Division of Aging Waiver Enrollment Process MAC Meeting

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Division of Aging Waiver Enrollment Process MAC Meeting August 2015

Division of Aging Waiver Enrollment Process MAC Meeting August 2015

Role of Indiana’s Area Agencies on Aging (AAAs) • All 16 AAAs are certified

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)

Role of Indiana’s Area Agencies on Aging (AAAs) • AAAs are the gateway to

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

The Aged and Disabled Medicaid Waiver • Must be Medicaid eligible – Special income

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

The Enrollment Process • AAA conducts assessment, includes statement from physician (or nurse practitioner)

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)

The Enrollment Process • Service plan is reviewed by DA staff and either –

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

The Enrollment Process • When all pending items are resolved, AAA case manager confirms

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

Potential Sources of Delay • AAA capacity issues may delay the time it takes

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

Potential Sources of Delay • DA staff capacity can be an issue as well

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

A&D Waiver Monthly Participant Count Jul-15

A&D Waiver Monthly Participant Count Jul-15

Impact for Rebalancing • Process needs to be faster, more streamlined • For hospitals

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)

Pre Admission Screening • Required of individuals seeking admission to Medicaidcertified nursing facilities, regardless

Pre Admission Screening • Required of individuals seeking admission to Medicaidcertified 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.

Potential Solutions • Pending technology changes will allow the DA to more effectively track

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.

Contact Information Yonda Snyder Director, Division of Aging 317 -232 -7123 Yonda. Snyder@fssa. in.

Contact Information Yonda Snyder Director, Division of Aging 317 -232 -7123 Yonda. [email protected] in. gov Debbie Pierson Deputy Director, Operations 317 -232 -0604 Debbie. [email protected] in. gov