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Virginia’s

COMMUNITY LIVING PROGRAM (NURSING HOME DIVERSION)

MODERNIZATION GRANTS

Grant Ended March 31, 2013

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AoA NHD GrantsAoA NHD Grants

AoA launched the NHD initiative in the fall of AoA launched the NHD initiative in the fall of 2007. In its initial year, AoA issued awards to 12 2007. In its initial year, AoA issued awards to 12 states for a combined federal and non-federal states for a combined federal and non-federal funded grant program of $8.8 million. In 2008, funded grant program of $8.8 million. In 2008, AoA issued awards to 14 states reaching a AoA issued awards to 14 states reaching a combined federal and non-federal amount of combined federal and non-federal amount of approximately $16.2 million. In 2009, AoA approximately $16.2 million. In 2009, AoA issued awards to 16 states. issued awards to 16 states.

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The Purpose of the AoA NHD The Purpose of the AoA NHD GrantsGrants Encourage the Aging Services Network to modernize Encourage the Aging Services Network to modernize

and transform the funding they receive under the Older and transform the funding they receive under the Older Americans Act, or other non-Medicaid sources, into Americans Act, or other non-Medicaid sources, into flexible, consumer-directed service dollarsflexible, consumer-directed service dollars

Complement the CMS Money Follows the Person Complement the CMS Money Follows the Person Initiative by strengthening the capacity of states to reach Initiative by strengthening the capacity of states to reach older adults before they enter a nursing home and spend older adults before they enter a nursing home and spend down to Medicaiddown to Medicaid

Support states’ long-term care rebalancing effortsSupport states’ long-term care rebalancing efforts

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Need to Rebalance/Transform

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Goal of the CLP - 1

Divert 55 individuals who are at imminent risk from nursing home placement and Medicaid spend-down through consumer direction of services provided within a designated monthly allotment of up to $1200

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Community Living Program - 2 September 30, 2009 – September 29, 2011

Participant enrollment begins October 1, 2010

Budget $1,463,851 Federal $ 939,730 Match (25%) $ 463,851

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Goal of CLP - 2

Divert 95 individuals who are at imminent risk from nursing home placement and Medicaid spend-down through consumer direction of services provided within a designated monthly allotment of up to $1200

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Community Living Program – 2Funding for Services

20% of service funds are federal

80% of service funds are from other sources OAA funds (Title III-B, III-E, III-C2) State General Funds Local Funds Other (foundation grants, etc.)

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Objectives of the CLP Project

Identify and enroll 95 eligible individuals from ten pilot Area Agencies on Aging (AAAs)

Offer consumer direction and assistance of a fiscal intermediary

Evaluate the program

Educate policy makers

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Expansion Projects in CLP - 2

Bay Aging will evaluate the use of a mobile intake center for enrolling participants in its rural Planning and Service Area

Jefferson Area Board for Aging will utilize telemedicine in partnership with the University of Virginia to serve 5 participants in rural Nelson County

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Pilot Planning and Service AreasArea Agencies on Aging (AAA): Appalachian Agency for Senior Services Bay Aging Crater District AAA District Three Senior Services Jefferson Area Board for Aging Peninsula Agency on Aging Prince William AAA Shenandoah AAA Senior Connections Senior Services of Southeastern Virginia

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Expected Enrollment by AAAAAA # Participants Participant Months

AASC 14 117.0

Bay Aging 5 41.8

Crater 12 100.3

District 3 5 41.8

JABA 10 83.6

Peninsula 10 83.6

Prince William 5 41.8

Senior Connections 10 83.6

Senior Services 14 117

Shenandoah 10 83.6

Totals 95 794.2

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Criteria

Age: 65 and older

AND Informal Support System Status: A

caregiver demonstrating difficulty meeting the needs of their family member

AND

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Criteria continued

Functional: Dependent in 2 – 4 ADLs

OR Cognitive/Emotional Status: Cognitive

impairments including Need for prompting or supervision Impairments in decision-making ability Inability to avoid injury in emergency situations

Note: May have a health condition that requires at least monthly monitoring (e.g. diabetes, heart disease), medical/nursing (skilled care) needs and can be evidenced by a hospitalization or prior nursing facility stay and use of medications

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Targeting Financial Criteria Financial:

INCOME at or below 300% of SSI (2,022 a month) for the participant and likely to be denied Medicaid eligibility due to excess resources.

RESOURCE LEVEL should be no less than and no more than

these ranges: Single individual: $21,912 -$43,824 Individual with spouse: $43,824-$219,120

The project only considers liquid resources. This would be cash or in any other form which can be converted to cash within 20 work days (such as checking, savings, bonds and certificates of deposits)

If a person is eligible for Medicaid or Medicaid Wavier programs,they are not eligible for this project.

A couple can each individually qualify for the program

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Self-Declaration

Admission into the CLP program is by the participant’s self-declaration of income and resources.

The Service Coordinator may ask for this information for reporting purposes.

If the participant is offered the CLP program, he/she is not required to provide any income or resource documentation.

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Budget for Participant

Monthly budget of $1200

Savings budget A participant may save up to half of the $1,200 ($600)

a month to purchase a more expensive service, such as a ramp.

Funds authorized for a participant but unspent can accumulate in the participants savings budget

The maximum allowable savings is $5,000

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Menu of CLP Services

Service Coordination Respite Companion/Homemaker Personal Care Chore Home Delivered Meals

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Menu of CLP Services continued Adult Day Care Transportation Assisted Living Senior Apartments Personal Emergency Response System Assistive Devices Disposable Medical Supplies

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Menu of CLP Services continued Home Modification/Housing Rehabilitation Dental Care (Optional by AAA) Nutritional Supplements Groceries Prescription Medications Recreational Devices

There is no participant co-pay or partial pay for these services. However, the project will only pay up to the $1,200 maximum monthly allotment.

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Traditional Services

If a CLP participant needs services beyond the $1,200 limit, he/she can also receive traditional services

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Provider of Services

As this is a participant (consumer)-directed program, the participant is able to choose who provides their service.

Providers may be: A person hired directly by the participant An agency The AAA

Some services have provider qualifications.

There is no limit on personal attendant hours within the $1,200 monthly budget.

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PeerPlace

CLP2 will be a Program in PeerPlace Grant funds will pay for the set-up

All service units paid from the $1,200 will be entered in the PeerPlace CLP2 program

Traditional services delivered beyond the $1,200 will be entered in traditional PeerPlace programs

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Payment for Services

Payments are being handled through a fiscal intermediary, Public Partnerships, LLC (PPL)

PPL tracks the participants monthly and savings budgets

All participant payments are processed by PPL

For personal attendants hired directly by the participant, timesheets will be submitted to PPL and payments will be made to the personal attendant. For all other services, AAA pays for the service and then processes invoices through PPL.

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PPL Fund Advancement

VDA will advance funds for services to the AAA’s.

Initially, PPL will invoice each AAA for three months of service advance funding based on the estimated number of participants that will be enrolled and their monthly allotments.

Thereafter, PPL will send a monthly invoice for one month’s funding.

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PPL Reports

Reconciliation Report: Reconciles the service advance to the monthly authorizations.

Administrative Invoice: PPL bills $88 per participant per month (PPPM) fee

Detailed Spending Report: Provides a list of service spending that can be sorted by participant

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Expected Outcomes of the CLP A minimum of 95 individuals will be served

80% will be diverted from nursing home placement and Medicaid spend-down

85% of participants and/or their caregivers will report an improvement in their QOL

85% of participants and/or their caregivers will report an excellent or good experience with CLP

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Evaluation by Virginia Tech

The Center for Gerontology (The Center) will serve as the external evaluator for CLP2 Grant.

The outcome evaluation will track and report on client-level data and document the effectiveness of the project

AAAs will need to report client-level data to the Center

Evaluators will interview participants

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AAA Outreach Use of CLP Brochure VDA/DMAS Webinar Pre-Admission Screening Teams AAA educate own staff for internal referrals AAA outreach to local community

DSS Adult and Long Term Care Medicaid staff Health Departments Hospitals and Physicians Nursing Home Discharge Planners Health Fairs and Community Events Adult Day Centers Alzheimer’s Association Advisory Councils and Service Boards Interagency Meetings Ombudsman Meetings County Administrators Legal Aid Radio events

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AAA Responsibilities

Designate the following: A programmatic lead A fiscal lead A person to build and maintain PPL user ids

Participate in planning and implementation calls and meetings

Respond to VDA requests for information