Balancing Incentive Program – No Wrong Door January 27, Balancing Incentive Program and LTSS Screen Joyce Pohlman Grants Coordinator Community Access and Grants DADS

Balancing Incentive Program – No Wrong Door January 27, Balancing Incentive  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 – No Wrong Door January 27, Balancing Incentive  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.

Balancing Incentive Program – No Wrong Door January 27, BIP Mandated 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

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  A short, easy to complete process that directs individuals to long term services and supports (LTSS) for which they may be eligible.

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  BIP Requirements  Part of No Wrong Door Required by BIP - Level 1 Screen  Efficient, standardized approach to needs assessment  Refers people who are potentially eligible for Medicaid LTSS

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27,  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 LTSS Screen

Balancing Incentive Program – No Wrong Door January 27, Participating LTSS Doors  Aging and Disability Resources Centers (ADRC)  Area Agencies on Aging (AAA)  Local Authorities (LA)  DADS Regional Office (RO)  DADS Access and Intake Interest List (A&I IL)  Medicaid Managed Care Organization (MCO)  HHSC STAR+ Program Support Unit (PSU)  Local Mental Health Authorities (LMHA)  Outreach, Screening, Assessment, and Referral Centers (OSAR)

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  Process for Developing Screen:  Surveyed LTSS Doors  Reviewed current intake forms  Reviewed other states’ screens  Developed and evaluated draft screens  Met with representatives for each LTSS Door

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen Tell us about the individual’s needs a) Has an intellectual disability (IQ is less than 70). b) Has an autism spectrum disorder. c) Has dementia (not able to think clearly), Alzheimer's disease, a brain injury, or other cognitive impairment. d) Needs help with daily living needs such as bathing, dressing, eating, shopping, laundry, or making meals. e) Cares for someone with one or more of the conditions listed above (a. to d.) and doesn't get paid to give care. f) 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. g) Has or had a mental health diagnosis. h) Lives alone or doesn't have anyone to call for help in case of emergency. i) 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. j) Has or had a diagnosis of alcoholism or drug abuse.

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  Do you have any questions about Medicare or private long-term care insurance?  Yes  No  No answer  Have you dropped many activities and interests lately?  Yes  No  No answer  Do you feel full of energy?  Yes  No  No answer  How many times in the past 12 months have you had 3 or more drinks of alcohol in a single sitting? □ 0 □ 1 □ 2 □ 3 □ 4 □ 5 or more  If you can't get care at home, how likely are you to move into a nursing home?  Very likely  Likely  Somewhat likely  Not likely  A nursing home is not an option that is being considered  No answer

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  Does Homer think it is wonderful to be alive now?  Yes  No  No answer  During the past 30 days, has Homer taken any of the following? (check all that apply) □Medicines for pain or problems like back pain, muscle pain, headaches, arthritis, or fibromyalgia. Don't count: (1) vitamins, (2) herbs, (3) natural remedies, or (4) over-the-counter medicines such as aspirin, ibuprofen, TYLENOL, Advil, or Aleve. □Medicine for diabetes. □Medicine to help with sleep. Don't count: (1) vitamins, (2) herbs, (3) natural remedies, or (4) over-the-counter medicines such as melatonin, Benadryl, TYLENOL PM, or Advil PM. □Medicine for anxiety, nerves, or emotional upset. Don't count (1) vitamins, (2) herbs, (3) natural remedies, or (4) over-the-counter medicines. □Medicine for heart disease or high blood pressure. □Alcohol - beer, wine, wine cooler, or hard liquor.

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  Do you feel that your life is empty?  Yes  No  No answer  Programs you think might help. Learn more about these programs at Most of these programs have an interest list. Check all that apply. If you're not sure about a program, check it anyway:  Helps older adults and people age 21 and older with disabilities get support services in a home setting. (STAR+PLUS Waiver)  Helps people living in certain Texas areas get support services. See the list of areas. (Program for All-inclusive Care for the Elderly - PACE)  Helps people with developmental disabilities get support services. (Community Living Assistance and Support Services Waiver - CLASS)  Helps get support services for people who: (1) are deaf and blind, and (2) have another disability that keeps them from living on their own. (Deaf Blind with Multiple Disabilities Waiver - DBMD)  Helps get support services to families who are the main caregivers for children and young adults who need help with their medical care. Helps the child or young adult with: (1) moving from a nursing facility to a home setting or (2) staying in a home setting. (Medically Dependent Children Program - MDCP)

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen  You told us that you take care of someone. Could you use help? Help can include: (1) getting a short break - respite services, (2) helping you learn more about giving care, or (3) telling you about other support services.  Yes  No  No answer  The person you care for has:  Dementia (can't think clearly), Alzheimer’s disease, brain injury, or other cognitive impairment.  Another disability.  Tell us more about the person you care for:  Their age  Their relationship to you  Do they live with you?  Yes  No  No answer

Balancing Incentive Program – No Wrong Door January 27, Using the LTSS Screen Darshana Gore Business Analyst DADS IT Project Management Office

Balancing Incentive Program – No Wrong Door January 27, Step One: Access the Screen By phone

Balancing Incentive Program – No Wrong Door January 27, Step One: Access the Screen By phone In person

Balancing Incentive Program – No Wrong Door January 27, Step One: Access the Screen By phone In person By Internet

Balancing Incentive Program – No Wrong Door January 27, Step Two: Data Collection By phone In person By Internet Data Collection

Balancing Incentive Program – No Wrong Door January 27, Step Three: Generate Referrals System Generates Referrals Data Collection

Balancing Incentive Program – No Wrong Door January 27, LTSS Screen System Generates Referrals Referral Management AAA ADRC A&I IL LA LMHA/OSAR MCO PSU RO Data Collection

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, System Generates Referrals  Individual consent  Allows release of information to other Doors  Can limit information shared  Identifies organizations that can receive information

Balancing Incentive Program – No Wrong Door January 27, 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

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Medicaid Managed Care Organization (MCO)

Balancing Incentive Program – No Wrong Door January 27, Referrals to MCO  Scenario  The individual is receiving Medicaid and  Currently enrolled with MCO and  Needs assistance

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Program Support Unit (PSU)

Balancing Incentive Program – No Wrong Door January 27, Referrals to PSU  Scenario 1  Individual is receiving Medicaid  NOT enrolled with Medicaid Managed Care Organization Potential MCO enrollment

Balancing Incentive Program – No Wrong Door January 27, Referrals to PSU  Scenario 2  Individual is NOT receiving Medicaid  Is at risk of moving to a nursing facility  Scenario 3  Individual is NOT receiving Medicaid  Expresses interest in STAR+ Waiver services

Balancing Incentive Program – No Wrong Door January 27, Referrals to MCO or PSU System Generates Referrals Referral Management MCO/PSU Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Regional Office (RO)

Balancing Incentive Program – No Wrong Door January 27, Referrals to RO  Scenario 1  Individual is a Texas resident and needs help with at least one of the following: Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) Cognitive Impairment Emergency Response Services Has physical disability and needs assistance purchasing medically necessary items or services

Balancing Incentive Program – No Wrong Door January 27, Referrals to RO System Generates Referrals Referral Management RO Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Area Agency on Aging (AAA)

Balancing Incentive Program – No Wrong Door January 27, Referrals to AAA  Scenario 1  Any Individual who has questions about Medicare or Long-term Care Insurance  Scenario 2  Individual or caregiver age 60 and over, needing help or information

Balancing Incentive Program – No Wrong Door January 27, Referrals to AAA  Scenario 3  Caregiver caring for an individual (care recipient) with Alzheimer’s Disease OR related disorders OR neurological/brain dysfunction  Scenario 4  Caregiver over age 54, who is a relative other than parent or spouse, living with and caring for an individual (care recipient) under age 19 or disabled

Balancing Incentive Program – No Wrong Door January 27, Referral to AAA System Generates Referrals Referral Management AAA Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Local Authority (LA)

Balancing Incentive Program – No Wrong Door January 27, Referrals to LA  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

Balancing Incentive Program – No Wrong Door January 27, Referrals to LA  Scenario 2  Individual has Autism Spectrum Disorder  Scenario 3  Individual has an Intellectual Disability

Balancing Incentive Program – No Wrong Door January 27, Referrals to LA System Generates Referrals Referral Management LA Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Access and Intake Interest List (A&I IL)

Balancing Incentive Program – No Wrong Door January 27, Referrals to A&I IL  Scenario 1  An Individual is interested in learning more about one of the following: Community Living Assistance and Support Services Deaf-Blind with Multiple Disabilities Medically Dependent Children Program

Balancing Incentive Program – No Wrong Door January 27, Referral to A&I IL System Generates Referrals Referral Management A&I IL Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals Referral to the Aging and Disability Resource Center (ADRC)

Balancing Incentive Program – No Wrong Door January 27, Referrals to ADRC  Scenario 1  After a screening, an Individual does not have a referral to any of the other Doors  Scenario 2  Individual is a veteran  Scenario 3  Individual at risk of placement to a nursing facility

Balancing Incentive Program – No Wrong Door January 27, Referrals to ADRC  Scenario 4  Individual needs caregiver support, but does not qualify for AAA services  Scenario 5  ADRC can be manually added to the list of referrals

Balancing Incentive Program – No Wrong Door January 27, Referral to ADRC System Generates Referrals Referral Management ADRC Data Collection

Balancing Incentive Program – No Wrong Door January 27, Referrals to LMHA and OSAR  Referral to the LMHA and OSAR  Experts from these areas defined Referral Criteria  Behavioral health questions  Alcohol and drug abuse

Balancing Incentive Program – No Wrong Door January 27, Referral Management Receiving a referral  Acknowledge  Process  Forward, as necessary

Balancing Incentive Program – No Wrong Door January 27, Questions?