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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
Assistswith supplements
 and supplies.
Independent
           case
 management.
CHALLENGES
 Industry
         and community wide lack
 of awareness & understanding.
 Bureaucracy.

 Increasesstaff 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.
 Tierof 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 for
room and board costs. The
ADvantage      Assisted   Living
Services provider is allowed to
charge a maximum for room and
board that is no more than 90%
of the SSI Federal Benefit Rate
(Currently $606.60).
REIMBURSEMENT RATE
 Three tiered based on each
 consumer’s assessed need via
 independent UCAT assessment
 not associated with the AL but
 based 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:
   NursingEvaluations and
   Supervision.
   Nursing   Care.
   Medication   Administration.
   Assist
        with Transfer or
   Ambulation.
THANK YOU!
Achievis Services Include:

•DEVELOPMENT
•PROJECT MANAGEMENT
•FEASIBILITY ANALYSIS
•MARKETING & MANAGEMENT
Joyce Clark
 (405) 812-9089
achievis@cox.net

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Rewards and Challenges of Oklahoma Medicaid Assisted Living feb 2010

  • 1. REWARDS AND CHALLENGES OF PROVIDING MEDICAID ASSISTED LIVING IN OK OKAHSA March 2010
  • 2. Presented By Joyce Clark 405.812.9089
  • 3. 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.
  • 4. ADvantage ASSISTED LIVING  Assisted Living Providers Must Be OSDH Licensed. And Then  Assisted Living Providers Must Be ADvantage Program Certified by OKDHS.
  • 5. REWARDS Much easier for Medicaid certified nursing home to implement than private pay assisted living community.
  • 6. REWARDS Intrinsic New service option that promotes independence, avoids early institution, and slows health decline. Expands continuum of care.
  • 7. REWARDS Enlarges target market. Diversifies resident and revenue base. Increases opportunity to maintain 100% occupancy.
  • 8. REWARDS Assistswith supplements and supplies. Independent case management.
  • 9. CHALLENGES  Industry and community wide lack of awareness & understanding.  Bureaucracy.  Increasesstaff cost and operation expenses – especially for private pay assisted living provider.
  • 10. CHALLENGES  No reimbursement when resident is out of building (hospital, travel, rehab).  No pending or retroactive reimbursements.  Tierof Care is determined by OKDHS prior to IDT. Necessary modifications can be time consuming process that delays resident from move-in.
  • 11. CHALLENGES  Additional regulations and survey.  Threats of funding cuts.  Interagency differences.  Physical plant requirements.  Qualification process.
  • 12. FYI…  OKDHS & OSDH Partnership  Physical Requirements Lockable Doors Private Rooms Private Bathroom
  • 13. Kitchenette Minimum Square Footage: Built Prior to 1/1/08 = 250 sq. ft. Built After 1/1/08 = 360 sq. ft.
  • 14. ROOM & BOARD PAYMENT The member is responsible for room and board costs. The ADvantage Assisted Living Services provider is allowed to charge a maximum for room and board that is no more than 90% of the SSI Federal Benefit Rate (Currently $606.60).
  • 15. REIMBURSEMENT RATE  Three tiered based on each consumer’s assessed need via independent UCAT assessment not associated with the AL but based on ADL-IADL need.  Does Not Pay For Room and Board.
  • 16. 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)
  • 17. 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.
  • 18. SERVICES TO MEET CONSUMERS NEEDS MAY INCLUDE: Personal Care Housekeeping Laundry Meal Preparation
  • 19. SERVICES TO MEET CONSUMERS NEEDS MAY INCLUDE:  NursingEvaluations and Supervision.  Nursing Care.  Medication Administration.  Assist with Transfer or Ambulation.
  • 21. Achievis Services Include: •DEVELOPMENT •PROJECT MANAGEMENT •FEASIBILITY ANALYSIS •MARKETING & MANAGEMENT
  • 22. Joyce Clark (405) 812-9089 achievis@cox.net