Linking PASRR to Other Programs & Initiatives to Support Olmstead Planning and Implementation Frank L. Tetrick, III Julie A. Stanley PASRR Technical Assistance Center (PTAC) June 9, 2015
Julie Stanley (Virginia) Assistant Attorney General (1987-1993) Assistant Commissioner, DBHDS (1993-2004) Director, Olmstead Cross-Agency, Cross-Disability Strategic Planning Initiative (2004-2010) Co-Author, MFP application and operational protocol (2006) MFP Community Integration Specialist (2011) Program Specialist, UCEDD (2010-present) Coordinator, Statewide Options Counseling standards and on-line certification training modules (2012-2013) Interviewer and Regional Interview Coordinator, National Core Indicators Project (2012-2014) Manager, No Wrong Door Planning Grant (2014-present) Board Chair of AAA offering CCTP, MFP transition coordination, ADRC, and Options Counseling (2014-present)
What We ll Cover Your state s PASRR Program: Many Questions to Consider Olmstead and PASSR (the Basics) PASRR Gateway Options: Programs that can link to PASRR to support Olmstead implementation System reform initiatives that can link to PASRR to support Olmstead implementation How PASRR may be able to help your state in other ways
Objectives Explain the linkage of PASRR with Olmstead Align PASRR with federal and state initiatives that support diversion and transition outcomes for individuals Link PASRR with the diversion and/or transition roles of six distinct Gateway Programs to address the Olmstead decision Communicate the importance of PASRR to state agency leaders
Acronyms ADRC: Aging and Disability Resource Centers CCTP: Community-Based Care Transitions Program MFP: Money Follows the Person PACE: Program of All-Inclusive Care for the Elderly PASRR: Preadmission Screening and Resident Review VD-HCBS: Veterans-Directed Home and Community Based Services WIOA: Workforce Innovation and Opportunity Act
Is PASRR a Missing Piece of Your State s Olmstead Puzzle? MFP WIOA State-specific Initiatives Community Programs VD-HCBS Final HCBS Rule Medicaid Waivers PACE ADRC PASRR Specialized Services Person-Centered Counseling CCTP
Does Your State s PASRR Program Include all responsible agencies on a collaborative, ongoing basis? Through the Level I screening process, identify all individuals who have or might have a mental illness (MI), intellectual disability (ID) or related condition (RC)? Through the Level 2 screening process: Adequately confirm or disconfirm a positive Level I screening? Properly determine whether placement or continued stay in the requested or current nursing facility (NF) is appropriate? Appropriately enumerate the MI/ID/RC services the individual needs, including services the NF can provide under its per diem and specialized services that must be arranged separately? Assure that the identified services are provided?
Does Your State's PASRR Program...? Support and advance existing state initiatives? Promote continuity of care? Support recovery? Use person-centered thinking and planning? Emphasize community integration? Promote empowerment of the individual?
Does Your PASRR Program Include Specialized Services Aligned with CMS Guidance? Specialized Services is a PASRR term of art for services provided to individuals who have MI/ID/RC Specialized Services have three key characteristics: They are provided to individuals with MI, ID, or RC while they are residing in a NF setting. They go beyond the services normally provided in a NF. Specialized Services exceed the typical capabilities of a NF. They address individualized needs related to an individual s MI, ID, or RC, as identified in the Level II evaluation.
PASRR An Olmstead Tool for Connecting NF Applicants to Resources MFP Final HCSBS Rule ADRC WIOA Community Programs VD-HCBS Care Transitions PASRR Medicaid Waivers State-specific initiatives Specialized Services in NF Person Centered Counseling PACE
Olmstead: It s the Law! Olmstead v. L.C., 527 U.S. 581 (1999) Individuals with disabilities must receive services in the most integrated setting appropriate to their needs A top enforcement priority for the Department of Justice (DOJ) DOJ has recently become involved in litigation in federal courts in more than 20 states to enforce Olmstead Cases have involved a broad range of disability groups (including people with MI, ID, RC and physical disabilities) and a range of institutional settings (including state run psychiatric and DD institutions, private and public NFs, private adult homes, and ICF/IIDs)
Preadmission Screening and Resident Review (PASRR): It s Also the Law! Created in 1987 through language in the Omnibus Budget Reconciliation Act (OBRA) 42 CFR Part 483.100-138 Ensures that individuals with MI, ID, or RC: are not inappropriately placed in NFs do not inappropriately remain in NFs receive services unique to their disability (called specialized services) if they are PASRR-eligible and admitted to a NF
Olmstead and PASRR in a Nutshell CMS: PASRR is an important tool for integration PASRR requires states to assure that individuals with mental disabilities or developmental disabilities being considered for admission to a nursing facility are evaluated to determine the most integrated setting to meet their needs. PASRR requires states to provide or arrange for specialized services Resource Webinar: An Overview of Olmstead Planning: Addressing Nursing Facility Placement Issues in the Process
PASRR: A Primary Tool for Olmstead Implementation CMS: PASRR is a powerful tool for diversion from institutions and... a powerful tool for transition. -5/20/10 Dear State Medicaid Director Letter Regarding Community Living Initiative DOJ: actively involved in enforcing Olmstead through ensuring that states use their PASRR process to place individuals in the most integrated settings appropriate to their needs
PASRR: A Gateway to Community Services Properly tied to other programs such as Money Follows the Person (MFP), PASRR can serve as the gateway to community services, however they are structured or funded (whether with local resources, state-only funds, or Medicaid dollars). PASRR has a power unique in all of Title XIX: to ensure that individuals are appropriately placed, thereby helping states implement the requirements of Olmstead.
PASRR Gateway Options Opening Doors for Community Integration Program DIVERSION DISCHARGE Medicaid Waiver and Other Community Services Program of All-Inclusive Care for the Elderly (PACE) Money Follows the Person (MFP) Community-Based Care Transitions Program (CCTP) Veterans Directed Home and Community- Based Services (VDHCBS) Workforce Innovation and Opportunity Act
Medicaid Waivers and Other Community Services Waivers are one of many options made available to states by CMS to allow the provision of long-term services and supports in home and community based settings under the Medicaid Program; generally they may be used for both NF diversions and discharges. Other non-waiver community services can support diversion plans, address unique MI/ID needs when a NF is the most appropriate setting, and assist with timely transition from NF to the community.
Program of All-Inclusive Care for the Elderly (PACE) Medicare program that can be provided as optional Medicaid benefit Comprehensive medical and social services to frail, community-dwelling older adults; most eligible for both Medicare and Medicaid Interdisciplinary health professional team; coordinated care Comprehensive service package enables most individuals to remain in the community rather than receive care in a NF; can also be used NF discharges Becomes the sole source of Medicaid and Medicare benefits for individuals who participate
Money Follows the Person (MFP) Medicaid program that provides states an opportunity to help individuals living in institutions to return to the community As an incentive to participate, MFP gives states an enhanced federal matching rate (the federal Medicaid assistance percentage) for state Medicaid spending on home and community-based services provided to MFP program enrollees.
Community-Based Care Transitions Program Improves transitions from the inpatient hospital setting to other care settings, including home and community Improves quality of care Reduces hospital readmissions for high-risk individuals Documents measurable savings to the Medicare program
Veterans Directed Home & Community-Based Services Program of self-directed care offered by the Veterans Administration Empowers veterans to choose & manage services and supports in their homes as an alternative to living in a long-term care facility The veteran hires, supervises, evaluates and pays the employee to provide specific services and supports that the vet needs to live in own home. Can receive home health aide, homemaker, respite, and other services
Workforce Innovation & Opportunity Act Supersedes Workforce Investment Act of 1998; amends Adult Education and Family Literacy Act, Wagner-Peyser Act, and Rehabilitation Act of 1973 Establishes transition services as a core service for Centers for Independent Living Transition services are those that: Facilitate the transition of individuals with significant disabilities from NFs and other institutions to home and community-based residences, with the requisite supports and services; or Provide assistance to individuals with significant disabilities who are at risk of entering institutions so that the individuals may remain in the community.
Systems Reform Initiatives Enhancing and Supporting Olmstead Implementation Final CMS Home and Community-Based Services (HCBS) Rule Aging and Disability Resource Center (ADRC) Person-Centered (Options) Counseling
HCBS Final Rule Sets forth new requirements under which states may provide home and community-based longterm services and supports Enhances the quality of HCBS Provides additional protections to individuals who receive services under state Medicaid authorities
Aging and Disability Resource Centers (ADRCs) A collaborative effort of CMS, the Administration for Community Living (ACL), and the Veterans Health Administration (VHA) Also referred to as No Wrong Door (NWD) Support state efforts to streamline access to long-term services and supports (LTSS) community and related options for older adults and individuals with disabilities Simplify access to LTSS Are a key component to LTSS systems reform!
Person-Centered (Options) Counseling A person-centered process whereby individuals, family members and/or significant others are supported to develop a plan for addressing LTSS needs that aligns with their preferences, strengths, values, and needs Counselors: conduct a person-centered interview assist in developing a person-centered plan assist the individual to connect with services follow-up over time to ensure individuals are meeting their objectives and accessing desired services Useful in any setting, including decision-making about NF diversion and discharge
PASRR is Smart for Your State and Right for the People You Serve If your state leverages Waivers, community programs, PACE, VD-HCBS, Care Transitions, MFP WIOA, and PASRR And uses the principles of the final HCBS rule, person-centered counseling and the ADRC to support these programs Your state will be well on its way to completing the Olmstead puzzle and providing the best possible outcomes for people!
How Else Can PASRR Help My State? Could PASRR screenings also play a role in admissions to and diversions from assisted living facilities or adult care homes in your state (at 50% FMAP)? Could your state s PASRR and Level of Care screening processes be better integrated to improve both outcomes for individuals and screening efficiencies? Could your state's PASRR process be a starting point for integration of primary health and behavioral health?
We Help States Put the Puzzle Pieces Together http://www.pasrrassist.org/ Request FREE PASRR Technical Assistance at http://www.pasrrassist.org/forms/request-assistance
Networking with NAPP (National Association of PASRR Professionals) http://www.pasrr.org/about.aspx Networking with NAPP is a follow up discussion on the webinar. The next Networking with NAPP session is: Tuesday, June 23 rd, 2015 1 PM EST To register for the session, please contact Betty Ferdinand: (bferdinand@cii.us.com). A reminder invite will be sent to all webinar participants.
Wellness: Building Capacity for Tomorrow s Older Adults Featuring Dr. Carol Ryff, Dan Timmel & Barbara Speeding Oklahoma State University-Tulsa in conjunction with the PASRR Technical Assistance Center and the National Association of PASRR Professionals http://osu-okgec.okstate.edu Linking Gerontology and Geriatrics Evidence-based resources and practices for community members and behavioral health, human services and health professionals working with older adults. Please join us for the 2015 Fall Conference! September 24-25, 2015 To register for the conference, please contact Tammy Henderson: (phone 405-744-8350 or email linking.gero.geri@okstate.edu).