Improving Access to Home and Community-Based Services – Information Bulletin # 319 (8/2010).http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Nearly five years ago, Congress amended Medicaid by adding Section 1915 (i), intending to increase community-based services instead of institutional Medicaid services by permitting greater flexibility than Waivers permit. Unfortunately, only a few states took advantage of this.

In enacting the Affordable Care Act in 2010, Congress made a number of additional changes which are extremely important to the disability community. However, unless your State opts to take advantage of these changes, they will not happen. These amendments take away many excuses the States have used in the past.

On August 6, 2010, CMS wrote a “Dear State Medicaid Director” encouraging States to take advantage of the ACA 2010 amendments. Here are the changes:

1. The ACA strengthened Section 1915 ( i ) to remove the requirement that

individuals had to meet an institutional level of care in order to

qualify for home and community-based services. Unlike eligibility for

Medicaid Waivers which require a person meet an institutional level of

care, the 2010 amendments permit your state to provide community-based

services for people who are not otherwise eligible for institutional

care. Heh – makes sense to provide services before a person loses more

ADLs.

2. Another big change is that the Affordable Care Act amended this

Section to permit States to provide community-based services to persons

with chronic mental illnesses and/or substance use disorders.

Services for this population are defined extremely broadly. This is

long overdue and will help a portion of the disability community that

has been shortchanged too long.

3. States now have the option to provide thee community-based services to

persons whose incomes are 300% of the SSI income benefit.

4. Benefits can be targeted either to specific population groups without

violating Medicaid’s comparability requirements. Alternatively, States

could target by functional needs. This permits States to have multiple

programs, each targeted at specific populations, e.g., one for persons

with physical needs and another benefit package targeted at persons

with chronic mental illnesses. It permits your State to define

populations’ needs with great precision and specifics.

5. Services can be narrowly defined, e.g., personal care or home health

aide, instead of the Waiver package of services. There goes a big

excuse States have used with Waivers, i.e., they had to provide a broad

range of services to everyone on the Waiver.

6. States have the option to offer consumers “self-direction.” In the

8/6/10 Dear State Medicaid Director letter, it states that “CMS urges

all States to afford participants the opportunity to direct some or all

of their HCBS. Self-direction permits participants to plan and

purchase their HCBS under their direction and control or through an

authorized representative.” Well, how about that?

These changes become effective October 1, 2010.

You and your State Medicaid officials have to begin this process now!

Let’s not let this slip away. There could be great financial savings if these provisions are used creatively.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at

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Steve Gold, The Disability Odyssey continues

Contact: Deane Beebe, Media Relations Director

June 10, 2010                                                                 718-928-2033 (office) 646-285-1039 (cell)

   dbeebe@phinational.org

Two-Thirds of States Lack Public Registries to

Help Consumers and Independent Home and Personal Care Aides Locate One Another

– Public Infrastructure is Needed to Support Trend in Consumer-Directed Care –

New York, NY— A national survey conducted by PHI to assess whether states have a public “matching services registry” to facilitate connections between consumers who receive self-directed care in their homes — and independent direct-care workers who provide that care — found that only one-third of the states have developed this type of registry.

Self-directed care allows elders and people with disabilities, or their families, to directly hire and supervise independent caregivers who provide personal care services and supports.

“Consumer-directed care is the fastest growing service delivery option,” said PHI Director of Policy Research Dorie Seavey, Ph.D., who conducted the survey, “yet there is little public infrastructure in place to help consumers and providers find each other for appropriate and efficient employment matches.

“Robust, public matching service registries can alleviate some of the challenges that both consumers and workers face. They can reduce unmet need due to difficulties that consumers encounter trying to locate independent providers. And for workers, they can play a valuable role in stabilizing employment and providing access points for training and other resources,” Dr. Seavey said.

Public “matching service registries” are interactive electronic databases that typically provide up-to-date detailed information about the consumer’s needs and preferences and the worker’s availability, skills, and preferences. They may also offer additional services such as worker screening and orientation, access to consumer and worker training, and recruitment and outreach to potential workers. Consumers and workers must each initiate their side of the transaction.

PHI’s state-by-state survey on public “matching services registries” found that:

• 16 states had statewide matching services
• 5 states had regional matching services
• 2 states had matching services under consideration or development
• 28 states had no statewide or regional matching service

A list of the states is below.

“The typical information and referral service offered by resource centers in aging and disability networks today is little more than a list pulled out of a drawer and the information may not be up to date,” said Dr. Seavey. “Matching service registries can play a significant role in building an infrastructure for the self-directed care that will be in even greater demand with the passage of the CLASS Act.”

There are two other types of public registries currently in use. “Quality assurance registries” –  such as the nurse aide registries that exist in every state – provide directories of individuals who have satisfactorily completed a state’s training requirements to work in nursing homes and other long-term care programs. Some states also maintain “safety registries” that list workers with criminal backgrounds or abuse findings.

Today there are over 3 million direct?care workers and over one million new positions are needed by 2018, according to the U.S. Bureau of Labor Statistics (BLS). A quarter of the nearly one million Personal and Home Care Aides in 2008 were either directly employed by private households or were self-employed, according to the BLS Employment Projections Program. However, a PHI Fact Sheet explains that this figure significantly underestimates the number of independent providers of direct-care services.

The PHI Public Matching Services Registry Project is a multi-year project that will continue to document and track matching service registries across the states; highlight what is learned from these efforts; and encourage policies that improve and support infrastructure for self-direction.

More information on public matching services registries is available on PHI’s website, including an interactive map that illustrates what states have these registries and provides a snapshot description of the service. The PHI Public Matching Services Registry Project is funded with support from the National Institute on Disability and Rehabilitation Research through the Center for Personal Assistance Services at the University of California at San Francisco.

Statewide Matching Service Registries (16)

Arkansas

California (52 county-based registries)

Connecticut

Massachusetts

Maine

Michigan

North Dakota

New Hampshire

New Jersey

Ohio

Oregon

Rhode Island

South Carolina

Vermont

Washington

Wisconsin

Regional Matching Services Registries (5)

Idaho

Illinois

Kansas

New York

Pennsylvania

Recent Legislative Efforts to Launch Matching Services Registries (2)

Connecticut

Missouri

– end –

PHI works to improve the lives of people who need home and residential care—and the lives of the workers who provide that care. Using our workplace and policy expertise, we help consumers, workers, employers, and policymakers improve eldercare and disability services by creating quality direct-care jobs. Our goal is to ensure caring, stable relationships between consumers and workers, so that both may live with dignity, respect, and independence. 

WSANA now has e- mail lists that will allow us to notify you when new posts are made to any category that interests you. To get on a e-mail list please send your name, town and e-mail address to us at info@wsana.org. Please put category name and mailing list in subject  line. Call us at 708-383-6258 for information

Framework Initiative Established to Shape Quality Improvement Efforts in Geriatic Home Care

U.S. home health care leaders and geriatics experts have established the first national framework to define home care excellence and shape the future of home health services for older people.

The Framework Initiative, spearheaded by the Visiting Nurse Service of NEw York (VNSNY) Center for Home Care Policy & Research (Center) with funding from the John A. Hartford Foundation, forged  a ground-breaking consensus on key values, critical practice areas, and core preferences, needs and values of older people and their families.

Continue reading ‘NEW HOME CARE GOALS for OLDER AMERICANS’ »