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Agency Information DAAA’s Mission Who Does DAAA Serve? What Is Medicaid Waiver? Waiver Program Rules Why Do Consumers Have Choice of Care Setting? MI CHOICE Background MI CHOICE Services Functions of a Supports Coordinator / Care Manager MI CHOICE Eligibility Requirements How To Apply for MI CHOICE Benefits of MI CHOICE Contact Information
Overview
Detroit Area Agency on Aging (DAAA) is a private non-profit agency established in
1980 to assist frail adults 60 and over and people with disabilities 18 and over.
Paul E. Bridgewater is the President & CEO of DAAA and has been with the agency for over 30 years.
DAAA is part of a national network of 670 Area Agencies on Aging (AAAs) in the United States.
DAAA is one of 16 AAAs located in Michigan.
DAAA is responsible for administering and coordinating a comprehensive system of home and community-based services within its planning and service area. The services provided are Community Access, Community Services, Long-
Term Care Services, and Planning and Service Provider Development.
Agency Information
To educate, advocate and promote healthy aging to enable people to make choices about home and community-based services and long-term care that will
improve their quality of life.
DAAA’s Mission
Frail seniors and disabled that live in our region of nine communities: Detroit, the five Grosse Pointes, Hamtramck, Harper Woods and Highland Park
Who Does DAAA Serve?
The Social Security Act authorizes multiple waivers and
demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a
distinct purpose and distinct requirements. In our state, the governing administrative body for Medicaid programs
is the Michigan Department of Community Health (MDCH).
http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/
What Is Medicaid Waiver?
Within the parameters of broad Federal guidelines, States have
the flexibility to develop Home and Community-Based Services (HCBS) Waiver programs designed to meet the specific needs of targeted populations. Federal requirements for states choosing to implement a HCBS Waiver Program include: Demonstrating that providing Waiver services to a targeted
population is no more costly than the cost of services these individuals would receive in an institution.
Ensuring that measures will be taken to protect the health and welfare of consumers.
Providing adequate and reasonable provider standards to meet the needs of the targeted population.
Ensuring that services are provided in accordance with a plan of care.
Waiver Program Rules
OLMSTEAD & HCBS WAIVERS
In the 1999 Olmstead v. L.C. decision, the Supreme Court affirmed the right of individuals with disabilities to receive public benefits and services in the most integrated setting appropriate to their needs. The Olmstead v. L.C. decision interpreted Title II of the American with Disabilities Act (ADA) and its implementing regulations. Medicaid can be an important resource to assist states in fulfilling their obligations under ADA. The HCBS Waiver program in particular is a viable option for states to use to provide integrated community-based long-term care services and supports to qualified Medicaid eligible recipients.
Why Do Consumers Have Choice of Care Setting?
In early 1992, the Michigan Medical Services Administration (MSA)
received approval from the U.S. Department of Health and Human Services (HHS), Centers for Medicare/Medicaid Services (CMS), to implement a Home and Community-Based Services for Elderly and Younger Adults with Disabilities (HCBS/ED) Medicaid Waiver Program.
In the summer of 1997, Michigan upgraded its standardized assessment system, adopting the Resident Assessment Instrument-Home Care© (RAI-HC) assessment system to use in the statewide expansion of MI CHOICE. The MDS-HC is compatible with the RAI Minimum Data Set (MDS) mandated by the United States Congress for use in nursing facilities and thus permits comparisons between individuals in nursing facilities and home care.
MI CHOICE Background
During 1998-99, Michigan deployed the MI CHOICE Information System
(MICIS), a computerized on-line operating system infrastructure for the RAI-HC assessment system. MICIS allowed both Waiver agents and state level managers to monitor participant activity and daily program expenditures. (In 2009, the Center for Information Management (CIM) deployed COMPASS a new web-based information system for collecting participant data that serves as the successor to MICIS.)
During 2000 and 2001, Michigan Waiver staff participated in a three-nation effort with Inter-RAI involving researchers, clinicians, and policy makers from Canada, the United States, and Japan to develop quality indicators from the MDS-HC data set. This research resulted in 22 MDS-HC Quality Indicators (QIs) that were used in MI CHOICE as new tools laying the groundwork for a home care quality improvement system. These indicators provided high-quality evidence on performance at the agency and State level in MI CHOICE.
MI CHOICE Background Cont’d
In 2004 and 2005, MDCH implemented a new Nursing Facility Level of Care
(NFLOC) determination instrument used in both institutional and community-based settings. Adopting Self-Determination (SD) as a principle, MDCH applied Person Centered Planning (PCP) processes to MI CHOICE, resulting in choice and control by participants.
In 2005, a leadership group composed of seven participants, their peers, and seven providers organized formally into the MI CHOICE Person Focused Quality Management Collaboration (QMC) to work on developing a person focused quality management plan. The purpose of the QMC is to include participants and their peers in the development, discussion, and review of quality management activities for MI CHOICE. The QMC provides a venue where providers, participants, and their peers review and discuss measured provider performance and participant outcomes and recommend improvements to the Michigan Medicaid service delivery system.
MI CHOICE Background Cont’d
During fiscal year 2008, MDCH officially implemented PCP and the SD
in LTC option expanded statewide.
Fiscal year 2009 brought an expansion of MI CHOICE into licensed residential settings, e.g. Adult Foster Care (AFC) homes and Homes for the Aged (HFA). MDCH added Residential Services to the array of available MI CHOICE services. Residential services enhanced the continuum of care for persons in need of long-term care who choose not to receive services in a nursing facility.
MI CHOICE Background Cont’d
MI CHOICE performs the following functions to assist the participant toremain in their care setting of choice:
Assessment - A comprehensive in-person assessment of physical, social/emotional functioning, medications, physical environments, informal support potential and financial status.
Care Plan Development - A written plan of care, which states specific interventions to be secured. The care manager and participant establish which services will be secured and provided, as well as, the frequency and duration of services.
Service Arrangements - In-home health and social services for the participant are arranged and/or purchased by care managers according to the frequency and duration established by the care managers and participant as approved in the plan of care.
MI CHOICE Services
• Adult Day Services • Homemaker Services
• Chore Services • Independent Living Skills Training• Counseling • Environmental Modifications• Home-Delivered Meals • Private Duty Nursing • Residential Services • Fiscal Intermediary Services • Goods & Services • Community Living Supports
• Personal Care Waiver• Nursing Facility Transition Services (NFTS)• Medical Equipment & Supplies• Out-of-Home Respite Care• Personal Emergency Response System• Non-Medical Transportation• In-Home or In-Home of Another Respite Care
Based Upon Financial & Medical Eligibility Services May Include:
Monitor participant’s health and well-being via assessments and phone
contacts.
Determine financial and medical eligibility via nursing facility Level of Care Determination.
Prepare service orders for participants utilizing our Provider Network System.
Linking participants to other community resources as needed.
Participants Are Assigned a Supports Coordinator
Age/Disability
Frail adults 65 years of age or older (MI Choice) Frail adults 60 years of age or older (OSA/CM) Persons who are physically disabled age 18 or older
Financial Eligibility An individual participant’s income is $2,199 or less per month. Allowable assets for an individual participant are limited to $2,000. Amounts are for 2015 and are subject to change.
Service Need Participants must need at least one MI CHOICE Waiver service on an
ongoing basis. DAAA contracts with community-based providers for these services.
Eligibility Requirements
Medical
The Michigan Medicaid nursing facility Level of Care Determination (NFLOC or LOCD) must be completed for all individuals enrolling into the our programs. The Michigan Medicaid Nursing Facility LOCD’s medical/functional criteria include seven domains of need:
Activities of Daily Living Cognitive Performance Physician Involvement Treatments & Conditions Skilled Rehabilitation Therapies Behavior Service Dependency
Eligibility Requirements Cont’d
Call the Detroit Area Agency on Aging at (313) 446-4444 and ask for the Intake
& Assessment Division for the MI CHOICE Waiver program.
1. The Intake & Assessment staff conduct a telephone screening Record financial and medical information to determine potential eligibility
for the MI CHOICE program Educate regarding other community service options, when applicable.
1. A waitlist is established whenever there are more individuals requesting MI CHOICE services than there are available MI CHOICE slots. The DAAA utilizes the MDCH Waitlist policy for removing individuals from the Waitlist. Priority placement is as follows:
Persons no longer eligible for Children’s Special Health Care Services (CSHCS).
How To Apply
Nursing Facility Transition participants (NFTS). Individuals facing imminent risk of Nursing Facility placement
(Diversion). Participant Transfers from other MI CHOICE Waiver Agents.
3. Once the MI CHOICE program has an available slot, the initial determination of MI CHOICE eligibility will be conducted in the participant’s home. If approved, the in-home clinical assessment is scheduled.
How To Apply Cont’d
The benefits of the MI CHOICE program includes:
An alternative to institutionalized care through the provision of supportive services in the comfort of your own home.
Keeping participants in the community as long as it is medically, socially, and financially feasible.
Allows individuals to stay in their home for care. Allows participants to stay active in their community. Reduce hospital readmissions and nursing facility placements. Provide supportive services for individuals with long term disabilities
or illnesses. Allow participants to maintain dignity and independence.
Benefits of MI CHOICE
Person-centered care planning facilitated by a Registered Nurse and Licensed Social Worker.
Thorough assessment of participant’s needs.
Benefits of MI CHOICE Cont’d
DETROIT AREA AGENCY ON AGING
1333 BREWERY PARK BLVD., SUITE 200DETROIT, MICHIGAN 48207-4544
TEL. (313) 446-4444FAX (313) 446-4447
HTTP://WWW.DAAA1A.ORG/
PAUL E. BRIDGEWATER, PRESIDENT & CEOSYLVIA BROWN, DIRECTOR LONG TERM CARE SERVICES (EXT.
5230) [email protected]
For more information contact:
