Post on 14-Dec-2015
transcript
COORDINATED CARE INITIATIVEQUARTERLY STAKEHOLDER MEETING
JULY 10, 2014
Pamela Mokler, Vice President, LTSS, Care 1st
Vicki Macedo, Program Specialist, HHSA AIS
Mark Sellers, Asst. Deputy Director, HHSA AIS
COUNTY OF SAN DIEGO
Health & Human Services Agency
Aging & Independence Services
Behavioral Health Services
Children’s Services
Public Health Services
Self-Sufficiency Support Divisions
AGING & INDEPENDENCE SERVICES
Area Agency on Aging/ADRC Adult Protective Services/Senior Mental Health Team In Home Supportive Services Multipurpose Senior Services Program ( & “MSSP-Like”) Long Term Care Ombudsman Call Center PA/PG/PC Veteran Services Senior Nutrition Community Services – IG, CM, RSVP, Health Promotions Community-Based Care Transitions Program
AB 1040- CA Long Term Care Integration Pilot Project (LTCIP) –
Planning Committee formed 1999 with the following mission:
“Develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD).”
Began with 50 participants – now over 800 members strong:Multiple Medical, Behavioral Health, Social Service Providers, Consumers, Caregivers and Advocates
LTCIP
ADRC
San Diego
Network of Care
CCI Advisory Committ
ee
Community-
based Care
Transitions
Program
www.sdltcip.org
SAN DIEGO CCI ADVISORY COMMITTEE Cal MediConnect Health Plans established to
provide them recommendations about operations, access to services, outreach & education, etc.
Communications Sub-Group: coordinated outreach to consumers, providers, physicians, pharmacists, hospitals/clinics, etc.
Coordination Guide Sub-Group: coordination between the Health Plans & IHSS/PA & MSSP
SAN DIEGO CCI ADVISORY COMMITTEE MEMBERSHIP
Cal MediConnect Health Plans
HHSA/AIS Public Authority Dual-eligible
consumers Hospital Association SD Medical Society Consumer Center HICAP
CBAS PACE Advocates Community Clinics HCBS Providers SNF Harbage Consulting
Firm Behavioral Health Disability Rights
IHSS COORDINATION GUIDE DEVELOPMENT
Workgroup: All 5 Health Plans, AIS IHSS Managers/Program Staff, Public Authority
Commitment: A single protocol
CCI Advisory Committee: review &
approval
HEALTH PLAN PERSPECTIVE
IHSS is a core service that is needed to keep members with ADL/IADL deficiencies living in the community
We need to make it easier for our members to transition from hospital to home with IHSS services, than it is to transition from a hospital to a SNF! – especially on a Friday evening! We need expedited IHSS assessments and extended hours.
All IHSS recipients’ needs are not the same! Programs need to be FLEXIBILE to meet changing needs of members/clients.
IHSS COORDINATION GUIDE KEY ELEMENTS
Application Process flow chart – especially helpful for the Health Plans at the beginning of the process
Call Center and Web Referral processes – giving them the contact information they would need and letting them know what type of information they will need to provide on referrals.
The establishment of “expedited” referral criteria and the development of an “expedited” referral process
IHSS COORDINATION GUIDE KEY ELEMENTS
Differentiating between “expedited referrals” and situations where “urgent service referrals” are appropriate
Explaining form requirements and how the Health Plans may play a key role in assisting the member with this
Providing phone numbers to each district office, as well as a zip code list of which office handled which zip code, so that Health Plans could contact the clerical staff at each office with questions.
EXPEDITED IHSS APPLICATIONS
Expedited applications will be processed within 10 business days of receipt by the IHSS Social Worker. Health Plans will be contacted if there are problems that prevent or delay the process. Examples could include but are not limited to the following: Refusal of services by the Health Plan
Member
Failure to cooperate or provide required information
EXPEDITED CRITERIA
Someone who has critical care
needs and: No one is available to
provide in-home care
Is unsafe in his/her own home
Is at risk of hospitalization (or re-hospitalization) without additional assistance
Someone who has critical care needs:
That cannot be fully met without additional assistance from IHSS
Is unsafe in his/her own home
Is at risk of hospitalization (or re-hospitalization) without services in place
ADDITIONAL EXPEDITED INDICATORS
Other indicators for an expedited referral could include:
A diagnosis of a terminal illness.
A rapid decline in health.
Client Is transitioning out of a hospital, and no one is available to provide in-home care or the care needs can’t be fully met.
If necessary the IHSS Social Worker may conduct a needs assessment in the hospital. Once the Member transitions home, the IHSS Social Worker must complete an in-home needs assessment within 10 business days from the date of discharge.
APPROVAL/DENIAL ON EXPEDITED APPS A Notice of Action (NOA) will be issued
providing information on services and the number of hours authorized, or the reason for any denial of services
IHSS will inform the Health Plan of any ineligibility to IHSS services
The client has 90 days from the date of the Notice of Action to file an appeal
HEALTH PLAN PERSPECTIVE: IMPORTANT ACCOMPLISHMENTS
AIS was willing to be flexible AIS was willing to expedite referrals for
Plan members transitioning from hospital or SNF to home
Agreement from all 5 Health Plans, Public Authority and AIS on a single, core protocol
Shared value for the consumer-driven foundation of the IHSS program
CCI IMPLEMENTATION CHALLENGES & OPPORTUNITIES
Partnerships/relationships are everything!! Broad coordination is critical! Training, re-training…and more training! Slow beginning for IHSS – applications
(standard and expedited) and CCT’s – Why? Continuous efforts at delivering information
and resources to consumers & IP’s HICAP/Consumer Center for Health
Education & Advocacy calls – steady, but settling, burst at start of the month