Long haul Care The Texas Experience: Overview San Diego County LTCIP Planning Committee October 26, 2001 Cindy Adams
Slide 2What is STAR? An oversaw mind conveyance framework Objectives: Emphasize early intercession Promote enhanced access to quality care Improve wellbeing results for the focused on populace, with a unique concentrate on pre-birth and well youngster mind Targeted Members: Individuals accepting Temporary Assistance to Needy Families (TANF) and TANF related advantages
Slide 3What is STAR+PLUS? An oversaw administer to the SSI and SSI-related populace Dually qualified individuals selected for LTC benefits just Build on the STAR Program
Slide 4Why STAR+PLUS? SCR 55: Requires a cost-impartial long haul mind coordinated model New difficulties: Increasing expense of long haul mind More individuals with constant conditions Fragmented conveyance: Acute and long haul mind
Slide 5STAR+PLUS - 1915 (b) and (c) 1915 (b) - Waives flexibility of decision to permit mandatory investment 1915 (c) - Allows extra administrations for 1915 (c) waiver eligibles Encourages HMOs to include waiver benefits as esteem included administrations Provides more choices
Slide 6STAR+PLUS Objectives Integrate intense and long haul mind into oversaw mind framework Provide the appropriate sum and sort of administration to help individuals remain as autonomous as conceivable Serve individuals in the most group based setting reliable with their own security Improve get to and nature of administer to mind Improve results of care Control costs
Slide 7Harris Choices: Required STAR+PLUS Groups Medicaid just customers Choice of HMOs If customer does not pick, default to HMO - Both intense and long haul mind
Slide 8Harris Choices: Required STAR+PLUS Groups Dual Eligible (Medicare/Medicaid) Choice of STAR+PLUS HMOs If customer does not pick, default to HMO STAR+PLUS HMO is in charge of long haul mind administrations. Customer may pick HMO or conventional Medicare for intense care
Slide 9People Not in STAR+PLUS Excluded Clients inhabitants of Intermediate Care Facilities for the Mentally Retarded (ICF/MR) Clients not qualified for full Medicaid benefits Undocumented outsiders Children in state child care Nursing office occupants In nursing office when turned out to be qualified 120 days after admission to nursing office (selected STAR+PLUS individuals)
Slide 10STAR+PLUS Plans Competitive acquisition prepare for HMOs HMO Blue Amerigroup Texas Health Network (PCCM)
Slide 11STAR+PLUS Enrollment 10/1/01 56,569 Total 27,357 Dual Eligibles 29,171 Medicaid Only
Slide 12Harris County Estimated STAR+PLUS Clients FY'01
Slide 13STAR+PLUS Services Primary, preventive and intense care (specialist, doctor's facility, lab, x-beam) (Medicaid just) Mental wellbeing and substance manhandle administrations (Medicaid just) Personal care administrations Adult day wellbeing administrations Nursing office administrations Care coordination Waiver administrations (treatment, rest, grown-up child care, helped living, versatile gear, in-home adjustments) Value-included administrations (grown-up dental administrations, waiver administrations for non-waiver customers)
Slide 14Behavioral Health Services Screening, conclusion, treatment Hospital inpatient - MH/SA Licensed Master's Social Worker (LMSW - AP) Licensed Professional Counselor (LPC) Psychology Psychiatry Hospital Inpatient (under 21 years old) Value-included administrations
Slide 15HMO Blue STAR+PLUS Value Added Services without toll medicinal help line 24 hours a day, 7 days seven days Dental watch over grown-ups More decisions in eyeglass outlines Extra administrations if endorsed and therapeutically essential: Home conveyed suppers Medical hardware Assisted living/child care Emergency ready frameworks Relief for your parental figure Home/people group based administrations (non-crisis transportation when no other source is accessible)
Slide 16Care Coordination HMO required to contact individuals inside 30 days of enlistment HMO makes home visit and surveys individuals needs, as fitting HMO allots a care organizer (or coordination group), as proper
Slide 17Care Coordinator Member Family or Representative PCP Care Coordination Model Who RN or authorized Master's level social laborer (with particular social and phonetic ability) Responsibilities Coordinator, facilitator, examiner, contact, advocate, engaged to approve administrations Leads group of specialist organizations Close cooperation with restorative suppliers, patient, and family Knowledge of TPL/Medicaid/Medicare assets Summary: Care Coordinators are the way to building up a complete, individualized Plan of Care to serve the part at all prohibitive condition, with the most quality situated, practical care/administrations.
Slide 18Level I (Routine) Major Functions Telephonic care coordination Member training ICP (singular care arrange) with here and now needs Respite mind, 1x just DME administrations, and so on. Month to month part moves Assignment Criteria New enlistment of Non-CBA, DAHS (Day Activity and Health Services) or NF individuals No LTC administrations Assignment by districts Stable populace with roundabout support and occasional appraisal
Slide 19Level II (Moderate) Major capacities Team based approach/partners doled out to care facilitator Combination of field and telephonic care coordination Telephonic help from care organizer partners ICPs/objectives Member training CBA overhaul (if fitting) Assignment criteria HHN = < 1 visit for every month PAS = beneath 120 units for every month DAHS part ER/doctor's facility = < 1 in 6 months Ongoing medicinal supplies Basic LTC sort administrations
Slide 20Level III (Intense) Major capacities Team based approach/partners alloted to care organizer Combination of field and telephonic care coordination Telephonic help from care facilitator partners ICPs/objectives and results Member instruction MDS NF/HC (which ever suitable) Assignment criteria CBA or NF part Ventilator or dialysis subordinate HHN > 1 visit for each month PAS > 120 units for each month ER/clinic > 2 visits in 6 months
Slide 21Most Restrictive Least Restrictive Specialty Unit inside a nursing office Skilled Nursing Facility Adult Care Home Adult Foster Care Home Personal Care Home Assisted Living/Residential Care DAHS Home or Apartment Full Continuum of Placement Options for Those Individuals Requiring Long Term Care
Slide 22STAR+PLUS Quality change arrange (from HMOs) State contractual worker - Texas Health Quality Alliance Consumer studies and customer center gatherings Provider fulfillment review Focused reviews Access to mind Targeted examines on care coordination and behavioral human services Utilization administration
Slide 23Evaluation Criteria Consumer fulfillment Integration of care Access to care Quality of care Emphasis of group construct mind Impact in light of spending Impact on suppliers
Slide 24Consumer Satisfaction 60% of shoppers experience no issue getting the care they require, when they require it 52% of buyers get the care they require without long holds up 65% of buyers demonstrate their specialist discusses well with them 71% feel office therapeutic staff treats them with affability, regard, and supportiveness 56% experience no issue getting extraordinary restorative hardware 65% of purchasers experience no issue getting all the home social insurance required
Slide 25Challenges Enrollment Medicaid populace LTC suppliers move Computer frameworks Dual eligibles
Slide 26Opportunities Early mediation Disease administration Care coordination Home visits Integration of care Flexibility in administration conveyance
SPONSORS
Sea Overview 
Employing so as to improve Client Experience Aggregate Knowledge
Thorough Waiver Application Overview 
Pro Homeless and Primary Care Perspective 
Destroying the Cradle to Prison Pipeline in Houston and Texas 
Developing Unaffordability of Health Care: Incremental versus Genuine Health Care Reform 
Trns port Preconstruction Production Experience 
Modern strategy and rivalry: The Italian experience