Medicaid Home-and-Community-Based Waivers Home Care by Choice

1. Medicaid Home-and-Community-Based Waivers Home Care by Choice Long-Term Care Division Terry A. Smith, Director Virginia Department of Medical Assistance Services (DMAS) July 2007

2. VA Medicaid - Home Care By Choice 2 What is Long-Term Care Long term care is a holistic response to an individuals physical, mental, and social needs by a network of providers to insure they can live in the least restrictive setting designed to meet all of their needs. Care is continual throughout the life of the individual.

3. VA Medicaid - Home Care By Choice 3 Long Term Care Medicaid Services

4. VA Medicaid - Home Care By Choice 4 Eligibility Determination

5. VA Medicaid - Home Care By Choice 5 Facility and Institutional Optional Programs that: Targets services to individuals in need who may not otherwise qualify for Medicaid Afford states flexibility to develop and implement alternatives to institutionalization Allows states to �waive� some requirements that would otherwise apply to Medicaid. Services can be targeted to specific groups.

6. VA Medicaid - Home Care By Choice 6 Facility - Based

7. VA Medicaid - Home Care By Choice 7 Facility - Based Services Nursing Facility Services Skilled Nursing Intermediate Care Rehabilitative Care Assisted Living Services Medication Management Support with Activities of Daily Living (ADLs) Structured Socialization

8. VA Medicaid - Home Care By Choice 8 Community - Based Services

9. VA Medicaid - Home Care By Choice 9 Waiver Services Elderly and Disabled with Consumer Direction (EDCD) Adult Day Health Care (State Plan Option) Personal Care Services (Consumer-Directed or Agency) Personal Emergency Response System (PERS) Monitoring Installation Medication Monitoring Medication Monitoring Respite (Consumer-Directed, or Agency)

10. VA Medicaid - Home Care By Choice 10

11. VA Medicaid - Home Care By Choice 11 Key Support Services For waiver services to be successful it requires the support of other services

12. VA Medicaid - Home Care By Choice 12 Services provided to individuals who are enrolled in a waiver that provide the continuous assessment, coordination, and monitoring of the needs of the individuals. Complete ongoing review activities as required by DMAS to ensure the health, safety and welfare of the individual. Case Manager  (Care Coordinator)

13. VA Medicaid - Home Care By Choice 13

14. VA Medicaid - Home Care By Choice 14 A provider who is responsible for supporting the individual and their family/caregiver, as appropriate, by ensuring the development and monitoring of the Consumer-Directed Services, and completing ongoing review activities as required by DMAS for services with an option of a consumer-directed model. Service Facilitator

15. VA Medicaid - Home Care By Choice 15 Service Facilitator

16. VA Medicaid - Home Care By Choice 16 Consumer-Direction This is a growing trend for services delivery. Why is it growing? Individuals want control over their lives Individuals want to remain in their own homes Frequently changing caregivers Costs are lower than facility based services

17. VA Medicaid - Home Care By Choice 17 What does Consumer-Directed mean? Direct your own care. Develop and maintain service plan Monitor changes in need Consumer is the employer of their attendant Consumer has IRS Employer Identification Number (EIN) Hire, train, manage, and fire, if necessary, their own personal assistant. Fiscal agent (currently Public Partnership LLC) provides payroll services for employer Receives and processes timesheets per business rules Produces and distributes payroll checks if submission meets business rules Handles tax issues on behalf of individual recipients Prior Authorization of all services ( KePRO) Receives and approves requests for services when compared to service limits

18. VA Medicaid - Home Care By Choice 18 CD Services & Supports Services: Personal Assistance Respite Care

19. VA Medicaid - Home Care By Choice 19 Conclusion Services in long - term care are much like the petals of a flower that surround and protect the heart of the flower. They are there as long as needed and provide a variety of services.

20. VA Medicaid - Home Care By Choice 20 Questions? Terry A. Smith Steve Ankiel Yvonne Goodman 804-371-8490 804-371-8894 804-786-0503 Terry.smith@dmas.virginia.gov Steve.ankiel@dmas.virginia.gov Yvonne. Goodman@dmas.virginia.gov Virginia Department of Medical Assistance Services Division of Long-Term Care 600 East Broad Street, Richmond, VA 23219 Telephone: 804-786-1465; FAX: 804-371-4986 www.dmas.virginia.gov