Transitioning a Child to Consumer Directed Health Care
description
Transcript of Transitioning a Child to Consumer Directed Health Care
Transitioning a Child to Consumer Directed Health
Care
Preventing Service Gaps and Planning the Move to the Consumer
Directed Adult System of Care
Consumer Direction Regional Conferences - June, 2006Sponsored by
Colorado Department of Health Care Policy and FinancingIndependence Plus Grant #18-P-92019/8-01
Colorado Medicaid • Offers a range of consumer directed
service options• Maintains a leadership position
among states’ Medicaid programs with consumer direction program innovations
• Receives broad community, legislative and executive support of consumer direction initiatives
Workshop Objectives:
• Identify barriers to seamless transition to the adult system of care
• Identify resources and skills to ease the transition to consumer directed adult health care
Workshop Content
• Parents’ transition activities– Skills and timing
• Quick review of Medicaid (very quick)– State plan, HCBS, consumer direction
• Intro to the adult system of care• Authorized Representatives
When Should Transition Begin?
• Parents should begin to plan at the initial onset of the child’s disability– Birth, or– Date of injury
• Children can begin to absorb pertinent info at the age of 14
•START EARLY!
Seamless Transition Depends On:
• The wishes of the child and family• Complexity of child’s health condition• Presence (or absence) of adult health
care resources in the community• Parent’s knowledge (and willingness to
teach the child) of transition process and community resources
Building Appropriate Skills in the Transitioning Child/Consumer
• Identify and communicate changes in health condition
• Communicate effectively with a provider– Obtain appointments– Evaluate interventions– Express the child’s/family’s wishes
COMMUNICATION!
Building Appropriate Skills: SHARE YOUR KNOWLEDGE
• Prevent injury and/or illness
• Manage child’s health needs
• Coordinate services
Medicaid 101
• Federal and state partnership providing payment for health care services for the disabled and low-income populations– Federal/state share of costs is 50/50
• Financial Eligibility is determined by results of an asset/means test– Consult the county in which you live
Medicaid 101
• State Plan:– A package of medically necessary
services available to all Medicaid eligible clients.
•Includes:– Acute care– Home health care
Medicaid 101 - Waivers
Home and Community Based Services
• Allow the state to offer services in addition to the State Plan services
• Services are appropriate and specific to a population with a specific diagnosis
• Called “waivers” because the equal access to equal services requirement of the state plan are “waived” for specific populations
Medicaid 101 - Waivers
HCBS eligibility requirements• Client must be eligible for Medicaid• Client must need long-term care at an
institutional level of careHCBS offers a spectrum of client choice• Traditional agency model – least choice• IHSS (agency with choice) – moderate
choice• CDAS – most choice
Medicaid 101 – Consumer Direction
• IHSS – “agency with choice”- consumer direction option available to HCBS-EBD and C-HCBS clients only.
• CDAS – most flexible consumer
directed option available to all eligible Medicaid clients with long term care needs
Two Systems in Long Term Care Physically Disabled
Children
Waiver: C-HCBS
Apply: SEP, CCB, CMA
Wait list: Yes
Adult
Waivers: EBD (18+), BI (16-64), PLWA (all)
Apply: SEP
Wait list: No, except SLP in BI waiver
Two Systems in Long Term Care Cognitively Disabled
Children
Waiver: CES
Apply: (CCB)
Waiting List: Yes
Adult
Waivers: SLS, DD, MI
Apply: CCB SEP (MI only)
Waiting List:SLS: YesDD: Yes
Case Management Responsibilities
SEP/CCBResponsibiliti
es
Eligibility Determination HCBS Waivers
Case Management
Service Coordination
Referral and Information Distribution
Quality Assuranc
e
SEP Responsible
for all Authorization of Home
Health
Authorized Representative (AR)
• AR may be a family member, a friend or a legal guardian of the client
• AR may assist the client in the direction of the client’s care
• AR assists the client to define quality, risk and safety in the client’s care
Requirements to be an AR
• AR must be at least 18 years old• AR must know client for two years• AR must not be convicted of
abuse, exploitation or assault• AR must not have a condition that
could result in harm to the client
Preventing conflicts of interest
• AR may not be paid• AR may not be a paid caregiver• AR must enjoy the trust of the client• AR must be willing to accept client’s
responsibilities for the client’s consumer directed care
• AR must be able to distinguish between the client’s and AR’s wishes
Authorized Representative - Benefits for the Consumer
• Any eligible client may choose this option• AR option enables cognitively disabled
clients to transition into consumer directed services
• Transitioning clients may choose an AR to help identify service quality standards
• With an AR, transitioning clients can turn service deficiencies to strengths and improve support quality
Authorized Representative
in IHSS• Client’s physician determines need
for an AR to assist in client’s care
• Client and AR select provider agency
• Client and AR select attendant
• Client and AR determine training needs of attendant
Authorized Representative
in IHSS – (cont)• Client and AR conduct training
• Client and AR select back-up attendants
• Client and AR establish procedures for critical incident management, back-up utilization – within the confines of the provider agency’s requirements
Authorized Representative in CDAS
• Client or legal guardian designates• Complete affidavit and questionnaire• May not be paid• May not have a conviction for abuse,
exploitation, or assault• May not have a mental, emotional, or
physical condition that could harm client
Emergency Backup, Safety and Prevention Strategies
• See the Strategies Resource Manual– Safety and Prevention – Decision tree– Back-up care– Community disaster– Identity and property safety– Health care emergency forms
Finally…..
What you risk reveals what you value
Jeanette Winterson
When you're through changing, you're through
William Safire
Contact Information
IHSSGeorge Good-deCurnou
in Denver metro:303-866-2704
in state:1-800-221-3843 x 2704
CDASMarie Garcia
in Denver metro:303-866-2755
in state:1-800-221-3943 x 2755
Questions?
Please write down questions you have for the Q&A panel and leave them in the box
provided on the registration table.
Please complete the evaluation form in the “Additional
Information” section of your conference binder.
We appreciate your feedback!
If you would like additional conference materials, please
complete the conference materials request form.