March 3rd, 2010

Skilled nursing: $60,000 a year
Homecare: $20-22k a year

ICO

Sen. Ward: How much money have we spent to develop ICO and what costs are associated with implementing the ICO?

Hall: We haven’t spent much to develop it yet, but I will get those numbers for you shortly. We have not signed any contracts or waivers for this yet. I am not sure of the cost associated with implementation, but not addressing it will be crippling.

NPMI

Sen. Ward: The budget includes savings in closing the $5mil Medicare Part D donuthole as well as from the NPMI. Please explain this.

Hall: The National Medicaid Pooling Initiative has 11 states participating at present. It helps to increase buying power and get better drug prices. We are currently pursuing getting our PACE program into the pool, as right now it is an SPAP program. The government is not frowning on putting a medicaid and a PACE program together.

MICHAEL DALLAS WAIVERS

Sen. Vance: When did the department receive information about MDW?

Hall: We receieve information by way of a report card on every waiver one year prior to its expiration, so probably around June or Fall of 2009. Right now we are working to see if the issues are curable and what the best way to address them are.

Sen. Vance: I would like to disagree and state that you receieved this information in January of 2009. What actions are being taken to assist in getting the MDW fixed?

Hall: We have looked at the new CMS requirements. They are now requiring more specific documentation, are being more strict with cost neutrality, and better quality assurance. There is a new calculation system for cost neutrality and on average the 88 people on MDW are $50,000 over the limit. These waivers do not meet the CMS requirements in any of the 6 areas. If the waivers stay as they are right now, we will be denied by the CMS.

Sen. Farnese: If you hope to transition those on MDW to the Independence Waivers, will they still receive skilled nursing and shift nursing?

Hall: Yes, they will still receieve skilled nursing. We will ensure a continuity of care consistent with their clinical needs. There will be no shift nursing, the patient will only receive the hours suggested by their care plan.

Sen. Farnese: How are the comparable costs determined?

Hall: We compare the average annual cost of care vs. institutional care

LONG TERM CARE

Costa: How are we doing when it comes to providing long term care?

Hall: We are working to expand our home and community based programs. They cost around 1/2 to 1/3 less than the cost of a nursing home, so we hope to grow home and community based long term living service waiver programs.

ENHANCED RATES FOR ADULT DAY

Sen. Costa: Please discuss the new enhanced rates for adult day services.

Hall: In the past, reimbursement was very poor. We as a state were paying $30 less per day than the national average. We have increased our payment to be comparable to the average, however in order for adult day programs to receieve this increased rate, they must be open longer and more days per week, offer strong attention to needs, and able to address hygiene issues.

OPTIONS SERVICES

Sen. Greenleaf: What is going on with the waiting lists for options services?

Hall: The options services waiting list has not grown. No one under the aging waiver has to wait for services. With the option waivers, we must assess and prioritize those on the list from greatest to least amount of need. This is connected to the funding formula. We have to find a fair way to distribute money based on population and social/economic needs.

Sen. Tomlinson: What is the future of these services? How can we get more?

Hall: We are trying to develop fairer funding programs. Right now, we are moving into a future where the number of people requesting services far outdoes our ability to support them all. The tobacco fund money is dwindling, the lottery is flat. We simply must work to figure out how to get services to those in greatest need and prioritize our resources.

SENIOR CENTERS

Sen. Greenleaf: What is going on with senior centers?

Hall: Senior centers are a big funding challenge. We must find a way to make them relevant to keep seniors at home as well as keep them involved in their communities. We have had numerous policy changes to Meals on Wheels and other senior programs.

Right now, using ARRA money, we have created a grant program for senior centers and nutrition centers to address their problems. We are working to offer these to centers with no handicap access, outdated kitchens, etc. This will be the first major infusion in senior centers in a while.

Sen. Lisa Baker: With these grants, how much are they entitled to and how many applications have you received?

Hall: We are sorting the applications by county and having them reviewed by the AAA’s. The total pot was $3mil and out of 160 applications, $12mil in funding was requested. We will have each county agency sort the ones that they feel have the most need and make decisions within the coming months.

CHILDREN RAISED BY GRANDPARENTS

Sen. Musto: 150,000 children in our state are being raised by grandparents. What are we doing to provide them with technical assistance/training that they need. What do we need to do to better inform grandparents raising kids?

Hall: Recent reports have found seniors very stretched to meet their own needs, let alone a grandchild’s need on their fixed income. We are currently address the limitations on the state family caregiver support program. Each year, we are unable to spend all of the money allocated because of access limitations. We need to fix this program and allign it with the same requirements as the federal program.

ALZHEIMER’S

Sen. Rafferty:  Alzheimer’s is one of the fastest growing areas. How are we meeting the needs of seniors with this disease?

Hall: It is growing at an alarming speed. Partially because people are now living longer. We are working to expand the aging waiver, as well as working with the enhancements to adult day.

SENIOR LEGAL ADVOCACY

Sen. Lisa Baker: There are far too many seniors that are being taken advantage of through financial and legal issues. How can we help them?

Hall: Unfortunately, the senior law helpline was paid for by federal grant money that was only allocated for 3 years. The federal government paid $100,000 a year and the state matched with $33,000. The grant is over and unfortunately, it is the burden of the people to find a new way to fund this program.

QUALIFYING FOR MEDICAID REIMBURSEMENT

Sen. Vance: What guidance is being provided to home health agencies to be sure they meet the qualifications for medicaid reimbursement?

Hall: These have undergone much change and revision. The manual unfortunately has not been kept up. The best way to read the most up to date info is to find it in the waiver documents. We are in the processing of updating all manuals, but it is a very long process. It is a high priority to our department.