Missouri’s LOC Transformaon Final Stakeholder Meeng · Overarching Goal : Create a new Level of...

Missouri’sLOCTransforma1onFinalStakeholderMee1ng

November27,2018

1.  Refreshmemoryofjourneythusfar2.  Sharefeedbackresultscollectedfromstakeholdergroups3.  Offerrevisedmodeloftheframework4.  OutlinenextstepsincludingopportuniCesforinput

Session’sAgenda

OverarchingGoal:CreateanewLevelofCare(LOC)modelthat:

1.  EnsureaccesstocareformostinneedofHCBSprovidingleastrestric1vecommunityseMngaslongassafelypossible

2.  UselimitedstateresourcesonthosemostinneedofHCBScomparedtomorecostlyfacilityplacement.

3.  EnsureindividualsabletoliveinthecommunityarenotinappropriatelyplacedinamorerestricCveseMng.

BeginWithTheEndInMind

• NosubstanCveupdatessince1982• Inherentproblemswithcurrentmodel

• Exacerbatedwhenmovedfrom21to24points• Missouri’sagingdemographic• StateAuditor’sOfficerecommendaCon

WhyNow?

• RobertWoodJohnsonfundingthroughPrincetonUniversity’sStateHealth&ValueStrategies

• FundedtoperformfollowingacCviCes:1.  NaConallandscapescan

• Deeperdivesintospecificstatesofinterest2.  Stakeholderengagement3.  Co-createthenewmodel4.  SummarizekeylearningsandbestpracCces

TechnicalAssistance(TA)Grant

1982

NFLevelofCareEligibilityCriteriaAddedtoMissouri

Regula1ons

1982 2001

1stSignificantChangetoLOCMovefrom18to21points


Regula1ons

1982 2001

2017



Regula1ons

2ndSignificantChangetoLOC–Movefrom21to24

points

AwardedRobertWoodJohnsonFounda1onGrant

1982 2001

2017



Regula1ons

2ndSignificantChangetoLOC–Movefrom21to24

points

AwardedRobertWoodJohnsonFounda1onGrant

JanuarytoJuneResearchandDiscovery

JulytoDecember

StakeholderEngagementandModelForma1on

2018

June25,2018• 161HCBSProviders,52SNFProviders,and78Staff

July13,2018

• 197HCBSProviders,88SNFProviders,and84Staff

November27,2018• 298HCBSProviders,111SNFProviders,and94Staff

StakeholderEngagementSessions

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• NaConallandscapefindings• LOCeligibilitycriteria• FuncConalassessmenttoolsused• Assessor/Determinatorsofservicesandsupports• Scoringsystems

June25Mee1ngHighlights

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FrailElderlyDoorwayFeedback

Staff

HCBS

SNFs

Definition Changeage,couldbetieredage:65-70,70-79,80andup;maybestartatage75,startatage70sincemanyareinpoorhealth,startatage65,noagelimitbecausediscriminatory

� � �

Addshort-termrehabdoor �Indicators AddADLsincludingpersonalcare,supervision,transfers � �

AddIADLsincludinggroceryshopping,laundry,medprep,medmanagement,moneymanagement,schedulingmedicalappointments,lighthousework,usingphonetoaccomplishtasks,usingphoneapps,personalhygiene,householdchores,billpaying,othershoppingtasks,guardian,carrying10lbs.,readinglabels,andtransportation

�

�

�

�

AddtoSafety:A/N/E,memory,livingconditions � �

AddMedication:specificallyavailabilityandadministration �

PhysicalLimita1onDoorwayFeedback

Staff

HCBS

SNFs

Definition Addtowording:HIV,endstagedisease,kidney,liver,cancer �

Addtowording:morbidlyobeseanddiabetes;identifytimeframe

�

Addtowording:rehabandhospice;Howaccountforindividualswithlimb/muscleconstrictionoramputeewhonolongerneedclinical?

�

Indicators AddADLsincludingpersonalcare,grooming,bathing,dressing,allADLs � � �

AddIADLsincludingtransportation,mealprep,medicationprep,moneymanagement,householdchores,laundry,shopping(forMSorALSclients) ��

AddtoSafety:A/N/E � � �

AddtoSafety:fallrisk,transfers �

AddtoClinical:catheters,ostomies,etc. �

Demen1aDoorwayFeedback

Staff

HCBS

SNFs

Definition Changewording:HIV/AIDScouldbeinthisdoorwayorwhatkindofdx?Specifically,Dementiawordonly?

�

Changewordingtoidentifytimeframe;isanMDaspecialist,notruetestDementia(indicatorsmaybepresentbeforediagnosis);Needtoaddressthatindicatorsmaycomefirst

�

�

Changewording:doesadiagnosisofunspecifieddementiaqualifyasprofessionaldementiadiagnosis?

�

Indicators AddtoSafety:fallrisk �

AddtoSafety:risktoothers �

AddtoSafety:livingconditions;addpromptingandstandbyassist �

MentallyIllDoorwayFeedback

Staff

HCBS

SNFs

Definition Changewording:Toosubjective;vettedbyDMH?

�

Indicators Defineself-careunderIADLs � �

AddADLs:All �

AddIADLs:includingmedprep,medmanagement,personalhygiene,mealprep,groceryshopping,lighthousekeeping,payingbills,moneymanagement,abilitytomaintainaresidence,householdchores,schedulingmedappointments.

� �

AddtoSafety:self-harm,suicide,poordecisions,medicationcompliance;AddCognitionforimpairment �

AddtoSafety:refusingcare,noncompliance � ��

AddtoBehavioral:medication � �

AddtoSafety:A/N/Eandlivingconditions � � �

I/DDorABIDoorwayFeedback

Staff

HCBS

SNFs

Definition Changethewording:Tooopenended;addagoalorientedaspectwithintenttoimprovecapacity;needtoincludetheentiredefinitionofstatutetoincludeSCI;identifyandexpandtimeframe;vettedwithDMH?

�

�

�

Indicators AddADLs:includingtoiletingandbathing � �

AddIADLs:includinggroceryshopping,laundry,housework,medmanagement,doctor'sappointments,transportation,essentialcommunicationwithothers,self-care

� �

Defineself-careunderIADLsanddefineBehavioral �

AddtoClinical:medicationmanagement,verbalskills �

AddCognitionandfamilysupport/dynamics �

WeLearnedFromYourValuableFeedback

KeyTakeawaysfromFeedback

• Certaintypesofpeopleeveryoneagreesneedshelp•  Easyentrydoorwayneededfortheseindividuals• PotenCalforexclusionofsomeparCcipants•  Technicallydifficultandexpensivetoimplementwithcurrentassessmentandweb-basedsystem

CommonSenseApproach

AskedourselvesfouressenCalquesCons:

Inthecurrentsystem,1. What’sworking?2. What’snotworking?3. What’smissing?4. Whatdidresearchsay?

• Mobility• ADLs• IADLs• RehabilitaCon

What’sWorking?

• NotMeasuringthe“Root”- Monitoring- RestoraCve- NumberofmedicaConstaken- Physicianordereddiet

What’sNotWorking?

• LookingatcogniCveandbehavioralseparately• Waytohelpthosethatobviouslyneedserviceseasilygetintosystem

What’sMissing?

• ADLsarewhattrulymaper–allstatesemphasizethis• ThosewithupdatedsystemsrecognizecogniCveandbehavioralseparately

• Blendedalgorithmmodelswithvariablepointvaluesmakesmostsense

• CerCfiedassessorswitheffecCvetrainingmapers• UClizeweb-basedsystemandworldrenownedassessmenttool

• UpdaCngmorethanevery30yearshelps

WhatDidResearchSay?

• NeedtheRIGHTpeopletocreateRIGHTsoluCon

• Needyou,too!

LOCDreamTeam

TransparencyinProcess

CategoriesofCriteria

CurrentCategory• Mobility

• Behavioral

•  Treatments

ProposedCategory• MovedtoADLcategory

• Behavioral(modified)

•  Treatments(modified)


CurrentCategory• PersonalCare

• RehabilitaCon

• Dietary

ProposedCategory• AcCviCesofDailyLiving(new)

•  Dietary•  Bathing•  ToileCng•  Mobility

• RehabilitaCon

• MovedtoADLcategory


CurrentCategory• MedicaCon

• RestoraCve

• Monitoring

ProposedCategory• ModifiedtomedicaConmanagementonly

• Removedcategory

• Removedcategory

TwoProposedNewCategoriesofCriteria

ProposedCategory

• CogniCon• Safety

• Category-specificquesConsinassessment• PointsbasedoneachquesCon• CommonsensetriggerquesCons- LatestagesofdemenCa,bedbound,quadriplegic

ScoringProcess

• Intenselyanddeliberatelytrainedassessors- LookatallinformaConconsistently- UsemulCplesourcesofinformaCon

• Clientresponse,healthrecords,providerinformaConandothersources

- EnsureauthenCcityofneeds

Administra1onofProcess

• Wanttostudyourownresidents• Thoseinthesystem• Thosenotinthesystem

• RightservicesfortherightpeopleattherightCmeintherightseMng

That’salottogetRight!

LookatActualMissourians


JulytoDecember


2019-2020

Phase1:FinalizeandTestAlgorithm

Phase2:

Predic1veBudge1ngModelandBudgetProcess

Phase3:

Implementa1onModifica1ons

CyberAccessChangesInterRAIHCChangesAssessorCer1fica1on

Transi1onPlansRegula1onChanges

WaiverAmendments(4)

2020

2018

1982 2001

2017



Regula1ons

2ndSignificantChangetoLOC–Movefrom

21to24points

AwardedRobertWoodJohnson

Founda1onGrant


JulytoDecember


ThreePhasesofDevelopmentandImplementa1on

2020

2018

HCBSEligibilityProcessChangesNeeded

• Personcenteredcareplans• RegionaldispariCes

• CerCfiedassessors• Mobileassessments• Servicedeliverypackage

YourHolidayGid

GidDelivery

• PM/VMannouncements• MHDandMMACblast• AssociaConreps• Allfeedbackwelcome!

Homework:DashAwayandDoCaseStudies

Homework:DashAwayandDoCaseStudies

• NewwebpagelinkedfromHCBSproviderpage

• InstrucConswillbegivenforfeedback• UnClMarch31,2019toprovidefeedbackandactualcasestudies

Missouri’s LOC Transformaon Final Stakeholder Meeng · Overarching Goal : Create a new Level of...

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