Opportunities for Participant Direction A closer look at the - - PowerPoint PPT Presentation
Opportunities for Participant Direction A closer look at the Affordable Care Act (ACA) The National Resource Center for Participant-Directed Services (NRCPDS) September 26, 2010 HCBS Conference 2010 Session Overview Introductions
Introductions Overview of the participant direction
A closer look at federal opportunities
Cash & Counseling lessons learned as states
Open discussion
It will be “participant-driven” We will not be interpreting the ACA, “just the facts” Diversity of the panelists and their opinions is intentional Active involvement of the audience is important
Erin McGaffigan, NRCPDS, Public Policy Lori Simon-Rusinowitz, NRCPDS, Research Suzanne Crisp, NRCPDS, Technical Assistance Phyllis Shingle, National Participant Network Mike Hanshew, Consumer Direct Management Solutions
The Robert Wood Johnson Foundation The Atlantic Philanthropies, with additional support from:
U.S. Administration on Aging Office for the Assistant Secretary for
Veterans Health Administration
long-term care services that help people of all ages across all
sometimes referred to as consumer-directed or self-directed
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WA AK Hawaii OR CA NV ID MT WY AZ CO NM TX OK KS NE SD ND MN IA MO AR LA MS TN KY IL WI MI IN
WV
AL GA FL SC NC VA PA NY
DC MD DE NJ RI MA NH VT ME
OH
CT
15 Cash & Counseling States 16 Additional States with Budget Authority Programs
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WA AK Hawaii OR CA NV ID MT WY AZ CO NM TX OK KS NE SD ND MN IA MO AR LA MS TN KY IL WI MI IN
WV
AL GA FL SC NC VA PA NY
DC MD DE NJ RI MA NH VT ME
OH
CT
2008 – 7 States 2009 – Grew by 3 states for a total of 10 2010 – Expect to grow by 18 states for a total of 28
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Addressing the Uninsured Improving Care Coordination Expanding HCBS Quality Reform Addressing Workforce Needs
Subtitle E--New Options for States to Provide
Title XXXII- Community Living Assistance
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As of October 2011, amends 1915 of the Social Security Act to
Six percentage point increase in Federal Medicaid Assistance
Requires maintenance or expansion of HCBS during
Requires statewideness and services based on need
Eligible for medical assistance
Require assistance with ADLs,
Income does not exceed 150
If greater, the income level
Require the individual/representative to select, manage, and
Services are controlled “to the maximum extent possible” by the
Required
Assistance with ADLs, IADLs,
and health related tasks
Skills development Back up systems/mechanisms Voluntary training on selecting,
managing, and dismissing workers Permissible
Transition costs Expenditures to increase
independence or substitute for human assistance where $ would have been used for human assistance Excluded
Room and board costs Special education and
related services
Vocational rehabilitation services Assistive technology and services
(except emergency back up devices)
Medical supplies
and equipment
Home
modifications
Functional needs assessments Person-centered plans “Qualified” attendants/services, including family members
Comprehensive quality assurance system Annual evaluation, data collection, and reporting Method for addressing payroll taxes, unemployment and workers
Stakeholder involvement strategy
Medicaid and beyond Strategies to maximize their independence, including
Individuals, family caregivers, and representatives Design an individualized, self-directed,
State Medicaid Directors’ letter issued August 6, 2010
Suzanne to provide an overview of 1915(i) changes resulting
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allows individuals with functional limitation to maintain their
establishes infrastructure that will help to address the Nation’s
paid for entirely by premiums with no government
18 years or older Actively employed (including self-employed) Not living in a hospital or facility-based setting
Automatic enrollment by an employer via payroll deduction Alternative enrollment procedures for self-employed, have more
Election to “opt out”
Established by the Secretary based on expert consultation and
Lower monthly premiums for:
employed individuals below poverty line full time, employed college students
No underwriting requirements (other than on the basis of age)
Five year vesting period required (with minimum employment
No life time or aggregate limits on benefits Presumptive eligibility for certain institutionalized enrollees
Benefits paid under CLASS are disregarded when determining
Assumed (although based on future analysis) that the “cash”
Benefit amount will vary based on scale of functioning ability
Benefit plan to be determined by October 2012
home modifications assistive technology accessible transportation homemaker services respite care personal assistance services home care aides nursing support assistance with
Although called a “cash” benefit, use of funds is restricted Used to purchase non-medical services and supports that the
Funds are paid into a “Life Independence Account” on a daily,
Individuals cannot roll over funds from year to year Funds are electronically managed, including use of debit cards
States to assess and address capacity (and worker availability)
Authorized representatives may be put in place to receive access
Administrative expenses are not to exceed an amount equal to
Advocacy services and advice and assistance counseling are
Eligibility Assessment System and agreements with
Medicaid Coverage for the Lowest Income Populations Money Follows the Person Rebalancing Demonstration Funding to Expand State Aging and Disability
Incentives for States to Offer Home and Community-
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Medicaid OAA VHA Other
Participant Direction
Section 1115 Section 1915(a) Section 1915(b) Section 1915(c) Section 1915 (i) Section 1915 (j) Section 1915(k) State Plan
Institutionalization link continues to be
Needs-based criteria required Services for mental health/mental illness/substance
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Targeting unique populations allowed No comparability testing Income raised to 300% Must be statewide May not limit number of participants Approved for 5 years
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Allow and encourage participant direction Require person-centered planning Require functional needs assessment Allow income eligibility Require support functions
Counseling to provide information and assistance Financial Management Services (FMS)
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Encourages participant involvement Payment to legally responsible family members Quality management and improvement system Annual reporting
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Element 1915(c) 1915(i) 1915(j) 1915(k) Medical Eligibility LOC Needs-based Needs-based Needs-based Statewideness May limit May not limit May limit May not limit Target by Group Yes No Personal or attendant care Personal or attendant care Limit Number Yes No No Uncertain Cash No No Yes Yes FMS Reimbursement Admin/service Admin Admin Admin/service Goods and Services Broadly defined as a waiver service Broadly defined (new – under “Other” services) Broadly defined Excludes assistive devices, medical supplies, and home modifications
Section 1915(i) targets all/some target groups and
Section 1915(i) targets mental health/illness and
Section 1915(k) participant directs all state plan
Section 1915(j) continues to be the Gold Standard
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Lori Simon-Rusinowitz Director of Research, NRCPDS Suzanne Crisp Director of Program Design & Implementation, NRCPDS Phyllis Shingle Member of the National Participant Network, New Mexico Mike Hanshew Director of Policy, Consumer Direct Management Solutions
Panelists will have an opportunity to provide insights on each of
Each topic will receive a total of 10 minutes Moderator will ensure diverse points made within time allotted
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