[Northwest Senior Services Board]

ADVANCE MEETING MATERIALS

FEBRUARY 13, 2018

REGULAR MEETING

1:00 – 3:30PM SKAGIT PUBLISHING - COMMUNITY MEETING ROOM

1215 ANDERSON ROAD MOUNT VERNON, WA 98274

Northwest Regional Council 600 Lakeway Drive

Bellingham, WA 98225 360.676.6749

Map to

Skagit Publishing

1215 Anderson Road

Mount Vernon

5

Exit 225

Exit 225

Anderson Road

Skagit Publishing 1215 Anderson Rd

Cedardale Road

Anderson Road

Bellingham

Camano

Take exit 225 off I-5. At the end of the exit ramp, head east on Anderson Road. Skagit Publishing will be on your left, just past the Cedardale roundabout. If you get to Blodgett Road you have gone too far.

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Date: February 13, 2018

Time: 1:00pm – 3:30pm

Location: Skagit Publishing 1215 Anderson Road Mount Vernon, WA 98274 Community Meeting Room

Agenda Time Topic Pages Action

Required 1:00-1:05 Regular Meeting Call to Order

Barbara Pesola, Chair • Pledge of Allegiance• Introduction of Guests• Roll Call• Review of November Minutes• Announcements• Public Comments• Call for Expense Reimbursement

Forms

3-6 Motion

1:05-1:10 Mileage/Per Diem for 2018 Elizabeth Anderson

7-8 Information

1:10-1:15 Meeting Location Change and Certificate of Appreciation for Skagit Publishing Barbara Pesola, Chair

9-10 Motion

1:15-1:35 MAC/TSOA Update Caregiver Outreach Training Community Programs Staff

Handout Discussion

1:35-1:50 W4A Advocacy in Olympia Barbara, Georgiann, Shirley, Jodi, Alberta, Ryan, Elizabeth

11-18 Discussion

1:50-2:05 Legislative Session Update Dan Murphy

Handout Information

NORTHWEST SENIOR SERVICES BOARD

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2:05-2:25 Foundational Community Supports Ryan Blackwell

19-24 Information

2:25-2:35 Break

2:35-3:05 NWRC Agency Update Dan Murphy

• 2018 Budget• Office Move• Strategic Plan Update Approval• Behavioral Health Update

25-28 Discussion

3:05-3:15 State Council on Aging Update (SCOA) Georgiann Dustin

Verbal Information

3:15-3:30 Updates from Our Communities Members

Verbal Discussion

3:30 Adjourn Verbal Motion

Upcoming Northwest Senior Services Board Meetings and Events: March 7, 2018 Caregiver Outreach Training Mount Vernon* April 10, 2018 Regular Meeting Mount Vernon* June 12, 2018 Regular Meeting Mount Vernon* August 14, 2018 Regular Meeting Mount Vernon* October 9, 2018 Regular Meeting Mount Vernon* October 10-11, 2018 Fall Gathering and Conference Tacoma December 11, 2018 Regular Meeting Mount Vernon*

*NWRC Skagit Office- 301 Valley Mall Way Suite 100, Mount Vernon

Upcoming Northwest Regional Council Meetings: April 26, 2018 Governing Board Meeting Mount Vernon^ July 26, 2018 Governing Board Meeting Mount Vernon^ December 7, 2018 Governing Board Meeting Mount Vernon^

^Skagit County Commissioner’s Office- 1800 Continental Pl #100, Mt Vernon

Meetings are held in accessible facilities. For more complete information, please contact the NWRC at 360-676-6749 or 1-800-585-6749, 600 Lakeway Drive, Suite 100, Bellingham WA 98225.

Anyone needing special accommodations to participate in a meeting should contact the NWRC at least 48 hours in advance of the scheduled meeting.

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Northwest Senior Services Board Meeting Minutes November 1, 2017

Guests Present: Leah Wainman, North Sound Accountable Community of Health

Members Present: Anna Ankrum, Bill Bezanson, Carl Bender, Joan Fortune, Wendy Gilbert, Alberta Horn, Bob Monize, Ken O’Mhuan, Barb Pesola, Tasker Robinette

Members Absent: Georgiann Dustin, Jana Finkbonner, Shirley Forslof, Baozhen Luo, Jodi Sipes, Leslie Lawson

Staff Present: Elizabeth Anderson, Ryan Blackwell, Amy Charlot, Stacy Malone-Miller, Penny Morgan, Claudia Sampson-Blinder, Katie Stephens

Review of Minutes Motion was made by Bob Monize, Island County, and seconded by Tasker Robinette, Skagit County, that the minutes from the October 4, 2017 meeting be approved. The motion passed unanimously.

Announcements: There were no announcements

Public Comment: There was no public comment

Expense Reimbursement Forms: Collected

North Sound Accountable Community of Health (NSACH) Leah Wainman, Community Engagement Coordinator

Leah presented information about NSACH and the agency’s goals. The NSACH is a not-for-profit regional partnership working to improve the health of residents in Island, San Juan, Skagit, Snohomish, and Whatcom Counties. They are a partner within the statewide effort called Healthier Washington under the Washington State Health Care Authority fulfilling Initiative 1 of the Medicaid Transformation Demonstration. Each regional Accountable Community of Health brings together leaders from multiple health sectors to coordinate and integrate a new health system collaborating with clinicians, social services, community groups, and others who influence the health of people in our communities by addressing the needs of the whole person. NSACH handout distributed. Discussion followed.

The Role of NWRC in the NSACH Ryan Blackwell, Health & Human Services Planner and Leah Wainman, Community Engagement Coordinator

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Ryan and Leah discussed mutual goals of the two organizations and benefits of collaboration. Ryan reported that bidirectional referrals are a possibility. Leah mentioned that data sharing is also a goal the agencies are working toward.

Fall Gathering and Fall Conference Review Barbara Pesola and Wendy Gilbert

Wendy presented information on the 2017 Senior Lobby Day Fall Conference and Area Agency on Aging/State Council on Aging gathering. She highlighted two presentations. The first being Health Care in Washington which highlighted issues in long term health care and emphasized the concern that as our population continues to age there will be a decrease in available caregivers due to population demographics. The second was an informative talk regarding critical factors for the continued success of our State’s health care system given by Bob Crittenden, MD, Governor’s Health Policy Advisor.

A video of NWRC employee Peter Acosta’s Health Homes presentation at the conference was viewed.

Integration / Behavioral Health Update Elizabeth Anderson, Health & Human Services Planner

Elizabeth shared information about behavioral health services in Washington State and NWRC’s potential role to provide in-home counseling services as a small time provider. By 2020 behavioral health will be integrated with health services in Washington State. NWRC hopes to become established as a niche provider of home based services with the North Sound Behavioral Health Organization before integration occurs.

Caregiver Outreach Draft Materials Amy Charlot and Katie Stephens, Community Programs Staff

Amy and Katie presented several tools for use by the NWSSB outreach group including: a short PowerPoint presentation called “Caring for Caregivers,” an outline of the presentation with notes for presenters; and a flyer that could help family caregivers to self-identify as caregivers. The draft version of the presentation developed for Family Caregiver Support Outreach was reviewed in detail with input from Claudia Sampson, Community Programs staff. Handouts distributed. Discussion followed.

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2018 NWSSB Meeting Options and Advocacy Day Ryan Blackwell, Health & Human Services Planner

Ryan brought up for discussion the idea of meeting at a new location near the new NWRC Skagit county office location for NWSSB meetings in 2018.

A motion was made by Bill Bezanson, Whatcom County, and seconded by Bob Monize, Island County, recommending that NWRC staff pursue the use of the meeting space at North Sound Behavioral Health Organization for 2018 meetings of the NWSSB. Discussion followed. The motion passed unanimously.

Ryan presented two 2018 meeting schedule options due to scheduling conflicts in the coming year for staff and board members.

A motion was made by Tasker Robinette, Skagit County seconded by Bill Bezanson, Whatcom County, recommending that the 2018 NWSSB meetings be held on the second Tuesday of the month on 2/13, 4/10, 6/12, 8/9, 10/9, and 12/11. Discussion followed. The motion passed unanimously.

Ryan suggested that in 2018 the NWSSB focus its lobbying efforts on the W4A Advocacy Day due to results realized when legislators were approached earlier in the session in 2017. He noted funding increases to Health Homes and a vendor rate increase as two major goals that were accomplished after 2017’s focused efforts at the earlier Advocacy Day event.

Motion was made by Bill Bezanson, Whatcom County, and seconded by Bob Monize, Island County, that the Northwest Senior Services Board will focus their legislative efforts for 2018 by participating in the W4A Advocacy Day on Wednesday, January 31, 2018. Discussion followed. Motion carried.

Updates from Our Communities: Members shared updates from their communities.

Announcements and Adjourn • December 7, 2017 is the next NWRC Governing Board Meeting• January 31, 2018 is the date for the W4A Advocacy Day event in Olympia• February 13, 2018 is the date of the next NWSSB

There being no further business, Bob Monize, Island County, moved and Bill Bezanson, Whatcom County, seconded that the NWSSB adjourn. The Motion passed unanimously.

The meeting adjourned at 3:40pm.

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Q:\NWSSB\Agendas & Meeting Materials\2018\01- February\Workspace\5. November Minutes.docx

_____________________________________ Penny Morgan, Admin Assistant

Reviewed and approved by the Northwest Senior Services Board at the February 13th, 2018 meeting.

_________________________________ Barbara Pesola, NWSSB Chair

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2018NW Senior Services Board Travel Expense BATCH NO.

Northwest Regional Council

600 Lakeway Drive, Suite 100Bellingham, WA 98225

DATE MISC TOTAL EXPLANATION

From To Brkfst Lunch Dinner Room Miles Rate Allowance Other Total Purpose of Trip

0.545

0.545

0.545

0.545

0.545

0.545

0.545

0.545

0.545

0.545

Totals

Signed

Approved

TRIP MEALS AND LODGING

Department Head

Board Member

I hereby certify under penalty of perjury that this is a true and correct claim for necessary expensesincurred by me and that no payment has been received by me on account thereof.

VENDOR ID. #

NAMEVOUCHER NO.

ADDRESS

AUTOMOBILE

Q:\NWSSB\Agendas & Meeting Materials\2018\01- February\Workspace\6a. 2018 NWSSB Expense Form.xlsx7

Meal Rates

TOTAL$51$59$64$69$74

B$13$15$16$17$19

L$15$18$19$21$22

D$23$26$29$31$33

Per Diem Rates - As of October 1, 2017

Whatcom$93

Skagit$93

Snohomish$**

King$**

Pierce$117

Aso n$93

Lewis$93

Cowlitz$**

Clark$**

Skamania$**

Wahkiakum$93

Pacific$93

Thurston$**

Grays Harbor

$**

Mason$93

Kitsap$93

Jefferson$**

Clallam$**

Island$93

San Juan$93 Okanogan

$93

Chelan$93

Douglas$93

Ki tas$93

Grant$93

Yakima$93 Benton

$96

Klickitat$93

Ferry$93

Stevens$93

Pend Oreille

$93

Lincoln$93

Spokane$102

Adams$93 Whitman

$93

Franklin$96

Walla Walla$93

Columbia$93

Garfield$93

OFM Statewide Accoun ngRev. 9/17

For Out-of-State Per Diem Rates, refer to the GSA website at: h p://www.gsa.gov. To get the total meal and incidental expense rate breakdown of individual meal allowances, refer the State Administra ve and Accoun ng Manual (SAAM), Subsec on 10.40.10.c

09/01 - 06/30

07/01 - 08/3109/01 - 06/30

Clark, Cowlitz,& Skamania

Clallam & Jefferson

Grays Harbor

03/01 - 10/31 $18211/01 - 02/28 $149

07/01 - 08/31 $159$107

$128$101

$ Maximum Loding Rate** Seasonal Lodging Rates for Coun es:

King

Snohomish

Thurston

06/01 - 09/30

10/01 - 05/31

06/01 - 08/31 09/01 - 05/31

09/01 - 10/31 11/01 - 08/31

$179

$135$112

$112$128

$244

The privately owned vehicle mileage reimbursement

rate is $0.535 per mile. (effec ve 1/1/17)

POV Mileage Rate

King$**

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This certificate is awarded to

The Northwest Senior Services Board extends our sincere appreciation to Skagit Publishing for the use of the Community Room for our meetings. The generosity of

Skagit Publishing continues to benefit people with disabilities, and aging populations, in our region.

NWRC Executive Director

Date

Date

NWSSB Chair

S KAGIT P UBLI SH ING

C e r t i f i c a t e o f A p p r e c i a t i o n

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Key benefits: Reduces the administrative

burden of managing the IPworkforce.

Removes the State as a jointemployer of IPs.

Allows case managers tofocus their skills, time andattention on the clients weserve, on nursing homerelocations, diversions andtimely initial and ongoingeligibility approvals.

Contacts: Bea Rector Director, Home and Community Services (360) 725-2272Rectobm@dshs.wa.gov

Marilee Fosbre Chief, Home and Community Programs (360) 725-2536Marilee.Fosbre@dshs.wa.gov

Why is this legislation necessary? Currently, the primary management of Individual Provider (IP) administrative functions is conducted by case managers and contract staff in field offices. These functions are administratively burdensome and divert scarce case management staff time from clinical functions serving clients to administrative functions. Adding to this, the implementation of new Fair Labor Standards Act rules applying to home care workers has increased the complexity of IP management, including the necessity to recruit and enroll additional providers. This change would eliminate the state as a joint employer of Individual Providers.

What will the bill do? Create an Individual Provider Employment

Administrator (IPEA) to assume all administrativefunctions of IP management including; contracting,payroll, and workforce management to an externalentity

The IPEA will serve as a co-employer, alongside theclient employer, of the IP.

The IPEA will manage the use of overtime Relieve case management staff from the ever

expanding complexity of IP management functions. Enable case management staff to effectively focus on

clinical case management and client services.

How much will this cost? See fiscal information

HB 2426/SB 6199 Concerning the individual provider employment administrator program

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Contact: Kate White Tudor, 360-402-1272 kate@whitetudor.com or Dan Murphy, 360-649-4562 murphdk@dshs.wa.gov.

The Washington Association of Area Agencies on Aging

Legislative Priorities for 2018

Reduce training burden on family caregiver respite providers

Support HB 2435/SB 6206

In 2017 –

HB 1322 reduced training requirements for respite providers for people with

developmental disabilities from 35 hours to 14 hours

It allowed caregivers to do more training online

The bill helped respite providers doing less than 300 hours of care each year for

individuals with developmental disabilities

The problem –

HB 1322 bill left out respite providers for clients with other disabilities such as

Alzheimer’s, traumatic brain injury, or quadriplegia

There is no good reason to treat respite providers for people with other

disabilities differently than providers for people with developmental disabilities.

All family caregivers need respite to keep going.

For example, a college student home for the summer could provide respite care

for her brother with autism with 14 hours of mostly online training. However,

under current law she needs to get 35 hours of training to care for her

grandmother with Alzheimer’s.

We need to build the respite workforce –

Washington needs more respite caregivers. Respite is a critical piece of the new

Medicaid demonstration/waiver Medicaid Alternative Care (MAC) and Tailored

Supports for Older Adults (TSOA) programs.

MAC and TSOA will generate savings to Medicaid by supporting unpaid family

caregivers and delaying clients’ need for Medicaid long term care.

Area Agencies on Aging currently support about 1000 family caregivers with

respite and with the expansion through the MAC and TSOA programs we will

need to provide respite to 8000.

Please help pass HB 2435 and SB 6206 to equalize training requirements for respite

providers working less than 300 hours in a year.

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Contact: Kate White Tudor, 360-402-1272 kate@whitetudor.com or Dan Murphy, 360-649-4562 murphdk@dshs.wa.gov.

The Washington Association of Area Agencies on Aging

Budget priorities for 2018

Redirect shared savings to establish break-even rates for Health Home

Care Coordination for Dual-Eligible beneficiaries

The Health Home program provides care coordination for people on both

Medicaid and Medicare who have the most expensive chronic health problems.

By helping people manage their health and get the care and medications they

need, care coordinators help keep chronic conditions from getting out of control.

By reducing hospital, emergency department and nursing home visits, care

coordinators saved Medicare $67.5 Million over the first 30 months of the

program for a state investment of around $10 million over that period.

Washington has a shared savings agreement with CMS—we received $20 million

from Medicare for savings generated through December, 2015.

The 2017 budget funded incentive bonus payments for regions that engaged at

least 20% of their eligible beneficiaries. The incentive payments allow providers

in qualifying regions to recover their costs but the base rate by itself remains 20%

below the break-even level.

About half of the state’s eligible beneficiaries live in regions that don’t yet qualify

for the incentive payment, the largest of which are King, Pierce, and Thurston

counties. Care coordination providers in those regions are only paid the

inadequate base rate and cannot afford to take a 20% loss while building capacity.

The backlog of clients and funding shortfall is too large.

We urge legislators to increase the health homes reimbursement rate to the

break-even level, while preserving a 5% performance incentive payment, by

redirecting shared savings received by the state (no impact on the general fund).

For SFY 2019 (including a 20% base rate increase) $5.2 million would be paid to

care coordination providers, still leaving the state with $4.6 million in retained

savings. A 5% performance incentive payment would cost another $476,000.

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Health Home Coverage Areas

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Contacts: Kate White Tudor of W4A (360) 402-1272; Joanna Grist of AARP (206) 795-6837; Lauri St. Ours of WHCA (360) 402-1327; Madeleine Foutch with SEIU 775 (206) 250-2311

Updated: 1/23/18

Long-term Care Trust Act HB 2533/SB 6238 Affordable and Accessible Long-term Care for Washington

We face a crisis in long-term care—most people will not be able to pay for what they need.

Most Washingtonians over 65 will eventually need long-term care services, including help with bathing, dressing,toileting and eating.1

Long-term care is prohibitively expensive. The averagelifetime cost is $260,000.2

Most people have not saved enough to pay for their owncare. Median retirement savings for people over 65 isjust $148,000.3

Medicare does not cover long-term care services.

Nationally, family caregivers spend an average of 20percent of their income on out-of-pocket costs related tocaregiving.4

Long-Term Care Trust Act would provide long-term care insurance for people employed in Washington.

The program provides 365 days-worth of coverage. Vested employees receive benefit of $100 per day. The benefit would cover the complete cost of one year of

long-term care for the average Washington long-termcare consumer.5

The benefit coverage is financed by a 0.49% (half of onepercent) payroll deduction on all workers (an average of$23.30/ month6).

Vesting period is three of the last six years, or ten yearstotal.

Long-Term Care Trust Act would help protect the state budget from increased spending on Medicaid-funded long-term care.

Washington now spends $2.1 billion annually on Medicaid funded long-term service andsupports. This spending is projected to increase by 91% in 2040 to $8.02 billion perbiennium.7

In its first year, the program will save Washington $19 million in Medicaid spending. 8

By the 10th year, it would save the state $70 million every two years (biennium). 9

By 2040, this legislation could save Washington State $1.4 billion per biennium.10

BROAD COALITION SUPPORT

AARP

Alzheimer’s Association

Caring Across Generations

Washington Health CareAssociation

SEIU 775

Washington Association ofArea Agencies on Aging(W4A)

Senior Citizens’ Lobby

LeadingAge Washington

Long-term Care OmbudsmanProgram.

Adult Family Home Council

A full list of all endorsingorganizations is available athttp://responsiblefuture.org/about/

Majority of voters in Washington support the LTC Trust Act. A recent statewide poll found that 62% of likely voters support the LTC Trust Act.

17

Updated: 1/23/18

Long-Term Care insurance coverage would strengthen Washington’s economy. Coverage reduces the burden on family caregivers, increasing their ability to continue

working and save for their own retirement. Family members who leave the workforce to care for loved ones typically lose $300,000

in income and benefits. Women lose the most—an average of $324,044.11

The program would increase workforce and business productivity by reducing thenumber of family caregivers who must take time-off work or quit paid employment.

People would choose how to use their benefits. Under the Trust Act, families would get to choose the care setting that meets their loved

ones’ needs. Coverage can be used on in-home care aides, adult family homes, assistedliving, or skilled nursing facilities.

Beneficiaries can choose to use their 365 days of coverage consecutively or in smallerchunks as they need help.

We did the math.

The legislature directed Milliman to study and analyze two policy options to help makelong-term care more accessible and affordable: a public benefit trust similar to SocialSecurity, paid into by all workers and a public private solution to help stabilize theexisting private insurance market.

Milliman found the public benefit would have significant and broad impact on bothfamily and state budgets.

They also found that reviving the private market would require large state subsidies andrisk-sharing to increase the number seniors who could afford meaningful coverage.

Citations

1 Favreault, M. (2016). Long-Term Services and Supports for Older Americans: Risks and Financing. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Planning and Evaluation. Retrieved from https://aspe.hhs.gov/basic-report/long-term-services-and-supports-older-americans-risks-and-financing-research-brief 2 Ibid 3 Government Accountability Office. (2015). Most Households Approaching Retirement Have Low Savings (No. GAO-15-419). Washington D.C. Retrieved from https://www.gao.gov/products/GAO-15-419 4 Rainville, C., Skufca, L., & Mehegan, L. (2016). Family Caregiving and Out-of-Pocket Costs: 2016 Report (p. 7, Rep.). Washington D.C.: AARP.5 Rector (DSHS/ALTSA), Bea-Alise. “Average Monthly Personal Care Hour Utilization. “Average Monthly Personal Care HourUtilization, 20 Nov. 2017.6 Washington and U.S. average wages. (2017, August 16). Retrieved December 18, 2017, fromhttps://www.ofm.wa.gov/washington-data-research/statewide-data/washington-trends/economic-trends/washington-and-us-average-wages7 Report to the Legislature. Feasibility Study of Policy Options to Finance Lon-Term Services and Supports (p. 7, Rep.). (2017).Olympia, WA: Aging and Long-Term Services Administration (DSHS).8 Report to the Legislature. Feasibility Study of Policy Options to Finance Lon-Term Services and Supports (p. 31, Rep.). (2017).Olympia, WA: Aging and Long-Term Services Administration (DSHS).9 Ibid10 Mancusco, D. (2017). Washington State Changing Patterns of Long-Term Services and Supports.11 MetLife Mature Market Institute. (2011). The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy forBaby Boomers Caring for Their Parents.

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Fact sheet revised by the Washington State Health Care Authority and the Washington State Department of Social and Health

Services, December 2017

Foundational Community Supports Connecting our most vulnerable populations with targeted

Medicaid benefits for supportive housing and supported

employment

Washington State and the Centers for Medicare and Medicaid Services (CMS) have

finalized an agreement for a five-year Medicaid Transformation Demonstration that will

strengthen state efforts to improve health care for Washington families and control costs.

The research is clear: unemployment and job insecurity, along with homelessness and unstable housing,

contribute to poor health. Homelessness is traumatic and cyclical—and it puts people at risk for physical

and mental health conditions, and substance use disorders. There is also substantial evidence linking

unemployment to poor physical and mental health outcomes, even in the absence of pre-existing

conditions.

Foundational Community Supports addresses these factors by creating targeted benefits for supportive

housing and supported employment. The goal is to enhance the availability of these services for those

who are the most vulnerable and have complex care needs.

Foundational Community Supports

What it is

Targeted Medicaid benefits that help eligible

clients with complex health needs obtain and

maintain housing and employment stability

Supportive housing services

Supported employment services

What it isn’t

Ongoing payments for housing, rent, or

room and board costs

Wages or wage enhancements for clients

An entitlement

Supportive housing services

Foundational Community Supports will create a benefit of targeted, supportive housing services for

eligible Medicaid beneficiaries. These housing-related services do not include payment for room and

board, however the Demonstration will pay for services that help Medicaid beneficiaries get and keep

housing. The supportive housing service package includes services that identify and assist individuals in

obtaining appropriate housing and provide tenant support to maintain housing. The supportive housing

benefit will not replace existing services currently available to eligible populations.

Supportive housing services will demonstrate the positive effect that safe, secure housing has on people

in need:

People who have experienced chronic homelessness

People who depend on costly institutional care

People who depend on restrictive adult residential care/treatment settings

In-home care recipients with complex needs

19

Those at highest risk for expensive care and negative outcomes

In order to be eligible for these services, individuals must be eligible for Medicaid, complete a needs

assessment, and be in qualify for at least one of the groups described above.

Supported employment services

These services will help people who are eligible for Medicaid and have physical, behavioral, or long-term

service needs that make it difficult for them to get and keep a job. It will provide the ongoing services and

supports these individuals need, including individualized job coaching and training, employer relations,

and assistance with job placement.

These services have proven especially effective for certain populations with complex needs. These

include:

Individuals with disabling conditions struggling to remain engaged in labor market

Those experiencing significant mental illness, substance use disorder, or co-occurring conditions

Long-term care recipients with complex needs

Vulnerable youth and young adults

Like the supportive housing benefit, referral to these services must be the result of a needs assessment.

Provider reimbursement

Supportive housing and supported employment services will be provided as targeted benefits

administered by Amerigroup, a third-party administrator (TPA) contracted by the state Health Care

Authority. In order to participate in the FCS program, providers must have a contract with Amerigroup

TPA.

Stay informed

Visit the Medicaid Transformation page.

Join the Healthier Washington Feedback Network and receive regular updates and announcements

of upcoming webinars.

Learn about participating in FCS by contacting Amerigroup – 1 (844) 451-2828, or

FCSTPA@amerigroup.com

Email questions and comments to medicaidtransformation@hca.wa.gov.

These investments are not funded by a grant.

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FAQ produced by the Washington State Health Care Authority, December 2017

Supportive housing

Supported employment

Supportive housing

Community support services:

These are ongoing supports to help people find and keep stable, independent housing. Services include:

Housing assessments

Identifying housing resources

Support obtaining a lease

Independent living skills development

Landlord relations

Crisis management

Supported employment (based on the Individual Placement and Support (IPS) model)

Supported Employment services help people find jobs (in competitive or customized work settings or

self-employment) and gain the skills necessary to be successful. Services include:

Vocational/job-related discovery or assessment

Planning for employment

Job placement, development, coaching

Skills-building for negotiating with prospective employers

The supported employment benefit will not cover or supplement a beneficiary’s wages.

FCS services are targeted benefits, meaning they are not entitlements for all enrollees. Supportive housing

services are designed for people who experience:

Chronic homelessness (as defined by the U.S. Department of Housing and Urban Development)

Frequent or lengthy institutional contacts

Frequent or lengthy stays in adult residential care

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2

Frequent turnover of in-home caregivers

PRISM (Predictive Risk Information SysteM) Risk score of 1.5 or above

Supported employment services target:

People enrolled in the Aged, Blind or Disabled program or the Housing and Essential Needs program

People diagnosed with severe and persistent mental illness (SPMI), substance use disorder (SUD), or

co-occurring mental illness and SUD

Vulnerable youth and young adults with behavioral health needs

People who receive long-term services and supports

People who fall into these categories also must be determined to have a functional need for the services.

The state has contracted Amerigroup Washington to be the Third Party Administrator (TPA) to select,

qualify, and contract with employment and housing providers. Amerigroup will also authorize FCS

services and reimburse providers. Interested providers should contact Amerigroup directly at 1 (844)

451-2828 or FCSTPA@amerigroup.com.

Providers of supportive housing and supported employment services must:

Bill for and receive Medicaid service reimbursements

Provide supportive housing and/or supported employment services, within the state and federal

guidelines

Examples of potential provider types may include:

Appropriate certification for licensed behavioral health

A contract with the Aging and Long-Term Supports Administration to deliver comparable services

Demonstrated service expertise and billing capacity

Details about provider qualifications will be released after a TPA is selected.

Interested providers should contact Amerigroup at 1 (844) 451-2828 or FCSTPA@amerigroup.com

No. By law, Medicaid must be the payer of last resort. This means that Medicaid funds enhance, but do not

replace, existing services. The state must demonstrate how these services benefit people who are not

already receiving comparable services under other programs or funding sources.

Individuals will be assessed to ensure they meet eligibility requirements and have an appropriate functional

need. Need can be demonstrated by:

Assessments conducted within the behavioral health or long-term services and supports systems

Meeting specific, functional criteria

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3

Supportive housing and supported employment are important tools for the nine, regional Accountable

Communities of Health (ACH) as they implement their Medicaid transformation projects. Because of this,

FCS providers can play a critical role in achieving better health, better care, and stronger communities.

Providers can build partnerships with other providers at the ACH table, coordinating services and building

referral pathways. The statewide goals for Medicaid transformation are best achieved through dynamic

community partnerships. ACHs are not responsible for paying for or delivering FCS services.

The purpose of transforming Medicaid is to build an integrated, whole-person health care delivery system,

that is. The success of this effort will provide Washington State with definitive evidence that better health,

better care, and lower costs are possible, now and in the future.

Medicaid transformation will address the complex, costly and interdependent needs of Medicaid recipients.

Success will show:

An overall increase in health measures

Improved employment statistics

More stable living situations and a reduction in the use of intensive services

Significant cost savings

Healthier people and stronger communities

We believe these benefits can be sustained within existing Medicaid rates beyond 2021 - the end of the five-

year Medicaid Transformation.

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Q:\NWSSB\Agendas & Meeting Materials\2018\01- February\Workspace\10. Budget Message 2018.docx

November 15, 2017

TO: Northwest Regional Council

FROM: Dan Murphy, Executive Director

SUBJECT: Budget Message--2018 NWRC Budget

I recommend the enclosed 2018 NWRC Budget of $16.5 Million for your consideration and approval. This budget represents an 11% increase from 2017.

On the expense side, please note the following changes from our 2017 baseline:

• An increase of 4 FTE’s as follows:

o An additional Care Coordinator position to address increased demand forHealth Home Services

o Two new Behavioral Health Counselor positions to provide in-homeBehavioral Health services for seniors and people with disabilities,assuming authorization to proceed with the Behavioral Health contract,which is a separate agenda item at our meeting.

o Creation of a Network Administrator position to address the growingcomplexity of out IT systems.

• A 5% increase in the employer cost for health care coverage.

• A net increase of $116,838 in our Occupancy/Insurance line to cover the newleases for expanded office space in our Skagit and Bellingham Offices.

• Several pay and classification changes. NWRC uses a scoring system toevaluate the skills, scope, and authority of its positions in order to place them atthe appropriate classification level. This budget assumes three classificationchanges as outlined below:

1. Reclassification of the Community Programs Manager to CommunityPrograms Director. In April I provided an overview of the five year plan forexpansion of our Family Caregiver Support Program with federal Medicaidfunding. The initial stages of development added significant complexityand scope to the position. To compensate and give time to assess long-term implications, I authorized a temporary interim assignment payincrease to the Director level. I am now recommending that changebecome permanent in recognition of the ongoing impact of the expansion,

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and in recognition of the number of diverse programs in the Community Programs Unit. That change will make the approximately 11.5% increase in pay for that position permanent.

2. Retitling the positions of Receptionist/Secretary (2FTE) toReceptionist/Administrative Aide and moving those positions and the JailHealth Medical Assistant (2 FTE) up one level on the classification scale.These positions are the only ones on the lowest level of the currentNWRC pay scale, with a starting salary in 2017 of $15.53. This movewould increase the starting salary by about 8% to $16.77 per hour.

The Receptionist/Secretary positions were last classified in 1999 andthere have been significant changes in necessary technologic skill and inthe complexity of the NWRC programs these positions support. They arethe “face” of NWRC to many of our customers and often work with walk-inclients with significant mental health and/or behavioral health challenges.

The change in classification of the Medical Assistant positions will help usstay competitive in the health sector market where we have beencontinually challenged to recruit and retain staff.

3. Retitling the Office Manager/HR Generalist to Office/Human ResourcesManager and reclassifying it from the first-line supervisory level to themanagerial level. As NWRC has grown (and by necessity built itsadministrative capacity) this position has become more of a truemanagement position that oversees a broader scope of administrativeactivities than in the past.

The clearest example is in human resources. When this position was lastclassified NWRC had sixty staff and recruited for four to six positions peryear as vacancies occur. In 2018 NWRC will have 100 FTE’s and willrecruit to fill four to five times as many vacancies. In addition, as staffinghas grown, so has the complexity of maintaining compliance with HR lawand requirements, which has emerged as a primary focus of this position.This change represents about an 11% increase in pay for the position.

• The changes in obligations to subcontractors (covered by discretionaryrevenues) recommended by the Northwest Senior Services Board. Please seemy separate memo on the update to the 2017-2019 Strategic Plan for Aging andDisability Services which includes those recommendations.

• This budget also includes a 2% COLA for staff salaries that is consistent withNWRC’s compensation philosophy and allows the NWRC to maintain marketposition in recruiting and retaining staff.

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On the revenue side, Medicaid resources will increase due to:

• Increased overall numbers of clients and a small per-client rate increase for in-home services case management

• A 58% increase in Health Home funding due to higher earnings from expandedservice levels and continuation of the 20% performance incentive payment

• Increased service levels in our transportation program

• Startup of our Behavioral Health program as outlined in my separate memo onthat subject that will be discussed as a separate agenda item.

The Medicaid administrative funding for the Family Caregiver Support Program expansion will remain flat for 2018 but is expected to grow in 2019 and beyond as the numbers of clients receiving services increases.

Of our remaining major revenue sources, we project:

• A 1.5% rate increase for our Jail Health Program

• A 2% increase in our discretionary federal Older American’s Act, mostly due toincreased carryover

• A 2% increase in state Senior Citizen Services Act, and state Family CaregiverSupport Program funding.

We have also included our Financial Management Policies and the Purchasing Polices that are updated based on the contracting authority amendment to the NWRC bylaws that was approved at your last meeting. If you have any questions, please do not hesitate to call.

PROPOSED MOTION: The Northwest Regional Council approves the 2018 budget as presented, including a cost of living adjustment of 2% for all NWRC employees, effective January 1, 2018.

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