self-direction for dually eligible individuals utilizing ltss · self - direction for dually...

httpswwwResourcesForIntegratedCarecom

Self - Direction for Dually Eligible Individuals Utilizing LTSS Credit Information sect If you are a social worker in a National Association of Social Workers (NASW) state and

would like to receive CE credits through NASW for this event or a nurse looking to obtain CNE credits through the California Board of Registered Nursing please complete the pre - test posted here httpswwwsurveymonkeycomrselfdirectionpresectYou will also be required to complete a post - test a link to this test will appear at the end of the presentation

sectFor more information about obtaining CE credit for social workers in non - NASW states psychologists PAs nurses (NP APRN RN LPN) pharmacists marriage and family counselors etc or CME credit via the Centers for Medicare amp Medicaid Services Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf

Audio and Platform Information sectThe audio portion of the presentation will automatically stream through your computer speakers If you experience challenges with the audio please click the phone icon at the bottom of the screen for dial - in information sectIf you are experiencing any technical difficulties with this platform please use the QampA feature for assistance or click the help button for additional information

1


August 21 2019

Self - Direction for Dually Eligible Individuals Utilizing Long - Term Services and Supports

(LTSS)


Overview

sect This session will be interactive (eg polls and interactive chat functions) with 60 minutes of presenter - led discussion followed by 30 minutes of presenter and participant discussions

sect Video replay and slide presentation are available after each session at httpswwwresourcesforintegratedcarecom

2


Accreditation sect Individuals are strongly encouraged to check with their specific regulatory

boards or other agencies to confirm that courses taken from these accrediting bodies will be accepted by that entity

sect The American Geriatrics Society has been approved by the California Board of Registered Nursing to provide continuing education

sect The American Geriatrics Society is accredited by the National Association of Social Workers (NASW) to provide continuing education for social workers

sect This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Centers for Medicare amp Medicaid Services CMS is accredited by ACCME to provide continuing medical education for physicians

sect The Centers for Medicare amp Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET) The Centers for Medicare amp Medicaid Services complies with the ANSIIACET Standard which is recognized internationally as a standard of excellence in instructional practices As a result of this accreditation the Centers for Medicare amp Medicaid Services is authorized to issue the IACET CEU

3


Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos

No relevant financial interests or affiliations No relevant financial interests or affiliations

sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations

sect Courtland Townes No relevant financial interests or affiliations

sect Kristen BugaraNo relevant financial interests or affiliations

4


Continuing Education Information

5

If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits

Social Worker

The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour

Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval

1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019

NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing

1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019

Option 2 Centers for Medicare amp Medicaid Services (CMS)

Physician (MD or DO)

The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity

Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019

Other

The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity



Support Statement

sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar

sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom

6


Introductions

Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities

Courtland Townes Deputy Director Boston Center for Independent Living

Corinne Eldridge Executive Director California Long-Term Care Education Center

7


Introductions

Carole Stewart IHSS Consumer

Maida Castellanos Personal Care Attendant

8


Learning Objectives

sect Describe key features of self - direction and what it entails for the consumer

sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan

sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team

9


Webinar OutlineAgenda

sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer

Choice sect Personal Care Attendants and the Interdisciplinary Care

Team sect Making it Work Voices of a Consumer and In - Home

Supportive Services Provider sect QampA sect Evaluation

10


Overview of Self - Direction and the Role of Care Managers

Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities

11


What is Self-Direction

1 Applied Self Direction (2018) What is Self-Direction Retrieved from

12

httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-

center-participant-directed-services

Self-Direction (self-directed services)

bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them

bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1

bull Also referred to as participant direction or consumer direction

History of Self-Direction

bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993

bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction

bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2


The Self-Direction Model

sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently

sect Helps people maintain their independence sect Allows people to determine for themselves what mix of

services and supports work best for them

13


Goals of Self-Direction

sect Seeks to maximize each personrsquos ability to control their own decisions

sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their

supports and services sect Complements person - centered planning and facilitation

14


Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role

(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview

hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot

self - direct

15


Authorized Representatives for Self-Direction

sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf

sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve

as the paid care provider for the person

16


Self - Direction Authority Employer Authority

sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3

sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider

sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary

3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https

17

wwwmedicaidgovmedicaidltssself-directedindexhtml


Self - Direction Authority Budget Authority

sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3

sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive

Devices sect The person assumes responsibility for choosing provider for

service scheduling service and setting pay rate (within guidelines)


18



Traditional Care Management vs Self-Directed Care Management

19

Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment

Consumer and Care Manager decide which services are needed based on assessment

Care Manager locates providers Consumer locates providers with assistance from care manager

Provider agency decides which worker to send and when to provide careservice

Consumer determines schedule based on assessed need

Provider agency hires trains and manages employees

Consumer hires trains and manages employees

Care Manager is responsible for management of provider issues

Consumer addresses service issues directly with assistance from care manager as needed

Care Manager contacts provider with any service issues

Care Manager monitors quality of service and satisfaction


The Role of Care Management in Self-Direction

sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support

20


Care Management and Self-Direction Education

sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen

service sect Aware of their responsibilities as the employer and the

responsibilities of the provider sect In Ohio care managers answer questions about self-

direction and provide support when needed during quarterly visits or when people experience significant changes

21


Care Management and Self-Direction Facilitation

sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take

action sect Helping the person identify goals sect Working with the person to guide the selection of supports

and services sect Assisting when possible with the application process rate

negotiation and service reviews

22


Care Management and Self-Direction Support

sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative

outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment

application processes when possible sect Helping people understand supervisory responsibilities

23


Consumer Benefits of Self-Direction

sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer

24


Care Management Benefits of Self-Direction

sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo

areas such as rural areas with direct care worker shortages

sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly

sect Fewer requests for change of service providers sect Satisfaction with all services increases

25


The Role of the LTSS Coordinator in Supporting Consumer Choice


27


Massachusetts One Care Programrsquos Independent Living LTSS Model

sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid

sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators

sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team

27


Supporting Consumers who Choose to Live Independently

sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the

memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning

process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals

28


The Role of IL-LTSSCs

sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery

sect Conduct initial assessments to help consumers identify the services they need

sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model

sect Have experience working with people with disabilities (may include lived experience with a disability)

sect Provide expertise on community services and community service providers

29


Supporting Individuals Who are Self-Directing Personal Care Services

sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer

sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers

identify the services they need sect Once services are approved through the Care Management

Team the IL - LTSSC begins the necessary service coordination to put vendor services in place

sect Consumers have the right to make changes to their selected services

30


What Other Types of Supports and Services are Offered to Individuals

sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services

31


Strength-Based Needs Assessments

sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams

sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths

32


Utilizing a Strength-Based Approach

sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to

assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has

addressed this problem in the past

sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area

33


Case Study 1 ldquoKarenrdquo

sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis

sect Extremely reliant on her brother and mother for assistance with IADLs

sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation

sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment

34


Case Study 2 ldquoRicardordquo

sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities

sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years

sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program

sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service

35


Personal Care Attendants and the Interdisciplinary Care Team

Corinne Eldridge Executive Director California Long - Term Care Education Center

37


Californiarsquos In - Home Supportive Services (IHSS) Program

sect There are 14 million dually eligible individuals in California4

sect The IHSS program serves 564000 consumers in CA5

sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English

sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country

sect There are 509000 IHSS workers in CA5

sect Over 50 of IHSS workers are family members

4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf

37


California Long - Term Care Education Center (CLTCEC) IHSS Training

sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as

part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)

sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California

38


Basic Tenants of the IHSS Training Program

39

Voluntary participation

IHSS provider learns new skills

Honors consumer-directed model of care

Competency-based education


IHSS Training Program

sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training

and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes

if possible sect 17-week course includes additional modules on body systems and disease-

specific care sect Training modules discuss the role of the IHSS provider and integration

into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration

are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have

discussions with IHSS consumer about what was learned in class that week

40


Five Key Roles of an IHSS Provider

41

Monitor

Communicator

Coach

Navigator

Care Aide


IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and

ears sect Notice important information about the day - to - day

health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention

sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight

sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer

42


Successful Care Team Integration

sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider

sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team

sect The IHSS provider is invited to interdisciplinary care team meetings

43


IHSS Training Program Successes

sect CLTEC has trained over 1884 IHSS providers through the LA Care Program

sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to

consumerrsquos care team

sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved

44


Making it Work Voices of a Consumer and IHSS Provider

Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant

47


Questions

46


Thank You for Attending

sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom

sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost

sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf

sect Questions Please email RIClewincom

sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products

49


Webinar Evaluation Form

sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation

sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ

50


Resources

sect Applied Self - Direction httpwwwappliedselfdirectioncom

sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg

sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml

sect Training Tips amp Videos httpscltcecorg

sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf

49


Sources

1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction

2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-

3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services

httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from

httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D

5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf

50

Credit Information

Self - Direction for Dually Eligible Individuals Utilizing Long - Term Services and Supports (LTSS)

Overview

Accreditation

Disclosure Statement


Support Statement

Introductions

httpswwwResourcesForIntegratedCarecomIntroductions

Learning Objectives






Characteristics of Candidates for Self-Direction



























IHSS Providers Play Valuable Roles on Care Teams




Questions



Resources

Sources


August 21 2019

Self - Direction for Dually Eligible Individuals Utilizing Long - Term Services and Supports

(LTSS)


Overview



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Accreditation



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Sources



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Accreditation



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Resources

Sources


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Resources

Sources


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Learning Objectives




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Accreditation



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Resources

Sources


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Sources







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47


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49


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50


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49


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50

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49


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50

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