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WELCOME TO OUR REGIONAL MEETING
LEADINGAGE MICHIGAN SPONSORS
TECHNOLOGY EXPO – FEBRUARY 27, 2020
LEADINGAGE MICHIGAN TEAM
Ellie DavisMember Communication
Liaison
Laura FullerExecutive Director of Education Foundation
Laura FunschDirector of Regulatory
Strategy
Dalton HerbelDirector of Public
Policy
Bobbi KuyersExecutive Assistant
Deanna MitchellExecutive Director of
Senior Care Resources
Dennis SmithAccountant
Blake WellerBusiness Partner &
Member Engagement Coordinator
STRATEGIC PLAN
MICHIGAN IN REVIEW AND POLICY BRIEFS
LTSS System Design
The State of Managed Care
Primer on the Provider Tax
The Not for Profit Difference
MICHIGAN IN REVIEW:
Long Term Care Services and Supports – August 2019
MEMBER ENGAGEMENT – BOARDS, COMMITTEES AND TASKFORCES
Board of Directors
Public Policy Taskforce
Member Awards Committee
Political Action Committee
Networks and Education
Human Resource
Fund Development
Business Partner
Assisted Living, SNF and DON
COUNTDOWN TO PDPM
Webinar:
We will be hosting a LIVE WEBINAR on Friday, September 13, from 1:30 – 2:30pm
PDPM expert, Leah Klusch will be our facilitator
Open Forum Q & A:
We will be hosting an open forum Q & A with Leah Klusch on Wednesday, September 25, from 10:30am – 12:00pm.
This will be a quick update on all things PDPM and a time for everyone to get their questions answered by the expert.
Michigan’s Cone of
Budget Uncertainty
DISPOSITION OF MICHIGAN REVENUES FY 2018
MICHIGAN IS CHANGING
Michigan’s Largest Employers - 2019
Crain’s Publications 2019
Company Top Executive Michigan Employees
20192018
World Wide Employees
General Motors Mary Barra 52,02752,113
167,440180,000
Ford Motor Company Jim Hackett 46,00048,009
NA
State of Michigan Gretchen Witmer Gov 45,09344,680
95,61980,865
FCA US LLC (Chrysler) Michael Manley 36,83533,863
51,20349,797
University of Michigan Mark Schlissel 36,14834,904
51,20349,797
US Government NA 29,24428,782
2,002,3632,085,449
Beaumont Health John Fox 27,58728,038
27,59127,055
Henry Ford Health System Wright Lassiter 26,01725,514
NA25,554
Trinity Health Richard Gilfillan 24,30423,063
NA131,000
McLaren Health Corporation Philip Incarnati 22,61322,850
NA23,201
James E. Orlikoff is president of Orlikoff & Associates, Inc., a consulting firm specializing in health care governance and leadership, strategy, quality, and organizational development.
“If policymakers are celebrating economic success for your state and your largest employers are hospitals, universities and/or government entities …..your state is facing economic trouble.”
“I don’t mean to be glib, but the answer is we wait for the great reckoning. Which, I think like Hemingway said about bankruptcy, happens gradually and then suddenly.”
LeadingAge Annual Conference 2017
MICHIGAN RANKS 34TH IN OVERALL HEALTH
Michigan’s Cone of
Budget Uncertainty
NATIONAL PERSPECTIVE OF MEDICAID MLTSS
Source: Center for Health Care Strategies
MICHIGAN’S POPULATION OUTSIDE MANAGED CARE
MANAGED CARE IN LTCSS
By September 30, 2015, the department of community health shall identify all remaining populations eligible for managed care, develop plans for their integration into managed care, and provide recommendations for a performance bonus incentive plan mechanism for long-term care managed care providers that are consistent with other managed care performance bonus incentive plans. (PA 107 of 2013)
By July 1, 2018, the department shall explore the implementation of a managed care long term support service. (Conference Committee)
MI HEALTH LINK
MDHHS Goals: Access to high-quality services in the setting of one’s choice, better integration of LTSS with physical and behavioral health care, improved person-centered care coordination, and the ability for individuals to live independently in their homes and communities.
Concerns for the Michigan program also include poor care coordination, poor integration of services, and structural issues around conflict-free options counseling, standardized processes and quality measures across each health plan.
CHRT/HPM recommends an overall timeline of five years as a starting point to guide MDHHS’ next steps for global LTSS improvements and MLTSS planning. The first step is for MDHHS to extend the MI Health Link demonstration for an additional three years beyond the 2020 end date.
The MDHHS has issued a draft waiver renewal application that extends the program for five years, essentially ‘as is’.
Michigan is still waiting for the MI Health Link final report that will be completed by RTI – the Research Triangle Institute – due to be completed later this year.
THE LTSS FEASIBILITY STUDY– HB 4674
Requires MDHHS to perform an independent feasibility study and actuarial model of options for people to access and afford Long Term Supports and Services
Would look at creating an affordable LTSS benefit model in Michigan
Would examine the existing programs and gaps that exist
Would analyze workforce issues
LTCSS COALITION
MICHIGAN PROVIDER TAX PROGRAM
2019 - unexpected increase in number of Medicaid bed days; provider taxes are based on estimates for each year
State fell short of funds to make QAS payments for this year because revenues were based on smaller estimates
MDHHS increasing the provider tax for August and September 2019
Increase from $26.15 to $32.45 for the middle tier
Upper tier moves from $19.25 to $23.45
The current program is set to sunset October 1, 2019. We are working on SB 0444 (Hertel) extending to 2023.
QUALITY IMPROVEMENT INITIATIVE - QMI
QMI provides payments to NFs based on average CMS quality domain rating and submission of information about their satisfaction survey Must send all questions in the survey and summary of results
No protected health information
Number of residents residing at time of survey and number of responses
The number of completed surveys a) completed by residents, b) completed by guardian or representative, c) the total number of surveys completed, d) survey date range (date sent to date due), e) survey frequency, f) entity that conducted survey, g) survey data collection method, and h) an explanation of how the provider uses the data to improve services.
Survey must occur no earlier than 12 months prior to the due date (May)
Changes to the Provider Tax affects the QMI payments as well 1 Star = $800
$368.69 for each additional star now moved to $391.85
Hopefully, this will offset additional QAAP payments
79%
80%
81%
82%
83%
84%
85%
86%
87%
88%
89%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
MICHIGAN and US NURSING HOME OCCUPANCY 2003-2015
Michigan
US
380
390
400
410
420
430
440
450
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Total Number of Michigan CertifiedNursing Facilities 2003-2015
MICHIGAN NUMBER OF NURSING HOME BEDS
44000
45000
46000
47000
48000
49000
50000
51000
52000
1995 2000 2013 2018
NOT FOR PROFIT TRANSITIONS• 11 % of the Skilled Nursing Facilities in
LeadingAge Michigan have been SOLD in the last five years• There has been one closure• Eight facilities have been sold to For Profits• Five of the Nine were single site properties
• Three other LMI members in the Grand Rapids market are moving away from Skilled Care.
City View in the Square, a new senior housing co-operative
27
Life Plan Communities 30 Registered under the Act - application pending9 of the 31 offer both Entrance Fee Model or Rental
Continuing Care Community or Community means a retirementcommunity in which a person undertakes to provide or arrange for continuing care and which is one or more of the following:i. An adult foster care facilityii. A home for the agediii. An independent living unitiv. A nursing homev. A home health care services agencyvi. Hospicevii. A place that undertakes to provide care to a member for more than 1 year
28
PACE IN MICHIGAN
HOME AND COMMUNITY SERVICES NETWORK
Members:
A&D Home Care Waiver Division
MORC
Northern Michigan Healthcare Management
Reliance Community Care Partners
Senior Services
The Information Center
LTSS FUNDING
0
0.5
1
1.5
2
2.5
3
3.5
FY 2013 FY 2014 FY2015 FY 2016 FY 2017 FY 2018 FY 2019
Michigan Medicaid NF Funding and LTSS Non-NF Funding Trends
NF Budgeted Funding Non NF Budgeted Funding
Housing (Affordable)
Tax Reform Debate in Washington
Differences between the House and Senate
Qualified Allocation Plan – 2019 -2020 Seek an increase in the statutory set-aside of Not-for-Profit
Modify the scoring for walkable elder communities
Performing a Housing needs study
MICHIGAN IN REVIEW – FIVE AREAS OF FOCUS
Charitable Purpose
LTSS System Design and Managed Care
Regulatory Burden
Housing
Workforce
MICHIGAN IN REVIEW:
Long Term Care Services and Supports – August 2019
CHARITABLE PURPOSE
We must maintain support for our communities that are mission-driven with a higher purpose to serve. Local and other taxing agencies have been attacking not-for-profit charitable purpose based on the legal definitions here in Michigan. It is critical that we continue our ability to provide higher quality of care and prioritize quality of life over profit maximization.
Use the standardized CMS Quality Reporting Program measures for all state programs: homes for the aged, adult foster care, Home Help, MI Choice Waiver, MI Health Link
Create transparency in data across all LTSS programs; development of an annually published report that identify quality challenges, outcomes, spending for programs and any integrated models
Elevate and escalate the conversation about the efficiency and efficacy of the survey and certification process at state and federal levels – without undermining the capability of the state to deal with low-performing providers
Consider legislative solutions to guard against Tax Exempt Challenges
LTSS SYSTEM DESIGN AND MANAGED CARE
With the recent trends toward managed care in both Medicare and Medicaid, it is critical that we ensure that these programs work to support the provider in delivering an appropriate level of care and minimize cost shifting.
No further expansion or extension of MI Health Link until objective research demonstrates that it truly works for Michigan
A routine regional analysis of programs for access, quality, and cost across the state with specific attention to duplication of services and regional revenue streams for LTSS
The evaluation of MI Health Link must include how any savings were achieved and demonstrate how the MI Health Link population (55% of which is under age 65) is really comparable to other senior programs
Increased MI Choice funding to eliminate the waiting list
A moratorium on new nursing home construction
Review and analysis of access to affordable senior housing; adequate senior housing is a primary social determinant for positive outcomes
REGULATORY BURDEN
Incremental increases in regulatory burden over time have brought us to an almost crisis point. We need to elevate and escalate the conversation about what really works to protect residents.
Stop dependence on annual survey visits that can be anticipated; increase timing between annual visits for high performing providers
Utilize focused random visits for facilities who are trending poorly, using LTC ombudsman if necessary
Use a LTC Ombudsman across all venues
Improve reporting methods for facility reported incidents that include all the necessary information about follow up actions to the incident and any necessary reporting to public enforcement agencies to better prioritize need for on-site visits
Monitor performance trends over time to address poor performers who move in and out of significant compliance problems in consistent SQOC (Substandard Quality of Care) areas
Licensure and/or oversight of home health and personal care for participant safety
Consider litigation against LARA – Equal Protection under the law
HOUSING
Safe and affordable housing is one of the most important social determinants of health. Public funding is diminishing for the senior, and senior poverty overall is affecting their ability to find secure housing.
Increased MI Choice funding to eliminate the waiting list
A moratorium on new nursing home construction
Review and analysis of access to affordable senior housing; adequate senior housing is a primary social determinant for positive outcomes
WORKFORCE
To prepare for LTSS in the 21st century, it is important that Michigan form a vision for training and support to formal and informal caregivers. Specific initiatives must be developed to identify programs that will strengthen and support recruitment, retention, training, and mentoring.
Michigan support of initiatives that will review the breadth and depth of issues and validate what truly drives recruitment and retention issues across the industry
Protection of expanded Medicaid benefits and tax credits that allow direct care workers to obtain health insurance coverage
Revision to CNA Michigan training programs and onboarding requirements
Funding for successful training models, standards, and curricula for aides, through grants
Pilot training programs for certain conditions such as diabetes and Alzheimer’s
Processes to gather better data to measure Michigan workforce volume, stability, compensation, turnover, vacancy rates, wages, and benefits
Conference & Trade Show May 17-20, 2020Lansing Center / RadissonLansing
ANNUAL CELEBRATIONS
Michigan Night OutOctober 28, 2019 The Deck – Moonshine FlatsSan Diego, CA
Thank you for coming!