The Executive Office of Elder Affairs Home Care Program 2020 - PowerPoint PPT Presentation

The Executive Office of Elder Affairs Home Care Program 2020 Shannon K. Philbrick, MSM Home Care Program Coordinator

EOEA Mission The Executive Office of Elder Affairs promotes the independence, empowerment, and well-being of older adults, individuals with disabilities, and their caregivers.

EOEA/OLTSS Program Units  Assisted Living Operations – Certification & Ombudsman  Aging & Disability Resource Consortia  Home Care Programs  Nutrition Title III Programs  Protective Services  Family Caregiver Support Program  Information & Referral  Community Care Ombudsman  Long Term Care Ombudsman  Council on Aging  Prescription Advantage  Senior Employment  SHINE  Office of Long Term Supports and Services/MassHealth – PCA, HHA, AFC, GAFC, SCO, PACE, DME, ADH

EOEA Home Care Program Team • Lynn C. Vidler – Director of Home & Community Programs • Devon Garon – Assistant Director Home & Community Programs • Brenda Correia – Coordinator of Elder Community & Support Programs • Desiree Kelley – Clinical Nurse Manager • Melissa Enos – Home Care & Program Analytics Nurse • Brian Glennon – Waiver Program Manager • Shannon Philbrick – Home Care Program Coordinator • Richard Sannon – Budget Analyst of Home & Community Programs

Brief history of Aging Services Access Points (ASAPs) • 27 Home Care Corporations (HCCs) established 1973-1975 • Unique geographic service areas • Community based non-profits • 51% of board members must be aged 60+ • ASAP law passed in 1997 – c.19a§4b • Request for Responses (RFR) issued 2010 • designation of 27 ASAPs • currently 25 ASAPs • Statutory responsibilities of ASAPs: • Information & Referral • Clinical Assessment & Eligibility for Medicaid-funded institutional & community based care • Care management &service coordination • Authorization & purchase of services • Protective Services

ASAPs perform many functions • Information and Referral • Nursing facility pre-admission screening • Clinical eligibility determinations • Home Care Program eligibility determinations • Interdisciplinary Case Management and In-home Support services • Care Plan development • Authorization of services • Monitoring of service delivery • Family Caregiver Support Services • Options Counseling • Protective Services

The Role of the ASAP RN: Coordination of Care

Clinical Assessment & Eligibility (CAE) MassHealth Screenings:  Adult Day Health  Group Adult Foster Care  Eligibility screens completed by Coastline Elderly Services only  Frail Elder Waiver Clinical Eligibility  Nursing Facility Clinical Eligibility  Pre-Admission Screenings  Post-Admission Screenings State Home Care Screenings:  ECOP Clinical Eligibility  Personal Care Determinations (PC, SHCA, HHA)

Comprehensive Service & Screening Model (CSSM)  A program for MassHealth members/applicants residing in a nursing facility  CSSM team works with the member/applicant, family, & nursing facility to overcome the barriers & assist with discharge planning by formulating & implementing a care plan that meets the member/applicant’s needs in the community

Home Care Program

Eligibility for State Home Care • Age & Residence • Income • Functional Impairment Level (FIL) • Exceptions to Home Care Eligibility (formerly Uniform Intake Policy)

Eligibility for State Home Care • Age and residence: • 60 years of age or under 60 with a diagnosis of Alzheimer’s or related disorder • Resident of Massachusetts and not living in an institutional setting or Assisted Living Residence. • Income: • Based on a sliding scale, monthly co-payments of $10-$141/$18- $152 are required for individuals/couples with income above the Federal Poverty Level. • Respite/Over-Income and Over-Income eligible, monthly cost sharing of 50% - 100% of the service plan cost is required. • MassHealth members whose income is at or below 300% SSI FBR ($2,349 in 2020) will not have a co-payment for Home Care Services.

Eligibility for State Home Care • Functional Impairment Level (FIL): • Require assistance with at least One Activity of Daily Living (ADL) OR • 6 or more IADL impairments AND • a critical unmet need (any ADL, meal preparation, food shopping, home health services, medication management, Respite, transportation for medical treatments) • Exceptions to the Home Care Eligibility (only need 4 IADLs): • At Risk: Elders who are at risk due to a variety of factors, including, but not limited to substance abuse, mental health problems or cultural and linguistic barriers. • Protective Services: Elders who are receiving or are eligible to receive Protective Services. • Congregate Housing: Consumers residing in a Congregate Housing Facility. • Waiver Consumers: Consumers who are eligible for the Home and Community based Waiver Program.

The Home Care Program Home Care Basic/Non-Waiver Community Choices* Home Care Over Income Enhanced Community Options Home Care Basic/Waiver* Respite Over Income * Frail Elder Waiver Program, MassHealth Standard (Expanded Income Eligibility – 300% SSI FBR)

State Home Care Programs • Home Care Basic - a program for elders who: • meet the Home Care enrollment eligibility • require assistance with I/ADLs • have an Average service cost per consumer of $318.70/month (not a per person limit)

State Home Care Programs • Enhanced Community Options Program (ECOP) – a subset of Home Care Basic consumers who are: • 60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder) • State Home Care Program eligible • Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR 456.409) • Not MassHealth Standard eligible • Service plan monthly cost minimum of $557/month (1.75 times the Home Care Basic purchased service rate)

State Home Care Program • Over-Income Programs - supports consumers with or without caregivers in meeting the needs of elders who: • Meet the Home Care Program eligibility criteria of • 60 years of age or under 60 with a diagnosis of Alzheimer’s or related disorder • Residents of Massachusetts • Functional Impairment Level (FIL) • have an annual income over $28,866 (single) or $40,843 (couple) and are willing to pay an income-based percentage of the cost of services (50% to 100%) • Are not MassHealth eligible* (CommonHealth exception) • Are not eligible for other programs • Respite Over-Income (for consumers with a caregiver) • Home Care-Over Income (for consumers without a caregiver)

Home & Community Based Services Waiver Programs • Home Care Basic Waiver – a subset of Home Care Basic consumers who are: • 60 years of age or over • State Home Care Program eligible • Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR 456.409) • MassHealth Standard eligible • In need of and/or receiving a Waiver Service • Service plan monthly cost of $533 or less

Home & Community Based Services Waiver Programs • CHOICES - a subset of waiver consumers who are: • 60 years of age or over • State Home Care Program eligible • Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR 456.409) • MassHealth Standard eligible • In need of and receiving a Waiver Program Service • Service plan monthly cost minimum of $534

Frail Elder Waiver (FEW) Expanded Income Eligibility Frail Elder Waiver (FEW) Expanded Income Eligibility for MassHealth Standard: • Elders who meet all waiver program eligibility criteria except for MassHealth Standard eligibility: With income at or below 300% SSI FBR ($2,349 month in 2019) Have countable assets below $2,000 • If applicable: Spouse has countable assets at or below $128,640 in 2020 • Can apply for MassHealth Standard using the FEW expanded income eligibility rule

How to access the waiver for your consumers 1. Referral to Information & Referral Department at ASAP – 1-800-Age-Info 2. Consumer must be willing to: a. disclose income b. have an in-home assessment c. accept a “waiver” service 3. Once determined eligible for Home Care program, the waiver program may be identified as a program to meet consumer’s needs 4. An ASAP Nurse must conduct a clinical assessment to determine clinical eligibility (Nursing Facility level of care in accordance with 130 CMR 456.409)

How to access the waiver for your consumers MassHealth oversees the eligibility process: 1. Clinical eligibility submitted to MassHealth* a. If elder already has MassHealth b. If elder does not have MassHealth, clinical eligibility submitted with new MassHealth application (SACA-2) 2. MassHealth determines financial eligibility a. Income and Asset verification b. If elder is under age 65, MassHealth must verify disability status

Maintaining Waiver Eligibility • Consumers are visited & assessed a minimum of 2 x year for an in-home assessment • Consumers must have one waiver service scheduled monthly in order to maintain waiver status • Waiver clinical eligibility is re-determined every year to ensure consumer remains Nursing Facility eligible • MassHealth will collect updated income & asset information annually