Opportunities for Participant Direction A closer look at the Affordable Care Act (ACA) The National Resource Center for Participant-Directed Services (NRCPDS) September 26, 2010 HCBS Conference 2010
Session Overview Introductions Overview of the participant direction components of the ACA A closer look at federal opportunities for participant direction resulting from the ACA Cash & Counseling lessons learned as states implement activities resulting from the ACA Open discussion
A Note About Our Session It will be “participant-driven” We will not be interpreting the ACA, “just the facts” Diversity of the panelists and their opinions is intentional Active involvement of the audience is important
Presenter Introductions Erin McGaffigan, NRCPDS, Public Policy Lori Simon-Rusinowitz, NRCPDS, Research Suzanne Crisp, NRCPDS, Technical Assistance Phyllis Shingle, National Participant Network Mike Hanshew , Consumer Direct Management Solutions
The National Resource Center for Participant-Directed Services (NRCPDS) Center is launched in April 2009 and funded by: The Robert Wood Johnson Foundation The Atlantic Philanthropies, with additional support from: U.S. Administration on Aging Office for the Assistant Secretary for Planning and Evaluation Veterans Health Administration Housed at Boston College Graduate School of Social Work
What are Participant-Directed Services? Participant-directed services are… long-term care services that help people of all ages across all types of disabilities maintain their independence and determine for themselves what mix of personal care services and supports work best for them sometimes referred to as consumer-directed or self-directed services
Growth of Budget Authority Programs AK WA ME MT ND VT MN OR NY NH WI MA ID SD MI RI WY Hawaii CT PA IA NE NJ NV IN OH IL DE WV VA CO CA KS MO MD KY DC NC TN OK AR SC AZ NM AL GA MS LA TX FL 15 Cash & Counseling States 16 Additional States with Budget Authority Programs 7
Growth of VD-HCBS Program AK WA ME MT ND VT MN OR NY NH WI MA ID SD MI RI WY Hawaii CT PA IA NE NJ NV IN OH IL DE WV VA CO CA KS MO MD KY DC NC TN OK AR SC AZ NM AL GA MS LA TX FL 2008 – 7 States 2009 – Grew by 3 states for a total of 10 2010 – Expect to grow by 18 states for a total of 28 8
Overview of the Participant Direction: Components of the ACA Erin McGaffigan NRCPDS Public Policy Lead
How much do you know about participant direction within the ACA? 33% 33% 33% 1. Extremely informed. In fact, I should be the one presenting. 2. I do know what “ACA” stands for… 3. What workshop am I in? 1 2 3
How knowledgeable are you of the participant direction components of the ACA? 33% 33% 33% 1. Extremely knowledgeable 2. Somewhat knowledgeable 3. Very little to no knowledge 1 2 3
Affordable Care Act (ACA) Overview Patient Protection and Affordable Care Act (ACA, P.L. 111-148) was enacted on March 23, 2010 Major areas of focus for the ACA: Addressing the Uninsured Improving Care Coordination Expanding HCBS Quality Reform Addressing Workforce Needs The primary components discussed today are found under: Subtitle E--New Options for States to Provide Long-Term Services and Supports Title XXXII- Community Living Assistance Services and Supports (Section 3201-3210)
Affordable Care Act: Community First Choice- 1915(k) 13
Community First Choice- 1915(k): Overview As of October 2011, amends 1915 of the Social Security Act to allow States to provide new Medicaid State plan option: “Community-Based Attendant Services and Supports” Six percentage point increase in Federal Medicaid Assistance Payments (FMAP) Requires maintenance or expansion of HCBS during first fiscal year Requires statewideness and services based on need rather than age, disability, or support required
Community First Choice- 1915(k): Eligibility Financial Eligibility Clinical Eligibility Income does not exceed 150 Eligible for medical assistance percent of the poverty line under the State plan If greater, the income level Require assistance with ADLs, applicable for an individual IADLs, and/or health related who has been determined to tasks through hands-on require an institutional level assistance, supervision, or of care to be eligible for cueing nursing facility services under the State plan
Community First Choice- 1915(k): Systems Design Community-based attendant services and supports provided through an “agency-provider model or other model” Require the individual/representative to select, manage, and dismiss workers Services are controlled “to the maximum extent possible” by the individual/representative, regardless of model
Community First Choice- 1915(k): Scope of Services & Supports Excluded Required Assistance with ADLs, IADLs, Room and board costs and health related tasks Special education and Skills development related services Back up systems/mechanisms Vocational rehabilitation services Voluntary training on selecting, Assistive technology and services managing, and dismissing workers (except emergency Permissible back up devices) Transition costs Medical supplies Expenditures to increase and equipment independence or substitute for human assistance where $ would Home have been used for human assistance modifications
Community First Choice- 1915(k): Systems Design Functional needs assessments Person-centered plans “Qualified” attendants/services, including family members (defined by Secretary) Comprehensive quality assurance system Annual evaluation, data collection, and reporting Method for addressing payroll taxes, unemployment and workers compensation insurance, etc. Stakeholder involvement strategy
Affordable Care Act: Section 2402(a) and (b) Removal of Barriers to Providing Home and Community-Based Services
Section 2402(a) and (b) Removal of Barriers to Providing Home and Community-Based Services 2402 has TWO very distinct sections…. (a) Oversight and Assessment of the Administration of Home and Community-Based Services (b) Additional State Options- Section 1915(i) of the Social Security Act Amendments
Section 2402(a) Directs the Secretary of Health and Human Services (HHS) to create regulations that: (1) allocate resources for services responsive to the changing needs and choices of those receiving non-institutionally-based long- term services and supports (2) provide the support and coordination needed (3) improve coordination among, and the regulation of, all providers of such services under federally and State-funded programs
2402(a) Allocation of Resources Directs the Secretary of HHS to create regulations that… (1) allocate resources for services responsive to the changing needs and choices of those receiving non-institutionally- based long-term services and supports Medicaid and beyond Strategies to maximize their independence, including through the use of client-employed providers
2402(a) Support and Coordination Directs the Secretary of HHS to create regulations that… (2) provide the support and coordination needed Individuals, family caregivers, and representatives Design an individualized, self-directed, community-supported life
2402(a): Improve Coordination & Regulation of Providers Directs the Secretary of HHS to create regulations that… (3) improve coordination among, and the regulation of, all providers of such services under federally and State-funded programs in order to— (A) Achieve more consistent administration of policies and procedures across programs (B) Oversee and monitor all service system functions (including expectations pertaining to eligibility determination, individual assessments, quality management, and access to qualified workers)
2402(b)- Additional State Options 1915(i) Amendments State Medicaid Directors’ letter issued August 6, 2010 http://www.hcbs.org/files/193/9638/SMD10015.pdf Suzanne to provide an overview of 1915(i) changes resulting from ACA as well as a superb chart!
Affordable Care Act: The Class Act/ Program 26
The Class Program: Purpose Establishes a federally administered voluntary long-term care financing plan for purchasing community living assistance services and supports allows individuals with functional limitation to maintain their personal and financial independence and live in the community establishes infrastructure that will help to address the Nation’s community living assistance services and supports needs paid for entirely by premiums with no government subsidy
The Class Program: Program Eligibility & Enrollment Eligibility for Enrollment in Program 18 years or older Actively employed (including self-employed) Not living in a hospital or facility-based setting Enrollment Process Automatic enrollment by an employer via payroll deduction Alternative enrollment procedures for self-employed, have more than one employer, or employer elects not to participate Election to “opt out”
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