��� Department of Aging Office of the State Long-term Care Ombudsman Ombudsman Demonstration Karla Warren, Ombudsman System Liaison (project manager for demo)
������� As mandated by the federal Older Americans Act and Ohio law, the mission of the Long-Term Care Ombudsman Program is to seek resolution of problems and advocate for the rights of home care consumers and residents of long-term care facilities with the goal of enhancing the quality of life and care of consumers. ��������� ��� 2 Department of Stepping up for Aging Elder Rights
��������� � Federal Older Americans Act � State Law Enhancement Nursing Home Adult Day Care Residential Care Facility Home-delivered Meals Hospital-based SNF Personal Care Long-Term Acute Care Hospital Therapies County Home Transportation Residential Facility (“Adult Care Facility”) Respite Case Management Home Health Care Homemaker Services Respite Chore Services Any other health and social services provided to persons that allow them to retain their independence in their own homes or in community care settings. ��������� ��� 3 Department of Stepping up for Aging Elder Rights
����������������������� � State office � 12 regional ombudsman Programs � Some in AAAs, some not � SLTCO designation and certification of staff � 80 paid staff � 275 volunteers ��������� ��� 4 Department of Stepping up for Aging Elder Rights
������������� Complaint Handling 54.73% Work with Resident & Regular Famly Presence Councils 20.1% 1.2% Counseling Selection on Benefits, Assistance Rights, & Regulations 0.6% 3.5% Consumer Community Provider & Provider Consultation Education 1.8% 2.3% Participate Systems & in Survey Other Process Advocacy 0.4% 5% ��������� ��� 5 Department of Stepping up for Aging Elder Rights
��������������������������������������� � Ombudsman: The Ohio Office of the State Long-term Care Ombudsman Program is statutorily authorized to advocate and investigate on behalf of Ohio’s home- and community-based care and nursing facility-based recipients to safeguard due process, and serve as the early and consistent means of identifying systematic problems. Capitalizing on the function of Ohio’s Office of the State Long-Term Care Ombudsman, the State will create MyCare Ohio Ombudsman to support the objectives of Ohio’s newly integrated care delivery system. ��������� ��� 6 Department of Stepping up for Aging Elder Rights
��������������������������������������� � The MyCare Ohio Ombudsman program will expand the State Long-Term Care Ombudsman’s current accessibility to serve the needs of all beneficiaries participating in the Demonstration. The Ombudsman shall provide core ombudsman services to beneficiaries including outreach, consumer empowerment through education, complaint investigation, person-centered complaint resolution, and shall collect and report casework data to CMS on a quarterly basis. The Ombudsman shall be accessible to consumer advisory boards, and shall participate in all statewide stakeholder and oversight activities. The Ombudsman shall maintain access to and will coordinate with the CMT. ��������� 7 ��� Department of Stepping up for Aging Elder Rights
�������������������������� � CMS Funding Award: � Year 1: $272,354 � Likely Year 2 and 3: $317,716 � About 61 percent of original request, and thus our work will be regionalized. � Our partners: ODM, CMS and ACL. � Other states awarded: California, Illinois and Virginia. ��������� ��� 8 Department of Stepping up for Aging Elder Rights
���������������������������������� • NE MyCare – Ombudsman Program 10A (not in AAA) • EC and NEC MyCare – Ombudsman Program 10B (in AAA) • Central and WC MyCare – Ombudsman Program 6 (not in AAA) • SW MyCare – Ombudsman program 1 (not in AAA) • NW MyCare – Likely integrated into RP 4 (not in AAA) ��������� ��� Department of Stepping up for 9 Aging Elder Rights
�������������������������� � CMS funding to support services. � 3 FTE, 1 PTE regionalized across state. � Regional approach based on “community-well” population: � 10A, Cle – full-time MyCare Ohio ombudsman who would cover NE � 10B, Akron – full-time MyCare Ohio ombudsman who would cover EC and NEC � 6 – full-time MyCare Ohio ombudsman who would cover central and WC � 1 – part-time MyCare Ohio ombudsman who would cover SW � 4 – Likely integrated into current work � Most minimal approach we’ll have. Possible additional $ pending could allow for expansion. ��������� ��� 10 Department of Stepping up for Aging Elder Rights
�������������������������� � Many of these beneficiaries have already been our clients. � Community-well is new population. � Ombudsmen will continue with normal role with long- term care consumers and will get assistance from MyCare Ohio ombudsman as needed, for example, if case involves complicated managed care issue. � MyCare Ohio ombudsmen will handle acute care cases. ��������� ��� 11 Department of Stepping up for Aging Elder Rights
�������������������������� � ACL’s Office of Duals Demonstration Ombudsman Technical Assistance Program: � Plan and launch the program � Meet data collection and reporting requirements � Collaborate with other grantees to share ideas and experiences � Develop training materials ��������� ��� 12 Department of Stepping up for Aging Elder Rights
���������������������������������� � Provides Ombudsman Core Services (information, advocacy and complaint investigation) for dual-eligible members of MyCare Ohio and the “community-well.” Provides expert technical assistance to Ombudsmen in the North-Eastern Ohio region or as directed. Functions as a liaison to MyCare Plans and managers. � Provides information regarding rights and benefits to members, families and providers within the MyCare Ohio service delivery system. ��������� ��� 13 Department of Stepping up for Aging Elder Rights
���������������������������������� � Promotes positive relationships within the MyCare Ohio network of providers including those providing acute care services, as well as offering case management and community-based long term care services. � Enhances the presence of rights advocates within the MyCare service system by providing rights-related information to MCOs, case management organizations, acute care providers LTC facilities and other community venues. � Investigates and resolves complaints regarding MyCare Ohio enrollees and other LTC consumers receiving care from Managed Care Organizations. Assist and represent MyCare members and families in administrative hearings and appeal situations in accordance with Ombudsman policy. ��������� ��� 14 Department of Stepping up for Aging Elder Rights
������������������������������������� � Hire regional ombudsman staff. � Create written protocols, including a MOU between ODM and SLTCO, for the MyCare Ohio Ombudsman Program. � Implement first training for staff. � Establish regular meeting schedule with MyCare Ohio managed care plans and means for sharing of non-confidential data with ODM, CMS and plans. ��������� ��� 15 Department of Stepping up for Aging Elder Rights
������������������������������������� � Stakeholder advocacy outreach: � ADRN � Centers for Independent Living � Ohio Hospital Association � Ohio Association of County Behavioral Health Authorities � Ohio Consumer Voices for Integrated Care � Ohio Department of Mental Health and Addiction Services ��������� ��� 16 Department of Stepping up for Aging Elder Rights
������������������������������������� � Create ombudsman promotional materials and increase consumer awareness of the ombudsman program. � Present at community education events. � Deliver ombudsman services and investigate MyCare Ohio complaints. � Analyze data and make recommendations to CMS, ODM and any other entities on how to improve the final alignment initiative for individuals with Medicare and Medicaid. ��������� ��� 17 Department of Stepping up for Aging Elder Rights
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