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MDS 3.0 Section Q Slide Addendum with Additional Information Medicaid Program Balancing Initiatives MDS 3.0 Section Q

Medicaid Programmatic Balancing Initiatives . Real Choice Systems Change Grants (2001)Helps States change their long-term care systems to rely less on institutional services and to increase access to home and community-based servicesPromising Practices in HCBS Research (2001) and Expanded HCBS Wa

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MDS 3.0 Section Q Slide Addendum with Additional Information Medicaid Program Balancing Initiatives MDS 3.0 Section Q

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    1. MDS 3.0 Section Q Slide Addendum with Additional Information Medicaid Program Balancing Initiatives MDS 3.0 Section Q and PASRR Items Aging Disability Resource Centers (ADRCs) CMS Activities Supporting Section Q Bob Connolly, MSW, LCSW-C CMS Consultant Slide #3 – Section Q is only one tool, that when used effectively, can assist States in meeting the intent of the Supreme Court’s Olmstead decision. Slide #3 – Section Q is only one tool, that when used effectively, can assist States in meeting the intent of the Supreme Court’s Olmstead decision.

    2. Medicaid Programmatic Balancing Initiatives Real Choice Systems Change Grants (2001) Helps States change their long-term care systems to rely less on institutional services and to increase access to home and community-based services Promising Practices in HCBS Research (2001) and Expanded HCBS Waiver authority (2005) Under section 1915(b) waiver authority, States may offer a variety of services to individuals eligible for Medicaid under an home and community based services (HCBS) that can combine both traditional medical services as well as non-medical services (i.e. respite, case management, environmental modifications). Slide #5 - The balance of LTC is slowly shifting to a HCBS orientation Slide #5 - The balance of LTC is slowly shifting to a HCBS orientation

    3. Programmatic Balancing Initiatives (Cont’d) Money Follows the Person Program (2005) 30-States have MFP funding Residents must be Medicaid Eligible & 90 Days in a NH Provides transition from institutions (nursing home & ICF-MRs back to community care) Provides for enhanced federal medical assistance percentage (FMAP) for 365 days for qualified home and community-based services for each person transitions Promotes a strategic approach to implement a system that develops new services to promote successful transition into the community and better health outcomes. Slide #5 - The balance of LTC is slowly shifting to a HCBS orientation Slide #5 - The balance of LTC is slowly shifting to a HCBS orientation

    4. Programmatic Balancing Initiatives (Cont’d) Community Living Initiatives Provides new tools for community integration and encourages use of existing tools to support community living. CMS continues to incentivize states to build on innovations and identify new strategies to improve community living opportunities. Research on State Balancing 2008 Finds global budgeting of LTC services allows flexibility to effect LTC balance, integrate services and become more person centered . Home and Community Based Services (HCBS) Quality Tools Tools have been developed to monitor health, quality, safety and affordability to ensure the best quality of life. Slide #5 - The balance of LTC is slowly shifting to a HCBS orientationRecommendations for States Undertaking Rebalancing. States should adopt a set of core values that might include the following: Persons of all ages with disabilities choose and/direct a care plan involving “managed risk”, bounded by reasonable considerations of costs.Quality of life is as important as quality of care. States should work towards integrating services for all LTSS populations in the same agency, and towards achieving a unified budget for HCBS and institutional services. A State LTSS system needs a fast, timely and standardized way to assess financial and functional eligibility. A State LTSS system needs a high quality, accountable case-management system with capacity to provide information, assistance, and oversight for consumers. A State LTSS system needs a fair rate setting and contracting process for providers. A State LTSS system needs a process for assuring quality oversight throughout the system. A State LTSS system needs a sophisticated group of consumers/families and providers who advocate for the LTSS system. State lead agencies for LTSS should build a quality system by: substantial samples of individuals are surveyed about outcomes of the institutional and community supports they receive analyzing those data ,determine the settings and individuals for whom outcomes are relatively less well achieved; reporting those outcomes publicly The relevant State agency should review all regulatory language for any group residential settings to identify and remove requirements that force consumers to leave if they “need 24-hour nursing” or otherwise reach a certain level of disabilitySlide #5 - The balance of LTC is slowly shifting to a HCBS orientationRecommendations for States Undertaking Rebalancing. States should adopt a set of core values that might include the following: Persons of all ages with disabilities choose and/direct a care plan involving “managed risk”, bounded by reasonable considerations of costs.Quality of life is as important as quality of care. States should work towards integrating services for all LTSS populations in the same agency, and towards achieving a unified budget for HCBS and institutional services. A State LTSS system needs a fast, timely and standardized way to assess financial and functional eligibility. A State LTSS system needs a high quality, accountable case-management system with capacity to provide information, assistance, and oversight for consumers. A State LTSS system needs a fair rate setting and contracting process for providers. A State LTSS system needs a process for assuring quality oversight throughout the system. A State LTSS system needs a sophisticated group of consumers/families and providers who advocate for the LTSS system. State lead agencies for LTSS should build a quality system by: substantial samples of individuals are surveyed about outcomes of the institutional and community supports they receive analyzing those data ,determine the settings and individuals for whom outcomes are relatively less well achieved; reporting those outcomes publicly The relevant State agency should review all regulatory language for any group residential settings to identify and remove requirements that force consumers to leave if they “need 24-hour nursing” or otherwise reach a certain level of disability

    5. Aging and Disability Resource Centers (ADRC) Provides ‘‘one-stop’’ entry points into the long term support system. Provides information and referral services for individuals regardless of health insurance payer source May provide transition services or work with another entity for transition services. Stared with the elderly and now all ages and disability Programs are based in local communities accessible to people who may require long term support and serve individuals who need long-term support, their family caregivers, and those planning for future long-term support needs.

    6. Aging and Disability Resource Center Grants (Through the Administration on Aging) ADRCs operate in at least one community in 50 States and 4 Territories.  There are currently over 200 ADRC sites across the nation 25 States have statewide LTC supports and services resource directories accessible via internet; 34 of 43 ADRC States have Medicaid applications available on-line with 11 more in process allowing consumer to complete the application and submit it electronically. 16 ADRC pilots have online consumer decision tools across partners so consumers only have to tell their story once. AAAs have an important connection to ADRCsAAAs have an important connection to ADRCs

    7. Medicaid and Health Reform 2009 Affordable Care Act Provisions

    8. Health Reform Expands MFP Provides an opportunity to competitively award grants to non-participating States to access remaining funding from the $1.750 billion Deficit Reduction Act of 2005 for Federal Fiscal Year 2011 14 Additional States have applied for funds Additional funding of $2.25 billion will be available for Federal fiscal Years 2012- 2016. The fiscal year 2016 awards can be expended for Federal fiscal year 2016 and four additional years through 2020

    9. MFP Provisions Provides an opportunity to use administrative funds at 100% match for infrastructure development and sustainable processes, advance and expand transition programs and balance the State’s delivery of Medicaid LTC services Can include: MFP travel, outreach and marketing, training, positions such as housing and transition coordinators, and community integration specialists Each State awarded an MFP demonstration grant will have the amount of each award based on the proposed number of transitions, service provision, rebalancing initiatives and administrative costs of the demonstration

    10. Health Reform Medicaid Provisions Expands and simplifies Medicaid eligibility State plan option (4-1-2010) includes non-elderly, non-pregnant, non-dual eligibles New mandatory category Federal Poverty Level income eligibility level for children ages six to 19 changes from 100 percent to 133 percent 133% (1-1-2014) Modified Gross Income Creates a new State option to provide Medicaid coverage through a State plan amendment beginning on April 1, 2010, as amended by Section 10201. Eligible individuals include: all non-elderly, non-pregnant individuals who are not entitled to Medicare (e.g., childless adults and certain parents). Creates a new mandatory Medicaid eligibility category for all such “newly-eligible” individuals with income at or below 133 percent of the Federal Poverty Level (FPL) beginning January 1, 2014. Also, as of January 1, 2014, the mandatory Medicaid income eligibility level for children ages six to 19 changes from 100 percent FPL to 133 percent FPL. States have the option to provide Medicaid coverage to all non-elderly individuals above 133 percent of FPL through a State plan amendment. Creates a new State option to provide Medicaid coverage through a State plan amendment beginning on April 1, 2010, as amended by Section 10201. Eligible individuals include: all non-elderly, non-pregnant individuals who are not entitled to Medicare (e.g., childless adults and certain parents). Creates a new mandatory Medicaid eligibility category for all such “newly-eligible” individuals with income at or below 133 percent of the Federal Poverty Level (FPL) beginning January 1, 2014. Also, as of January 1, 2014, the mandatory Medicaid income eligibility level for children ages six to 19 changes from 100 percent FPL to 133 percent FPL. States have the option to provide Medicaid coverage to all non-elderly individuals above 133 percent of FPL through a State plan amendment.

    11. Health Reform Provisions (Cont’d) Community First Choice States can offer community-based attendant services/supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Protection against spousal impoverishment Applies spousal impoverishment rules to beneficiaries who receive home & community based services (HCBS) Increased funding for Aging Disability Resource Centers (ADRCs) Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015). Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015).

    12. Health Reform Provisions (Cont’d) Sense of the Senate regarding LTC Address LTC in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Establishes a Federal Coordinated Health Care Office (CHCO) to bring together officials of the Medicare and Medicaid programs to: More effectively integrate benefits under those programs Improve the coordination between the Federal and State governments for dual eligibles to ensure that dual eligibles have full access to the items and services to which they are entitled Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015). Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015).

    13. Health Reform Provisions (Cont’d) Community Living Assistance Services and Supports (CLASS) A voluntary, self-funded, insurance program that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. Closes the Medicare Part D “donut hole” by 2020 Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010. Community Health Centers Provides $11 billion over 5-years (FY 2011 – FY 2015) Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015). Community First Choice Option. Establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded. Reconciliation postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care Money Follows the Person Rebalancing Demonstration. Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days. Protection for recipients of home and community-based services against spousal impoverishment. Requires States to apply spousal impoverishment rules to beneficiaries who receive HCBS. This provision would apply for a five-year period beginning on January 1, 2014. Funding to expand State Aging and Disability Resource Centers. Appropriates, to the Secretary of HHS, $10 million for each of FYs 2010 through 2014 to carry out Aging and Disability Resource Center (ADRC) initiatives. Sense of the Senate regarding long-term care. Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions. Federal coverage and payment coordination for dual eligible beneficiaries. Requires the Secretary to establish a Federal Coordinated Health Care Office (CHCO) within CMS by March 1, 2010. The purpose of the CHCO would be to bring together officials of the Medicare and Medicaid programs to (1) more effectively integrate benefits under those programs, and (2) improve the coordination between the Federal and State governments for individuals eligible for benefits under both Medicare and Medicaid (dual eligibles) to ensure that dual eligibles have full access to the items and services to which they are entitled. Community Living Assistance Services and Supports (CLASS). Provides a lifetime cash benefit that offers people with disabilities some protection against the costs of paying for long term services and supports, and helps them remain in their homes and communities. -- A voluntary, self-funded, insurance program with enrollment for people who are currently employed. -- Affordable premiums will be paid through payroll deductions if an individual’s employer decides to participate in the program. -- Participation by workers is entirely voluntary. Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020. Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse. Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015).

    14. All Section Items MDS 3.0 Section Q Return To Community

    15. Participation in Assessment and Goal Setting Q0100 - Participation in assessment Documents the participation of the resident, family or significant other and guardian or legally authorized representative in the assessment process

    16. Q0300 - Resident’s Overall Expectation Document the resident expectations in Q0300A and the source of expressed/ communicated expectations in Q0300B

    17. Q0400A Discharge Plan Coding Instructions Document whether an active discharge plan is in place for the resident to return to the community. Slide #36 – Q0400 A: this asks the staff is there a Discharge plan-so this is not a ? to the resident, the records are checked to see status: If no go to the next question If yes-skip to Q600 to see status of discharge planning and if referral has been made Slide #36 – Q0400 A: this asks the staff is there a Discharge plan-so this is not a ? to the resident, the records are checked to see status: If no go to the next question If yes-skip to Q600 to see status of discharge planning and if referral has been made

    18. Q0400B Coding Instructions Document the determination of the resident and care planning team regarding discharge to the community. Slide #37 – Q0400 B: Document the results of Discharge Planning: whether results are not yet determined; are in progress; discharge determined to be feasible if so-skip to referral question to see results of discharge planning and if referral has been made; or discharge to community determined by resident and care planning team determined to not be feasible. Slide #37 – Q0400 B: Document the results of Discharge Planning: whether results are not yet determined; are in progress; discharge determined to be feasible if so-skip to referral question to see results of discharge planning and if referral has been made; or discharge to community determined by resident and care planning team determined to not be feasible.

    19. Q0500A Coding Instructions Document whether resident has been asked about returning to the community. Slide #40 – Q0500A: This ? documents whether or not the resident has been asked about talking to someone about possibilities for care and transitioning to the community If no, then go to B and ask the question If yes, but previously was no, go to B and ask the ? If yes, have been asked ? then go to 0600 to see what happened and if referral was made If unknown-do not know if ? asked before, go to 500B and ask ? Slide #40 – Q0500A: This ? documents whether or not the resident has been asked about talking to someone about possibilities for care and transitioning to the community If no, then go to B and ask the question If yes, but previously was no, go to B and ask the ? If yes, have been asked ? then go to 0600 to see what happened and if referral was made If unknown-do not know if ? asked before, go to 500B and ask ?

    20. Q0500B Coding Instructions

    21. Q0600 Coding Instructions Document whether a referral has been made to a local contact agency. Slide #43 - Q600: This ? documents whether or not a referral has been made to LCA Slide #43 - Q600: This ? documents whether or not a referral has been made to LCA

    22. Referral Question Follow-up If a referral has not been made, NH is to conduct additional information gathering and assessment to determine why Care Areas Assessment (CAA) is triggered and a checklist that assists NH to do further assessment If assessment shows that a referral should have been made and resident wants to talk to someone about community care, referral initiated Slide #44 - Follow up after Section Q: If No, a referral was not made BUT a determination has been made that it is not possible –by resident and LCA/NH no further action is necessary If no, referral has not been made-MAKE THE REFERRAL If yes a referral was made, what has happened as a result of referral ? Slide #44 - Follow up after Section Q: If No, a referral was not made BUT a determination has been made that it is not possible –by resident and LCA/NH no further action is necessary If no, referral has not been made-MAKE THE REFERRAL If yes a referral was made, what has happened as a result of referral ?

    23. Return to Community Referral Care Area Assessment (CAA) Available Tool Slide #45 - If answer to no, a referral has not been made, it triggers the NH to look at and use the Care Area Assessment checklist to do further assessment, this is the only CAA is mandatory (unlike the other CAA that are not mandatory for NH to use because there are more evidenced-based clinical materials). Slide #45 - If answer to no, a referral has not been made, it triggers the NH to look at and use the Care Area Assessment checklist to do further assessment, this is the only CAA is mandatory (unlike the other CAA that are not mandatory for NH to use because there are more evidenced-based clinical materials).

    24. Section Q Discharge Planning Collaboration is not New Nursing home staff expected to contact Local Contact Agencies for those residents who express a desire to learn about possible transition back to the community. Local Contact Agencies expected to respond to nursing home staff referrals by providing information to residents about available community-based long-term care supports and services. Nursing home staff and Local Contact Agencies expected to meaningfully engage the resident in their discharge and transition plan and collaboratively work to arrange for all of the necessary community-based long-term care services. Slide #27 – (emphasize chain of collaboration) Slide #27 – (emphasize chain of collaboration)

    25. Local Contact Agencies LCAs can be: Center for Independent Living (CIL) Area Agency on Aging (AAA) Aging & Disability Resource Center (ADRC) Money Follows the Person program (MFP) Developmental Disabilities Administration Mental Health Administration Mix of these Other Updated Section Q LCA state point of contact list posted at: http://www.cms.gov/CommunityServices/10_CommunityLivingInitiative.asp#TopOfPage Slide #49 – Who/what is a LCA? Slide #49 – Who/what is a LCA?

    26. PASRR (Preadmission Screening and Resident Review) MDS 3.0 Revisions

    27. A1500 PASRR Preadmission Screening and Resident Review (PASRR) Ensures that individuals with serious mental illness or mental retardation are not placed in a NF inappropriately. PASRR applies only to Medicaid-certified nursing facilities (NFs). A1500 simply asks about the individual’s PASRR status. The person either has a Level II PASRR determination, or not. If you don’t know anything about PASRR, your state Medicaid agency can give you the procedures for your state, and may have training available. You don’t need to know much about PASRR to complete item A1500. It is just a statement of fact about whether a PASRR Level II determination (or a document by a slightly different name in your state) has been issued and indicates that the individual does have mental illness, mental retardation, or a related condition. In institutions with some units Medicaid-certified and some not, PASRR only applies to those in the Medicaid portion. A1500 provides for a response that the facility is not Medicaid certified. If you don’t know anything about PASRR, your state Medicaid agency can give you the procedures for your state, and may have training available. You don’t need to know much about PASRR to complete item A1500. It is just a statement of fact about whether a PASRR Level II determination (or a document by a slightly different name in your state) has been issued and indicates that the individual does have mental illness, mental retardation, or a related condition. In institutions with some units Medicaid-certified and some not, PASRR only applies to those in the Medicaid portion. A1500 provides for a response that the facility is not Medicaid certified.

    28. A1500 PASRR A1500 does not call for judgment about an individual’s mental illness, mental retardation or related condition. A1500 only reports on the results of the PASRR process. All applicants to Medicaid NF are screened by Level I PASRR. If positive, Level II is performed. Consult your state Medicaid Agency for PASRR procedures, including the role of the state MI and MR agencies. In MDS 2.0 the “PASRR question” [fill in MDS 2.0 item #. It was above what is now A1550] required facilities to decide what Dx should be entered. In MDS 3.0 this new question A1500 is simply a statement of fact — does or does not the resident have a positive Level II PASRR evaluation.In MDS 2.0 the “PASRR question” [fill in MDS 2.0 item #. It was above what is now A1550] required facilities to decide what Dx should be entered. In MDS 3.0 this new question A1500 is simply a statement of fact — does or does not the resident have a positive Level II PASRR evaluation.

    29. Why PASRR matters to the NF NFs may not admit a person who needs a PASRR level II evaluation until the state issues the PASRR determinations. Admission before a needed PASRR Level II is complete, is a survey deficiency. Federal Medicaid funding can be recouped for all days prior to PASRR completion. A1500 helps facilities avoid compliance problems, and meet resident’s needs. In a few states, facilities still admit individuals before PASRR Level II, if needed, is complete. If they question the requirement, the answer is that yes PASRR Level II must be complete prior to admission, and CMS is working with the states who have not complied. (They may not believe you, because this is a major change from their experience. Audience members from other states may not believe they are asking the question, so to avoid a messy discussion refer them to PASRR@cms.hhs.gov and we will explain further. We have a new national PASRR TA center with free help to states for everything from technical questions to practical tips, to evaluating or redesigning their state PASRR program.) The QIS will contain a PASRR pathway, and requires a PASRR Level II resident be included in the sample. Therefore, even if facilities have not experienced surveyor attention to PASRR in the past, they will in the future. CMS promised the HHS Office of Inspector General in 2007 that it would recoup FF from NFs if needed to improve compliance. Some states have done so. Facilities can use A1500 to avoid mistakes. As staff become familiar with looking for PASRR documentation, they can be sure it is complete prior to admission. Also A1500 tells facilities when a PASRR Level II Resident Review should be considered in connection with a Significant Change in Status Assessment .In a few states, facilities still admit individuals before PASRR Level II, if needed, is complete. If they question the requirement, the answer is that yes PASRR Level II must be complete prior to admission, and CMS is working with the states who have not complied. (They may not believe you, because this is a major change from their experience. Audience members from other states may not believe they are asking the question, so to avoid a messy discussion refer them to PASRR@cms.hhs.gov and we will explain further. We have a new national PASRR TA center with free help to states for everything from technical questions to practical tips, to evaluating or redesigning their state PASRR program.) The QIS will contain a PASRR pathway, and requires a PASRR Level II resident be included in the sample. Therefore, even if facilities have not experienced surveyor attention to PASRR in the past, they will in the future. CMS promised the HHS Office of Inspector General in 2007 that it would recoup FF from NFs if needed to improve compliance. Some states have done so. Facilities can use A1500 to avoid mistakes. As staff become familiar with looking for PASRR documentation, they can be sure it is complete prior to admission. Also A1500 tells facilities when a PASRR Level II Resident Review should be considered in connection with a Significant Change in Status Assessment .

    30. Importance for residents Between 10-25% of NF residents have serious MI, MR, or a related condition. Historically these individuals have been inappropriately placed and underserved. PASRR is a powerful tool for diversion or transition to the most appropriate available service setting. PASRR helps states comply with the Olmstead decision.

    31. CMS Section Q Nursing Home Activities What Was Done before MDS 3.0 Implementation? Expanded Transition Funding Opportunities MFP Program expansion- Solicitation release – 7/30/2010 ADRC funding creates opportunities to increase state services National Teleconferences Teleconferences with State Medicaid Agencies - Held Monthly since 2009 Section Q Day Conference Follow-up - 5/19/10 Role of the Ombudsman in Section Q -7/7/2010 Return to Community Brochure Teleconference 8/4/2010 National Presentations National Survey and Certification Training 3/2010 National Stakeholders Training 4/2010 Informing LTC Choice Section Q Conference – 4/16/2010 Las Vegas Section Q Presentation 8/2010 Slide #52 – Next steps Slide #52 – Next steps

    32. CMS Section Q Activities (Cont’d) Implementation Workgroups and Pilot Testing Section Q Improving Transition Workgroup and Pilot test formed in 1/2008 Return to Community Brochure Workgroup – 5/2010 Section Q Skip Pattern Workgroup -6/2010 Disseminated Informational Tools Discharge Planning Checklist - 2009 MDS 3.0 Section Q Pilot Test Interim Report 3/2010 Implementation Section Q Q & A document – 6/7/2010 State Point of Contact (POC) List for MDS 3.0 Section Q Referrals – 9/2010 Post Section Q Day Training Materials & Video – 9/2010 mdsformedicaid@cms.hhs.gov – E-mail questions Slide #52 – Next steps Slide #52 – Next steps

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