EOEA Mission. The Executive Office of Elder Affairs. EOEA/OLTSS Program Units

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1 The Executive Office of Elder Affairs Shannon Philbrick Home Care Program Coordinator EOEA Mission The Executive Office of Elder Affairs promotes the independence, empowerment, and well-being of older adults, individuals with disabilities, and their caregivers. EOEA/OLTSS Program Units Assisted Living Operations Certification and Ombudsman Aging & Disability Resource Consortia Home Care Programs Nutrition Title III Programs Protective Services Family Caregiver Support Program Information & Referral Community Care Ombudsman Counsel on Aging Prescription Advantage Senior Employment SHINE Office of Long Term Supports and Services/MassHealth PCA, HHA,AFC, GAFC, SCO, PACE, DME, LTC Ombudsman

2 Brief history of Aging Services Access Points (ASAPs) 27 Home Care Corporations (HCCs) established Each with a unique geographic service area Community based non-profits 51% of board members must be aged 60+ ASAP law passed in 1997 c.19a 4b Request for Responses (RFR) issued 2010; designation of 27 Aging ServicesAccess Points (ASAPs) currently 26 ASAPs Statutory responsibilities of ASAPs: Information & Referral Clinical eligibility for Medicaid-funded institutional and community based care Care management and service coordination Authorization and purchase of services Protective Services ASAPs perform many functions Information and Referral Nursing facility pre-admission screening Clinical eligibility determinations Home Care Program eligibility determinations Interdisciplinary Case Management and In-home Support services Care Plan development Authorization of services Monitoring of service delivery Family Caregiver Support Services Options Counseling Protective Services Coordination of Care The Role of the ASAP RN

3 Clinical Eligibility and Assessment (CAE) MassHealth Screenings Adult Day Health Group Adult Foster Care/Adult Foster Care Eligibility screens completed by Coastline Elderly Services only Frail Elder Waiver Clinical Eligibility Nursing Facility Clinical Eligibility Pre-Admission Screenings Post-Admission Screenings State Home Care Screenings ECOP Clinical Eligibility Personal Care Determinations (PC, SHCA, HHA) Comprehensive Service & Screening Model (CSSM) A program for MassHealth members/applicants residing in a nursing facility CSSM team works with the member/applicant, family, & nursing facility to overcome the barriers and assist with discharge planning by formulating & implementing a care plan that meets the member/applicant s needs in the community Home Care Program

4 Eligibility for State Home Care Age and residence: 60 years of age (under 60 with a diagnosis of Alzheimer s or related disorder) Resident of Massachusetts and not living in an institutional setting orassisted Living Residence. Income: Based on a sliding scale, monthly co-payments of $10-$141/$18-$152 are required for individuals/couples with income above the Federal Poverty Level. Respite/Over- Income and Over-Income eligible, monthly cost sharing of 50% - 100% of the service plan cost is required. Functional Impairment Level (FIL): Require assistance with at least One Activity of Daily Living (ADL) and have a critical unmet need (anyadl, meal preparation, food shopping,home health services,medication management, Respite,transportation for medical treatments). Exceptions to the Uniform Intake Policy: At Risk. Elders who are at risk due to a variety of factors, including, but not limited to substance abuse, mental health problems or cultural and linguistic barriers. Protective Services. Elders who are receiving or are eligible to receive Protective Services. Congregate Housing. Consumers residing in a Congregate Housing Facility. Waiver Consumers. Consumers who are eligible for the Home and Community basedwaiver Program. Home Care Programs Home Care Basic/Non-Waiver Respite Over/Income Over-Income Enhanced Community Options Program/Non- Waiver (ECOP) Home Care Basic/Waiver* CHOICES/Waiver* *MassHealth Standard (Expanded Income Eligibility -300% FEW) Home Care Enrollment FY17 YTD as % of Total Overall Home Care Enrollments 14% 7% 54% Home Care Basic - Waiver Home Care Basic - Non-Waiver 16% 9% Home Care Basic - RC Over- Income ECOP Non-Waiver Choices Waiver

5 Care Planning/Care Management Initial on-site assessment (OSA) to determine consumer eligibility Initial Service Plan developed with consumer to address identified unmet needs Visit schedule of an OSA at least every six months Annual re-determination of home care program eligibility Review of care plan/service plan at least annually Annual re-determination of personal care needs, as well as clinical eligibility for waiver and ECOP by ASAP RN Home Care Services Adult Day Health Alzheimer s/dementia Coaching Behavioral Health Services Chore Companion Environmental Accessibility Adaptations Grocery Shopping/Delivery Services Home Based Wandering Response Systems Home Delivered Meals Home Delivery of Pre-packaged Medication Homemaker Home Health Aide Laundry Services Medication Dispensing System Nutrition Assessment/Counseling Occupational Therapy Personal Care PERS/Enhanced PERS Respite Skilled Nursing Supportive Day Program Supportive Home Care Aide Transportation Transitional Assistance Vision Rehabilitation *delivered through MH -waiver consumers Service Delivery Options Traditional service providers ASAP contracted service providers Consumer Directed Care a service delivery option for non-waiver enrolled consumers in accordance with EOEA PI Consumer can choose to recruit, train and hire their own worker for personal assistance services ASAP assesses need and authorizes an average number of hours per week and is responsible for the overall management of program service costs within the limits for HCB-NW and ECOP program Services Offered Homemaking Personal Care Home Health Aide Transportation Chore Companion

6 Other Program Options Veteran s Independence Plus Program (VIP) VIP Program serves Veterans of any age at risk of nursing home admission Supports family Caregivers VIP Program qualifications Receive primary care at Bedford or BostonVAMC (Veteran s Administration Medical Center) Have ava primary care team Meet the eligibility criteria for home and community based services as determined byva Receive a referral tovip Program from theva Medical Center ASAP case managevip enrollees (Care Advisor) Title III Meals The Senior Nutrition Program provides nutritious meals to seniors who are unable to leave their homes due to illness, disability or frailty through the Home Delivered Meals Program. Supper and weekend meals are also available in some areas. Nutrition assessments and nutrition counseling are provided to the homebound elders who are at nutritional risk. Who Qualifies? People age 60 or older if they: Have physical, emotional, or cognitive impairments, or have inadequate kitchen facilities, resulting in an inability to prepare nutritionally adequate meals Are unable to attend congregate meal sites Have no one to help with meal preparation Meet home delivered meals intake criteria Act as a caregiver to an immediate family member, and the family member is disabled or homebound. No income eligibility review required

7 MassHealth OLTSS Programs AFC Adult Foster Care GAFC Group Adult Foster Care HHA- Home Health Aide Services SCO- Senior Care Option PACE- Program of All-inclusive Care for the Elderly PCA- Personal Care Attendant Program Private Home Care Private pay home care services can be purchased in hourly blocks of time or as overnight or live in services Private pay home care companies provide a broad range of services Private pay home care services are not subject to eligibility rules and restrictions, or ASAP/EOEA monitoring requirements Private pay home care companies can be a company within a Certified Home Health Agency, but not always Certified Home Health Agency CHHA s are home care providers certified by Federal Medicare Program provide and bill for services meet requirements for patient care and management CHHA s provide the following: In-home assessment Developed plan of care Skilled care health services for 60 day increments

8 Qualifying for Certified Home Health Care (CHHA) To qualify for Medicare home health coverage, a person must: Need skilled care (SN, OT, PT) Have a physician s order for care and have seen by the physician ordering care either within 90 days before care or 30 days after starting care Be homebound, i.e. unable to seek medical attention without severe taxing effort Discharge from an acute or rehabilitation/hospital is not necessary Family members or others can refer to CHHA Physician s order for care is required (see above) Information and Referral Aging Services Access Point (ASAP) AGE-INFO Aging & Disability Resource Consortia (ADRC)