7/21/2015 Balancing Incentive Program and LTSS Screen Joyce Pohlman Grants Coordinator Community Access and Grants DADS

Balancing Incentive Program The Affordable Care Act created the Balancing Incentive Program (BIP), which helps states provide quality care in the most appropriate, least restrictive setting.  

Balancing Incentive Program Increases the Federal Matching Assistance Percentage (FMAP) to States that make structural reforms to increase nursing home diversions and access to non-institutional LTSS. Enhanced matching payments are tied to the percentage of a State’s LTSS spending, with lower FMAP increases going to States that need to make fewer reforms.

BIP Requirements Requires structural reforms to increase access to Medicaid community based long-term services and supports (LTSS). Create a “no wrong door” to provide a single point of information and allow individuals to provide demographic information once. Core standardized assessment instruments: ensure all assessment instruments cover mandated “domains” Ensure “conflict-free” case management in all programs All objectives must be met by September 30, 2015

LTSS Screen A short, easy to complete process that directs individuals to long term services and supports (LTSS) for which they may be eligible.

LTSS Screen BIP Requirements Part of No Wrong Door Required by BIP - Level 1 Screen Refers people who are potentially eligible for Medicaid LTSS

LTSS Screen No Wrong Door A common screen used in all major entry points to the LTSS system Individuals have a uniform experience Directs individuals to participating LTSS Doors

LTSS Screen LTSS Screen Simple, concise, easy to complete 7/21/2015 LTSS Screen LTSS Screen Simple, concise, easy to complete Individuals tell their story only once Most will be completed via web or phone, but may be done in person

Participating LTSS Doors Aging and Disability Resources Centers (ADRC) Area Agencies on Aging (AAA) Local Intellectual and Developmental Disability Authorities (LIDDA) (referrals only) DADS Regional Offices (RO) DADS Access and Intake Interest List (A&I IL) Medicaid Managed Care Organizations (MCO) (referrals only) HHSC STAR+ Program Support Unit (PSU) (referrals only) Local Mental Health Authorities (LMHA) Outreach, Screening, Assessment, and Referral Centers (OSAR)

LTSS Screen Advantages to Individuals Receive assistance from programs for which they may be eligible Find the right help more easily Tell their story only once

LTSS Screen Advantages to intake workers Less time gathering demographic information More time providing personal assistance System automatically produces referrals Individual contact history is maintained

LTSS Screen Advantages to organizations (Doors) Provides enrollment and referral information for the individual Reduces need for in-depth understanding of other programs Consistent evaluation of individual’s LTSS needs

LTSS Screen Screen Questions - Demographic Name Address where services will be delivered Date of birth Gender Race/ethnicity Social Security Number Caregiver information Military service Insurance information

LTSS Screen Screen Questions Determination of LTSS need Need for benefits counseling Caregiver need Nursing facility risk Referral to programs with Interest Lists Behavioral health Alcohol and drug abuse

LTSS Screen Tell us about the individual’s needs Has an intellectual disability (IQ is less than 70). Has an autism spectrum disorder. Has dementia (not able to think clearly), Alzheimer's disease, a brain injury, or other cognitive impairment. Needs help with daily living needs such as bathing, dressing, eating, shopping, laundry, or making meals. Cares for someone with one or more of the conditions listed above (a. to d.) and doesn't get paid to give care. Gets care from someone who: (1) helps with daily living needs such as bathing, dressing, eating, shopping, laundry, and making meals, and (2) doesn't get paid to give care. Has or had a mental health diagnosis. Lives alone or doesn't have anyone to call for help in case of emergency. Has a physical disability (for example, can't walk, can't see, or can't hear) and needs help paying for items or services needed for medical reasons. Has or had a diagnosis of alcoholism or drug abuse.

7/21/2015 Using the LTSS Screen

Data Collection Collected by Intake Demographic data Screen responses Pulled from existing systems (automatically) Managed care enrollment Enrollment DADS LTSS programs and Interest List Medicaid eligibility

Terms of Use Agreement Terms of Use Agreement Provides permission to send referrals electronically Provides access to information on Medicaid status, MCO enrollment, Interest List Not required to receive referrals

Referrals What is on the referral? Date and time of Screen Access mode (web/phone/in-person) Who conducted the Screen Demographic data Current enrollment data Screen responses List of referrals generated and organization contact information Comments

Referrals Referral to the Local Intellectual and Developmental Disability Authority (LIDDA)

Referrals to LIDDA Scenario 1 Individual is receiving Medicaid Currently enrolled with Medicaid Managed Care Organization and Enrolled in one of the following: Home and Community-Based Services Texas Home Living Intermediate Care Facilities for Individuals with IDD

Referrals to LIDDA Scenario 2 Scenario 3 Individual has Autism Spectrum Disorder Scenario 3 Individual has an Intellectual Disability

System Generates Referrals Referrals to LIDDA Referral Management LA System Generates Referrals Data Collection

Referral Management (Worker) 7/21/2015 Referral Management (Worker)

Referral Management Managing a referral Pick up Acknowledge Check other referrals ‘Get Next’ Process

Referral Management Pick up referral Requires ‘Referral Management’ role Go to Referral Management landing page This shows all the referrals assigned to you. Note that the top banner lists all open referrals and the number expedited. Referrals are typically in order from oldest to newest Workers should open the oldest expedited referral first

Referral Management Referral Management landing page (for workers)

Referral Management Select the box next to the referral to open it

Referral Management Select ‘Next’ to get to Referral details page

Referral Management Acknowledge Select in the upper right hand corner

Referral Management Clicking on the Acknowledge button brings up this screen

Referral Management Select ‘Acknowledge’ This brings you back to your home page ‘Success’ message

Referral Management Check other referrals Go to the Referrals details page Select ‘Associated Referrals’ tab This lists all the referrals associated with the screening Contact the Door-locations the referral was sent to coordinate services

Referral Management

Referral Management Identified: A referral was identified but the individual selected 'Don't send' at the end of the screening. This Screening Questionnaire is incomplete. Not Send-Deselect: The referral was not sent because it was deselected. Generated: A referral was  generated and sent to the Door-location but has not yet been assigned to staff for follow-up. Unassigned: The referral was sent to the Door-location and picked up by a Supervisor who selected the 'Assign/Reassign' icon and then selected 'Unassign'.  Assigned: The referral was sent and received by the Door-location and assigned to staff for follow-up. Acknowledged/Completed: The referral is assigned and processed. This is the last step in the referral management process.

Referral Management ‘Get Next’ Pick up new referrals, add to your referral queue

Referral Management Process the referral Follow current procedures for contacting individual Conduct more in-depth assessment No further LTSS action required

Referral Management (Supervisor) 7/21/2015 Referral Management (Supervisor)

Managing a referral: Supervisor Referral Management Managing a referral: Supervisor Assign Data Management Reports

Referral Management Assign Requires ‘Referral Management’ AND ‘Supervisor’ role Go to landing page This shows all staff that report to you and their current assignments. Note that the top banner lists all the open referrals and the number that are expedited.

Referral Management

Referral Management Go to ‘Referral Management’ page The ‘Assigned’ tab shows all the referrals that have been assigned

Referral Management Select ‘Unassigned’ tab

Referral Management Select an unassigned referral by selecting the box next to the name Select ‘Next’

Referral Management This page provides further detail on the referral

Referral Management To assign the referral, click on the icon showing two heads connected

Referral Management Complete the pop up box

Referral Management Clicking ‘submit’ takes you back to the home landing page. Note that there is now one assigned referral for Joyce Pohlman

Referral Management Data Management Requires ‘Reports’ role Go to ‘DataMart’

Referral Management Select report type

7/21/2015 Questions?