Community First Choice HUSKY Health Benefit

Community First Choice HUSKY Health Benefit

Medicaid Long Term Services & Supports Rebalancing Updates DSS Community Options Money Follows the Person Strategy Group 1 Topics MFP Benchmarks NH Closures Litigation Housing Quality Improvement CFC

UA TEFT: PHR & eLTSS NWD/MyPlaceCT CaringCareers Hospice Informal Caregivers Initiative 2 Presenters

Dawn Lambert, DSS Christine Weston, DSS Dane Lustila, DSS Karri Filek, DSS Talitha Coggins, DSS Paul Ford, DSS Tamara Lopez, DSS Julia Evans Starr, Consultant Deborah Migneault, UCONN 3 Community First Choice Benchmarks 4 MFP Benchmarks

1) Transition 5200 people from qualified institutions to the community 2) Increase dollars to home and community based services 3) Increase hospital discharges to the community rather than to institutions 4) Increase probability of returning to the community during the six months following nursing home admission 5) Increase the percentage of long term care participants living in the community compared to an institution (Based on latest data available at the end of the quarter ) UConn Health, Center on Aging Operating Agency: CT Department of Social Services Funder: Centers for Medicare and Medicaid Services 5 Benchmark 1: The number of demonstration consumers transitioned = 4,800 (non-demonstration transitions = 330) 6 Benchmark 4 Percent of SNF admissions returning to the community within 6 months

50% 40% 30% 25.4% 29.6% 31.5% 41.2% 36.8% 35.7% 36.7% 36.9% 38.9% 20% 10% 0% Source OPM and DPH data 7 Happy or unhappy with the way you live your life* 100% 79%

80% 78% 77% happy 60% 40% unhappy 60% 40% 21% 23%

22% 20% 0% baseline 6 month 12 month Source OPM and DPH data 24 month 8 Quarter Number of Transitions by Quarter: 12/2008 - 6/30/2018 141 140

2018 2 2018 1 2017 4 2017 3 2017 2 2017 1 2016 4 2016 3 2016 2 2016 1 2015 4 2015 3 2015 2 2015 1 2014 4 2014 3 2014 2 2014 1 2013 4 2013 3 2013 2 2013 1

2012 4 2012 3 2012 2 2012 1 2011 4 2011 3 2011 2 2011 1 2010 4 2010 3 2010 2 2010 1 2009 4 2009 3 2009 2 2009 1 142 154 169 171

195 181 207 201 163 159 117 121 147 132 120 114 109 60 19 0

38 43 50 74 199 166 167 152 107 83 215 166 110

66 209 213 98 62 100 150 200 250 Number of Transitioned Referrals Source OPM and DPH data 9

Community First Choice Nursing Facility Closures 10 Closure Procedures Money Follows the Person Project Team (MFP) works collaboratively with the Nursing home staff, Ombudsman and Receiver, if applicable. Identify preferences for setting and provide informed choice to all nursing home residents. Assess and develop care plans for MFP eligible participants that meet their goals and needs. Weekly meetings with the nursing home regarding MFP participants case status. Collaborate with Nursing facility during the discharge process. Support transition and ensure implementation of community care plan. 11 Current nursing home closures

Rosegarden Bridgeport Manor Census at start of closure: 41 Census at start of closure: 67 Current census: 10 Current census: 33 MFP involved residents: 9

MFP involved residents: 22 Housing Units identified: 8 Housing units identified: 11 Declinations: 43 Transitions: 2

Projected community percentage: 25-30% Timeline for closure is targeted for 9/26/18. Declinations: 22 MFP to follow to next facility: 7 Transitions: 3 Projected community transition percentage: 20-25% Closure is projected to meet the 60 days timeline on

9/16/18 12 Nursing Home Closures and Anticipated Need: 2005 through 2025 Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

2021 2022 2023 2024 2025 384T NH Recipients 18,728 18,637 18,238 17,591 17,396 17,263 17,083 16,896 16,683 16,769 16,778 16,647 16,122 15,721 15,320

14,919 14,477 14,036 13,594 13,153 12,711 2005 Through 2017 2018 Through 2025 TOTAL MFP Transitions 162 315 434 510 612 596 792 791

4,212 Mercer Report Projections 17,665 17,340 17,015 16,690 16,365 16,037 15,636 15,235 14,834 14,433 14,032 13,590 13,149 12,707 12,266 11,824

Actual Cumulative Estimated Number of Reduction Reduction in Total Facilitie s in Nursing Nursing Available NH Closed Home Beds Home Beds Beds 1 160 160 28,712 1 59 219 28,552 2 180 399

28,493 2 190 589 28,313 3 295 884 28,123 2 207 1,091 27,828 4 472 1,563 27,621 4 464 2,027 27,149 2 165

2,192 26,685 0 2,192 26,520 2 210 2,402 26,508 4 395 2,797 26,412 1 145 2,942 25,777 401 3,343 25,376 401 3,744 24,975

401 4,145 24,574 442 4,587 24,132 442 5,028 23,691 442 5,470 23,249 442 5,911 22,808 442 6,353 22,366 28 2,942 3,411 6,353

Estimated Occupancy Rate 91.4% 91.4% 89.6% 87.0% 86.6% 86.9% 86.6% 87.2% 87.6% 88.6% 88.6% 88.3% 87.6% 86.8% 85.9% 85.0% 84.0% 83.0% 81.9%

80.8% 79.6% Additional Bed Reductions toget to 95% Occupancy Over 8 Years 450 900 1,350 1,800 2,250 2,700 3,150 3,600 133,600 Nursing Facility Closures SFY 2005-2018 Year

Nursing facility 2005 Hamilton 2006 Mercyknowll 2007 Darien Health Care Center 2007 Oakcliff Convalescent 2008 New Coleman Park 2008 Haven Health Center of Waterford 2009 Sterling Manor 2009 Griswold Health and Rehab 2009 Cresent Manor 2010 Courtland 2010 West Rock Health Care 2011 Rocky Hill Skilled Nursing 2011 Soundview 2011 Bishop's Coner Skilled Nursing 2011 University Skilled Nursing 2012 Richard Rosenthal Hospice 2012 Tandet 2012 Clintonville 2012 Wethersfield Healthcare 2013 Laurel Hill 2013 Hilltop - Ansonia 2015 Marshall Lane Manor

2015 The Kent 2016 Holy Spitit Healthcare 2016 Alexandria Manor 2016 Astoria Park 2016 Paradigm South Windsor 2017 Greensprings 2018 Ellis Manor 2018 Blair Manor Town Norwich West Hartford Darien Waterbury Bridegport Waterford East Hartford Griswold Waterbury Stamford New Haven Rocky Hill West Haven

W. Hartford New Haven Stamford Stamford North Haven Wethersfield Winstead Ansonia Derby Kent Putnum Bloomfield Bridgeport South Windsor East Hartford Hartford Hartford 2018 Derby Birmingham Health Center

# of Beds closed 160 59 120 60 100 90 90 90 115 120 87 120 102 130 120 12 130 112 210 75 90

120 90 40 120 135 100 145 105 98 120 14 Community First Choice Litigation 15 Basis: Federal Lawsuit involving Department of Social Services, Department of Mental Health and Addiction Services, Chelsea Place and Touchpoints of Manchester, alleging violations with

the American Disability Act and Rehabilitation Act, concerning individuals with mental illness at risk of entering these nursing homes, but with appropriate services may live in community setting. Litigation 16 Extended Settlement Period Following a joint motion to modify the settlement agreement in June 2018, the settlement was extended for a period of 618 months. The extension agreement included 18 class members. Since July 2018, 2 class members have been removed from the data tracking and 1 class member transitioned to the community. There are currently 15 class members that the Departments continue to follow to satisfy the settlement obligations. In-reach for informed choice has continued in the both skilled nursing facilities for the previously identified non-class members. 17

Community First Choice Housing 18 Project Based Subsidy CT 811 COMMUNITY PARTNERSHIP One component of the Frank Melville Supportive Housing Act of 2010 creates a new emphasis on multifamily housing to encourage nonprofit sponsors to set aside up to 25% of units PARTNERSHIP ACROSS AGENCIES The Department of Housing and Urban Development (HUD), The Department of Housing (DOH), The Department of Developmental Services (DDS) Autism Spectrum waiver unit, The Department of Mental Health Coordinated Access Network (DMHAS-CANS), and The Department of Social Services Money Follows the Person (DSS-MFP) Demonstration are partnering in the project based subsidy program intended to serve very-low income consumers with disabilities. PROCESS

CT is a 2013 awardee, to date two contracts have been executed. Units become available based on turnover from each property. Consumer access is limited to target populations of the partnered agencies listed above. 19 Project Based Subsidy CT 811 Department of Housing Successes 4 properties under contract 1 is new construction 2nd Grantee of 2013 awardees to have units under contract and tenants leased. 36 units under contract MFP : 5 leased units CANS (DMHAS): 10 leased units MFP CT has the fastest transition time for 811 units across all MFP states working with the 811 program.

20 Community First Choice Quality Improvement 21 Overview of Quality Management Plan Health and safety issues of consumers receiving HCBS Training of providers, staff and other stakeholders Consumer access to services Provider qualifications Consumer choice 22

Quality Management System Components Quality Control Quality Assurance Quality Initiative 23 Quality Assurance Activities Home and Community Visits Critical Incidents Site Reviews and Review of Consumer records 24 Quality Improvement Committee The work of the committee is guided by essential questions as it relates to better health outcomes and higher participant satisfaction and the financial impact on the system. 25

Essential Areas of Focus Assistive Technology Community Integration Social Determinants of Health Self-Direction 26 Community First Choice Community First Choice 27 Community First Choice HUSKY Health Benefit 7019 unique applications (up 2300 since last year) 2416 active CFC participants

(this includes those participants using CFC with the PCA Waiver) 2611 cases recommended for closure/closed 207 pending care plan submission to DSS 2153 pending assignment to field 28 Community First Choice Re-design and Re-assessment On Jan 3, 2018, letters were sent to all applicants and active participants of CFC notifying them of a design change and informed everyone they would be reassessed for program eligibility and individual budget authorization. CFC Access Agency staff began reassessments on all active CFC participants. This process is still 2/3 complete at this time. 29 Community First Choice There is continued demand for the CFC Medicaid Option. As evidenced in the

staggering number of applications over the last 3 years, CFC is serving an unmet need in CT. Additional benefits of CFC is the growth of the workforce. Each additional participant accessing services, grows the workforce by a 2:1 ratio. 30 Universal Assessment v1.7 31 Universal Assessment (UA) Over the last year the UA has been implemented across additional LTSS Programs. In March 2018 Autism Waiver In June 2018 PCA Waiver and ABI Waivers I & II In July 2018 CHCPE Waiver Focus has shifted to development of a quality training and quality assurance plan. We currently have 300 assessors active in the system with 6,800 finalized assessments.

32 TEFT 33 TEFT had Four (4) Components Awarded by CMS in 2014 to nine states to test HCBS tools Lewin conducted monitoring and evaluation Truven Health Analytics provided training and technical assistance Grants wrapped up in 2018 Why is TEFT unique? Focused on beneficiary experience within HCBS settings Focused on standardization, allowing for use of tools across HCBS populations Addresses the gap between HCBS populations and electronic exchange/health IT States tested four tools and these tools and lessons learned can be used by other state organizations (e.g., Medicaid agencies, AAAs, hospitals, providers) 34

TEFT Tools & Accomplishments 1. Experience of Care Survey (HCBS CAHPS Survey) Obtained Consumer Assessment of Healthcare Providers and Systems (CAHPS) trademark and National Quality Forum endorsement CT is using this with most waiver populations, with DDS and Mental Health to be added in the near future. 2. Functional Assessment Standardized Items (FASI) Developed a set of functional assessment measures for use with HCBS beneficiaries 3. Personal Health Record (PHR) To demonstrate use with HCBS beneficiaries MFP Population to start and then expand to the entire CT Medicaid Population CT has a received an extension and anticipates launching the tool on September 20 th 4. Electronic Long-Term Services and Supports (eLTSS) Plan Created eLTSS Dataset with 56 data elements Submitted data elements to standards development organization (goal eLTSS standard) CT developed an on-line tool for the Community First Population Allows participants to complete their tool-kit using an on-line automated tool that upon completion moves the kit through the approval process electronically and upon final

authorization transmits the date directly to the fiscal intermediary and will transmit the plan into the participants PHR. 35 Coming Soon! 36 NWD/My Place CT CaringCareers.org 37 No Wrong Door MyPlace.org ~ Virtual hub Helping people navigate LTSS, Health & Well-being Planning, End of Life Caregiver Center (UConn) Leverage Technology Heighten Engagement

My Place Partners In Communities Across CT Navigators Partner Portal Training Hub Empower Plan for the Future Access Key Services & Supports - Connect 38 CTDOL occupational projections between 2016-2026 Home Health Aides to increase by 34% PCAs by 25% CaringCareers.org CTHires.com Now: hand-off to help PCAs find jobs on CTHires.com

Next: Promote health & LTSS job opportunities make connections & show ladder/lattice Create an on-line platform for learning for job seekers & employers ~ Develop videos on select job types (eg: care coordinator) ~ Develop educational content on skills ~ Develop dynamic tools for the employers of PCAs Partner w/ CT Dept. of Labor & GeoSolutions Next: Create a CT Portal to streamline, simplify and guide 39 Hospice 40 Baseline Analysis of Hospice Utilization in CT Medicaid Only and Dually Eligible Decedents Overall Objective: To identify the barriers to hospice care for State of CT

Medicare/Medicaid participants with Chronic Medical Conditions. Initial Baseline Data Analysis UConn Center on Aging and Westat (formerly JEN Associates) in partnership with Yale School of Medicine conducted a baseline analysis of Medicare and Medicaid hospice claims from 2014 and 2016 of Medicaid-only and dually eligible decedents. 41 Hospice Utilization in Connecticut Dually Eligible and Medicaid-Only Decedents Hospice Utilization Dually Eligible and Medicaid-Only Decedents 50% 45% 40% 35% 30% 25% 20% 15%

10% 5% 0% 44% Average Length of Stay in Hospice (Days) Dually Eligible and Medicaid Only Decedents 60.00 50.00 49.65 40.00 18% 26.58 30.00 20.00 10.00 Dual Eligible

n=12,090 Medicaid Only n=2,979 0.00 Dual Eligible n=12,090 Medicaid Only n=2,979 42 Type of Length of Hospice Utilization Among Hospice Users Categories of Type of Length Appropriate Use: >7 days, <180 days Potentially Concerning Use: Hospice disenrollment or very long hospice enrollment (>=180 days) in 12 months prior to death Very short hospice enrollment (<=7 days) among

hospice users prior to death 43 Type of Hospice Length Dually Eligible Decedents Dually eligible decedents that used hospice (n=5321) 52% with potentially concerning use (n=2,768) 48% with appropriate use (n=2553) defined as total days between 7 and 180 days 9.7% with disenrollment in 12 months prior to death (n=517) 36% with very short enrollment (7 days) prior to death (n=1913) 6.4% with very long enrollment(>180

days) prior to death (n=338) 44 Type of Hospice Length Medicaid Only Decedents Medicaid-only decedents that used hospice (n=541) 54% with potentially concerning use (n=292) 46% with appropriate use (n=249) defined as total days between 7 and 180 days 13.3% with disenrollment in 12 months prior to death (N=72) 40.7% with very short enrollment (7 days) prior to death (N=220) 45

Hospice Next Steps Goals: Foster a conversation around how to discuss hospice care with Medicare/Medicaid participants and their families Increase public knowledge and awareness about hospice and the Medicare benefit. Intervention: Work with subject area experts and stakeholders to design an outreach/educational intervention targeting hospitals, physicians, and other practitioners to increase awareness and understanding of hospice benefits. 46 Informal Caregiver Initiatives 47 Informal Caregiver Initiative Overall Objective: Provide comprehensive information and resources to caregivers.

Focus Groups: UConn Center on Aging conducted 2 focus groups (Hartford and Torrington) to gather qualitative data on caregivers needs. Focus groups were held in the last month; analysis in progress. 48 Informal Caregiver Initiative Examples of Focus Group Questions Please tell us how you have tried to find information or services, what methods or process have you used? Where do you look for information? How well has your search process worked? What services or information have been the most helpful? What has worked well for you and your family member? Does your family member get all the help or services that he/she needs? What additional help is needed? What prevents getting any needed help (probe: cost, not available in area, lack of information, language/culture differences)? Do you get all the help you need? What additional help or services do you need, as a caregiver? 49

Informal Caregiver Initiative Next Steps Analyze focus group results and develop recommendations for informal caregiver supports, including the development of a technical assistance center. Create online technical assistance center for caregivers through MyPlace. 50 Questions 51 Guest Speaker 52

Recently Viewed Presentations

  • Conjugating Verbs

    Conjugating Verbs

    Infinitive. Theinfinitiveform of theverbistheunconjugatedor"to" of theverb.. Infinitive. Form. totalk - toeat - toswim. Conjugated. Form - talks -eats - swims - talking - eating - swimming - talked -ate - swam - swum
  • mhsoac.ca.gov

    mhsoac.ca.gov

    HART'S LADDER OF YOUTH PARTICIPATION. ROGER HART'S LADDER OF YOUTH PARTICIPATION. can help adults understand whether they are meaningfully engaging youth. It's important to note that the bottom three rungs of the ladder — tokenism, decoration, and manipulation — are...
  • Chapter 1 Biology: The Study of Life

    Chapter 1 Biology: The Study of Life

    Includes the kingdoms plantae, animalia, fungi, and protista * Kingdom Protista Protists do not have organs They are classified into three groups: Plant-like Animal-like Fungus-like * Kingdom Fungi Characteristics of Fungi absorb nutrients from their environment.
  • Chapter 2 Brain and Behavior - Rogue Community College

    Chapter 2 Brain and Behavior - Rogue Community College

    Fig. 2-4, p. 51. The interior of an axon. The right end of the top axon is at rest. Thus, it has a negative charge inside. An action potential begins when ion channels open and sodium ions (Na+) rush into...
  • Submodularization for Binary Pairwise Energies

    Submodularization for Binary Pairwise Energies

    Olga Veksler. Contents. Introduction. CRF with Potts pairwise potentials. sparsely connected. fully connected CRF (Full-CRF) Gaussian edge weights. mean field optimization. Quantized edge. Full-CRF. optimization. two label case. multi-label case. connection to Gaussian Edge CRF .
  • The Alliance system Triple Alliance (aka Central Powers)

    The Alliance system Triple Alliance (aka Central Powers)

    France was worried about the growing power of Germany, so the French built up their armies and industries. 1892 - Alliance signed with Russia to help each other if attacked by Germany. ... Create an acrostic poem (doesn't need to...
  • Research and publication ethics: why and how Margaret

    Research and publication ethics: why and how Margaret

    Council member University of Oxford Research Ethics Committee (CUREC)2009-2014. Researcher and supervisor: basic science, clinical trials and PI. Publication . Editor in Chief Maturitas, Elsevier 2008- present. Editor in Chief Case Reports in Women's Health Elsevier 2017- present. Editor in...
  • Stormwater 101: How to stay out of trouble

    Stormwater 101: How to stay out of trouble

    NOC - post on job board. TNRXXX <- permit tracking number. Rainfall monitoring. Discuss at Precon. Twice weekly inspections. Contractor to perform and document. Documentation should stay with field SWPPP. Site assessments . Designer to perform.