1. 7/21/2015
Balancing Incentive Program and LTSS Screen Joyce Pohlman Grants Coordinator Community Access and Grants DADS

2. 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.  

3. 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.

4. 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

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

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

7. 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

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 7/21/2015
Using the LTSS Screen

17. 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

18. 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

19. 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

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

21. 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

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

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

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

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

26. 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

27. Referral Management
Referral Management landing page (for workers)

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

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

30. Referral Management
Acknowledge
Select in the upper right hand corner

31. Referral Management
Clicking on the Acknowledge button brings up this screen

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

33. 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

34. Referral Management

35. 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.

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

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

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

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

40. 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.

41. Referral Management

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

43. Referral Management
Select ‘Unassigned’ tab

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

45. Referral Management
This page provides further detail on the referral

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

47. Referral Management
Complete the pop up box

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

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

50. Referral Management
Select report type

51. 7/21/2015
Questions?