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The Role of Aging Service Technologies in LTC Reform: Early Medicaid Initiatives. Majd Alwan, Ph.D., Director Center for Aging Services Technologies (CAST) Medicaid Congress June 6, 2008. What is CAST?. Government Agencies. Providers of Aging Services. University Researchers.

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The role of aging service technologies in ltc reform early medicaid initiatives

The Role of Aging Service Technologies in LTC Reform:Early Medicaid Initiatives

Majd Alwan, Ph.D., DirectorCenter for Aging Services Technologies (CAST)Medicaid CongressJune 6, 2008

What is cast
What is CAST?



Providers ofAging Services



Tech Industry




A national coalition of more than 400 organizations working together to improve the aging experience through technology

Why we re here
Why We’re Here

  • CAST Mission

  • Help older adultsmaximizetheirindependence

  • Supportprofessional and familycaregivers’needs

  • Improvequalityof care and quality of life

  • Reduceour nation’s health carecosts

  • Increaseaging services providers’efficiency

Shift left through technology


Healthy, Independent Living


Community Clinic

Chronic Disease Management

Doctor’s Office



Assisted Living


Specialty Clinic

Skilled Nursing Facility

Community Hospital









“Shift Left” through Technology

Categories of aging services technologies
Categories of Aging Services Technologies

Safety in the Environment

Physical & Mental Health/ Wellbeing

Social Connectedness to others

EHRs & Point of Care/ Point of Service

Cost effectiveness proof

Three-month study on the impact of

monitoring technology on care

Billable interventions

Hospital days

75% cost savings

Cost-Effectiveness Proof

Transferred more time away from paperwork

and towards direct care and reduced workloads.

New york state medicaid home telehealth
New York State Medicaid Home Telehealth

New York State Enacts Medicaid Reimbursement for Home Telehealth in 2007[Senate Bill S.2108-C, Chapter 58 of the Laws of New York (budget bill)]

  • State 18-month new Medicaid Waiver pilot that will evaluate cost effectiveness and assess permanent rate

  • The bill is a result of collaborative effort between Visiting Nurse Services of NY (VNSNY) the NY Home Care Association, and the NY legislature and executive branch

  • Only providers who have existing telehealth programs are eligible to participate.

New york state medicaid home telehealth1
New York State Medicaid Home Telehealth

3-Tier Monthly Reimbursement (rates set by DOH on 2/1/08)

  • Tier 1: $270/month/patient – FDA approved Class 2 Device Capable of interoperability with Point of Care (POC) Software

  • Tier 2: $310/month/patient - Interconnected with POC software

  • Tier 3: (rate to be developed) - Interconnected with EMR and statewide health information network

  • Installation Fee: Providers can bill for a "one time" installation fee of $50 for each Telehealth user.

New york state medicaid home telehealth2
New York State Medicaid Home Telehealth

Precursors to Reform:

  • Several home health agencies throughout NYS, including VNSNY, had begun to pilot Telehealth

    • Funded mostly through private grants or self-funded

    • Facilitated by NYS Telehealth grants that had been offered to HHAs since 2003

  • Visiting Nurse Services of NY (VNSNY) ran a 500 patient pilot that demonstrated reduced hospitalization and ER visits and shared the results with the State

  • VNSNY shared with the State its Telehealth Evaluation tool for Risk & Placement Criteria which help identify those patients who would benefit most from Telehealth in the home.

  • New york state medicaid home telehealth3
    New York State Medicaid Home Telehealth

    The rates cover:

    • Monitoring patient vital signs

    • Patient education

    • Medication management

    • Equipment maintenance

    • Review of patient trends and/or changes in patient condition and identifying changes necessitating intervention.

    New york state medicaid home telehealth4
    New York State Medicaid Home Telehealth

    Patient criteria for the program:

    • Patients who have conditions or clinical circumstances which require frequent monitoring; and

    • Patients for whom Telehealth can appropriately reduce the need for an unscheduled nursing visits, in-office visit or acute or LTC facility admission (regulatory definitions to be resolved).

    • Not limited to patients with specific diagnoses; specific conditions are listed as examples of targeted patients, these include: CHF, COPD, wound care, polypharmacy, mental/behavioral problems, technology-dependent care etc.

    California initiatives in medicaid waiver programs
    California Initiatives in Medicaid Waiver Programs

    I. Electronic Care Assessment & Management: web-based, with medication tracking

    II. Virtual Multi-Disciplinary Care Team (“Virtual MDT”):

    • Riverside County Office on Aging partnering with other local government partners including the Community Health Agency, Dept. of Mental Health and Dept. of Public Social Services (adult protective services)

    • Population is isolated older adults (including Medicaid enrollees) with multiple and complex health and social issues, as well as victims of elder abuse & neglect

    • Video-conferencing technology in clients’ homes, satellite office or congregate setting that is convenient for the older adult enable senior to participate in the MDT meeting and promote more frequent use of MDTs

    • The technology respects the social dynamic of presence more than phone conferencing and email

    Pennsylvania initiatives in medicaid waiver programs
    Pennsylvania Initiatives in Medicaid Waiver Programs

    Medicaid 60+ “PDA Waiver” Reimbursement

    for Home Telehealth & Telemonitoring

    • Reimbursements began Sept. 1, 2007

    • Covers range of telecare services provided by home health, DME providers, pharmacies or hospitals via AAA contract for specified older adults:

      • Health Status Measuring & Monitoring: $10/day

      • Activity & Sensor Monitoring: $200/install $79.95/mo.

      • Medication Dispensing & Monitoring: $50/mo.

      • Personal Emergency Response Systems: $30/mo.

    • New Medicaid aging waiver to begin July 2008, with telecare language pending CMS approval

    Pennsylvania initiatives in medicaid waiver programs1
    Pennsylvania Initiatives in Medicaid Waiver Programs

    Medicaid 60+ “PDA Waiver” Reimbursement

    for Home Telehealth & Telemonitoring


    • Medical need for the services (Dr.’s order) and evidence that services are not covered under Medicare, State Plan or other third party resources

    • Participants must:

      • Meet nursing facility clinically eligible (NFCE) determination

      • Meet at least three of the following needs criteria:

        • Three (3) or more hospitalizations in the past year

        • Frequent, recurrent, repeated or regular use of the emergency room

        • Poor adherence with physician orders or medications

        • Formal or informal support systems are limited or absent

        • Documented history of falls within the last six months that resulted in an injury that required medical or emergent care

        • Lives alone or is at home alone for extended periods of time or care access challenges (for example, RN shortage, rural access issues, etc.)

      • Be cognitively able to operate equipment if needed or have caregiver

      • Be in a residence that allow the use of the technology

    Pennsylvania initiatives in medicaid waiver programs2
    Pennsylvania Initiatives in Medicaid Waiver Programs

    Virtual Care Management Pilot

    • PA Department of Aging and rural AAA covering a four county area through Medicaid Waiver program planning to pilot “Virtual care management” to older adults at senior centers/ affordable senior housing communities (co-located) using high-quality hands free video conferencing technology

    • One care manager can serve older adults in several locations, and/or triage to specialized provider via video conference (mental and behavioral health, legal aid)

    • Provides capacity for “walk-in” AAA services at senior centers and increased utilization of center programs

    • HUD Neighborhood Networks funding available for video-conference technology installation costs and monthly fee at affordable senior housing communities

    Opportunities to utilize ast s in medicaid ltc
    Opportunities to Utilize AST’s in Medicaid LTC

    • Existing State LTC Reform Efforts

      • 5-year CMS “Money Follows the Person” ($FP) Grants to 30 states and D.C. are demonstrating how to support persons who transition from SNF to home setting with LTC services & supports

      • Aging Service Technologies have great potential to be important tools for states to use to achieve $FP goals

      • Connecticut, Delaware, Georgia, Iowa, Kentucky, Nebraska, New Hampshire, New York, North Dakota, Oregon, Pennsylvania, Virginia, and Washington identified technology in their menu of services to demonstrate with this population

    • HCBS Medicaid Waiver (AAAs)

      • Pilot use of technology to serve existing HCBS waiver population like in PA

      • Important to be able to demonstrate cost savings to meet cost neutrality rules

    • Pursue dedicated Medicaid Reimbursement for Telehealth/ Aging Services Technologies

    • Pilots and objective evaluation data are key to reform.



    Majd Alwan, Ph.D.

    Director, CAST

    (202) 508-9463