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1. Virginia�s NURSING HOME DIVERSION MODERNIZATION GRANT The Community Living Program

2. Goal of the Project 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

3. Objectives of the Project Design program policies, protocols and tools Identify and enroll 55 eligible individuals from three pilot Area Agencies on Aging (AAAs) Offer consumer direction and assistance of a fiscal intermediary Evaluate the program Expand consumer direction to other AAA regions Educate policy makers

4. Expected Outcomes of the Project A minimum of 55 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 and excellent or good experience with the project

5. Menu of Services Service Coordination Respite Companion/Homemaker Personal Care Chore Home Delivered Meals

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

7. Menu of Services continued Home Modification/Housing Rehabilitation Dental Care (Bay Aging only) 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. A participant may save part of their monthly allotment up to $5,000 to purchase a more expensive service, such as a ramp.

8. 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.

9. Payment for Services Payments are being handled through a fiscal intermediary, Public Partnerships, LLC (PPL) PPL will track the participants budget All participant payments will be 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, the AAA will process invoices through PPL.

10. Pilot Planning and Service Areas Area Agencies on Aging (AAA): Bay Aging Jefferson Area Board for Aging (JABA) Valley Program for Aging Services (VPAS)

11. Enrollment of Participants by AAAJuly 1, 2009 through October 31, 2010

12. Bay Aging Total Enrollment 25 Tel: 804-758-2386 Fax: 804-758-5773 Counties of: Essex Gloucester King and Queen King William Lancaster Mathews Middlesex Northumberland Richmond Westmoreland

13. JABATotal Enrollment 25 Tel: 434-817-5222 Fax: 434-817-5230 City of Charlottesville Counties of: Albemarle Fluvanna Greene Louisa Nelson

14. VPASTotal Enrollment 5 Tel: 540-949-7141 Fax: 540-949-7143 City of: Harrisonburg County of: Rockingham

15. Eligibility Criteria Age: 65 and older AND Informal Support System Status: A caregiver demonstrating difficulty meeting the needs of their family member or an individual that lacks informal support AND

16. Eligibility 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

17. Eligibility Criteria continued Health Status: May have a health condition that requires at least monthly monitoring (e.g. diabetes, heart disease) medical/nursing (skilled care) needs recent hospitalization or prior nursing facility stay

18. Eligibility Criteria continued Financial: INCOME at or below 300% of SSI for the participant and likely to be denied Medicaid eligibility due to excess resources RESOURCE LEVEL must 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) If a person is eligible for Medicaid or Medicaid Wavier programs, they are not eligible for this project.

19. Forms for Referring IndividualsSend Forms directly to the AAA Begin July 1, 2009 Nursing Home Diversion Project AAA Referral Form AND Uniform Assessment Instrument OR Nursing Home Diversion Project Quick Form AND Copy of the consent form used by the Pre-Admission Screening Team If it appears a person is not Medicaid eligible, an NHD referral can be made without the person being denied for Medicaid.

20. Services After the Grant The grant ends March 31, 2010 The AAAs are committed to continuing services to existing NHD participants If continued funding becomes available, VDA will advise interested parties

21. Virginia Department for the Aging