rewards and challenges of oklahoma medicaid assisted living feb 2010

REWARDS AND

CHALLENGES OF

PROVIDING MEDICAID

ASSISTED LIVING IN OK

OKAHSA

March 2010

Presented By Joyce Clark

405.812.9089

ADvantage PROGRAM

1915(c) Home & Community Based Medicaid Waiver that Serves Medicaid Eligible Persons Who Meet NF Level of Care.

Resident must also meet other qualification criteria to be eligible for assisted living services.

ADvantage ASSISTED LIVING

Assisted Living Providers Must Be OSDH Licensed.

And Then

Assisted Living Providers Must Be ADvantage Program Certified by OKDHS.

REWARDS

Much easier for Medicaid

certified nursing home to

implement than private pay

assisted living community.

REWARDS

Intrinsic

New service option that

promotes independence,

avoids early institution, and

slows health decline.

Expands continuum of care.

REWARDS

Enlarges target market.

Diversifies resident and

revenue base.

Increases opportunity to

maintain 100% occupancy.

REWARDS

Assists with supplements

and supplies.

Independent case

management.

CHALLENGES

Industry and community wide lack

of awareness & understanding.

Bureaucracy.

Increases staff cost and operation

expenses – especially for private

pay assisted living provider.

CHALLENGES

No reimbursement when resident is

out of building (hospital, travel, rehab).

No pending or retroactive

reimbursements.

Tier of Care is determined by OKDHS

prior to IDT. Necessary modifications

can be time consuming process that

delays resident from move-in.

CHALLENGES

Additional regulations and

survey.

Threats of funding cuts.

Interagency differences.

Physical plant requirements.

Qualification process.

FYI…

OKDHS & OSDH Partnership

Physical Requirements

Lockable Doors

Private Rooms

Private Bathroom

Kitchenette

Minimum Square Footage:

Built Prior to 1/1/08 = 250 sq. ft.

Built After 1/1/08 = 360 sq. ft.

ROOM & BOARD PAYMENT

The member is responsible forroom and board costs. TheADvantage Assisted LivingServices provider is allowed tocharge a maximum for room andboard that is no more than 90%of the SSI Federal Benefit Rate(Currently $606.60).

REIMBURSEMENT RATE

Three tiered based on eachconsumer’s assessed need viaindependent UCAT assessmentnot associated with the AL butbased on ADL-IADL need.

Does Not Pay For Room and Board.

PER DIEM RATE STRUCTURE

Standard = $42.24(estimated 20% ADv AL consumers)

Intermediate = $57.00(estimated 50% ADv AL consumers)

High = $79.73(estimated 30% ADv AL consumers)

DEFINITION OF ADvantage

ASSISTED LIVING

Assisted living services are personal care & supportive services furnished in a homelike, non-institutional setting including 24-hour on-site response capability to meet needs & provide supervision, safety and security.

SERVICES TO MEET CONSUMERS

NEEDS MAY INCLUDE:

Personal Care

Housekeeping

Laundry

Meal Preparation

SERVICES TO MEET CONSUMERS

NEEDS MAY INCLUDE:

Nursing Evaluations and Supervision.

Nursing Care.

Medication Administration.

Assist with Transfer or Ambulation.

THANK YOU!

•DEVELOPMENT

•PROJECT MANAGEMENT

•FEASIBILITY ANALYSIS

•MARKETING & MANAGEMENT

Achievis Services Include:

Joyce Clark

(405) 812-9089

achievis@cox.net