Missouri’s LOC Transformaon Final Stakeholder Meeng · Overarching Goal : Create a new Level of...

Missouri’sLOCTransforma1onFinalStakeholderMee1ng

November27,2018

1.  Refreshmemoryofjourneythusfar2.  Sharefeedbackresultscollectedfromstakeholdergroups3.  Offerrevisedmodeloftheframework4.  OutlinenextstepsincludingopportuniCesforinput

Session’sAgenda

OverarchingGoal:CreateanewLevelofCare(LOC)modelthat:

1.  EnsureaccesstocareformostinneedofHCBSprovidingleastrestric1vecommunityseMngaslongassafelypossible

2.  UselimitedstateresourcesonthosemostinneedofHCBScomparedtomorecostlyfacilityplacement.

3.  EnsureindividualsabletoliveinthecommunityarenotinappropriatelyplacedinamorerestricCveseMng.

BeginWithTheEndInMind

• NosubstanCveupdatessince1982• Inherentproblemswithcurrentmodel

• Exacerbatedwhenmovedfrom21to24points• Missouri’sagingdemographic• StateAuditor’sOfficerecommendaCon

WhyNow?

• RobertWoodJohnsonfundingthroughPrincetonUniversity’sStateHealth&ValueStrategies

• FundedtoperformfollowingacCviCes:1.  NaConallandscapescan

• Deeperdivesintospecificstatesofinterest2.  Stakeholderengagement3.  Co-createthenewmodel4.  SummarizekeylearningsandbestpracCces

TechnicalAssistance(TA)Grant

1982

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

1982 2001

1stSignificantChangetoLOCMovefrom18to21points

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

1982 2001

2017

1stSignificantChangetoLOCMovefrom18to21points

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

2ndSignificantChangetoLOC–Movefrom21to24

points

AwardedRobertWoodJohnsonFounda1onGrant

1982 2001

2017

1stSignificantChangetoLOCMovefrom18to21points

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

2ndSignificantChangetoLOC–Movefrom21to24

points

AwardedRobertWoodJohnsonFounda1onGrant

JanuarytoJuneResearchandDiscovery

JulytoDecember

StakeholderEngagementandModelForma1on

2018

June25,2018• 161HCBSProviders,52SNFProviders,and78Staff

July13,2018

• 197HCBSProviders,88SNFProviders,and84Staff

November27,2018• 298HCBSProviders,111SNFProviders,and94Staff

StakeholderEngagementSessions

•!fNJ3gR<O)h)W($/)0(?/7?/9)15+.0)0($)6.&&$/0)G<F)6&?0$&?1)1/4):&+6$''b)@(10)1&$)0($)0(&$$)0+)^>$)*+'0)'?9/?^61/0)6(188$/9$')+&)?''.$')$B:$&?$/6$4)5,)0($):+:.81C+/'),+.)'$&>$i))•!W&?0$)+/$)?4$1):$&)/+0$61&4)

•!O+)8$'')0(1/);)61&4')•!O+)*+&$)0(1/)a)61&4')•!Y8$1'$)@&?0$)8$9?58,)

U%.7(>W(!771.:(X":83":85#(

• NaConallandscapefindings• LOCeligibilitycriteria• FuncConalassessmenttoolsused• Assessor/Determinatorsofservicesandsupports• Scoringsystems

June25Mee1ngHighlights

U%.7(>W(!771.:(X":83":85#(

R%),+.)6+.84)@?998$),+.&)/+'$)1/4)*17$)?0)*19?6188,)(1::$/b)@(10)6(1/9$')@+.84),+.)8?7$)0+)'$$)?*:8$*$/0$4)?/)0($)G<F):&+6$'')?/)S?''+.&?i)

U%3F(BY(!771.:(X":83":85#(

•!#$:+&0$4)+/):&+6$'')1/4)%&1*$@+&7)%$$45167)•!3(1&$4)^&'0)4&1k)+%)/$@)G<F)6&?0$&?1)

•!\?>$)4++&@1,')l):+?/0')

(V$$&L-F(BZ(2&-"3(J397&3F((

V7S."1$.E)R/4?>?4.18')19$)Qc)1/4)+>$&)@?0()1)4$6&$1'$4)15?8?0,)%+&)?/4$:$/4$/0)8?>?/9)4.$)0+)6(&+/?6)($180():&+58$*'b):(,'?618)8?*?01C+/'b)1/4j+&)?*:1?&$4)*$/018)15?8?C$'"))+&"57&"-(J3":"="3"5F(

•! U]GT')HU6C>?0,)+%)]1?8,)G?>?/9I)$"9")L10(?/9b)S+5?8?0,b)g&1/'%$&'b)]&$''?/9b)D&++*?/9b)g+?8$C/9b)J1C/9)

•! RU]G')HR/'0&.*$/018)U6C>?C$')+%)]1?8,)G?>?/9I_S$18):&$:)

•! 31%$0,_U]G')?*:16C/9)($180(b)\188)&?'7)H510(?/9b)0&1/'%$&'I)

((V$$&L-F(>Z([8F#"E-3()"0"5-1$.#((( V7S."1$.E)U/)?/4?>?4.18)@?0()1):(,'?618)8?*?01C+/b)

*$4?618)4?19/+'?'b)1/4j+&)6(&+/?6)6+/4?C+/)0(10)8$14')0+)0($)/$$4)%+&):(,'?618)(1/4'_+/)61&$"))+&"57&"-)J3":"="3"5F(

•! U]G'_L10(?/9b)S+5?8?0,b)g&1/'%$&'b)]&$''?/9b)D&++*?/9b)g+?8$C/9b)J1C/9)

•! RU]G'_S$18):&$:)•! 31%$0,_U]G')?*:16C/9)($180(b)\188)&?'7)H510(?/9b)0&1/'%$&'I)

((V$$&L-F(YZ(V707.1-((( V7S."1$.E)Y&+%$''?+/18)]$*$/C1)]?19/+'?')

&$m.?&$4")))+&"57&"-)J3":"="3"5F(•!U]G'_J1C/9b)S+5?8?0,b)]&$''?/9b)D&++*?/9b)L10(?/9b)g+?8$C/9)

•! RU]G')

((V$$&L-F(TZ(!7.5-33F(K33((( V7S."1$.E)Y&+%$''?+/18)S$/018)K$180()

]?19/+'?')&$m.?&$4")))+&"57&"-)J3":"="3"5F(

•! RU]G'_3$8%)61&$)•! 31%$0,_W1/4$&?/9jJB?0)'$$7?/9b)L$(1>?+&18b)\188)&?'7)

((V$$&L-F(WZ(K\VV(NK.57337E5%-3($&(V7<73$G07.5-3(V"#-="3"5FO($&(DHK(ND9%35(H&-".(K.]%&FO((( V7S."1$.E)Y&+%$''?+/18)]?19/+'?')+%)Rj]]b)

U6m.?&$4)L&1?/)R/-.&,)+&)g&1.*1C6)L&1?/)R/-.&,)1')4$^/$4)?/)#3S<_!P2"e;a"))+&"57&"-)J3":"="3"5F(

•! RU]G'_3$8%)61&$)•! 31%$0,_W1/4$&?/9jJB?0)'$$7?/9b)L$(1>?+&18b)\188)&?'7)

((()

U%3F(BY(!771.:(DE1<"17#(

Y816$4)4+0')5,).:)0+)'?B)?0$*')@(?6()'(+.84)'01,)0($)'1*$)?/)0($)^/18)%&1*$@+&7))

Y816$4).:)0+)0(&$$):+'0_?0)/+0$')@?0()?4$1')%+&)?*:&+>$*$/0)H144?C+/'b)4$8$C+/'b)6(1/9$'I))

<=$&$4)'.99$'C+/')%+&)'6+&?/9)1/4):&+>?4$4)*+&$)?/%+&*1C+/)?/)+/8?/$)'.&>$,)

FrailElderlyDoorwayFeedback

Staff

HCBS

SNFs

Definition Changeage,couldbetieredage:65-70,70-79,80andup;maybestartatage75,startatage70sincemanyareinpoorhealth,startatage65,noagelimitbecausediscriminatory

� � �

Addshort-termrehabdoor �Indicators AddADLsincludingpersonalcare,supervision,transfers � �

AddIADLsincludinggroceryshopping,laundry,medprep,medmanagement,moneymanagement,schedulingmedicalappointments,lighthousework,usingphonetoaccomplishtasks,usingphoneapps,personalhygiene,householdchores,billpaying,othershoppingtasks,guardian,carrying10lbs.,readinglabels,andtransportation

�

�

�

�

AddtoSafety:A/N/E,memory,livingconditions � �

AddMedication:specificallyavailabilityandadministration �

PhysicalLimita1onDoorwayFeedback

Staff

HCBS

SNFs

Definition Addtowording:HIV,endstagedisease,kidney,liver,cancer �

Addtowording:morbidlyobeseanddiabetes;identifytimeframe

�

Addtowording:rehabandhospice;Howaccountforindividualswithlimb/muscleconstrictionoramputeewhonolongerneedclinical?

�

Indicators AddADLsincludingpersonalcare,grooming,bathing,dressing,allADLs � � �

AddIADLsincludingtransportation,mealprep,medicationprep,moneymanagement,householdchores,laundry,shopping(forMSorALSclients) �� �� �

AddtoSafety:A/N/E � � �

AddtoSafety:fallrisk,transfers �

AddtoClinical:catheters,ostomies,etc. �

Demen1aDoorwayFeedback

Staff

HCBS

SNFs

Definition Changewording:HIV/AIDScouldbeinthisdoorwayorwhatkindofdx?Specifically,Dementiawordonly?

�

Changewordingtoidentifytimeframe;isanMDaspecialist,notruetestDementia(indicatorsmaybepresentbeforediagnosis);Needtoaddressthatindicatorsmaycomefirst

�

�

Changewording:doesadiagnosisofunspecifieddementiaqualifyasprofessionaldementiadiagnosis?

�

Indicators AddtoSafety:fallrisk �

AddtoSafety:risktoothers �

AddtoSafety:livingconditions;addpromptingandstandbyassist �

MentallyIllDoorwayFeedback

Staff

HCBS

SNFs

Definition Changewording:Toosubjective;vettedbyDMH?

�

Indicators Defineself-careunderIADLs � �

AddADLs:All �

AddIADLs:includingmedprep,medmanagement,personalhygiene,mealprep,groceryshopping,lighthousekeeping,payingbills,moneymanagement,abilitytomaintainaresidence,householdchores,schedulingmedappointments.

� �

AddtoSafety:self-harm,suicide,poordecisions,medicationcompliance;AddCognitionforimpairment �

AddtoSafety:refusingcare,noncompliance � ��

AddtoBehavioral:medication � �

AddtoSafety:A/N/Eandlivingconditions � � �

I/DDorABIDoorwayFeedback

Staff

HCBS

SNFs

Definition Changethewording:Tooopenended;addagoalorientedaspectwithintenttoimprovecapacity;needtoincludetheentiredefinitionofstatutetoincludeSCI;identifyandexpandtimeframe;vettedwithDMH?

�

�

�

Indicators AddADLs:includingtoiletingandbathing � �

AddIADLs:includinggroceryshopping,laundry,housework,medmanagement,doctor'sappointments,transportation,essentialcommunicationwithothers,self-care

� �

Defineself-careunderIADLsanddefineBehavioral �

AddtoClinical:medicationmanagement,verbalskills �

AddCognitionandfamilysupport/dynamics �

WeLearnedFromYourValuableFeedback

KeyTakeawaysfromFeedback

• Certaintypesofpeopleeveryoneagreesneedshelp•  Easyentrydoorwayneededfortheseindividuals• PotenCalforexclusionofsomeparCcipants•  Technicallydifficultandexpensivetoimplementwithcurrentassessmentandweb-basedsystem

CommonSenseApproach

AskedourselvesfouressenCalquesCons:

Inthecurrentsystem,1. What’sworking?2. What’snotworking?3. What’smissing?4. Whatdidresearchsay?

• Mobility• ADLs• IADLs• RehabilitaCon

What’sWorking?

• NotMeasuringthe“Root”- Monitoring- RestoraCve- NumberofmedicaConstaken- Physicianordereddiet

What’sNotWorking?

• LookingatcogniCveandbehavioralseparately• Waytohelpthosethatobviouslyneedserviceseasilygetintosystem

What’sMissing?

• ADLsarewhattrulymaper–allstatesemphasizethis• ThosewithupdatedsystemsrecognizecogniCveandbehavioralseparately

• Blendedalgorithmmodelswithvariablepointvaluesmakesmostsense

• CerCfiedassessorswitheffecCvetrainingmapers• UClizeweb-basedsystemandworldrenownedassessmenttool

• UpdaCngmorethanevery30yearshelps

WhatDidResearchSay?

• NeedtheRIGHTpeopletocreateRIGHTsoluCon

• Needyou,too!

LOCDreamTeam

TransparencyinProcess

CategoriesofCriteria

CurrentCategory• Mobility

• Behavioral

•  Treatments

ProposedCategory• MovedtoADLcategory

• Behavioral(modified)

•  Treatments(modified)

CategoriesofCriteria

CurrentCategory• PersonalCare

• RehabilitaCon

• Dietary

ProposedCategory• AcCviCesofDailyLiving(new)

•  Dietary•  Bathing•  ToileCng•  Mobility

• RehabilitaCon

• MovedtoADLcategory

CategoriesofCriteria

CurrentCategory• MedicaCon

• RestoraCve

• Monitoring

ProposedCategory• ModifiedtomedicaConmanagementonly

• Removedcategory

• Removedcategory

TwoProposedNewCategoriesofCriteria

ProposedCategory

• CogniCon• Safety

• Category-specificquesConsinassessment• PointsbasedoneachquesCon• CommonsensetriggerquesCons- LatestagesofdemenCa,bedbound,quadriplegic

ScoringProcess

• Intenselyanddeliberatelytrainedassessors- LookatallinformaConconsistently- UsemulCplesourcesofinformaCon

• Clientresponse,healthrecords,providerinformaConandothersources

- EnsureauthenCcityofneeds

Administra1onofProcess

• Wanttostudyourownresidents• Thoseinthesystem• Thosenotinthesystem

• RightservicesfortherightpeopleattherightCmeintherightseMng

That’salottogetRight!

LookatActualMissourians

JanuarytoJuneResearchandDiscovery

JulytoDecember

StakeholderEngagementandModelForma1on

2019-2020

Phase1:FinalizeandTestAlgorithm

Phase2:

Predic1veBudge1ngModelandBudgetProcess

Phase3:

Implementa1onModifica1ons

CyberAccessChangesInterRAIHCChangesAssessorCer1fica1on

Transi1onPlansRegula1onChanges

WaiverAmendments(4)

2020

2018

1982 2001

2017

1stSignificantChangetoLOCMovefrom18to21points

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

2ndSignificantChangetoLOC–Movefrom

21to24points

AwardedRobertWoodJohnson

Founda1onGrant

JanuarytoJuneResearchandDiscovery

JulytoDecember

StakeholderEngagementandModelForma1on

ThreePhasesofDevelopmentandImplementa1on

2020

2018

HCBSEligibilityProcessChangesNeeded

• Personcenteredcareplans• RegionaldispariCes

• CerCfiedassessors• Mobileassessments• Servicedeliverypackage

YourHolidayGid

GidDelivery

• PM/VMannouncements• MHDandMMACblast• AssociaConreps• Allfeedbackwelcome!

Homework:DashAwayandDoCaseStudies

Homework:DashAwayandDoCaseStudies

• NewwebpagelinkedfromHCBSproviderpage

• InstrucConswillbegivenforfeedback• UnClMarch31,2019toprovidefeedbackandactualcasestudies