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Rewards and Challenges of Oklahoma Medicaid Assisted Living feb 2010

Joyce Clark
Joyce Clark

General info and review of challenges and rewards to offering Medicaid assisted living in Oklahoma. This is a new program that began in 2010 in Oklahoma.

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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 consumers 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 consumers 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