Post on 20-Jan-2016
Oregon’sLong Term Care System
Jim McConnell, DirectorMultnomah County Aging & Disability Services
503-988-3441August 2002
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Multnomah County Aging and Disability Services
County-based Area Agency on Aging State contract to administer
Medicaid Long Term Care Eligibility and Case management (Oregon Law ORS 410)
Medicaid provider payments stay with the State
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Older Americans Act $2,387,074
USDA 350,000
Medicaid (Title XIX) block grant 27,923,727
Oregon Project Independence 1,246,418
Multnomah County General Fund
4,569,075
General Fund-other cities 613,541
Contributions/Fees 399,911
Total $37,489,746.
Multnomah County Funding Sources (FY 2002-03)
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AAA LTC SystemAAA LTC System
Referrals
• people needing help
• relatives, friends
• human services agencies;
• hospitals
• health care;
• gatekeepers;
• police
24 hour HELPLINE
Access points
•Eligibility determination (Food Stamps,Financial, LTC, Health Plan, Vets)
•Case Management
•Senior center/meals
•Info & assist., outreach
• PAS/Relocation
•Protective investigations
•Insurance/ housing assist,
•Enrollment in managed care health plans.
Community Services: Transportation, day care, legal, respite, guardian, meals
In-Home Services: Home/ personal care, chores, live-in, medical equipment, meals
Housing Options: ACH, ALF, RCF, NH,other
Caregiver support
Other Community Resources:MH, DD, Voc ReH.,Employment
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Aging & Disability Services - Values
Be customer driven Involve people in the decisions that
affect them Promote client independence and choice Use client and public resources with the
utmost effectiveness Act with personal and professional
integrity
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ADS – June 2002
Clients Medicaid 27,518
N.Facility 1,340
Adult Foster care
1,479
RCF 531
ALF 338
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ADS – June 2002 (contd.)
After Hours 449
Spec.Living 38
In-home 3,944
Food Stamps only
2,191
Health 26,933
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ADS – June 2002 (contd.)
Public Guardian(new)
33
Transportation 437
Protective 245
Financial Assistance
19,270
SSI Liaison 893
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How the Oregon system evolved
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Senior Advocates Wanted integration of services i.e.
Senior centers, meal sites, Medicaid case managers, etc.
Health services were not included. State developed a test model –
FIG waiver. Legislature passed new law in
1981.
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Two State Initiatives Long term care – designed to
promote alternatives to nursing homes/client independence
Oregon health plan (OHP) – designed to mainstream health care for low income persons
OHP original plan was to be a public/private plan for all Oregonians
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Oregon Long Term Care
1981 legislative mandate: “…a growing elderly population demands services be provided in a coordinated manner…; That the elderly and disabled citizens of Oregon will receive the necessary care and services at the least cost and in the least confining situation…it is appropriate that savings in nursing home…allocations…be reallocated to alternative care services…”
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LTC System Development
1974-80 state initiatives to control LTC spending e.g.
- Oregon Project Independence (OPI) 1975.
- FIG waiver 1978. - Pre-admission screening. 1980 governor’s
commission/coalition - draft legislation.
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LTC Development (contd.)
1981 Legislation (SB955) - Philosophy
* Independence, Choice, Dignity* Savings from Nursing Homes to
go to CBC- Single State Agency\Combined Funding- Local/AAA administration of LTC- Advisory Committees at State and Local level
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LTC Development (contd.)
1984 - Enhanced Single Entry (Financial
and Food Stamps added) - Use of Single Client
Assessment Statewide (360) - ADLs
1985-89 All regulation of Homes transferred to SDSD
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LTC Development (contd.)
1990 Disability Transfer to SDSD
1999-2002 Planning for Integration of Health and LTC?
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Nursing Facility/Community-Based Care
0
500
1000
1500
2000
2500
3000
1992 1993 1994 1995 1996 1997 1998 1999
CBC
NF
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Total Dollars $801.8 Million
27.7%
1.5%
46.5% 24.2%
Nursing Facilities $373.2
Substitute Homes $194.0
Oregon Project Independence $12.3
In-Home Care $222.3
Total Cases 36,026
18.7%
25.5%
10.3%
45.5%
Nursing Facilities 6,741
Substitute Homes 9,177
Oregon Project Independence 3,717
In-Home Care 16,391
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Oregon Health Plan development
1994 Oregon Health Plan - managed care - AAA choice counseling Managed Care/Capitation Contracts with
HMOs/PCCM/Fee for service
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OHP development (contd.) Benefits Limitations-Health Care
Commission Medicaid Waiver – 1115 Dual Eligibles – mandatory with
exceptions Statewide – if plans are available All ages
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Multnomah Co.OHP Enrollees – June 2002
Elderly – 7792 Persons with disabilities –
13,106 Spending - $12 million Receiving benefits – 3.74% 5 Plans (incl. PACE) – 86%
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AAA Developments
Transfer of State staff to AAA Eligibility Workers became Case
Managers Co-location in Senior Centers Enhanced Outreach (Gatekeeper) and
Information and Referral Extensive Development of Alternative
Living: 600 Adult Foster Care Homes Specialized Adult Foster Care Homes Services in congregate living
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AAA Developments (contd.)
Assisted Living Facilities Enhanced Protective Service Investigations
& Interventions (funded by Medicaid) Participation in PACE (400 Medicaid clients) Enhanced advocacy by seniors for Medicaid
services at local and state level Enhanced case management quality with
Multi-Disciplinary Teams.
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AAA Developments (contd.)
Increased Title XIX Medicaid Funds available by using local government funds for match
Local AAAs/HMOs consortium Enhanced transportation system Employment Initiative – 1998 Veterans Initiative - 2000
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Key Elements in LTC
Single State Agency Single Local Agency/coordinated
funding Easy Access at local level Case Management continuum (I&R
to Protective to Guardianship)
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Key Elements
Empowered Case Manager Assessment Care Planning Eligibility Service Broker Authorize payments
State/Local Partnership in: Policy Development Quality Review Planning
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Key Elements
Expansive Federal Waiver. Community-Based/Social Model
Preference. Broad Continuum of
services/options. Provider Network. Cooperating Partners i.e. Health,
Housing, Mental Health, Law Enforcement, Transportation, etc.
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Key Elements
Liberal Nurse Delegation Act Values - Independence, Choice,
Dignity, Least Intensive Intervention
Standard Statewide Assessment Statewide Service Priority List
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CASE MANAGER FUNCTIONS
Determines eligibility Develops, implements, and
monitors holistic care plan Coordinates medical care, as
necessary, with primary care practitioner and/or ENC
Locates and prior-approves all LTC and community based services
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CASE MANAGER FUNCTIONS
Provides advocacy and linkages to various other services
Uses MDT for consultation Provides choice counseling Processes fee-for-service prior
authorization requests
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Use of Medical Professionals
Pre-admission screening clients at risk of entering nursing
facility Branch Nursing Consultation
teamed with case manager Quality Assurance RNs
random site visits
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Medical Professionals (Contd.)
Liaison with ENCC at HMOs Multi-Disciplinary Teams
consultation on complex cases Private Duty Nursing
in home care, training, supervision
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Multnomah County in Partnership with Local Business (2002)
36 Nursing Facilities 600 Adult Foster Care Homes 2,100 Housekeepers & Live-In
Attendants 30 Contract Registered Nurses 3 Housekeeping Agencies 37 Residential Care Facilities 14 Assisted Living Facilities 4 Managed Care Plans
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ADS and Health system Eligibility/enrollment/dis-enrollment Options-Managed Care(4)
/FFS/PACE/SHMO Case Manager/ENCC liaison Joint Case Manager tracking demo: Diabetes High Risk Joint discharge planning
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What have we learned? Case Management is our core mission. Empower the CM/client to make all
systems work for the client – including Health, Housing, Mental Health, etc.
Integration with one specialty. e.g. Health, means dis-integration with others.
All business plans have limitations e.g.
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Fully integrated/fully capitated PACE-style model-costs controlled. Efficient, flexible Gov.$$, cost-
savings in Medicare stay in the community, high quality,intense service mix
In Portland, people have become patients – and live in the system
Client gives up some choices Health-based model
Oregon’sLong Term Care System