Division of Aging Waiver Enrollment Process

1. Division of Aging Waiver Enrollment Process MAC Meeting August 2015

2. Role of Indiana’s Area Agencies on Aging (AAAs) • All 16 AAAs are certified as Aging and Disability Resource Centers (ADRCs) • The ADRCs are the entry point for our HCBS programs • AAAs administer Title III, SSBG, and CHOICE dollars contracted out by the Division of Aging (all non-Medicaid)

3. Role of Indiana’s Area Agencies on Aging (AAAs) • AAAs are the gateway to the Aged and Disabled and Traumatic Brain Injury Medicaid waiver programs • The AAAs also conduct nursing facility preadmission screening under current state statute • Preadmission screening is separate from waiver enrollment • Nursing facility level of care is required for the Aged and Disabled Waiver but is not determined through the preadmission screening process

4. The Aged and Disabled Medicaid Waiver • Must be Medicaid eligible • Special income limited is used • Spousal impoverishment protection is applied • Must meet nursing facility level of care • Currently there is no waiting list for the Aged and Disabled Waiver

5. The Enrollment Process • AAA conducts assessment, includes statement from physician (or nurse practitioner) • Eligibility determination made by AAA • Plan developed with individual and whoever else they wish to include • Service plan submitted to the Division of Aging (DA)

6. The Enrollment Process • Service plan is reviewed by DA staff and either • Approved; • Denied; or • Additional information requested • If approved, it may be pending certain items, such as Medicaid approval or discharge from a nursing facility

7. The Enrollment Process • When all pending items are resolved, AAA case manager confirms the start date of waiver services • That also comes to the Division for review • Some auto approvals • Some require verification by DA staff • Then authorizations for services are issued to providers

8. Potential Sources of Delay • AAA capacity issues may delay the time it takes to complete the assessment • May be difficult to secure document from physician • May be difficult to get information or schedule appointments with consumer or their families

9. Potential Sources of Delay • DA staff capacity can be an issue as well • End of waiver year issues can make slots unavailable until the new waiver year starts • Medicaid issues • Disability determinations • Miller’s Trust • Failure to produce documents

10. A&D Waiver Monthly Participant Count Jul-15

11. Impact for Rebalancing • Process needs to be faster, more streamlined • For hospitals discharges, nursing facility is the faster, easier option • Waiver capacity (DA, AAAs, providers) has grown but not at the same rate as waiver participation • Need to evaluate rates • Need to encourage capacity building (fear among AAAs and providers is that the waiver will wait list again)

12. Pre Admission Screening • Required of individuals seeking admission to Medicaid-certified nursing facilities, regardless of payer source. • Current process conflates CMS-required PASRR process (for individuals with MH or ID/DD conditions), along with LOC determinations. • Process is expensive and inefficient and does not lead to outcomes required of enabling statute and regulations. • Legislation last session with a sunset date of June 30, 2016 of state-mandated PAS. Current redesign process underway.

13. Potential Solutions • Pending technology changes will allow the DA to more effectively track AAA response and processing times to identify and troubleshoot problem areas more directly. • PAS/PASRR redesign process is underway. This will allow more directed targeting of individuals discharging from hospitals with options counseling and divert or prevent long term institutionalization. • Trying to identify funding to support capacity building efforts.

14. Debbie Pierson Deputy Director, Operations 317-232-0604 Debbie.Pierson@fssa.in.gov Contact Information Yonda Snyder Director, Division of Aging 317-232-7123 Yonda.Snyder@fssa.in.gov