Stephanie Hull MGA Conference Chief, Long Term Services and Supports June 7, 2012 Maryland Department of Aging

 People living productive independent lives  People staying in their communities  People staying close to their loved ones  People supported by families and friends  People with chronic medical conditions and physical disabilities taking charge of their lives  People taking care of themselves and planning for health and independence  People staying out of nursing homes

 Enhancing the individual’s ability to purchase assistance with private resources  Using public resources to supplement individuals’ and families’ private resources  Supporting people with disabilities in employment  Diverting people from Medicaid spend down  Diverting people from institutional placement  Shifting the cost of care from institutional to community-based settings

 Strong consumer preference for home and community-based options and self-direction  Landmark legislation and court decisions  Partners  Federal, State and local agencies  Cross-disability consumers and providers  New focus on diversion from nursing homes or helping people transition from nursing homes to the community  Expansion of community options  National funding directed at change -new programs with a focus on reform

Focus is on shifting funding and service programs:  from institutional based service to community-based service and  from professional-directed to self-directed services by:  Streamlining access to information and assistance for long term services and supports  Consistent standards for providing information on long term services and supports and futures planning  Diverting people from nursing homes and Medicaid spend down  Providing more options for self-direction among recipients of long term services and supports

 Purpose is to provide trusted and visible source of information and assistance through partnerships at all levels to streamline eligibility and access to services  A national movement now in 54 states and territories  Supported by the Administration on Community Living, Centers for Medicare and Medicaid Services the Federal Veterans Administration  Conduit for new rebalancing initiatives  Builds on Aging Network of Information and Assistance Partnered with Disability Information and Assistance

 Maryland Department of Aging  Maryland Department of Health and Mental Hygiene (Medicaid Agency)  Maryland Department of Disabilities  Maryland Department of Human Resources  Maryland Department of Veteran’s Affairs  Local Area Agencies on Aging  Regional Centers for Independent Living  Consumers, Advocates, Providers, Policy Makers

 Community Living Administration and Administration on Aging  Grants  Older American’s Act Funding ( I & A, SHIP)  Centers for Medicare and Medicaid Services  Grants  Medicaid Incentive Payment Programs (MFP, BIP)  Veteran’s Administration  Program Funding (VDHCBSP)  Other Federal Programs and Private Foundations  The Lewin Group

 2010 Administration on Aging grant of $500,000  Developing standards and procedures for providing information and assistance for long term services and supports and futures planning  Howard County piloting standards and instruments  Statewide roll out January 2013 to coincide with statewide Level One assessment roll out

 Maryland Department of Aging  Maryland Department of Health and Mental Hygiene Medicaid Agency  Maryland Department of Disabilities  Maryland Disability Law Center  Howard County MAP  Freedom Center for Independent Living  HCBS Strategies, Inc.  University of Maryland School of Social Work

 2009 Centers for Medicare and Medicare Services grant $1.3 million  Maryland Medicaid supports nursed in two counties  Six MAP sites and eight hospitals  MAP Nurse Liaison working with patients at high risk of long term nursing home discharge and Medicaid Spenddown  Targeting high risk and intervention  Evaluation to consider state expansion and funding  Community Based Care Transitions  Guided Care MAP Partnership

 Maryland Department of Aging  Maryland Department of Health and Mental Hygiene Medicaid Agency  Howard, Worcester, Wicomico, Somerset, Anne Arundel, Carol, Washington, and Harford MAPs and hospital partners  University of Maryland School of Nursing  Centers for Independent Living

 2010 AoA grant of $400,000  Pilot partnership between Guided Care Program and Baltimore City MAP  Guided Care is nationally validated model for working with complex older adult patients with multiple chronic conditions to prevent acute episodes, in appropriate hospitalizations and to improve quality of life  Primary medical practice employs nurse liaisons to work with patients in their homes and to provide support and education  MAP pilot program teams a MAP case manager with the Guided Care nurse to expand support services and extend the program  Partners: Maryland Department of Aging, Johns Hopkins Community Physicians, Baltimore City MAP, Johns Hopkins Bloomberg School of Public Health

 CMS Funded Program to improve transitions from hospitals and reduce readmissions  Requires hospital to partner with Community Based Organization  Focus on :  30-day all cause readmission rates  90- and 180-day readmission rates  mortality rates  observation services  emergency department  Four MAP sites involved in applications

 2007 AoA grant of $700,000  Target and intervention of people in the community at high risk of nursing home placement and Medicaid spend down  Provide flexible self-directed monthly benefit  Funded through grant and Senior Care  Fiscal Intermediary/Fiscal Management Agency  Modeled on Cash and Counseling Model  Created infrastructure for Veteran Directed HCBS Program

 Funded through Veterans’ Administration  Flexible self-directed monthly benefit  Fiscal Intermediary/Fiscal Management Agency  Participant employs service providers  Supports Counselor  Agreed up service plan including savings and rainy day

 Maryland Department of Aging  Veterans’ Administration  Maryland Department of Health and Mental Hygiene Medicaid Agency  Baltimore City and Baltimore, Prince George’s, Washington, MAC, Inc., and Washington MAPs  ASIWorks, Inc.

 Funded at $2.5 million by AoA and Weinberg Foundation grants.  Stanford University Evidence based model.  Lay-led workshops provided statewide through senior centers, community organizations, hospitals, etc.  Chronic Disease Self Management Program including: Diabetes, Chronic Pain and Arthritis Self Management.  Implemented in 13 MAPs with further expansion planned.  Improves: quality of life and individuals’ ability to manage chronic illness in the community and reduces medical costs  3500 persons served since Appropriate for adults over 18 years.  Statewide license, plans to provide workshops in at least 20 of 23 counties by 2015.

 Balance Incentive Program  Integration and Diffusion  Information Technology  Broadening Partnerships  Statewide Access  Statewide Quality  New Opportunities

Stephanie A. Hull Chief, Long Term Services and Supports Maryland Department of Aging 301 West Preston Street Baltimore, Maryland Voice