Long Term Service and Supports Reform through Maryland’s Aging and Disability Networks

Stephanie Hull MGA ConferenceChief, Long Term Services and Supports June 7, 2012Maryland Department of Aging

What Is the Reform About?

People

People living productive independent lives People staying in their communities People staying close to their loved ones People supported by families and friends People with chronic medical conditions and

physical disabilities taking charge of their lives People taking care of themselves and planning

for health and independence People staying out of nursing homes

Money

Enhancing the individual’s ability to purchase assistance with private resources

Using public resources to supplement individuals’ and families’ private resources

Supporting people with disabilities in employment

Diverting people from Medicaid spend down Diverting people from institutional

placement Shifting the cost of care from institutional to

community-based settings

What/Who Is Driving the Change?

Strong consumer preference for home and community-based options and self-direction

Landmark legislation and court decisions Partners

Federal, State and local agencies Cross-disability consumers and providers

New focus on diversion from nursing homes or helping people transition from nursing homes to the community

Expansion of community options National funding directed at change -new

programs with a focus on reform

Major Elements of Reform

Focus is on shifting funding and service programs:

from institutional based service to community-based service and

from professional-directed to self-directed services by: Streamlining access to information and assistance for long

term services and supports Consistent standards for providing information on long term

services and supports and futures planning Diverting people from nursing homes and Medicaid spend

down Providing more options for self-direction among recipients of

long term services and supports

Streamlining Access to Information and Services: Aging and Disability Resource Centers

Purpose is to provide trusted and visible source of information and assistance through partnerships at all levels to streamline eligibility and access to services

A national movement now in 54 states and territories

Supported by the Administration on Community Living, Centers for Medicare and Medicaid Services the Federal Veterans Administration

Conduit for new rebalancing initiatives Builds on Aging Network of Information and

Assistance Partnered with Disability Information and Assistance

www.marylandaccesspoint.info

MAP Partners

Maryland Department of Aging Maryland Department of Health and Mental

Hygiene (Medicaid Agency) Maryland Department of Disabilities Maryland Department of Human Resources Maryland Department of Veteran’s Affairs Local Area Agencies on Aging Regional Centers for Independent Living Consumers, Advocates, Providers, Policy

Makers

MAP Funding and Technical Assistance

Community Living Administration and Administration on Aging Grants Older American’s Act Funding ( I & A, SHIP)

Centers for Medicare and Medicaid Services Grants Medicaid Incentive Payment Programs (MFP, BIP)

Veteran’s Administration Program Funding (VDHCBSP)

Other Federal Programs and Private Foundations

The Lewin Group www.adrc-tae.org

Options Counseling

2010 Administration on Aging grant of $500,000

Developing standards and procedures for providing information and assistance for long term services and supports and futures planning

Howard County piloting standards and instruments

Statewide roll out January 2013 to coincide with statewide Level One assessment roll out

Options Counseling Partners

Maryland Department of AgingMaryland Department of Health and

Mental Hygiene Medicaid AgencyMaryland Department of DisabilitiesMaryland Disability Law CenterHoward County MAP Freedom Center for Independent

LivingHCBS Strategies, Inc.University of Maryland School of

Social Work

Care Transitions: Person Centered Hospital Discharge Program

2009 Centers for Medicare and Medicare Services grant $1.3 million

Maryland Medicaid supports nursed in two counties Six MAP sites and eight hospitals MAP Nurse Liaison working with patients at high

risk of long term nursing home discharge and Medicaid Spenddown

Targeting high risk and intervention Evaluation to consider state expansion and funding Community Based Care Transitions Guided Care MAP Partnership

Person Centered Hospital Discharge Partners

Maryland Department of AgingMaryland Department of Health and

Mental Hygiene Medicaid AgencyHoward, Worcester, Wicomico,

Somerset, Anne Arundel, Carol, Washington, and Harford MAPs and hospital partners

University of Maryland School of Nursing

Centers for Independent Living

Care Transitions: Baltimore City MAP Guided Care

2010 AoA grant of $400,000 Pilot partnership between Guided Care Program and

Baltimore City MAP Guided Care is nationally validated model for

working with complex older adult patients with multiple chronic conditions to prevent acute episodes, in appropriate hospitalizations and to improve quality of life

Primary medical practice employs nurse liaisons to work with patients in their homes and to provide support and education

MAP pilot program teams a MAP case manager with the Guided Care nurse to expand support services and extend the program

Partners: Maryland Department of Aging, Johns Hopkins Community Physicians, Baltimore City MAP, Johns Hopkins Bloomberg School of Public Health

Care Transitions: Community Based Care Transitions

CMS Funded Program to improve transitions from hospitals and reduce readmissions

Requires hospital to partner with Community Based Organization

Focus on : 30-day all cause readmission rates 90- and 180-day readmission rates mortality rates observation services emergency department

Four MAP sites involved in applications

Diversion and Self Direction: Community Living Program

2007 AoA grant of $700,000 Target and intervention of people in the

community at high risk of nursing home placement and Medicaid spend down

Provide flexible self-directed monthly benefit Funded through grant and Senior Care Fiscal Intermediary/Fiscal Management

Agency Modeled on Cash and Counseling Model Created infrastructure for Veteran Directed

HCBS Program

Diversion and Self Direction:Veterans Directed HCBS Program

Funded through Veterans’ Administration

Flexible self-directed monthly benefit Fiscal Intermediary/Fiscal

Management AgencyParticipant employs service

providers Supports CounselorAgreed up service plan including

savings and rainy day

Community Living and VDHCBS Program Partners

Maryland Department of AgingVeterans’ AdministrationMaryland Department of Health and

Mental Hygiene Medicaid AgencyBaltimore City and Baltimore, Prince

George’s, Washington, MAC, Inc., and Washington MAPs

ASIWorks, Inc.

Living Well Programs

Funded 2006-2012 at $2.5 million by AoA and Weinberg Foundation grants.

Stanford University Evidence based model. Lay-led workshops provided statewide through senior

centers, community organizations, hospitals, etc. Chronic Disease Self Management Program including:

Diabetes, Chronic Pain and Arthritis Self Management. Implemented in 13 MAPs with further expansion planned. Improves: quality of life and individuals’ ability to manage

chronic illness in the community and reduces medical costs 3500 persons served since 2006. Appropriate for adults

over 18 years. Statewide license, plans to provide workshops in at least 20

of 23 counties by 2015.

Moving Forward

Balance Incentive Program Integration and Diffusion Information TechnologyBroadening PartnershipsStatewide Access Statewide Quality New Opportunities

Contact Information

Stephanie A. HullChief, Long Term Services and SupportsMaryland Department of Aging301 West Preston StreetBaltimore, Maryland 21201Voice 410-767-1107sah@ooa.state.md.us www.marylandaccesspoint.infowww.adrc-tae.org