November 14, Chief Clinical Operating Officer Division of Medical Assistance Department of Health and Human Services

Transcription

1 Department of Health and Human Services Division of Medical Assistance Response To Questions from the Adult Care Home Transition Subcommittee of the Blue Ribbon Commission November 14, 2012 Presenter: Tara Larson Chief Clinical Operating Officer Division of Medical Assistance Department of Health and Human Services Subject: Institutions for Mental Diseases (IMD) Summary: The Centers for Medicare and Medicaid Services (CMS) contend that North Carolina may have facilities which are improperly receiving Medicaid funding. CMS contend these facilities are institutions for mental diseases (IMD). CMS directed the North Carolina Division of Medical Assistance (NC Medicaid Program) to investigate and determine whether or not any facilities receiving Medicaid funding are IMDs. That investigation and determination is ongoing. What is an IMD? IMDs are defined as a hospital, nursing facility or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services (42 CFR ). An institution is considered an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. An institution for the mentally retarded is not an IMD. However, facilities for the treatment of substance abuse are considered IMDs. More than 50% of all the patients in the facility will have a current need for institutionalization resulting from mental diseases. In applying the 50% guideline, North Carolina needs to determine if the primary diagnosis of mental health is the reason for living in the residential setting. Medicaid match is not available for any services provided to beneficiaries who are residing in an IMD (1905(a) of the Social Security Act) except in limited conditions which the facilities being reviewed do not qualify. 1

2 Brief Update on IMD Designation DHHS Response: Phase II of IMD determination began in September NC is on track to complete the ACH phase of the IMD reviews by November 30, 2012, as required in the corrective action plan with CMS. The status to date: 50 Homes were identified on the initial data run. Of those 50 homes, an additional 10 homes were identified to be reviewed as a result of the shared ownership call. 3 homes closed or were being converted to Special Care Units 4 homes remain under the preliminary injunction 3 homes were removed as a result of the shared ownership review the multiple homes functioned as a single entity thus the bed occupancy was rolled into one instead of separate homes. The percentage of MH/SA recipients was less than 50% once the occupancy count was combined. 3 homes were deemed not to be an IMD based upon the onsite review and review of the documentation obtained during the onsite. 1 home is deemed to be an IMD and the letter is pending legal review. 46 homes remain under review 16 on site reviews have been conducted and records are being reviewed. 10 on-sites are scheduled for the week of November 12, homes were sent notice of payment suspension for failure to respond to phone calls and letters to initiate step one of the review process on November 9 th. Step One is the shared ownership interview. Family Care Homes and 122c Group Homes that are on the same property will be reviewed by November 30 th. We continue to review the data. The remaining Family Care Homes will be reviewed by March, 2013 and the 122c group homes by June 30, Subject: Personal Care Services (PCS) PCS are available to eligible North Carolina Medicaid recipients who, because of a medical condition, disability or cognitive impairment, require assistance with certain activities of daily living (ADL), including: Bathing Eating Mobility 2

3 Toileting Dressing PCS are available to Medicaid recipients who live at home or who live in a facility such as an adult care homes, family care homes, group homes or combination facility. Under current eligibility rules, in-home PCS recipients must need: hands-on assistance with three of five ADLs or hands-on assistance with two of five ADLs, if one is at the level of extensive assistance or full dependence. Under current eligibility rules adult care homes, family care homes, group homes or combination facilities can qualify for PCS if they need assistance with one ADL. Due to legislative changes, on January 1, 2013, eligibility requirements for residents of adult care homes, family care homes, group homes or combination facilities that receive PCS will be raised to current in-home levels. To receive PCS Medicaid recipient must need: three of five ADLs, or two of five if needs are extensive assistance or full dependence level. The Department of Health and Human Services (DHHS) has contracted with the Carolinas Center for Medical Excellence (CCME) to perform individual assessments on PCS recipients currently living in adult care homes and group homes. CCME nurses assessments will be the basis of case-by-case determinations of PCS eligibility under the new law. Is there any chance that you know how many did not qualify for PCS in-home when we did the IAs on In-Home PCS? (It might be helpful to have as the results of the PCS ACH IAs emerge.) DHHS Response: The current In-Home Care (IHC) PCS program was implemented June 1, At that transition, program entrance criteria increased from 2 handson ADLs or two ADLs including one at the extensive or full dependence level. Approximately 2,000 recipients did not qualify to transition to the IHC program. PCS qualifying criteria remains the same for (3 ADL/2 extensive or limited) therefore, effective January 1, 2013, all current qualifying IHC beneficiaries will qualify for the new PCS program. So, let s say that my mom no longer qualified for PCS in-home. I lived too far away to help her. But when she no longer qualified, I had the option to arrange for some private pay ADL assistance and I could pay for it as the child. Is that correct? 3

4 DHHS Response: Yes, if a person on Medicaid doesn t qualify for a Medicaid covered service then the service can be purchased with private funds. If my mother lives in an ACH and no longer qualifies for PCS, could I arrange for an outside provider to provide assistance with ADLs on a private pay basis with someone other than the resident as the responsible party? Or does it have to be paid through the normal PCS provider in the ACH? G.S. 131D-2.1 provides that an adult care home is An assisted living residence in which the housing management provides 24-hour scheduled and unscheduled personal care services to two or more residents, either directly or for scheduled needs, through formal written agreement with licensed home care or hospice agencies. Do most ACHs obtain licensing to provide their own PCS, or do they contract that out to an entity separate from the ACH? DHHS Response: Yes, ACHs are licensed to provide personal care services. If they wished to provide just room and board, they could choose to register as a multiunit assisted housing with services. If the resident needed additional services such as personal care or home health services, the facility could contract through a home care or hospice agency of their choice. The licensed adult care home is responsible for the care and services planned and provided to the resident. If the facility does not employ their own staff to provide scheduled personal care services they could contract for services through a licensed home care agency, but they would remain responsible for the quality and delivery of those services. Licensed hospice and home health agencies provide the services the facility (ACH) is not licensed to provide. Any of the additional services provided direct or via contract, must meet all applicable Medicaid regulations, if billed to Medicaid. The quality and delivery of those services would be subject to the requirement of their licensing rules. If we could allow family, or other interested party, to supplement care for someone in an ACH, then are there things that need to be considered from an accountability standpoint? DHHS Response: The licensed facility is responsible to ensure family and other caregivers are trained to provide the services to the resident. At times, family members may provide feeding assistance during meals or assist residents in transfers and toileting. The facility should work with the family member to be aware of the resident s specific needs and how to assist if they choose. Under the current program requirements, while the resident is in the facility, the facility is responsible for the care and service delivered and would expect the family member to call for assistance or service on behalf of the resident. 4

5 Can family members contribute to the cost of care for a family member who is a resident of an ACH and not jeopardize the SA? DHHS Response: The question has been researched in terms of SSI s and NC s Optional State Supplement Program (SA) and continued Medicaid eligibility and a family s voluntary payment to a facility for personal care would not be counted as income for SSI and our State Supplement Program (SA) nor would it be counted as income for Medicaid. Based on any feedback you have received from CMS, does DHHS have a tentative date of when the SPA will be approved and individuals may begin being notified that they no longer qualify for PCS? DHHS Response: All questions received from CMS have been answered and multiple calls have occurred. As of 10/31/12, CMS staff report that they have submitted the SPA for approval and North Carolina should expect approval by late November. Once the SPA is approved, DMA will begin to issue approval letters and adverse decision letters. Is the notification process in place and ready to go? Would the letters go out all at once or in some type of batch process - first assessed, etc? DHHS Response: Yes, the decision notices are final and have been given to vendors for programming. Yes, the calculations are ready to be downloaded into the decision notices. All notices will need to be distributed prior to January 1, The plan is to distribute all notices (adverse and approvals) associated with the same provider number at once. The vendor will issue notices per facility starting with those facilities assessed first. If the vendor is in process of making return visits to assess any new admissions since the initial review, those notices may not go out in the same main batch. Subject: Independent Assessment Results How many independent assessments have been conducted as of a given date (whatever date you feel most comfortable using)? DHHS Response: See Tables at the end of the questions and responses. For the IAs completed in #3, can you give us a breakdown of # ADLs with which individuals needed assistance including those who don t qualify so we can see how they break-out? 5

6 DHHS Response: See Tables at the end of the questions and responses. For the IAs completed in #3, can you give us a breakdown by facility type, age, and primary diagnosis for qualifiers v. non qualifiers? (Specifically, I have been asked to get 55+ breakdown, but the more specificity you have the more helpful it would be so we can see what the impact will be among various populations. DHHS Response: See Tables at the end of the questions and responses. The total number of adults in the IDD group homes. DHHS Response: There are 6000 licensed beds in 5600 c group homes. At this point, we are able to matching recipients to paid Medicaid claims, special assistance payments and state funded (IPRS) payments to try to ascertain actual occupancy of those homes. If there are residents in the homes that pay privately, we will not know. Of that number, how many individuals are receiving state plan PCS funding. DHHS Response: Since June 1, 2012, 1628 people with IDD received IPRS (state funded) residential services based upon claims submitted through October. Of those people, 851 of them received Medicaid PCS based upon paid claims submitted through October of the 1628 recipients with IDD were also receiving Special Assistance (SA) payments. Of the 851 people who received Medicaid PCS services, 788 received SA payments. How many could lose PCS services? DHHS Response: See Tables at the end of the questions and responses. Apparently there is inconsistency in the information being provided about how many people in IDD homes will lose PCS funding. It is believed that a large number of those people receive PCS funded via CAP-MR/DD waiver slots and they will continue to maintain this funding. DHHS Response: Individuals who receive PCS CAP-MR/DD waiver services are not impacted by the change in eligibility for state plan PCS. 6

7 Additionally, it is anticipated that many of these group homes receive state funding through the LMEs for supported living low or moderate but we apparently have not been able to get this information. DHHS Response: Supervised Living $9,639,546 serving 395 people Supported Living $2,853,367 serving 581 people Family Living $2,256,055 serving 179 people Group Living $20,962,228 serving 1,744 people The above figures do not include any payments for residential supports through CAP-MR/DD or Innovations that group homes may receive. Only under certain criteria may the same person receive state funds and CAP- MR/DD or Innovations funds for residential services for the same individual. Subject: Other Service or Funding Areas for Discussion B-3 services (these services may be approved to be funded by saved money in LME/MCOs) what is available now, what can be added in that the B-C waiver that is up for renewal in December? DHHS Response: Yes, the 1915 b/c waiver is in process of the regular renewal schedule. All MCOs will have the B-3 services of respite, peer support specialist, and community guide. PBH will have additional B-3 services of in-home skill building for people with IDD, comprehensive services for women with substance abuse, and transitional living for children. Supported Employment will begin as a state funded service limited to three sites that will meet the fidelity model identified in the DOJ agreement. Once start up is completed and fidelity met, then supported employment will be added as a B-3 service for implementation for July We are reviewing the possibility of adding One-Time Transitional cost as a b-3 service. These transitional costs would be limited to a dollar amount and could be used to assist with deposits and needed furniture purchases to enable the person to move into a supported housing arrangement. Medicaid state plan services ( eg Community Treatment Teams) DHHS Response: Currently, Assertive Community Treatment Teams (ACT) is being revised to reflect the evidence based model adopted through the DOJ settlement process, TMACT (Tools for Monitoring ACT). These changes will be made as part of the amended 1915b/c waiver. The current ACT definition 7

8 remains in effect under fee for service. Once the b/c waiver is statewide, only the fidelity model will be allowed to contract with the MCOs. Community Support Team (CST) is currently being reviewed by the ACT workgroup to determine any changes that need to be made that enhances the definition. Focused Medicaid habilitation I option for adults with IDD; I option for other populations? DHHS Response: The planning for the 1915i for adults with IDD continues. This draft will address target population and eligibility criteria that captures those individuals not meeting the eligibility criteria for the regular state plan PCS services. The first service to be included on the 1915i option will be a personal assistance definition focusing on habilitation (training, cueing, prompting) of activities of daily living (ADLs) or hands on assistance to complete the ADLs. The service definition will also include those IADLs associated with completion of the ADLs such as meal prep or setting up supplies for bathing or cleaning up the bathroom once the bath is completed. This approach also maximizes existing assessments and infrastructure that has been used to assess recipients for state plan PCS, thus reducing duplication of assessment for the recipient and reduction of burden on the provider. The draft outline will be submitted to CMS by November 30 th. Once this initial 1915i option is approved and implemented by the target date of July 1, 2013, simultaneous planning will continue for an additional two services under the option, (i.e. meaningful day activity and respite). The January 1, 2013 through July 1, 2013 planning will allow for: more accurate cost modeling, more accurate predictability of the number of people to be served to ensure cost neutrality of Medicaid funding and leveraging of state funds the Department to work with CMS around the inclusion of the 1915i option under the 1915 b/c waiver. Thus all funding sources for IDD would be under the managed care option and provide overall cost data for services to people with IDD. Legislative decision regarding expansion for additional services. Legislative authorization will be required for submission of the 1915i option for IDD. Draft submissions may be sent to CMS in the interim in order to receive feedback. Official submission to CMS means that we have the required funding in place and legislative authority to proceed. No planning for submission of a 1915i has begun for any other populations. Legislative authority will be required for submission of 1915i for any other population. 8

9 Expansion of the Innovations waiver slots DHHS Response: Innovations waiver expansion has been submitted to CMS for approval. An additional 250 slots have been submitted for approval as allowed in the certified Medicaid budget for this FY. Slots that were already in the system but were frozen have been unfrozen and are available for use. Other options shared housing etc. 9

10 TABLES: Licensed Adult Care Homes, Family Care Homes and Group Homes Assessment Results Current as of October 26, 2012 I. POPULATION SUMMARY A. Percentages of and Beneficiaries by Facility Type PCS Qualifying PCS Non-Qualifying SETTING Assessments Processed Count Percent Count Percent ACH Bed in NF % % Adult Care Home % % Family Care Home % % SLF 5600a % % SLF 5600c % % Special Care Unit % % Grand Total 12, % % All 10/26/2012 estimates of qualifying and non-qualifying percentages are within +/- 4 % of 10/01/2012 estimates. Approximately 19,000 assessments were completed as of 10/26/2012. Table results reflect all uploaded and processed assessments as of 10/26/12. Additional completed assessments have not yet been uploaded and/or are missing medical attestation forms required to upload and process assessments. To date, medical attestation forms have not yet been submitted for 18 percent of beneficiaries with completed assessments. B. Total Projected Numbers of and Beneficiaries Total Assessments Processed Number Percent Total Number Projected Number Percent Total Number Projected 12, % 10,899* % 9322* *Assumes total ACH-PCS census of 20,221 at transition, with 53.9 % qualification rate. C. Age Range of vs. Beneficiaries Mean Age 73 yrs 61 yrs Standard Deviation* 14 yrs 18 yrs Minimum Age 20 yrs 18 yrs Maximum Age 105 yrs 103 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 10

11 D. Age Distribution of Non-Qualified Beneficiaries Range IAs Processed Percent of Total 3 % 6 % 9 % 18 % 23 % 17 % 14 % 10 % 1 % 64 % Total Projected* *Assumes total census of 20,221 at transition, with 46.1 % non-qualification rate (9322 beneficiaries). E. Diagnosis Summary of and Beneficiaries* Chronic Medical 87 % 77 % Physical Disability 45 % 26 % MI/SA 33 % 54 % MR/DD 15 % 22 % Dementia 46 % 19 % *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. F. Activity of Daily Living (ADL) Needs of and Beneficiaries* Average Number Requiring Hands-On Assistance 4.1 ADLs 1.2 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. G. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 IAs Processed % of Total 22 % 16 % 13 % 3 % 13 % 28 % 5 % H. Personal Care Needs of Beneficiaries* Supervision/Cueing Only Hands-On Assistance Bathing 34 % 28 % Dressing 29 % 4 % Mobility 18 % 1 % Toileting 20 % 3 % Eating** 8 % 84 % 11

12 Medication Assistance 32 % 67 % (administration) * Includes the five qualifying ADLs plus medication assistance needs. ** Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. II. DETAILED ASSESSMENT RESULTS AND BENEFICIARY PROFILES A. Combination Homes (ACH Bed in NF) p. 3 B. Adult Care Homes p. 4 C. Family Care Homes p. 5 D. 5600a Supervised Living Homes (MI/SA) p. 6 E. 5600c Supervised Living Homes (MR/IDD) p. 7 F. Special Care Units p. 8 A. Combination Homes 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 2. Beneficiary Age Mean Age 78 yrs 72 yrs Standard Deviation* 13 yrs 15 yrs Minimum Age 34 yrs 24 yrs Maximum Age 104 yrs 103 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent 1 % 1 % 3 % 10 % 18 % 19 % 25 % 22 % 3 % 86 % 4. Diagnosis Summary* Chronic Medical 92 % 90 % Physical Disability 47 % 30 % MI/SA 27 % 34 % MR/DD 8 % 12 % Dementia 50 % 27 % 12

13 Predominant Primary Diagnoses CAD, CHF, COPD, Diabetes, Renal, HTN, Alzheimer'/Dementia, Mood Disorders, Schizophrenia Comparable to qualifying group, with lower incidence of physical disability and dementia *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 4.1 ADLs 1.3 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 25 % 12 % 17 % 2 % 19 % 20 % 5 % 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 27 % 46 % Dressing 32 % 2 % Mobility 23 % 1 % Toileting 19 % 3 % Eating* 5 % 87 % Medication Assistance 24 % 76 % (administration) * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. 13

14 B. Adult Care Homes 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 2. Beneficiary Age Mean Age 73 yrs 64 yrs Standard Deviation* 15 yrs 16 yrs Minimum Age 20 yrs 18 yrs Maximum Age 105 yrs 100 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent % 6 % 17 % 26 % 19 % 15 % 11 % 1 % 73 % 4. Diagnosis Summary* Chronic Medical 89 % 84 % Physical Disability 51 % 31 % MI/SA 35 % 54 % MR/DD 14 % 12 % Dementia 33 % 16 % Predominant Primary Diagnoses CHF, Renal, COPD, TBI, CAD, Arthritis, CVA, Blindness, CP, HTN, Mood, Schizophrenia, Alz/Dem, Comparable to qualifying group, with lower incidence of physical disability and dementia, higher incidence of MI *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 4.0 ADLs 1.2 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 14

15 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 21 % 15 % 13 % 3 % 14 % 30 % 4 % 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 28 % 28 % Dressing 22 % 4 % Mobility 16 % 1 % Toileting 16 % 3 % Eating 7 % 85 % Medication Assistance 34 % 65 % (administration) * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. C. Family Care Homes 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 2. Beneficiary Age Mean Age 63 yrs 51 yrs Standard Deviation* 16 yrs 15 yrs Minimum Age 20 yrs 19 yrs Maximum Age 98 yrs 89 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent 6 % 10 % 15 % 27 % 25 % 11 % 5 % 1 % 0 % 42 % 4. Diagnosis Summary* Chronic Medical 73 % 60 % Physical Disability 39 % 19 % MI/SA 55 % 71 % MR/DD 32 % 28 % Dementia 18 % 8 % 15

16 Predominant Primary Diagnoses CHF, Renal, COPD, TBI, CAD, Arthritis, CVA, Blindness, CP, HTN, Mood, Schizophrenia, Alz/Dem, Comparable to qualifying group; lower incidence of chronic medical, physical disability, dementia; higher incidence of MI *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 3.8 ADLs 1.1 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 11 % 13 % 10 % 3 % 13 % 42 % 9 % 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 41 % 21 % Dressing 38 % 4 % Mobility 22 % 1 % Toileting 26 % 4 % Eating 12 % 78 % Medication Assistance 28 % 70 % * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. 16

17 D. 5600a Supervised Living Homes (MI/SA) 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 2. Beneficiary Age Mean Age 47 yrs 41 yrs Standard Deviation* 15 yrs 14 yrs Minimum Age 22 yrs 18 yrs Maximum Age 84 yrs 74 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent 14% 23% 20% 22% 16% 4% 0% 0% 0% 20% 4. Diagnosis Summary* Chronic Medical 68 % 49 % Physical Disability 25 % 8 % MI/SA 64 % 87 % MR/DD 9 % 39 % Dementia 5 % 2 % Predominant Primary Diagnoses Schizophrenia, Mood Disorders Schizophrenia, Mood Disorders, Autism, Attention Deficit, MR *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 3.6 ADLs 1.0 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 17

18 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 2 % 6 % 5 % 2 % 12 % 57 % 16 % 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 47 % 11 % Dressing 38 % 4 % Mobility 21 % 1 % Toileting 26 % 1 % Eating 15 % 78 % Medication Assistance 32 % 67 % (administration) * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. E. 5600c Supervised Living Homes (MR/IDD) 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 2. Beneficiary Age Mean Age 48 yrs 44 yrs Standard Deviation* 13 yrs 13 yrs Minimum Age 21 yrs 19 yrs Maximum Age 95 yrs 79 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent 8 % 19 % 21 % 27 % 17 % 7 % 1 % 0 % 0 % 24 % 18

19 4. Diagnosis Summary* Chronic Medical 58 % 49 % Physical Disability 32 % 13 % MI/SA 48 % 44 % MR/DD 91 % 85 % Dementia 8 % 3 % Predominant Primary Diagnoses MR (mild to profound), CP, Down's, TBI MR (mild to moderate), Autism, Seizure Disorder, CP, Down's *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 3.7 ADLs 1.1 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 6 % 12 % 12 % 2 % 18 % 39 % 11 % 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 52 % 23 % Dressing 46 % 2 % Mobility 15 % 0 % Toileting 32 % 4 % Eating 9 % 82 % Medication Assistance 33 % 67 % (administration) * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. F. Special Care Units 1. Assessment Summary Total Assessments Number Percent Number Percent Processed % % 19

20 2. Beneficiary Age Mean Age 81 yrs 77 yrs Standard Deviation* 10 yrs 11 yrs Minimum Age 44 yrs 38 yrs Maximum Age 104 yrs 99 yrs *The Standard Deviation (SD) indicates the average difference between individual beneficiary age and the mean age. 3. Age Distribution of Non-Qualified Beneficiaries Range Percent 0 % 0 % 1 % 3 % 11 % 24 % 34 % 26 % 2 % 96 % 4. Diagnosis Summary* Chronic Medical 86 % 85 % Physical Disability 32 % 20 % MI/SA 22 % 28 % MR/DD 2 % 4 % Dementia 94 % 92 % Predominant Primary Diagnoses Alzheimer's, Dementia, Parkinson's, Vascular Alzheimer's, Dementia, Multi-Infarct, Vascular *Percentages reflect categories selected by attesting practitioners to describe up to ten diagnoses provided and are not mutually exclusive. Predominant Primary Diagnoses are based on qualitative review (visual inspection) of diagnosis documented in Primary Diagnosis field of medical attestation forms. 5. Activity of Daily Living (ADL) Needs* Average Number Requiring Hands-On Assistance 4.3 ADLs 1.4 ADLs *The five qualifying ADLs are Bathing, Dressing, Mobility, Toileting, and Eating. 6. Numbers of Hands-On ADL Needs ADLs (Ext) 2 (Lim) 1 0 Beneficiaries 40 % 26 % 14 % 2 % 9 % 8 % 1 % 20

21 7. Personal Care Needs of Non-Qualified Beneficiaries Supervision/Cueing Only Hands-On Assistance Bathing 43 % 44 % Dressing 56 % 6 % Mobility 33 % 1 % Toileting 37 % 3 % Eating 9 % 87 % Medication Assistance 23 % 77 % * Meal preparation is primary hands-on Eating ADL assistance need among non-qualifying beneficiaries. 21