Virginias

1
Virginias

• NURSING HOME DIVERSION
• MODERNIZATION GRANT
• The Community Living Program

2
Goal of the Project

• Divert 55 individuals who are at imminent risk
  from nursing home placement and Medicaid
  spend-down through consumer direction of services
  provided within a designated monthly allotment of
  up to 1200

3
Objectives of the Project

• Design program policies, protocols and tools
• Identify and enroll 55 eligible individuals from
  three pilot Area Agencies on Aging (AAAs)
• Offer consumer direction and assistance of a
  fiscal intermediary
• Evaluate the program
• Expand consumer direction to other AAA regions
• Educate policy makers

4
Expected Outcomes of the Project

• A minimum of 55 individuals will be served
• 80 will be diverted from nursing home placement
  and Medicaid spend-down
• 85 of participants and/or their caregivers will
  report an improvement in their QOL
• 85 of participants and/or their caregivers will
  report and excellent or good experience with the
  project

5
Menu of Services

• Service Coordination
• Respite
• Companion/Homemaker
• Personal Care
• Chore
• Home Delivered Meals

6
Menu of Services continued

• Adult Day Care
• Transportation
• Assisted Living
• Senior Apartments
• Personal Emergency Response System
• Assistive Devices
• Disposable Medical Supplies

7
Menu of Services continued

• Home Modification/Housing Rehabilitation
• Dental Care (Bay Aging only)
• Nutritional Supplements
• Groceries
• Prescription Medications
• Recreational Devices
• There is no participant co-pay or partial pay
  for these services. However, the project will
  only pay up to the 1,200 maximum monthly
  allotment.
• A participant may save part of their monthly
  allotment up to 5,000 to purchase a more
  expensive service, such as a ramp.

8
Provider of Services

• As this is a participant (consumer)-directed
  program, the participant is able to choose who
  provides their service.
• Providers may be
• A person hired directly by the participant
• An agency
• The AAA
• Some services have provider qualifications.
• There is no limit on personal attendant hours
  within the 1,200 monthly budget.

9
Payment for Services

• Payments are being handled through a fiscal
  intermediary, Public Partnerships, LLC (PPL)
• PPL will track the participants budget
• All participant payments will be processed by PPL
  
• For personal attendants hired directly by the
  participant, timesheets will be submitted to PPL
  and payments will be made to the personal
  attendant. For all other services, the AAA will
  process invoices through PPL.

10
Pilot Planning and Service Areas

• Area Agencies on Aging (AAA)
• Bay Aging
• Jefferson Area Board for Aging (JABA)
• Valley Program for Aging Services (VPAS)

11
Enrollment of Participants by AAAJuly 1, 2009
through October 31, 2010
As participants are discharged from the project,
the pilot AAA may identify another participant to
fill the slot if funds are available.
12
Bay Aging Total Enrollment 25 Tel
804-758-2386 Fax [phone]

• Mathews
• Middlesex
• Northumberland
• Richmond
• Westmoreland

• Counties of
• Essex
• Gloucester
• King and Queen
• King William
• Lancaster

13
JABATotal Enrollment 25 Tel [phone] Fax
434-817-5230

• City of Charlottesville
• Counties of
• Albemarle
• Fluvanna
• Greene
• Louisa
• Nelson

14
VPASTotal Enrollment 5 Tel [phone] Fax
540-949-7143

• City of
• Harrisonburg

• County of
• Rockingham

For the pilot VPAS is serving only Harrisonburg
and Rockingham
15
Eligibility Criteria

• Age 65 and older
• AND
• Informal Support System Status A caregiver
  demonstrating difficulty meeting the needs of
  their family member or an individual that lacks
  informal support
• AND

16
Eligibility Criteria continued

• Functional Dependent in 2 4 ADLs
• OR
• Cognitive/Emotional Status Cognitive
  impairments including
• Need for prompting or supervision
• Impairments in decision-making ability
• Inability to avoid injury in emergency situations

17
Eligibility Criteria continued

• Health Status May have
• a health condition that requires at least monthly
  monitoring (e.g. diabetes, heart disease)
• medical/nursing (skilled care) needs
• recent hospitalization or prior nursing facility
  stay

18
Eligibility Criteria continued

• Financial
• INCOME at or below 300 of SSI for the
  participant and likely to be denied Medicaid
  eligibility due to excess resources
• RESOURCE LEVEL must be no less than and no more
  than these ranges
• Single individual 21,912 -43,824
• Individual with spouse 43,824-219,120
• The project only considers liquid resources.
  This would be cash or in any other form which can
  be converted to cash within 20 work days (such as
  checking, savings, bonds)
• If a person is eligible for Medicaid or Medicaid
  Wavier programs, they are not eligible for this
  project.

19
Forms for Referring IndividualsSend Forms
directly to the AAA Begin July 1, 2009

• Nursing Home Diversion Project AAA Referral Form
• AND
• Uniform Assessment Instrument
• OR
• Nursing Home Diversion Project Quick Form
• AND
• Copy of the consent form used by the
  Pre-Admission Screening Team
• If it appears a person is not Medicaid eligible,
  an NHD referral can be made without the person
  being denied for Medicaid.

20
Services After the Grant

• The grant ends March 31, 2010
• The AAAs are committed to continuing services to
  existing NHD participants
• If continued funding becomes available, VDA will
  advise interested parties

21
Virginia Department for the Aging
Contact VDA 804-662-9333 Toll Free
800-552-3402 Kathy Miller Peggy
Nieder kathy.miller_at_vda.virginia.gov
peggy.nieder_at_vda.virginia.gov