HCB Services Celesta Hartgraves Director Division of Senior and Disability Services Department of Health and Senior Services 20112014 Projections are from the 2014 American Community Survey ID: 681025
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Home and Community Based (HCB) Services
Celesta Hartgraves, Director
Division of Senior and Disability Services
Department of Health and Senior ServicesSlide2
2011-2014
Projections are from the
2014 American Community Survey.Missouri Population Estimates2011201220132014Age 65+854,604884,325908,358931,890Age 18-64 and Disabled449,310454,722465,901478,963Total Missouri Population6,010,6886,021,9886,044,1716,063,589
Missouri Population EstimatesSlide3
What does this program do?Slide4
Home and Community Based ServicesThis core funding reimburses:Agencies providing in-home services; andIndividual vendors performing consumer directed services. Slide5
Long-Term Care EligibilityThe Department of Health and Senior Services (DHSS) is responsible
for assessing
Medicaid participants’ Level of Care (LOC) to determine if their needs meet a 21-point count, making them eligible for long-term care services under the Medicaid program.Those meeting the 21-point count qualify for nursing home or home and community-based services (HCBS).DHSS develops HCBS plans of care and makes changes to those plans as appropriate.DHSS manages and oversees annual reassessments of Medicaid participants currently participating in the HCBS program to ensure they remain eligible for such services and are receiving the appropriate level of services.Slide6
Home and Community Based Services
Medicaid
funded HCBS are available through either State Plan services or through a Home and Community Based Waiver.In Missouri, these services are available through both options. Slide7
State Plan Personal Care Services
Personal
Care Agency ModelPersonal Care Consumer Directed Model (CDS)Advanced Personal CareResidential Care Facility(RCF)/Assisted Living Facility(ALF) Personal CareNurse VisitsSlide8
Eligibility for State Plan Personal Care Services
At
least 18 years of ageIn active Medicaid statusBlind Pension may be authorized for personal careMeet nursing facility level of careSlide9
State Plan Agency Model, CDS Personal Care and RCF/ALF
Dietary
BathingMobility/TransferMedically necessary household tasks (rarely authorized in RCF/ALF)Dressing/GroomingToileting/ContinenceSelf-administration of medicationSlide10
State Plan Advanced Personal Care Tasks
Changing bags and hygiene around
ostomy site Application of medicated lotionsPassive range of motionUse of assistive device for transfersSlide11
Authorized Nurse Visits TasksFilling
Insulin syringes weekly for
diabeticsMonitoring skin conditionNail CareSlide12
Independent Living Waiver (ILW) RequirementsSlide13
ILW ServicesPersonal Care Assistance (CDS Model)
Bathing
Dressing/Grooming Toileting Assistance Cleaning Meal Preparation Laundry Essential Transportation Essential CorrespondenceSlide14
ILW Services (Cont.)
Financial Management Services
Case ManagementEnvironmental Accessibility AdaptationsSpecialized Medical EquipmentSpecialized Medical SuppliesSlide15
Status of Waiver AgreementSlide16
Aged and Disabled Waiver (ADW) RequirementsSlide17
ADW ServicesHomemaker
Meals/Dishes
Clean Laundry Iron/Mend Shopping/Errands Essential Correspondence TrashSlide18
ADW Services (Cont.)Chore – Short-term/Intermittent(Medically Necessary/Unmet Need)
Wash walls and woodwork
Clean closets, basements and attics Shampoo rugs Air mattresses and bedding Spray for Insects (over the counter) Rodent control (over the counter)Slide19
ADW Services (Cont.)Respite Care
Basic Respite
Unit (15 min) or Block (9-12 hours)Advanced Respite CareUnit (15 min) or Block (9-12 hours) or Daily (17-24 hours)Nurse Respite CareUnit (15 min) or Block (9-12 hours)Slide20
ADW Services (Cont.)Adult Day Care
Home Delivered MealsSlide21
Status of Waiver AgreementSlide22
Adult Day Care Waiver (ADCW) RequirementsSlide23
ADCW Services
Adult
Day Care (15 Minute Units)Limitations:10 hours per day5 days per weekNo more than 8 units per day of transportation to and from ADC facilitySlide24
RestrictionsNot
available
to:Residential Care FacilitiesAssisted Living FacilitiesIndividualized Supported LivingBlind PensionSlide25
Status of Waiver AgreementSlide26
Statistics on
ParticipantsSlide27
FY 2012
FY 2013
FY 2014FY 2015FY 2016New Referrals16,429*20,88621,77926,29423,796Care Plan Changes29,891*35,09035,32335,88237,694Home and Community Based Services* This number is low due to transition to third party administrator.Slide28
MO Medicaid Long Term Services & Supports (LTSS) ParticipantsSlide29Slide30
Program Expenditure HistorySlide31
Statistics on Participants
Consumer Directed Services Participants
vs. Agency Model ParticipantsAs of March 31, 2016Slide32
In-Home vs. Consumer Directed HCB Services
FY
2013FY 2014FY 2015FY 2016 Proj. In-Home Clients 37,97237,56635,96135,776Consumer Directed Services Consumers22,71825,85528,75031,311Individuals may appear in both countsSlide33
Home and Community Based Services
FY 2013FY 2014FY 2015FY 2016 ActualActualActualProjected
In-Home Clients (IHS) *
37,972
37,566
35,961
35,776
Consumer Directed Services Consumers (CDS)*
22,718
25,855
28,750
31,311
Residential Care Facility Clients (RCF)*
6,660
6,431
6,375
6,275
Home and Community Based Providers/Vendors
1,080
1,204
1,294
1,480
* Client numbers based upon number of clients receiving services during fiscal year. Slide34
Home and Community Based Services
FY
2012FY 2013FY 2014FY 2015FY 2016 YTD In-Home Services337348370388431CDS145197298378484ADHC/ADC Waiver89102113113
117
RCF
449
433
423
415
448
Total
1,020
1,080
1,204
1,294
1,480Slide35
Telephony/Electronic VisitVerification (EVV)In 2010, SB 1007 and SB 842 modified section 660.023 & 208.909
RSMo
.All providers and vendors shall have, maintain and use a telephone tracking system for the purpose of reporting and verifying the delivery of In-home and CDS as authorized by the department of Health and Senior Services, or its designee.The telephone tracking system shall be used to process payroll for employees and for submitting claims for reimbursement to the MO HealthNet Division.Slide36
Telephony/Electronic VisitVerification (EVV) (Cont.)The statutory requirement for using a telephone tracking system does not apply to providers of Personal Care in an Assisted Living Facility or Residential Care Facility (ALF/PC RCF) or Adult Day Care setting (ADCW).
DSDS promulgated a regulation regarding this statutory requirement for HCBS Providers. Missouri 19 CSR 15-9 Electronic Visit Verification became effective on February 29, 2016.Slide37
Telephony/Electronic VisitVerification (EVV) (Cont.)The term “Electronic Visit V
erification
” (EVV) as defined in the regulation, includes telephone and computer-based systems, as well as other electronic technology which HCBS providers can utilize to meet the statutory requirements.In instances where a telephone or other electronic verification options are not available or accessible in the participant’s home, or the participant refuses to allow the use of EVV, the vendor/provider must have documentation on file explaining the reason attendant is not using EVV.Slide38