IAAAA Policy Position
on
Home and Community Based Services

The Area Agencies on Aging wholly support the Division of Aging’s landmark rule change that would rebalance the long term care system and bring people out of institutions who are able to function in the community.  This transformation also brings an opportunity to affect systemic change in home and community based services by directing resources and policy toward the elimination of barriers experienced by the aging network.

This change in rule can have tremendous impact on Indiana’s efforts to rebalance the long term care system.  Millions of dollars could be infused into home and community based services from what was previously designated for nursing home care.

As more individuals leave nursing homes to return to the community, there will be a growing need to support the home and community based services infrastructure.  Those who are returning home will need an advanced system of care that is responsive and prepared to meet their additional needs.  Individuals must return home with the necessary support to ensure their success.  Area Agencies on Aging propose the following adaptations to the current system:

Options Counseling – Options Counseling provides a responsive system that supports and empowers the consumer to consider all options for the provision of their long term care needs.  This service, though related to case management, specifically helps the consumer understand their long term care needs.  The Area Agencies on Aging recommend that the Division of Aging, in partnership with the Area Agencies on Aging, support and fully fund a robust Options Counseling Service

Presumed Eligibility - The ability to determine financial eligiblity for Medicaid services presumptively, as was recently provided for pregnant women (Provider Bulletin BT200910) in Indiana, would permit options counseling services to be billed to a Medicaid Waiver from the first day of service provision. This would remove the current barriers to quick access to Medicaid Waiver services.

Pre-Admission Screening – Pre-admission screening services uniquely assist professional and family care givers to quickly indentify those who no longer require a nursing home level of care and return home. 

• Current pre-admission screening support Options Counseling as a function under Pre-Admission Screening (PAS).  Fully integrating Options Counseling into the PAS process would enhance access to home and community based services for every person requesting nursing home admission.

• Consumers who are Medicaid recipients require the same effort as those who are deemed “private pay” and yet the reimbursement rate for Area Agencies is significantly diffierent.  Leveling the payment rate for private pay and Medicaid consumers or permitting the AAA’s to bill private pay clients for the difference in reimbursement would assist the Area Agencies on Aging in funding the PAS program.

• AAA’s support a change that would provide a more aggressive time frame for completion of pre-admission screening.  We believe that the more time a consumer spends in the nursing home, the more opportunity there is to build both an acceptance of the culture and reliance on perceived safety within that environment. 

Build the infrastructure – Those who are returning home from a nursing home are likely to require a higher level of services to transition home safely.  Consumers will be reliant on a network of providers who must highly priortize the provision of their care. 

• Under the current system, funding for Medicaid Waiver clients does not effectively compete with other funding sources.  With the savings realized by moving individuals from nursing homes back home and community based services, Medicaid Waiver rates could be increased.  Equalizing rates would level the playing field with reimbursement from other state funded services.

• Services provided under Medicaid Waiver might be expanded to ensure that the needs of higher risk clients are met.  The Division of Aging has made great improvements in equalizing Medicaid waiver care and Medicaid nursing home care. Applying for and receiving Medicaid in an institution, however, remains a much easier process than in the community. 

• An improved understanding of the Medicaid Waiver by the Division of Family Resources staff would assist consumers in accessing services.  Medicaid Waiver clients often struggle with lingering spend down issues due to problems with category changes.  Some individuals may continue to have a spend down for six months or more while the AAA waits for the appropriate category change.

Indiana's Area Agencies on Aging are ready and willing to make the changes needed to enhance the existing Home and Community Based Service System.  We recommend that a portion of the savings realized by the proposed nursing home payment structure be directed to support, strengthen and enhance the Home and Community Based Service System.

Last Update May 2010