Long Term Services and Support Work Group

LONG TERM SERVICES AND SUPPORT WORK GROUP October 3, 2011

Attending: Pamela Ogoke-Lloyd, Heather Burkhardt, Annette Lauber, Cynthia Temoshenko, Jonathan Fischer, Angela Floyd, John Thompson, Don Herring, Ursula Robinson, Sheila Black, Lydia Dickens, Jim Graham, Peggy Smith, Bill for Mary Bethel, Susan McCracken, Janet Schanzenbach, Kristi Huff, Lou Wilson, Jeff Horton, Scott Tenbroeck, Nidu Menon, Elise Bolda

INTRODUCTIONS Introduction of review criteria Minutes review list of solutions Priority setting Summary of common themes from minutes

Annette – Discussion of flexibility to cover more of what they need, in terms of the types of things you’ll cover & getting providers into the system. Flexibility to get people who are most knowledgeable, have what’s covered be more flexible. When talking with people who are on Medicaid & have Medicare

Topic - Quality, system, coverage and providers Reviewed this topic using review criteria grid  Flexibility of grid - # one waiver & regular MCD/MCD –  Cost-savings need to think about providers - Yes, Cost – Annette – look at it 2 ways, more flexibility may be find things that cost less than what is typically out there now, could save on more expensive care. If this population had access to home alert systems without a monthly fee that could save a family decided – gee the person can’t stay at home and we don’t have enough funds to hire help to keep the person at home. – safely comfortably at home  Choice = yes  Core values – yes  Innovative  Builds on strengths  Ease to implementation – we have examples of consumer direction and flexibility – example –CAP choice model o Annette’s - Question - In CAP Choice model – is it easier for people who are not traditional providers to bill for services o We can pose that to DMA – o Ask – CAP IDD waiver – supports self-directed has more flexibility and more supports they allow o Cynthia – they submit the bill to the fiscal intermediary o Susan McCracken – yes state contracts with intermediary for that program, which is different than CAPDA Topic- Nurse Practitioner (NP) embedded in nursing facility, from solutions list on page 5

Kristi Huff - NP to provider mentoring, work with medical directors to prevent hospitalizations; we live in a litigious environment, when get a call at 5 pm on Friday, and medical director is not there (and typically t the medical director is not there), there’s a strong desire to send to the hospital. One facility did a pilot in 2008 – over course of the year employed NP 40 hours per week. Had a significant decrease in hospitalizations, reduced Emergency Department (ED) use, and increases discharges to home and to lower level of care. Significant cost savings

 Kristi will send report, can invite Karen Sudreth– from facility that looked at impact of hiring nurse practitioner  Heather – we need evidence base to give to run the numbers  Jeff Horton – are you saying this should be allowed as a separately billed services  Kristi- pay the salary – to have them in the building to talk with hospital,  Jeff – so recoup the costs for NP do you mean just NPs or i=does this include Physician Assistants - Physician Extenders (PE) ? o Kristi – Polly talks about NP, we need to have that conversation

Angela – in some 656 networks – there are doctors, a practice that is set up that all they do is go to NF to visit patients, might want to look at that as well. There are whole practices making office visits to patients in NF, some networks are looking at this instead of sending people to ED.

Heather – 30,000 reside in NF,  Jim Graham - I do understand NF I’d feel more productive  Jan S, maybe combine NF & ACH

Independent Living at home Sub-Work Group Annette Lauber Cynthia Temoshenko Angela Floyd John Thompson Don Herring Ursula Robinson Jonathan Fischer Jeff Horton – regulates everything, will call on him from both groups

Living in Nursing Facility/Adult Care Home Sub-Work Group Sheila Black – also medical directors at facilities – either group is fine Jim Graham Peggy Smith Mary Bethel (Bill) John Thompson Angela Floyd Susan McCracken Janet Schanzenbach Kristi Huff Lou Wilson Jonathan Fischer Jeff Horton – regulates everything, will call on him from both groups

Other elements of the system Palliative care & hospice care being allowed in the nursing homes Geriatric Specialty Teams – BH across the state – their job is trainers – no follow- up, a good model for transitional issues; run out of Division of Mental health

Work groups can meet on the Oct 21st NF & ACH 1 – 2:30, Community Living/ At Home 2:30 – 4

Work group can go through page 1 and step 1 – prioritize for what you group feels is most urgent

October 17 Meeting  Need to bring information back to the group  Accepting input up until early Dec.

Topic - Coverage of Therapists Annette questions – Not sure if we cover this or whether it belongs in medical home work group: Since care for people who are on Medicaid – as adults funnels back through medical home, the medical home needs to have the variety of staff to deal with the needs people have – I hear a lot that people can’t find speech therapists are attached to medical homes.  Speech language pathologists, particularly for evaluation for augmentative communication; Medicaid only pays if therapist is connected to medical homes, think same may be true for OT and PT  Ursula – I know you are right, what struck me in PACE program you have to have all these programs on staff, I can see how that is very difficult in community  Jeff – why can’t they contract with Home Health  Ursula – you have to meet skilled criteria

Topic - Universal Transfer Form Jeff – Attended CMS meeting in Atlanta, and has forwarded form Florida created in an attempt to decrease hospitalizations. Their hospital, assisted living and nursing facility rep worked together to create a universal transfer form. It contains basic information about the patient. They wanted to do it electronically – that was too much-- so did something similar with paper form. It contains things like high risk drugs – we may want to look at. Overall goal is to decrease admissions & improve quality of care. Thought it was low hanging fruit, we wouldn’t be starting from scratch – sent to Sabrena Lea for Transitions group as well.  Janet – transfer information is important, along with proper placement to begin with. To be sure all the information is given to begin with. Sometimes things are left out. Sometimes on purpose, the more we can put in a format that is expect of everyone, it will help with recidivism and proper placements. Example hospital didn’t share the person had been in prison. It is important to be sure all information is shared, good bad and indifferent. Also we need to make sure the Transition work group at the hospital association is pulled together – 55 people or so involved in that process.

Everyone clear on grid?  Would it people helpful if we pulled things out at first meeting and put them on the grid – and where we think they are, would that be helpful.  Challenges & solutions -- If you switch them a little they can be on one list For example – portable x-rays o Ursula, I think that’s a good idea; if will send that out in advance o Will get sent out on Friday

Note: We are coordinating beneficiary listening session – Oct 18th take note  Would like you to encourage participation we’d appreciate any help you can provide  And if there are any other events or ideas for listening sessions throughout the=is process, we’d be happy to partner  Ursula - Have 2 -3 caregivers who are willing to participate -?  Heather we’re going to have small groups with a set of questions,

Website will also allow feedback over time –

Next Meetings: Oct 21 same pass code for calls 1:00 – 2:30 pm Nursing Home and Adult Care Home Sub-Workgroup, 2:30 – 4:00 pm Community Living/ At Home Sub-Work Group

Nov 7 meet 1-3 pm will be meeting of full group With calling for those who cannot attend