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

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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
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What is CAST?
Government Agencies
Providers ofAging Services
University Researchers
Tech Industry Partners
Associations
CAST
A national coalition of more than 400
organizations working together to improve the
aging experience through technology
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Why Were Here

CAST Mission ? Help older adults maximize their
independence ? Support professional and family
caregivers needs ? Improve quality of care and
quality of life ? Reduce our nations health
care costs ? Increase aging services providers
efficiency
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Shift Left through Technology
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Categories of Aging Services Technologies

1. Safety in the Environment
2. Physical Mental Health/ Wellbeing
3. Social Connectedness to others
4. EHRs Point of Care/ Point of Service

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Cost-Effectiveness Proof
Transferred more time away from paperwork and
towards direct care and reduced workloads.
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New York State Medicaid Home Telehealth

• New York State Enacts Medicaid Reimbursement for
  Home Telehealth in 2007Senate 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.

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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.

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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.

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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.

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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.

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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

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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

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Pennsylvania Initiatives in Medicaid Waiver
Programs

• Medicaid 60 PDA Waiver Reimbursement
• for Home Telehealth Telemonitoring
• Requirements
• 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

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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

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Opportunities to Utilize ASTs 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.

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Questions?

• Majd Alwan, Ph.D.
• Director, CAST
• malwan_at_agingtech.org
• [phone]
• www.agingtech.org