1 CHOICES FOR CARE Blazing the Trail to Real Choices Joan K. Senecal, Commissioner Vermont Department of Disabilities, Aging and Independent Living

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Presentation transcript:

1 CHOICES FOR CARE Blazing the Trail to Real Choices Joan K. Senecal, Commissioner Vermont Department of Disabilities, Aging and Independent Living June 6, 2008 Long Term Care Financing and Coverage Reform

2 Overview Orientation to the Choices for Care Waiver Implementation Important Elements How are we doing?

3 Overview – Choices for Care A 5-year 1115 Demonstration Waiver Global Budget (nursing homes and home and community based services) 5-year budget is capped, but allows for an average 7.28% increase/year. Settings Nursing Homes Home-Based Services Enhanced Residential Care

4 Choices for Care Goals Provide equal access to various settings for long-term care services and supports Serve more people Create a balanced system of long-term care by increasing the capacity of the home and community-based system, and maintaining the optimum number of quality nursing home beds Manage the costs of long-term care Prepare for future population growth

5 CHOICES FOR CARE ELIGIBILITY Highest Need Moderate Need Group High Low Acuity of Need Level of Care for Eligibility Entitlement Groups High Need Group

6 SETTINGS AND SERVICES Nursing Homes Enhanced Residential Care Home-Based Care and Supports Case Management Personal Care Adult Day Respite Companionship Home Modifications/Assistive Technology Emergency Response System

7 Home-Based Care Options Agency Directed Consumer/Surrogate Directed Flexible Choices Programs for All-inclusive Care for the Elderly (PACE) 24-hour Option Spousal payment as caregivers

8 Providers Adult Day Providers (14) Area Agencies on Aging (5) Enhanced Residential Care Homes (49) Home Health Agencies (12) Nursing Homes (39) VT-PACE Inc. (2 sites) New: Developmental Services Providers & Traumatic Brain Injury Providers (limited)

9 Quick Overview Choices for Care offers equal choice among all long-term settings – nursing home, home-based services, and enhanced residential care. Applicant’s needs are based on a clinical assessment and determined to be Highest, High, or Moderate Need; individuals must also meet financial eligibility criteria. Highest Needs individuals are entitled to services and enrolled as soon as Medicaid financial eligibility has been determined. High Needs individuals are entitled; however are enrolled when funds are available. Wait list opened 2/1/ people. Moderate Needs services are preventative in nature. Include adult day, homemaker and case management. Enrollment is limited by the available funds.

10 Choices for Care At the Local Level

11 Getting Started Work in the Communities - Local Structure 14 Long Term Care Clinical Coordinators (LTCCCs) – State employees Co-located with Long Term Care Financial Eligibility Specialists in 12 district offices (VT does not have county government)

12 Getting Started Local Choices for Care (CFC) Teams meet monthly Members: LTC Eligibility Specialists, local case managers, CFC providers, hospital discharge planners, LTC Ombudsman LTCCC facilitates meetings Status of CFC applicants discussed Brainstorming on other available resources/services

13 Role of the LTCCC Receives CFC applications Contacts applicant within 3 working days to schedule clinical eligibility assessment Completes face-to-face LTC clinical eligibility assessment wherever the applicant is currently located; home, hospital, nursing facility, or residential care home Clinical assessment addresses health, functional and cognitive status of the client.

14 Role of the LTCCC (cont’d) If possible, provides an immediate answer about clinical eligibility. Provides Options Education: information about CFC services, choice of settings and information about other available community services and resources Explains choice of Case Management organizations and notifies selected agency about client’s choice and eligibility status Advises applicant/family to immediately apply for LTC Medicaid Financial eligibility

15 Participants have equal access to the long term care settings of their choice. Participants may move from one setting to another. Applicants have a face to face meeting for the LTC clinical eligibility assessment and learn about their long term care options. Formation of strong teams and partnerships to help ensure the participant is receiving necessary services in the setting of their choice. Important elements

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18 Financial Monitoring – FY 2008