Georgia’s Role in the
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Georgia’s Role in the Balancing Incentive Program Presenter: Dr. James Bulot, Division Director, Aging Services Presentation to: Board of Directors, Georgia Department of Human Services Date: Georgia Department of Human Services
Transcript of Georgia’s Role in the
Georgia’s Role in the
Balancing Incentive Program
Presenter: Dr. James Bulot,
Division Director, Aging Services
Presentation to: Board of Directors,
Georgia Department of Human Services
Date:
Georgia Department of Human Services
Vision, Mission and Core Values Vision Stronger Families for a Stronger Georgia.
Mission Strengthen Georgia by providing Individuals and Families access to services
that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults.
Core Values • Provide access to resources that offer support and empower Georgians and
their families.
• Deliver services professionally and treat all clients with dignity and respect. Manage business operations effectively and efficiently by aligning resources across the agency.
• Promote accountability, transparency and quality in all services we deliver and programs we administer.
• Develop our employees at all levels of the agency.
The Balancing Incentive Program (BIP)
What is BIP?
Grants to States to increase access to non-institutional long-term services and supports
Created by the Affordable Care Act of 2010 (Section 10202)
What will it do?
• Lower costs through improved systems performance and efficiency
• Create consumer tools for care planning and assessment
• Improve quality measurement and oversight
• Create new ways to serve more people in home- and community-based settings
Nursing Homes &
Other Institutions
Home and
Community-
Based Settings
Balanced Medicaid $
How is BIP financed?
More structural reforms lead to
• Increased nursing home diversions
• Increased access to non-institutional LTSS (long-term supports & services)
• Higher increases to the state’s Federal Matching Assistance Percentage (FMAP)
Up to $3 billion =Total Federal Funding over 4 Years (Oct 2011-Sept 2015)
$57,259,065 = Georgia’s Budget (4-year total)
Sustainability: Georgia will request state funds to match federal dollars.
Higher
FMAP
%
More Structural
Reforms
What are BIP’s four main elements?
No Wrong Door / Single Point of Entry
Outreach & Structure Development
Core Standardized Assessment
Conflict-Free Case Management
Who’s on Georgia’s BIP team?
Lead Agency:
Department of
Community Health
Chief Partner:
Department of Human Services, DAS GMCF
SILC
GHA
DBHDD
Statewide
Independent
Living
Councils
Role:
ESP service
database
enhancement Georgia Medical
Care Foundation
Role:
Independent
review of conflict-
free case
management
Georgia Healthcare
Association
Role:
Support of BIP
referrals from
nursing homes
Department of
Behavioral
Health and
Developmental
Disabilities
Role:
ESP service
database
enhancement
Main
Frontline:
Aging &
Disability
Resource
Connection
What have we already done right?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2009
Homes & Communities
Institutional Settings
Money Follows the Person A Georgia Success Story
$ for Medicaid Long-Term
Services & Supports
1,400 Transitions
2007-2012
What will BIP success look like?
• More 1915(c) Medicaid Waiver slots
• Higher pediatric home health reimbursement
• 3 new community-based services for behavioral health
• More community-based services for youth with emotional problems
• Expanded GA Pediatric Program Medically Fragile Day Care Service
• ADRCs established as primary point of entry for services
• Web-based training for community referral sources
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Principal Aims
● Reduce reliance on
institutional care
● Develop community-based
LTC opportunities
● Enable people with
disabilities to participate fully
in their communities
Money Follows the Person
● Medicaid beneficiaries in institutional care for at
least 90 days
– Nursing homes, hospitals, intermediate care facilities for
the mentally retarded, institutions for mental diseases
● Transition to a “qualified” residence
– Home, apartment, or group home with four or fewer
people
● Quality assurance
– 24-hour backup
– Risk assessment and mitigation processes
– Incidence reporting and management systems
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Money Follows the Person
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● MFP Services
– Eligible for one year – 365 days
– Package of home- and community-based services
(HCBS)
• Qualified HCBS
• Demonstration HCBS
• Supplemental services
● Continuity of services
– After MFP eligibility ends, qualified HCBS must
continue based on beneficiary’s Medicaid eligibility
status
Money Follows the Person
Money Follows the Person
• Program Overview of MFP
– Medicaid Grant to Department of Community Health
• DAS & DBHDD contracted to execute program
• Goal is to Rebalance Medicaid dollars from Institution to
HCBS (Medicaid Waivers)
• Evaluated at national level with Quality of Life Survey
• Transitions Medicaid beneficiaries from inpatient facilities to
community settings
MFP Transition Goals by Demonstration Year
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0
100
200
300
400
500
600
2007 2008 2009 2010 2011 2012
MFP Total Transitions
DAS+
DCH seeks to transition 2,142 individuals from institutional setting to the
community.
DAS Assumes Contract
MFP Quality of Life Dashboard
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33% 31%
83%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Older Adults People with Disabilities/TBI
Baseline
First Year
M1Q3: Do you like where you live
MFP Quality of Life Dashboard
15
73% 70%
85% 87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Older Adults People with Disabilities/TBI
Baseline
First Year
M2Q9: When you are at home, can you et when you want to? Yes
MFP Quality of Life Dashboard
16
48% 41%
88% 85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Older Adults People with Disabilities/TBI
Baseline
First Year
M3Q14: Do you ever go without a bath or shower when you need on? No
MFP Quality of Life Dashboard
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64%
47%
71%
64%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Older Adults People with Disabilities/TBI
Baseline
First Year
M6Q23: During the past week have you felt happy or unhappy with the
way you live your life? Happy
Program Improvement Project (PIP)
• DCH 2 Year, $968,297 grant from CMS
– Incorporate Adult Health Care Quality Measures into
Medicaid Programs
– Generate, report and validate adult quality performance
measure rates for the Medicaid Adult-Only members
• $360,000 year to DAS/Care Coordination Agencies for
implementation and monitoring
Program Improvement Project (PIP)
• CCSP PIPs will focus on:
– improvements in screening for clinical depression and
– improvements in the management of antidepressant
medications for the elderly
CCSP/PIP
• Deliverables
– PHQ-9 (Depression Screening) on all new enrollees
– Tailor Care Plan
• to include referral to PCP
• to facilitate Rx “picked up & taken”
– Record Data in AIMS
• New AIMS data fields, reports needed
• Integrate AIMS with GAMMIS to facilitate formulary and health
data transfers for CCSP clients and wards
Program Improvement Project (PIP)
1894
739
287 147 33
3345
1057
313 73 20
0
500
1000
1500
2000
2500
3000
3500
4000
0-4 None 5-9 Mild 10-14 Moderate
15-19 Mod Severe
20-27 Severe
18-64 Years
65+ Years
CCSP - PIP Baseline Data Report
Questions?
Contact
Dr. James Bulot
Division Director, Aging Services
Georgia Department of Human Services
2 Peachtree Street, NW, 33rd Floor
Phone: 404-657-5258
Email: [email protected]
