Alzheimer s Assisted Living Waiver Update

1. 1 Alzheimer’s Assisted Living Waiver Update LTC Network Spring Conference April 2010

2. 2 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

3. 3 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

4. 4 AAL Overview Allows participants to: Remain in a home-like setting for as long as possible Maximizes their autonomy, privacy, and dignity, even if they require a high level of services Provide relief for family caregivers 

5. 5 Admission criteria

6. 6 Admission criteria Diagnosis Defined by: A physician or psychologist for Alzheimer’s disease or related dementia (using the clinical guidelines) defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) Must not have a diagnosis of mental retardation /intellectual disability as defined by the American Association on Intellectual Disability or a serious mental illness as defined in 42 CFR 483.102(b)

7. 7 Reside in or be seeking admission to a safe, secure unit of a VDSS licensed assisted living facility, that has a DMAS provider agreement Be eligible / receiving an Auxiliary Grant; Qualifying Criteria

8. 8 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

9. 9 Summary of Proposed Changes

10. 10 Current Status of Proposed Regs

11. 11 Normal Regulatory Process Three significant steps NORA Proposed Final Items effecting Process General Assembly session New Administrations Typical time Line 18-24 months NOIRA ended 7/8/09 Started Proposed August 2009 got to Governors desk and back to Secretaries desk Current goal for completion 12/10

12. 12 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

13. 13 Medicaid Funding for AAL It was a difficult time for maintaining funding FMAP funding had significant impact How long will it last ? Auxiliary Grant Funding was effected Details from DSS

14. 14 Budget Reductions: Long Term Care FMAP Delayed proposed cuts in: Reduce rates for Home and Community-Based Care (HCBC) waiver services by five percent Freeze enrollment in HCBC waivers for one year, beginning Jan 1, 2011 250 new ID Waiver slots added Reduce allowable hours for respite services from 720/year to 240/year Assistive Technology (AT) and Environmental (EM) will be reduced to $3,000 per year from $5,000 per year.  Allowable monthly income for waiver eligibility would be reduced to 250% of SSI.  Current monthly income allowed is $2,022 (300% of SS). Reduced to $1,685 ($250% of SSI).

15. 15 Budget Reductions: Long Term Care Continued Non FMAP Related Reductions Maintain nursing facility rates at FY 2010 level (no inflation) Eliminate Intensive & Regular and Assisted Living Programs 3.1 million DMAS administrative reductions

16. 16 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

17. 17 Results of 2009 QMR’s Three out of four providers required a corrective action plan due to lack of staff training and staff license issues.

18. 18 AAL Cycle of Documentation

19. 19 Top (10) Technical Assistance Areas: Staff working in secured unit who had not received or completed the 12hr dementia-specific training within 30 days of their hire date. Staff working in secured unit who had not received eight hours of dementia-specific training annually. Staff working with AAL waiver participants on the secured unit who were not (CNA) certified nurse aide. Some Participants did not have a UAI completed annually. ISP (Individualized Service Plan) not reviewed quarterly. Some participant’s therapeutic and recreational objectives were not individualized. Some of the ISP’s did not contain the one to one activity The Comprehensive assessment was not completed by an RN One participant had a diagnosis of MR. Some AAL waiver participants did not receive their one hour per week of one to one activities.

20. 20 Discharge Notice New form Key Area’s Name of resident Medicaid number Date of Discharge Reason for discharge Signature of ALF Employee

21. 21 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

22. 22 Path to Becoming AnAlzheimer’s Assisted Living Waiver Provider Be enrolled with the Department of Social Services to participate in the Auxiliary Grant Program Contact Virginia Department of Social Services  Division of Finance  7 N. Eighth Street  Richmond, VA 23219  (800) 726-7252 Visit http://www.dss.virginia.gov/family/as/auxgrant.html Become a Medicaid Assisted Living Facility Provider if not one already Click on www.dmas.virginia.gov and go to Provider Enrollment for an enrollment package or Call 888.829.5373

23. 23 Path to Becoming AnAlzheimer’s Assisted Living Waiver Provider (continued) Be designated as a Safe and Secure unit by the Department of Social Services Contact your Local DSS Licensing Division to obtain criteria and procedure required to obtain the designation Complete and submit the DMAS-482 Request to be Screened as a Provider for the Alzheimer’s Assisted Living Waiver Can be obtained from forms section at www.dmas.virginia.gov Can be requested by calling 804.225.4222 Call 804.225.4222 to schedule a conference call to review your packet. Call 804-225.4222 should there be any questions during the process

24. 24 What can delay your Participant enrollment Submission of incomplete packages (use the Alzheimer’s Waiver Participant Application Package check-off sheet) Not calling Long Term Care Division with questions before you mail your enrollment package. Failure to watch the Alzheimer’s documentation Web-Ex training.

25. 25 Today’s Topics A recap on the AAL waiver Where AAL is in the Legislative process Effects of budget cuts Update on results of QMR for last year Training on the provider enrollment process Routine training resources available to providers

26. 26 Training resources Your State Association Department of Social Services Licensing Auxiliary Grants Department of Medical Assistance Services Web site Learning Network (Long Term Care) Helpdesk Division of Long-Term Care Technical Assistance

27. 27 DMAS Training Resources As of October 2009 providers can go to https://dmas.webex.com, click on recorded session. Scroll down to Alzheimer’s Assisted Living (AAL) documentation. This Web-Ex will give provider information regarding AAL waiver criteria, and forms needed to enroll participants into the AAL Waiver. Providers can also go to www.dmas.virginia.gov , click on Long Term Care – Waiver Services on the left side of the screen. Click on Waiver services at the top of the page. Providers will see an overview of the AAL Waiver and a link to the current AAL Waiver Regulations. Providers receive training during their (QMR) quality management review as needed or requested. All New AAL Waiver Providers will receive AAL Waiver Regulations training at the time of the initial on-site visit prior to enrolling participants, or prior to Provider Enrollment if needed. Up Coming Training Resources: Web-Ex training on how to complete the annual level of care (LOC) form is scheduled for April 2010

28. 28 Contact InformationDivision of Long-Term Care Division Director Terry Smith 804-371-8490 Alzheimer’s Waiver Program Manager Steve Ankiel 804-371-8894 Supervisor AAL Deborah Pegram 804-371-2912 Lead AAL Waiver Analyst Thelma Thomas 804-786-0167 Long-Term Care Phone 804-225-4222 Fax number 804-612-0050

29. 29 Alzheimer’s Assisted Living Waiver Thanks for your time and your interest in the Alzheimer's Assisted Living Waiver

30. 30 Alzheimer’s Assisted Living Waiver Any remaining questions?