New York State Department of Health

Office of Long Term Care

Long Term Care Restructuring

Annual Long Term Care Ombudsman Training Institute

October 18, 2007

The Lodge at WoodcliffFairport, New York

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Office of Long Term Care

Mark Kissinger Carla WilliamsDeputy Commissioner Deputy

Director

Vision

Patient Centered Long Term Care Government Role: Insure quality of care; develop policy and

implement in effective and efficient manner Basis for restructuring workforce to reflect consistent support to

patients/consumers accessing any long term care service

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Office of Long Term Care

Goals Long-term: develop and implement policy and

regulations resulting in sustainable, efficient services for consumers that are high quality

Intermediate-term: increase community based options available to consumers while insuring access to needed residential and higher levels of care

Short-term: reorganize the Department to align resources so that programmatic changes can be accomplished to support long and intermediate goals

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Office of Long Term Care

Objectives and Activities Increase appropriate utilization of HCBS Implement reimbursement, payment and right-sizing reforms to

encourage efficiencies and quality Improve transitions in care to reduce institutional placements Support initiatives related to a trained and available workforce Continued collaboration with NYSOFA to implement NYConnects Evaluate waiver programs for cost effectiveness, coordination and

expansion Increase marketing of Long Term Care Partnership and evaluate

options for increasing participation Implement NHTD Waiver and MFP Demonstration

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Nursing Home Transition and Diversion Waiver (NHTD)

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Philosophy

Person-Driven Participant Choice

– Services– Providers– Living Situation

Assuring Health and Welfare

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Eligibility

Nursing home level of care

Authorized for Medicaid long term care

At least 18 years of age or older

Choose community vs. nursing home

Capable of living in the community

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Regional Resource Development Centers(RRDC) - 9 Regions

Albany North Albany South Binghamton/Southern Tier Buffalo Long Island Lower Hudson Valley New York City Rochester Syracuse

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RRDC Responsibilities

Interviewing participants Interviewing providers Description of available choices Access to approved providers Reviewing Service Plans Determine eligibility for NHTD waiver Maintain regional budgets

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Quality Management Specialist

Provide support to DOH staff, RRDCs and providers statewide

Three Areas – Eastern– Western– Metro

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QMS Responsibilities

Assure Quality Management Program is implemented

Assisting in the retrospective review of Service Plans

Review Service Plans over $300 per day

Review Incident Reports

Satisfaction Surveys

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Sources of Supports and Services for Participants

Informal supports

Other State and Federally Funded Services

Medicaid State Plan

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NHTD Waiver Services

Service Coordination Assistive Technology Community Integration Counseling Community Transitional Services Congregate and Home Delivered Meals Environmental Modifications Home and Community Support Services Home Visits by Medical Personnel Independent Living Skills Training and Development

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NHTD Waiver Services (cont’d)

Moving Assistance Nutritional Counseling/Educational Services Peer Mentoring Positive Behavioral Interventions and Supports Respiratory Therapy Respite Care Structured Day Program Wellness Counseling Service

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Why use a Regional Aggregate Budgeting System ?

Serve Individuals with higher level needs

Assure maximum benefits

Maximum creativity and innovation

Increase flexibility for short term needs

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MONEY FOLLOWS THE PERSON

DEMONSTRATION (MFP)

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Background

Created by section 6071 of the Deficit Reduction Act of 2005 Total federal funding of $1.75 billion Demonstration period: January 1, 2007 – September 30, 2011 Demonstration supports State efforts to:

- Rebalance LTC system to support individual choice- Transition individuals from institutions- Promote a system that provides person-centered, needs-based, quality services

Enhanced FMAP for 365 days for qualified home and community-based services for each qualified person transitioned from an institution into the community during the demonstration period.

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MFP Application

Developed with input & guidance of ad hoc MFP Work Group in consultation with provider associations

MFP Work Group comprised of advocates and state agencies

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MFP Award Information

January 2007 – CMS approved New York’s MFP Application

New York 1 of 30 states and the District of Columbia awarded MFP funding

Award represents up to $27.2 million in additional FMAP

New York will receive an additional 25% FMAP for NHTD waiver services and certain LTC State Plan services provided to qualified individuals.

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Qualified Individuals

Have been in a nursing home for at least six months

Have been in receipt of Medicaid for at least one month pre-transition

Are in receipt of NHTD waiver services; and

Are transitioning into a “qualified residence”

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Money Follows the Person

New York’s goal – transition 2800 people over grant period

Includes people with physical, developmental, and mental health disabilities and seniors

All must use NHTD waiver

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MFP Phases

January 1, 2007 – December 31, 2007 is for Pre-Implementation

January 1, 2008 – September 30, 2011 is for Implementation

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MFP Initiatives

Contracts with Independent Living Centers to identify and outreach to select nursing home residents

Develop informational materials on community-based options aimed at hospitalized individuals in need of long term care

Activities related to promoting the availability of affordable, accessible and integrated housing

Increase the availability of Assistive Technology from the Technology Related Assistance for Individuals with Disabilities program (TRAID)

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MFP Initiatives (continued)

Activities related to promoting the availability of affordable, accessible and integrated housing

Increase the availability of Assistive Technology from the TRAID program

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Contact Information

For more information about the

NHTD Waiver or MFP Demonstration

contact 518-486-3154