Ohio Association of Area Agencies on Aging
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Larke Recchie recchie@ohioaging.org
(614) 481-3511
Integrated Care Delivery System
(ICDS)
Ohio Association of
Area Agencies on Aging www.ohioaging.org
Facebook: o4aadvocacy
Twitter: @o4aadvocacy

Ohio Association of Area Agencies on Aging
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Enrollment
Voluntary enrollment: September 2013
Passive enrollment: phased in by region Oct.
–Dec. 2013
Who will assist with enrollment?
• Enrollment broker, OSHIIP, ADRN (AAAs, CILS, other human services) Possible $4 million fund
How to roll out information for current dual eligible individuals? (Enrollment work group)
• Regional meetings (providers in morning and consumers/advocates in afternoon
• “Tiered messages” to consumers
• Branding: My Care Ohio
• Notices (CMS vs state)

Ohio Association of Area Agencies on Aging
Care delivery model
• Managed Care Plans coordinate services through a person-centered planning process
• Plans must contract with AAAs to coordinate HCBS waiver services for enrollees over age 60
Financing
CMS capitated financial alignment model
Benefits
Nearly all Medicare and Medicaid services and plan flexibility to add benefits

Ohio Association of Area Agencies on Aging
Targeted population
• Est. 114,00 beneficiaries
• Excludes those with developmental disabilities
• Only Full duals are included
• People with credible 3 rd party insurance are excluded
Ombudsman
Existing State Long-term Care Ombudsman will offer:
• Individual advocacy
• Independent systemic oversight
• Each MCO is required to have consumer advisory panels

Ohio Association of Area Agencies on Aging
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Rates: Participating plans receive capitation rate reflecting the integrated delivery of Medicare and Medicaid benefits based on:
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• Baseline spending in both programs.
Anticipated savings resulting from integration & improved care.
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Readiness Review: Ongoing process to asses plans’ Medicare and
Medicaid experience and Demonstration readiness.
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Two-step process that includes an onsite and desk review of participating plans.
Massachusetts first state to begin.

Ohio Association of Area Agencies on Aging
Ohio ICDS Regions
Williams
533
Lake
2,043
Ashtabula
2,133
Defiance
470
Fulton
418
Lucas
7,793
Henry
294
NW
Wood
1,146
Ottawa
527
Sandusky
858
Erie
1,031
Geauga
617
Paulding
238
Seneca
875
Huron
705
Lorain
3,466
Cuyahoga
24,396
NE
Medina
1,190
Summit
7,711
Portage
1,474
Putnam
350
Hancock
777
Van Wert
344
Allen
1,565
Wyandot
319
Crawford
808
Richland
2,083
Ashland
687
Mercer
375
Auglaize
436
Hardin
344
Marion
1,147 Morrow
461
Shelby
491
Logan
558
Darke
590
Preble
472
Champaign
512
Miami
1,165
WC
Montgomery
8,467
Clark
2,304
Greene
1,610
Union
341
Delaware
848
Central
Franklin
13,732
Madison
412
Pickaway
696
Fayette
640
Butler
3,737
Hamilton
11,363
Warren
1,567
SW
Clinton
570
Highland
907
Ross
1,413
Clermont
2,219
Pike
891
Licking
1,811
Fairfield
1,733
Jackson
913
Knox
942
Hocking
578
Vinton
292
Perry
675
Wayne
1,271
Holmes
452
Coshocton
677
Muskingum
1,887
Morgan
324
Athens
998
Meigs
511
EC
Stark
5,769
Tuscarawas
1,440
Guernsey
930
Noble
223
Washington
1,025
Carroll
458
Belmont
1,512
Monroe
277
Trumbull
3,139
NEC
Mahoning
4,475
Columbiana
1,670
Harrison
333
Jefferson
1,333
Brown
840
Adams
972
Scioto
2,559
Gallia
998
Lawrence
1,836
Average Potential ICDS Medicare/
Medicaid eligibles per month, SFY 2011
Non-demonstration counties
ICDS Regions and Demo Counties
Central NW - Northwest
EC - East Central
NE - Northeast
NEC- Northeast Central
SW - Southwest
WC - West Central

Ohio Association of Area Agencies on Aging
• Northwest: Aetna and Buckeye
• Southwest: Aetna and Molina
• West Central: Molina and Buckeye
• Central: Aetna and Molina
• Northeast Central: CareSource and United
• East Central: CareSource and United
• Northeast: Buckeye, CareSource, United

Ohio Association of Area Agencies on Aging
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Massachusetts, Ohio, and Illinois have approved capitated
Demonstrations
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Washington State has an approved managed fee-for-service
Demonstration
• Continuing to work with over 20 states on initiatives to better integrate care.
• Approved Demonstrations www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-
Coordination/Medicare-Medicaid-
CoordinationOffice/FinancialModelstoSupportStatesEffortsinCareCoordination.html

Ohio Association of Area Agencies on Aging
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Implementation and Monitoring:
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Ongoing milestones that allow CMS and States to monitor demonstration plan as enrollments begin.
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CMS and the State have the right to stop enrollment at any time.
• Evaluation:
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Contracted independent evaluator (RTI); and
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State-specific evaluation plans

Ohio Association of Area Agencies on Aging
• Illinois got MOU signed February 22, 2013
• 135,825 eligible beneficiaries in 2 regions
• Voluntary enrollment Oct through December 2013, May begin passive enrollment in January 2014
• May keep out of network providers 180, special exceptions after
• Care team led by care coordinator. Jointly develop care plan, review every 30 days for high risk, 90 days for moderate risk
• Ombudsman created outside Medicaid office
• Plans must offer contracts to LTSS providers to avoid redundant services

Ohio Association of Area Agencies on Aging
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Front door role remains the same
MCOs must contract with AAAs for waiver service coordination of NF LOC individuals over age 60
Provider rates protected 90 days to 1 year
Consumer chooses LTSS specialists (WSC): PASSPORT care managers are default for people over age 60
ICDS will align with other HHS initiatives (CMS care transitions program)
ICDS may contract with AAAs to do caregiver support, evidenced based disease management, provider network management

Ohio Association of Area Agencies on Aging
• Annually, AAAs:
• Answer 300,000 calls
• Perform 45,000 assessments
• Enroll 9,700 in PASSPORT
• Care manage 43,000 frail people
• Ohioans 60+ using Medicaid funded NFs down 14.5% in 12 yrs. despite 15% increase in 60+ population
• PASSPORT has 99.3% satisfaction rate statewide
• 25+ years of care management

Ohio Association of Area Agencies on Aging

Ohio Association of Area Agencies on Aging
The Ohio ICDS MOU requires ICDS Plans to default to
AAAs as the preferred provider of waiver service coordination for individuals over 60 years old.
Required Waiver Service Coordination:
Delegated component of ICDS Plan care management.
AAAs provide face to face services across all care settings of the ICDS Plan member’s choice, including the following:

Ohio Association of Area Agencies on Aging
Waiver Service Coordination/Care Management
• Establish personal goals and plans of care
• Address provider management issues
• Develop disaster preparedness/back-up plans
• Medication review
• Provide health and safety review and problem resolution
• Assist with transitions between care settings
• Work collaboratively with other community-based programs to provide a seamless system of care for the
Plan members

Ohio Association of Area Agencies on Aging
Care and Service Plan Review
Face to face, in-home visits to:
• Review of physical health systems, medical history, functioning (ADL/IADL), mental and cognitive abilities, social supports, environment, and financial resources (SSI, VA,
HEAP, Homestead Exemption)
• Provide disease management education
• Recommend housing modifications, DME, and service plan updates
• Coordinate benefits and confirm eligibility status
• Review and revise disaster preparedness plan
• Update care plans

Ohio Association of Area Agencies on Aging
Crisis Intervention
• Psycho-, social, and environmental problem solving
(non-medical)
• Provide family and care giver education
• Report abuse, neglect, exploitation
• Resolve and report service delivery incidents
Event-based Visits
• Address changes in home environment, caregiver, physical/mental functional areas
• Update care plans to address health and safety issues or areas of non-compliance

Ohio Association of Area Agencies on Aging
Institution-based Visits
• Coordinate with payer to identify diagnosis, treatment, and expected length of stay
• Advocate for member in discharge planning meetings
• Assist with transition home
Service Management
• Order and adjust services as needed
• Resolve service delivery issues and ensure service plans remain member-centered

Ohio Association of Area Agencies on Aging
Medicaid Resolution
Assist with Medicaid redetermination and food stamp resolution
Assessment of LTSS Need
Including functional needs assessment, environmental assessment, social needs assessment
Managing Member Care Through Independent
Providers and Consumer Direction

Ohio Association of Area Agencies on Aging
Technical Assistance:
Care Transitions Services
Evidence-based transition services, such as the Coleman
Care Transitions Intervention, are designed to assist MCO members transitioning from any health care facility to home.
These services have been proven to significantly reduce hospital readmissions.
Provider Management Assistance

Ohio Association of Area Agencies on Aging
Evidence-Based Wellness Programs
• Matter of Balance
• Chronic Disease Self-Management Program with special versions for individuals managing chronic pain and diabetes
• Healthy IDEAS
• Tai Chi

Ohio Association of Area Agencies on Aging
Caregiver Support
• Customized training and education
• Health and wellness programs
• Personal consultation
• Family mediation
• Caregiver planning

Ohio Association of Area Agencies on Aging
• Firewall protections between the Front Door and Care
Management/waiver service coordination
• Rates
• Enrollment process (transition)
• Interaction with 2 or 3 Plans and continued administration of
Medicaid waiver programs for non-duals and those that are presumptively enrolled in Medicaid (before final Medicaid determination)
• Evaluation

Ohio Association of Area Agencies on Aging

1.
Ohio Association of Area Agencies on Aging
Restore the 10% cuts ($3.6 million) for PASSPORT screening and assessment
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Increase all PASSPORT provider rates by 3%
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Permit individual care plans that fully support nursing home transition and diversion
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Ensure all seniors have access to life-enhancing services no matter where they live both inside and outside the
Integrated Care Delivery System
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Fully fund Adult Protective Services across the state ($11 million)
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Fund the Balancing Incentive Payment Program ($10 million

Ohio Association of Area Agencies on Aging
• PASSPORT assessors are the front door to link older adults to cost-effective in-home and community programs
• PASSPORT enrollment has stalled since July 2011 when 10% cuts to front door funding went into effect, forcing AAAs to lay off screeners and assessors
• HB 59 proposes only fractional increases to front door funding
• Not only is PASSPORT cost-effective, it also has 99.3% consumer satisfaction rate statewide

Ohio Association of Area Agencies on Aging
• While rates for assisted living and adult day care services are increasing, all other PASSPORT providers are flat-funded after sustaining a 3% cut from the last budget
• Providers who have earned a Medicare-Medicaid certification get a higher Medicaid reimbursement rate than PASSPORT’s and thus many of them choose not to provide the PASSPORT service
• ALL provider rates need to be restored to ensure that seniors receive quality services without delay

Ohio Association of Area Agencies on Aging
• o4a has submitted an amendment to the legislature that would restore front door funding and increase
PASSPORT provider rates
• AAA representatives continue to follow-up with local representatives, especially those of the House Finance &
Appropriations Committee
• Time to move to the Senate finance committee

Ohio Association of Area Agencies on Aging
• Good News:
• ½ of the request for increases in PASSPORT provider rates and
PASSPORT front door activities are in the bill ($6 million)
• Bad news:
• Only ½ of the funding is included…
• Funds for the Balancing Incentive payment Program were removed
• MEDICAID EXPANSION WAS REMOVED

Ohio Association of Area Agencies on Aging
• Lower care plan ceilings arbitrarily limit access to necessary services
• The previous budget reduced the amount AAAs can spend on an individual’s care plan, from an average of $1,147 in FY 2012 to
$1,060 in FY 2013
• Lower care plan ceilings have lowered the quality of life for many older Ohioans
• Prescribed services are necessary to avoid or delay nursing home placement

Ohio Association of Area Agencies on Aging
• Rural Ohioans should benefit from the same enhanced services being made available in the ICDS counties
• The Integrated Care Delivery System (ICDS) will offer an array of new home care services, but only seniors living in 29 predominantly urban and suburban counties are included in the ICDS
• The state is essentially creating two separate but unequal long-term care systems —one for poor communities and a better one for metropolitan areas
• Level of service shouldn’t be determined by where you live, but by your needs

Ohio Association of Area Agencies on Aging
• 39 counties do not have enough funding to have full-time adult protective workers
• Older Ohioans deserve protection from abuse, neglect, and exploitation
• o4a has testified in support of the Ohio Elder Justice Act
• This bill would expand the definition of “elder abuse” to include financial harm and make permanent the Elder Abuse Commission, among other provisions that strengthen Adult Protective Services Law

Ohio Association of Area Agencies on Aging
• Medicaid expansion makes Ohio stronger by improving the health outcomes of more people of all ages
• o4a estimates that not extending Medicaid eligibility would force $30 million in cuts to PASSPORT and other aging services over two years
• If such drastic cuts take effect, older Ohioans might have to go to expensive nursing facilities or be left on their own

Ohio Association of Area Agencies on Aging
WRAAA Annual Luncheon
Cleveland, OH
April 16, 2013
Larke Recchie recchie@ohioaging.org
(614) 481-3511
Ohio Association of
Area Agencies on Aging www.ohioaging.org
Facebook: o4aadvocacy
Twitter: @o4aadvocacy