Illinois Department of Aging
Adult Protection and Advocacy
Conference
August 1st, 2013
Deborah Merrill, Senior Policy Director, NASUAD
Heather Bruemmer, Wisconsin State Long-Term Care Ombudsman
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The Long-Term Care,
Home Care, & Managed Care
Ombudsman
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Long Term Care Ombudsman
Defined, mandated, and funded by Federal
government in the OAA
Home Care Ombudsman
Determined and funded by each state
12 states currently have some type of Home
Care Ombudsman program
Medicaid Managed Care Ombudsman
Determined at the state level but recommended
by CMS in the Managed Care process
28 states will have MC by end of 2014
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Older Americans Act
Work in this field because of the OAA
Mission of the OAA is broad:
 to help older people maintain maximum
independent in their homes and communities
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to promote a continuum of care for the vulnerable
elderly
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The OAA created the Aging Network:
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State Units on Aging – 56 states and territories
Area Agencies on Aging – 655 AAA’s
233 tribal and Native American Organizations
Services sponsored by the Act include:
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Nutrition
Elder Rights Protection
Health promotion
Access to information and assistance
HCBS long-term care
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OAA Titles
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Title I – Declaration of Objectives
Title II – Administration on Aging established
Title III – Grants to States and Communities
Title IV – Research and Health
Title V – SCSEP
Title VI – Grants to Native Americans
Title VII – Vulnerable Elder Rights Protection
– Long-Term Care Ombudsman Program
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Long-Term Care Ombudsman Programs
• 1972 - Ombudsman program began as a
demonstration project in 5 states
• 1975 – All but 2 state had LTCO programs
• 1978 – Ombudsman services required
• 1987 – LTC Ombudsman program received
separate authorization of funds
• Additional amendments have strengthened the
LTC Ombudsman programs
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OAA Requirements
of the
Long-Term Care Ombudsman
Program
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LTCO Program
State Long-Term Care Ombudsman is the head
of the office. This person, or his/her
representatives, shall:
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Identify and investigate complaints made by or on behalf
of residents
Provide assistance to residents to protect them
Inform residents of services
Represent the interests of residents
Advocate for resident’s interest
Promote citizen advocacy
Provide training
Provide technical support for resident and family
councils
Other activities determined by the Assistant Secretary of
Administration on Aging, Administrator of Administration
for Community Living
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State Ombudsman Programs
• State structures vary but must follow the OAA
requirements
• Common to all are:
– State Ombudsman position
– Voice (advocacy) for elderly residents
– Investigation and resolution of complaints
– Public education
– Training
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Home Care Ombudsman
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Not a mandate
– Not funded by OAA
– States make their own decision depending on
funding available
– 12 states have Home Care Ombudsman
– Not all organized the same way:
Some respond to complaints
Some follow NH discharge
Some do Money Follows the Person follow up
Pilots in certain areas of state – some statewide
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Home Care Ombudsman
• State must decide to have a Home Care
Ombudsman program and provide the statutes,
regulations, and funding to implement
• State can structure this how they think is
appropriate.
• No federal direction
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Medicaid Managed Care
Ombudsman
or
Beneficiary Ombudsman
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Many states moving to Medicaid
Managed Long-Term Services
and Supports
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Effort to better coordinate physical/acute delivery system and the long-term
services and supports delivery system
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Money – federal and state funds available, more controlled use of dollars,
emphasis on outcomes not outputs
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Various models of MC Ombudsman placement – in MCO, within existing LTC
Ombudsman office, in a state agency, or in independent agency
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A few states have had Managed Care for many years
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Some have had Managed Care for a few populations and now are adding
more populations and/or geographic areas.
– Kentucky, Louisiana, and New Hampshire have had negligible MC in
select populations but are now going statewide
– New York, Texas and California have had MC in urban areas but are
now going state wide
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Comparisons
Long-Term Care
Ombudsman
Home Care
Ombudsman
Managed Care
Ombudsman/
Beneficiary Advocates
Serve residents in state licensed LTC
facility, i.e. Nursing Home, Assisted
Living, Board and Care settings
Serve individuals in Community
settings, which could include Assisted
Living with waiver services
Serve Managed Care service
recipients wherever the individual
resides
Knowledge of facility licensure, survey
process, residents rights, Medicaid
Knowledge of tenant rights, residents
rights, Medicaid, state services
provided, waiver services
Knowledge of Managed Care
contracts, contracted entities
responsibilities, services provided,
appeal and grievances process,
insurance
Conflict free in both office location and
personnel
Conflict free in location and personnel
in relation to the home care provider
entities, regulators,
Conflict free in representation of the
Managed Care client
Consent of individual or their
representative
Consent of individual or their
representative
Consent of individual or their
representative
Develop relationships with nursing
home staff, local service agencies,
APS, transition staff,
Relationships with local service
agencies, facility staff if applicable,
family groups
Develop relationships with MCO
Member rights specialists, state
oversight agency, stakeholder groups
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Discussion Points
• How does the individual receive the most effective
advocacy?
• Where should a state locate the Home Care
Ombudsman?
• Where should a state locate the Managed Care
Ombudsman?
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Contact information:
Deborah Merrill
Senior Policy Director
NASUAD
202.898.2578 x 122
Dmerrill@nasuad.org
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For more information, please visit: www.nasuad.org
Or call us at: 202-898-2583