The second meeting of the LTC Transformation Workgroup took place on November 6th (click here for a summary of the first meeting). Materials for the second meeting can be accessed by clicking here. The main focus of the 2nd meeting was to discuss the role of case management and “supportive services in a residential congregate settings” – otherwise known as assisted living – including the provision of memory care services. Brief discussion of comments submitted on the 1493 Report were also held (click here for comments from IHCA, joined with INALA, HOPE and LeadingAge).
Before diving into the discussions, the Division noted that the work of the Workgroup would be a multi-year effort, but that there could be opportunity to tweak some elements of the existing A&D waiver program next year. The Division then presented a three-phased approach to waiver reform: Phase 1 – submission of the renewal to the existing A&D waiver, which needs to be submitted in January 2018; Phase 2 – redesign of the existing waiver that could be submitted via an amendment in late 2018; and Phase 3 – creation of a new waiver authority that could serve individuals who are less than nursing facility level of care in July 2019.
During the discussion on case management services, approaches from other states were presented where some states have case managers act more as brokers of services and others are structured to focus on clinical needs. The discussion indicated that Indiana’s current system is comparable to a brokered system, but there is inconsistent knowledge of case managers to really discuss the full range of options available to a waiver recipient.
Discussion about the differences between options counseling and case management, and how to merge the two via training, took place. Final thoughts focused on case management/options counseling being targeted to individuals based on need, called tiered approach, rather than based on all services that an individual could qualify for. Flexibility in meeting the needs of individuals was also discussed, rather than a focus on process and deadlines. IHCA suggested that deadlines are important for purposes of accountability, especially at the beginning of eligibility and the start of services, and that case management/options counseling may be different for the aged population than a younger population with developmental disabilities.
Supportive services in residential congregate settings were bucketed into three areas, one of which is assisted living as a provider owned and controlled setting. The other residential congregate settings categories were subsidized/participant controlled settings (Public Housing, Supportive Housing), and participant/family owned (Family Home or Independent Home/Apartment). The focus of the discussion was then on services required/offered in provider owned and controlled settings.
The services of today’s A&D waiver were discussed and an open question on whether a “core” group of services should be required of congregate settings, or if an a la carte style offering would be workable. A core group of services required by a congregate setting is more manageable by the setting and potentially for the recipient, but theoretically offers limited choice for the recipient, whereas an a la carte services offering is more difficult to managed for the case manager to track and assure quality.
The last topic that was discussed was the provision of memory care and the differences, or potential differences, between community based care and institutional care. The workgroup was asked to categorize the desires and wants of participants, based on responses from each workgroup member about what their own desires would be if they were moving into an institutional setting for purposes of memory care. Then, a discussion of what the provider’s view of those desires and wants occurred. It was not entirely clear what the outcome was from this discussion, but it is certainly a topic that will be revisited as providers who desire to serve Alzheimer’s and dementia residents in the Assisted Living setting do not have a clear pathway at the present to apply for and become waiver providers.
The next meeting of the workgroup is December 4th.