Presentation Transcript

1. Stephanie Hull MGA Conference Chief, Long Term Services and Supports June 7, 2012 Maryland Department of Aging

   Long Term Service and Supports Reform through Maryland’s Aging and Disability Networks

2. What Is the Reform About?
3. People People living productive independent lives People staying in their communities People staying close to their loved ones People supported by families and friends People with chronic medical conditions and physical disabilities taking charge of their lives People taking care of themselves and planning for health and independence People staying out of nursing homes
4. Money Enhancing the individual’s ability to purchase assistance with private resources Using public resources to supplement individuals’ and families’ private resources Supporting people with disabilities in employment Diverting people from Medicaid spend down Diverting people from institutional placement Shifting the cost of care from institutional to community-based settings
5. What/Who Is Driving the Change? Strong consumer preference for home and community-based options and self-direction Landmark legislation and court decisions Partners Federal, State and local agencies Cross-disability consumers and providers New focus on diversion from nursing homes or helping people transition from nursing homes to the community Expansion of community options National funding directed at change -new programs with a focus on reform
6. Major Elements of Reform Focus is on shifting funding and service programs: from institutional based service to community-based service and from professional-directed to self-directed services by: Streamlining access to information and assistance for long term services and supports Consistent standards for providing information on long term services and supports and futures planning Diverting people from nursing homes and Medicaid spend down Providing more options for self-direction among recipients of long term services and supports
7. Streamlining Access to Information and Services: Aging and Disability Resource Centers Purpose is to provide trusted and visible source of information and assistance through partnerships at all levels to streamline eligibility and access to services A national movement now in 54 states and territories Supported by the Administration on Community Living, Centers for Medicare and Medicaid Services the Federal Veterans Administration Conduit for new rebalancing initiatives Builds on Aging Network of Information and Assistance Partnered with Disability Information and Assistance
8. www.marylandaccesspoint.info
9. MAP Partners Maryland Department of Aging Maryland Department of Health and Mental Hygiene (Medicaid Agency) Maryland Department of Disabilities Maryland Department of Human Resources Maryland Department of Veteran’s Affairs Local Area Agencies on Aging Regional Centers for Independent Living Consumers, Advocates, Providers, Policy Makers
10. MAP Funding and Technical Assistance Community Living Administration and Administration on Aging Grants Older American’s Act Funding ( I & A, SHIP) Centers for Medicare and Medicaid Services Grants Medicaid Incentive Payment Programs (MFP, BIP) Veteran’s Administration Program Funding (VDHCBSP) Other Federal Programs and Private Foundations The Lewin Group www.adrc-tae.org
11. Options Counseling 2010 Administration on Aging grant of $500,000 Developing standards and procedures for providing information and assistance for long term services and supports and futures planning Howard County piloting standards and instruments Statewide roll out January 2013 to coincide with statewide Level One assessment roll out
12. Options Counseling Partners Maryland Department of Aging Maryland Department of Health and Mental Hygiene Medicaid Agency Maryland Department of Disabilities Maryland Disability Law Center Howard County MAP Freedom Center for Independent Living HCBS Strategies, Inc. University of Maryland School of Social Work
13. Care Transitions: Person Centered Hospital Discharge Program 2009 Centers for Medicare and Medicare Services grant $1.3 million Maryland Medicaid supports nursed in two counties Six MAP sites and eight hospitals MAP Nurse Liaison working with patients at high risk of long term nursing home discharge and Medicaid Spenddown Targeting high risk and intervention Evaluation to consider state expansion and funding Community Based Care Transitions Guided Care MAP Partnership
14. Person Centered Hospital Discharge Partners Maryland Department of Aging Maryland Department of Health and Mental Hygiene Medicaid Agency Howard, Worcester, Wicomico, Somerset, Anne Arundel, Carol, Washington, and Harford MAPs and hospital partners University of Maryland School of Nursing Centers for Independent Living
15. Care Transitions: Baltimore City MAP Guided Care 2010 AoA grant of $400,000 Pilot partnership between Guided Care Program and Baltimore City MAP Guided Care is nationally validated model for working with complex older adult patients with multiple chronic conditions to prevent acute episodes, in appropriate hospitalizations and to improve quality of life Primary medical practice employs nurse liaisons to work with patients in their homes and to provide support and education MAP pilot program teams a MAP case manager with the Guided Care nurse to expand support services and extend the program Partners: Maryland Department of Aging, Johns Hopkins Community Physicians, Baltimore City MAP, Johns Hopkins Bloomberg School of Public Health
16. Care Transitions: Community Based Care Transitions CMS Funded Program to improve transitions from hospitals and reduce readmissions Requires hospital to partner with Community Based Organization Focus on : 30-day all cause readmission rates 90- and 180-day readmission rates mortality rates observation services emergency department Four MAP sites involved in applications
17. Diversion and Self Direction: Community Living Program 2007 AoA grant of $700,000 Target and intervention of people in the community at high risk of nursing home placement and Medicaid spend down Provide flexible self-directed monthly benefit Funded through grant and Senior Care Fiscal Intermediary/Fiscal Management Agency Modeled on Cash and Counseling Model Created infrastructure for Veteran Directed HCBS Program
18. Diversion and Self Direction:Veterans Directed HCBS Program Funded through Veterans’ Administration Flexible self-directed monthly benefit Fiscal Intermediary/Fiscal Management Agency Participant employs service providers Supports Counselor Agreed up service plan including savings and rainy day
19. Community Living and VDHCBS Program Partners Maryland Department of Aging Veterans’ Administration Maryland Department of Health and Mental Hygiene Medicaid Agency Baltimore City and Baltimore, Prince George’s, Washington, MAC, Inc., and Washington MAPs ASIWorks, Inc.
20. Living Well Programs Funded 2006-2012 at $2.5 million by AoA and Weinberg Foundation grants. Stanford University Evidence based model. Lay-led workshops provided statewide through senior centers, community organizations, hospitals, etc. Chronic Disease Self Management Program including: Diabetes, Chronic Pain and Arthritis Self Management. Implemented in 13 MAPs with further expansion planned. Improves: quality of life and individuals’ ability to manage chronic illness in the community and reduces medical costs 3500 persons served since 2006. Appropriate for adults over 18 years. Statewide license, plans to provide workshops in at least 20 of 23 counties by 2015.
21. Moving Forward Balance Incentive Program Integration and Diffusion Information Technology Broadening Partnerships Statewide Access Statewide Quality New Opportunities
22. Contact Information Stephanie A. Hull Chief, Long Term Services and Supports Maryland Department of Aging 301 West Preston Street Baltimore, Maryland 21201 Voice 410-767-1107 sah@ooa.state.md.us www.marylandaccesspoint.info www.adrc-tae.org