may be present before diagnosis); Need to address � that indicators may come first Change wording : does a diagnosis of unspecified dementia qualify as � professional dementia diagnosis? Indicators Add to Safety : fall risk � Add to Safety : risk to others � Add to Safety : living conditions; add prompting and standby assist �

Mentally Ill Doorway Feedback Staff HCBS SNFs Definition Change wording : Too subjective; vetted by DMH? � Indicators Define self-care under IADLs � � Add ADLs: All � Add IADLs : including med prep, med management, personal hygiene, � � meal prep, grocery shopping, light housekeeping, paying bills, money management, ability to maintain a residence, household chores, scheduling med appointments. � Add to Safety : self-harm, suicide, poor decisions, medication compliance; Add Cognition for impairment Add to Safety : refusing care, noncompliance � �� � Add to Behavioral: medication � Add to Safety: A/N/E and living conditions � � �

I/DD or ABI Doorway Feedback Staff HCBS SNFs Definition Change the wording : Too open ended; add a goal oriented aspect with intent to improve capacity; need to include the entire definition of statute � � � to include SCI; identify and expand timeframe; vetted with DMH? Indicators Add ADLs : including toileting and bathing � � Add IADLs : including grocery shopping, laundry, housework, med � � management, doctor's appointments, transportation, essential communication with others, self-care Define self-care under IADLs and define Behavioral � � Add to Clinical: medication management, verbal skills Add Cognition and family support/dynamics �

We Learned From Your Valuable Feedback