Download Agency for Health Care Administration Assisted Living Facilities

Agency for Health Care Administration
Assisted Living Facilities
September 23, 2011
State & Local Government
Roles & Responsibilities
 Agency for Health Care Administration
 Licensure and Regulation
 Medicaid – Assisted Care Services, Various Waivers
 Department of Children and Families
 Adult Protective Services
 Mental Health Clients in ALFs
 Specific Medicaid Waiver
 Agency for Persons with Disabilities
 Developmentally Disabled Clients in ALFs
 Attorney General
 Medicaid Fraud Control
 Patient Abuse, Neglect and Exploitation (PANE)
 Operation Spot Check
 Health Department
 Health & Sanitation Inspections
State & Local Government
Roles & Responsibilities
 Department of Elder Affairs
 Rule Development for Assisted Living, Adult Family Care
Home, Adult Day Care, Hospice
 Comprehensive Assessment and Review of Long-Term
Care Services (CARES)
 Long-Term Care Ombudsman Program
 Statewide Public Guardianship Office
 Assisted Living Trainer Certification
 Specific Medicaid Waivers
 Local Authorities (ALF)
 Fire Authority – Fire & Life Safety Approval
 Zoning / Building Code Approval &Enforcement
Assisted Living Growth
• 30% Increase in Assisted Living Facilities
(ALF)
• 2,272 2003
• 2,960 2011
• 80% Increase in ALFs with Limited Mental
Health
• 30% Increase in Indigent Beds (Optional State
Supplementation – OSS
• Over Half of ALF beds have Six or Fewer Beds
AHCA Inspections
• Re-Licensure Surveys - Every Two Years
• Monitor Visits
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Limited Nursing Services License - Twice/Year
Extended Congregate Care License - Quarterly
• Complaint Investigations
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Prioritize Allegations
Investigate Based on Severity
Priority One – Investigate in Two Days
All Investigated on Average in 27 Days
40% Find Deficiencies
Fee for Complaint Investigations with Deficiencies
Regulatory Oversight Revisions
• Statewide Complaint Training of Survey Staff
• Revised ALF Inspection Process
• Focus on Consistency
Revised Assisted Living Survey
• Enhanced Focus on Residents
• Concentration on Interviews, Observations, and Record
Review
• Improve Consistency/ Revised Regulation (Tags)
• Abbreviated Review as Authorized by Law
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Two Survey Periods (Four Years)
Consistent Ownership
Survey History
Licensure Complaint History
Ombudsman Complaint History
• Largely Based on Wisconsin Model
Abbreviated Survey
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Focus on Resident and Family Feedback
Observations by the Surveyor
Record Reviews Based on Observations and Interviews
Concerns Identified Result in Expanded Sample
Selection up to Standard Survey
Regulatory Violations / Deficiencies
• Class I – Immediate danger or substantial probability
that death or serious physician or emotional harm would
result. Fine $5,000 to $10,000.
• Class II – Directly threaten the physical or emotional
health, safety, or security of clients. Fine $1,000 to
$5,000.
• Class III – Indirectly or potentially threaten physical or
emotional health, safety or security of clients. Fine
• Class IV – related to maintenance of provider or required
reports, forms, or documents that do not negatively
affect clients
Regulatory Sanctions
• Emergency Actions – Limited to Serious Ongoing Issues
(Imposed Before Due Process)
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Moratorium
Suspension
• Sanctions for Violations
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Fines / Conditional Licenses
Denial of License Renewal or Initial Application
Revocation of License
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Closure During Litigation
• Due Process for Sanctions
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Opportunity to Challenge
Agency Has Clear and Convincing Burden of Proof
Actions Pend During Litigation
Imposed by Final Order
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May Also Be Challenged
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Court Can Enjoin Agency Imposition
Consumer Information and Outreach
• Florida Health Finder
• Consumer Awareness Brochures
• Outreach to Partners and Providers
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Regulators
Managed Care Plans
Health Care Providers
Outreach Activities
• Interagency Staffing Meetings
• Joint Training Activities Include Other Departments
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Provider Training
Staff Training
• Access to Systems and Data Used by Partners
• Joint Visits With Partner Agencies
Medicaid Reimbursements in Assisted
Living Facilities
Presented by
Darcy Abbott
AHC Administrator
Bureau of Medicaid Services
September 23, 2011
Assistive Care Services
•Medicaid state plan service provided in assisted living
facilities (ALF), adult family-care homes (AFCH), and
residential treatment facilities (RTF)
•Population – Age 18+
•Eligibility – Services medically necessary as determined by a
physician or licensed health practitioner; require two of the
four service components of Assistive Care Services; and
reside in a Medicaid enrolled ALF, RTF, or AFCH
•Service Area – Statewide
•FY 2010-2011 enrollment – 12,130
•FY 2010-2011 expenditures – $27,240,926
•Medicaid maintains the administrative rule for this state plan
program.
Assistive Care Services
•Assistive Care services include:
assistance with activities of daily living,
assistance with instrumental activities of daily living, and
assistance with self administration of medications.
•Medicaid reimburses enrolled providers $9.28 per day for
assistive care services provided to Medicaid eligible
recipients.
Assisted Living Waiver
• Population – Age 60+
• Eligibility – Medicaid Institutional Care Program, and meet
additional clinical impairment criteria
• Services – case management, assisted living, and incontinence
supplies
• Service Area – Statewide
• FY 2010-2011 enrollment – 3,941
• FY 2010-2011 expenditures – $30,039,071
• Managed by the Department of Elder Affairs in cooperation with
the Agency for Health Care Administration
Assisted Living Waiver Reimbursement
• The waiver reimburses for assisted living services and if
necessary, incontinence supplies.
• Medicaid reimburses up to $32.20 per day for the assisted
living facility (ALF) assisted services provided to waiver
residents.
• Medicaid also reimburses for Incontinence supplies up to
$125.00 per month.
• Room and board costs detailed in the ALF resident contract are
paid by the resident.
Nursing Home Diversion Waiver
• Population – Age 65+
• Eligibility – Medicaid Institutional Care Program, Medicare parts
A & B, and meet additional clinical impairment criteria
• Services – Case management, and 20 other home and
community-based services including assisted living services,
11 acute care services, Medicare co-payments and coinsurance, and unlimited nursing facility care in enrolled
facilities
• Service Area – 41 counties
• 17 managed care plans provide services
• FY 2010-2011 enrollment – 23,158
• FY 2010-2011 expenditures – $312,771,163
• Managed by the Department of Elder Affairs in cooperation with
the Agency for Health Care Administration
Nursing Home Diversion Reimbursements in ALFs
• The Nursing Home Diversion waiver serves eligible aged adults
who can be safely served in standard licensed assisted Living
facilities (ALFs).
• Assisting Living services under this waiver include personal
care, homemaker, escort, medication administration, adult
companion, and other medically necessary long term cares
services
• Plan members select ALFs available in each Nursing Home
Division provider’s network.
• ALFs negotiate daily or monthly rates for services provided in
the facility with each Nursing Home Diversion plan.
• Room and board costs detailed in the ALF resident contract are
paid by the resident.
Questions ??