1. New York State Department of Health Office of Long Term Care Long Term Care Restructuring Annual Long Term Care Ombudsman Training Institute October 18, 2007 The Lodge at Woodcliff Fairport, New York

2. 2 Office of Long Term Care Mark KissingerCarla Williams Deputy CommissionerDeputy Director Vision Patient Centered Long Term Care Government Role: Insure quality of care; develop policy and implement in effective and efficient manner Basis for restructuring workforce to reflect consistent support to patients/consumers accessing any long term care service

3. 3 Office of Long Term Care Goals Long-term: develop and implement policy and regulations resulting in sustainable, efficient services for consumers that are high quality Intermediate-term: increase community based options available to consumers while insuring access to needed residential and higher levels of care Short-term: reorganize the Department to align resources so that programmatic changes can be accomplished to support long and intermediate goals

4. 4 Office of Long Term Care Objectives and Activities Increase appropriate utilization of HCBS Implement reimbursement, payment and right-sizing reforms to encourage efficiencies and quality Improve transitions in care to reduce institutional placements Support initiatives related to a trained and available workforce Continued collaboration with NYSOFA to implement NYConnects Evaluate waiver programs for cost effectiveness, coordination and expansion Increase marketing of Long Term Care Partnership and evaluate options for increasing participation Implement NHTD Waiver and MFP Demonstration

5. 5 Nursing Home Transition and Diversion Waiver (NHTD)

6. 6 Philosophy Person-Driven Participant Choice – Services – Providers – Living Situation Assuring Health and Welfare

7. 7 Eligibility Nursing home level of care Authorized for Medicaid long term care At least 18 years of age or older Choose community vs. nursing home Capable of living in the community

8. 8 Regional Resource Development Centers (RRDC) - 9 Regions Albany North Albany South Binghamton/Southern Tier Buffalo Long Island Lower Hudson Valley New York City Rochester Syracuse

9. 9 RRDC Responsibilities Interviewing participants Interviewing providers Description of available choices Access to approved providers Reviewing Service Plans Determine eligibility for NHTD waiver Maintain regional budgets

10. 10 Quality Management Specialist Provide support to DOH staff, RRDCs and providers statewide Three Areas – Eastern – Western – Metro

11. 11 QMS Responsibilities Assure Quality Management Program is implemented Assisting in the retrospective review of Service Plans Review Service Plans over $300 per day Review Incident Reports Satisfaction Surveys

12. 12 Sources of Supports and Services for Participants Informal supports Other State and Federally Funded Services Medicaid State Plan

13. 13 NHTD Waiver Services Service Coordination Assistive Technology Community Integration Counseling Community Transitional Services Congregate and Home Delivered Meals Environmental Modifications Home and Community Support Services Home Visits by Medical Personnel Independent Living Skills Training and Development

14. 14 NHTD Waiver Services (cont’d) Moving Assistance Nutritional Counseling/Educational Services Peer Mentoring Positive Behavioral Interventions and Supports Respiratory Therapy Respite Care Structured Day Program Wellness Counseling Service

15. 15 Why use a Regional Aggregate Budgeting System ? Serve Individuals with higher level needs Assure maximum benefits Maximum creativity and innovation Increase flexibility for short term needs

16. 16 MONEY FOLLOWS THE PERSON DEMONSTRATION (MFP)

17. 17 Background Created by section 6071 of the Deficit Reduction Act of 2005 Total federal funding of $1.75 billion Demonstration period: January 1, 2007 – September 30, 2011 Demonstration supports State efforts to: - Rebalance LTC system to support individual choice - Transition individuals from institutions - Promote a system that provides person-centered, needs-based, quality services Enhanced FMAP for 365 days for qualified home and community-based services for each qualified person transitioned from an institution into the community during the demonstration period.

18. 18 MFP Application Developed with input & guidance of ad hoc MFP Work Group in consultation with provider associations MFP Work Group comprised of advocates and state agencies

19. 19 MFP Award Information January 2007 – CMS approved New York’s MFP Application New York 1 of 30 states and the District of Columbia awarded MFP funding Award represents up to $27.2 million in additional FMAP New York will receive an additional 25% FMAP for NHTD waiver services and certain LTC State Plan services provided to qualified individuals.

20. 20 Qualified Individuals Have been in a nursing home for at least six months Have been in receipt of Medicaid for at least one month pre-transition Are in receipt of NHTD waiver services; and Are transitioning into a “qualified residence”

21. 21 Money Follows the Person New York’s goal – transition 2800 people over grant period Includes people with physical, developmental, and mental health disabilities and seniors All must use NHTD waiver

22. 22 MFP Phases January 1, 2007 – December 31, 2007 is for Pre- Implementation January 1, 2008 – September 30, 2011 is for Implementation

23. 23 MFP Initiatives Contracts with Independent Living Centers to identify and outreach to select nursing home residents Develop informational materials on community- based options aimed at hospitalized individuals in need of long term care Activities related to promoting the availability of affordable, accessible and integrated housing Increase the availability of Assistive Technology from the Technology Related Assistance for Individuals with Disabilities program (TRAID)

24. 24 MFP Initiatives (continued) Activities related to promoting the availability of affordable, accessible and integrated housing Increase the availability of Assistive Technology from the TRAID program

25. 25 Contact Information For more information about the NHTD Waiver or MFP Demonstration contact 518-486-3154