1. 1 Virginia’s COMMUNITY LIVING PROGRAM (NURSING HOME DIVERSION) MODERNIZATION GRANTS Grant Ended March 31, 2013

2. 2 AoA NHD Grants AoA launched the NHD initiative in the fall of 2007. In its initial year, AoA issued awards to 12 states for a combined federal and non-federal funded grant program of $8.8 million. In 2008, AoA issued awards to 14 states reaching a combined federal and non-federal amount of approximately $16.2 million. In 2009, AoA issued awards to 16 states. 2

3. 3 The Purpose of the AoA NHD Grants Encourage the Aging Services Network to modernize and transform the funding they receive under the Older Americans Act, or other non-Medicaid sources, into flexible, consumer-directed service dollars Encourage the Aging Services Network to modernize and transform the funding they receive under the Older Americans Act, or other non-Medicaid sources, into flexible, consumer-directed service dollars Complement the CMS Money Follows the Person Initiative by strengthening the capacity of states to reach older adults before they enter a nursing home and spend down to Medicaid Complement the CMS Money Follows the Person Initiative by strengthening the capacity of states to reach older adults before they enter a nursing home and spend down to Medicaid Support states’ long-term care rebalancing efforts Support states’ long-term care rebalancing efforts 3

4. 4 Need to Rebalance/Transform

5. 5 Goal of the CLP - 1 Divert 55 individuals who are at imminent risk from nursing home placement and Medicaid spend-down through consumer direction of services provided within a designated monthly allotment of up to $1200

6. 6 Community Living Program - 2 September 30, 2009 – September 29, 2011 Participant enrollment begins October 1, 2010 Budget $1,463,851  Federal $ 939,730  Match (25%)$ 463,851

7. 7 Goal of CLP - 2 Divert 95 individuals who are at imminent risk from nursing home placement and Medicaid spend-down through consumer direction of services provided within a designated monthly allotment of up to $1200

8. 8 Community Living Program – 2 Funding for Services  20% of service funds are federal  80% of service funds are from other sources OAA funds (Title III-B, III-E, III-C2) State General Funds Local Funds Other (foundation grants, etc.)

9. 9 Objectives of the CLP Project Identify and enroll 95 eligible individuals from ten pilot Area Agencies on Aging (AAAs) Offer consumer direction and assistance of a fiscal intermediary Evaluate the program Educate policy makers

10. 10 Expansion Projects in CLP - 2 Bay Aging will evaluate the use of a mobile intake center for enrolling participants in its rural Planning and Service Area Jefferson Area Board for Aging will utilize telemedicine in partnership with the University of Virginia to serve 5 participants in rural Nelson County

11. 11 Pilot Planning and Service Areas Area Agencies on Aging (AAA):  Appalachian Agency for Senior Services  Bay Aging  Crater District AAA  District Three Senior Services  Jefferson Area Board for Aging  Peninsula Agency on Aging  Prince William AAA  Shenandoah AAA  Senior Connections  Senior Services of Southeastern Virginia

12. 12 Expected Enrollment by AAA AAA# ParticipantsParticipant Months AASC14117.0 Bay Aging541.8 Crater12100.3 District 3541.8 JABA1083.6 Peninsula1083.6 Prince William541.8 Senior Connections1083.6 Senior Services14117 Shenandoah1083.6 Totals95794.2

13. 13 Criteria Age: 65 and older AND Informal Support System Status: A caregiver demonstrating difficulty meeting the needs of their family member AND

14. 14 Criteria continued Functional: Dependent in 2 – 4 ADLs OR Cognitive/Emotional Status: Cognitive impairments including  Need for prompting or supervision  Impairments in decision-making ability  Inability to avoid injury in emergency situations Note: May have a health condition that requires at least monthly monitoring (e.g. diabetes, heart disease), medical/nursing (skilled care) needs and can be evidenced by a hospitalization or prior nursing facility stay and use of medications

15. 15 Targeting Financial Criteria Financial:  INCOME at or below 300% of SSI (2,022 a month) for the participant and likely to be denied Medicaid eligibility due to excess resources.  RESOURCE LEVEL should be no less than and no more than these ranges:  Single individual: $21,912 -$43,824  Individual with spouse: $43,824-$219,120  The project only considers liquid resources. This would be cash or in any other form which can be converted to cash within 20 work days (such as checking, savings, bonds and certificates of deposits) If a person is eligible for Medicaid or Medicaid Wavier programs, they are not eligible for this project. A couple can each individually qualify for the program

16. 16 Self-Declaration  Admission into the CLP program is by the participant’s self-declaration of income and resources.  The Service Coordinator may ask for this information for reporting purposes.  If the participant is offered the CLP program, he/she is not required to provide any income or resource documentation.

17. 17 Budget for Participant Monthly budget of $1200 Savings budget  A participant may save up to half of the $1,200 ($600) a month to purchase a more expensive service, such as a ramp.  Funds authorized for a participant but unspent can accumulate in the participants savings budget  The maximum allowable savings is $5,000

18. 18 Menu of CLP Services Service Coordination Respite Companion/Homemaker Personal Care Chore Home Delivered Meals

19. 19 Menu of CLP Services continued Adult Day Care Transportation Assisted Living Senior Apartments Personal Emergency Response System Assistive Devices Disposable Medical Supplies

20. 20 Menu of CLP Services continued Home Modification/Housing Rehabilitation Dental Care (Optional by AAA) Nutritional Supplements Groceries Prescription Medications Recreational Devices There is no participant co-pay or partial pay for these services. However, the project will only pay up to the $1,200 maximum monthly allotment.

21. 21 Traditional Services If a CLP participant needs services beyond the $1,200 limit, he/she can also receive traditional services

22. 22 Provider of Services As this is a participant (consumer)-directed program, the participant is able to choose who provides their service. Providers may be:  A person hired directly by the participant  An agency  The AAA Some services have provider qualifications. There is no limit on personal attendant hours within the $1,200 monthly budget.

23. 23 PeerPlace CLP2 will be a Program in PeerPlace Grant funds will pay for the set-up All service units paid from the $1,200 will be entered in the PeerPlace CLP2 program Traditional services delivered beyond the $1,200 will be entered in traditional PeerPlace programs

24. 24 Payment for Services Payments are being handled through a fiscal intermediary, Public Partnerships, LLC (PPL) PPL tracks the participants monthly and savings budgets All participant payments are processed by PPL For personal attendants hired directly by the participant, timesheets will be submitted to PPL and payments will be made to the personal attendant. For all other services, AAA pays for the service and then processes invoices through PPL.

25. 25 PPL Fund Advancement  VDA will advance funds for services to the AAA’s.  Initially, PPL will invoice each AAA for three months of service advance funding based on the estimated number of participants that will be enrolled and their monthly allotments.  Thereafter, PPL will send a monthly invoice for one month’s funding.

26. 26 PPL Reports  Reconciliation Report: Reconciles the service advance to the monthly authorizations.  Administrative Invoice: PPL bills $88 per participant per month (PPPM) fee  Detailed Spending Report: Provides a list of service spending that can be sorted by participant

27. 27 Expected Outcomes of the CLP A minimum of 95 individuals will be served 80% will be diverted from nursing home placement and Medicaid spend-down 85% of participants and/or their caregivers will report an improvement in their QOL 85% of participants and/or their caregivers will report an excellent or good experience with CLP

28. 28 Evaluation by Virginia Tech The Center for Gerontology (The Center) will serve as the external evaluator for CLP2 Grant. The outcome evaluation will track and report on client-level data and document the effectiveness of the project AAAs will need to report client-level data to the Center Evaluators will interview participants

29. 29 AAA Outreach Use of CLP Brochure VDA/DMAS Webinar Pre-Admission Screening Teams AAA educate own staff for internal referrals AAA outreach to local community  DSS Adult and Long Term Care Medicaid staff  Health Departments  Hospitals and Physicians  Nursing Home Discharge Planners  Health Fairs and Community Events  Adult Day Centers  Alzheimer’s Association  Advisory Councils and Service Boards  Interagency Meetings  Ombudsman Meetings  County Administrators  Legal Aid  Radio events

30. 30 AAA Responsibilities Designate the following:  A programmatic lead  A fiscal lead  A person to build and maintain PPL user ids Participate in planning and implementation calls and meetings Respond to VDA requests for information