Pamela Mokler , Vice President, LTSS, Care 1 st Vicki Macedo, Program Specialist, HHSA AIS Mark Sellers, Asst. Deputy Director, HHSA AIS. Coordinated Care initiative quarterly stakeholder meeting July 10, 2014. Health & Human Services Agency Aging & Independence Services
Pamela Mokler, Vice President, LTSS, Care 1st
Vicki Macedo, Program Specialist, HHSA AIS
Mark Sellers, Asst. Deputy Director, HHSA AIS
Adult Protective Services/Senior Mental Health Team
In Home Supportive Services
Multipurpose Senior Services Program ( & “MSSP-Like”)
Long Term Care Ombudsman
Community Services – IG, CM, RSVP, Health Promotions
Community-Based Care Transitions ProgramAging & independence Services
AB 1040- CA Long Term Care Integration Pilot Project (LTCIP) –
Planning Committee formed 1999 with the following mission:
“Develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD).”
Began with 50 participants – now over 800 members strong:
Multiple Medical, Behavioral Health, Social Service Providers, Consumers, Caregivers and Advocates
Workgroup: recommendations about operations, access to services, outreach & education, etc. All 5 Health Plans, AIS IHSS Managers/Program Staff, Public Authority
Commitment: A single protocol
CCI Advisory Committee: review & approvalIHSS Coordination Guide Development
IHSS is a core service that is needed to keep members with ADL/IADL deficiencies living in the community
We need to make it easier for our members to transition from hospital to home with IHSS services, than it is to transition from a hospital to a SNF! – especially on a Friday evening! We need expedited IHSS assessments and extended hours.
All IHSS recipients’ needs are not the same! Programs need to be FLEXIBILE to meet changing needs of members/clients.Health plan perspective
Someone who has critical care
Someone who has critical care needs:
Other indicators for an expedited referral could include: days of receipt by the IHSS Social Worker. Health Plans will be contacted if there are problems that prevent or delay the process. Examples could include but are not limited to the following
If necessary the IHSS Social Worker may conduct a needs assessment in the hospital. Once the Member transitions home, the IHSS Social Worker must complete an in-home needs assessment within 10 business days from the date of discharge.
A Notice of Action (NOA) will be issued providing information on services and the number of hours authorized, or the reason for any denial of services
IHSS will inform the Health Plan of any ineligibility to IHSS services
The client has 90 days from the date of the Notice of Action to file an appealApproval/denial on expedited apps
AIS was willing to be flexible information on services and the number of hours authorized, or the reason for any denial of
AIS was willing to expedite referrals for Plan members transitioning from hospital or SNF to home
Agreement from all 5 Health Plans, Public Authority and AIS on a single, core protocol
Shared value for the consumer-driven foundation of the IHSS programHealth plan perspective: Important accomplishments
Partnerships information on services and the number of hours authorized, or the reason for any denial of /relationships are everything!!
Broad coordination is critical!
Training, re-training…and more training!
Slow beginning for IHSS – applications (standard and expedited) and CCT’s – Why?
Continuous efforts at delivering information and resources to consumers & IP’s
HICAP/Consumer Center for Health Education & Advocacy calls – steady, but settling, burst at start of the monthCCI Implementation Challenges & opportunities