Open Bridges Gains Steam!

CCLTSS writes a letter of support for CCI rate restructuring to allow Medi-Cal Funding for Assisted Living Settings.

By Jason Bloome

The Open Bridges campaign began about two years ago with a goal to change the rate tables for the California Coordinated Care Initiative (CCI) to allow Managed Care Organizations (MCOs) to use Medi-Cal to pay for assisted living settings.

Open Bridges got a major boost recently when, on November 17, the California Collaborative for Long Term Support and Services (CCLTSS), a coalition comprised of 34 statewide aging and disability rights agencies, wrote a letter to the Department of Health Services (DHS) fully supporting the goal of restructuring the CCI rate cells to allow MCOs to move long-term SNF patients to lower levels of care.

Their other policy recommendations include:

• Allow In Lieu of Services (or Care Plan Options — CPO) to be included in Rate Development Templates (RDT) which incentivizes plans to develop programs for institutional delay and diversion and promote independent, community-based living;
• Streamline operations, i.e., how members are tagged to appropriate rate cells;
• Build in savings for the state; and,
• Allow members to stay enrolled in both CMC and HCBS waivers.

If the DHS approves these policy goals it would help alleviate the plight of the estimated 11,000 low-income elderly in skilled nursing facilities (SNFs) with low-level care needs, who, if given the choice, could transfer to lower-level assisted living settings, including small home-like board and care homes that provide care for four to six residents. These settings with high staff to resident ratios would be ideal for seniors who require too much care to remain at home (e.g., require more than the maximum allowable In Home Support and Services hours) but who do not require skilled nursing level of care.

Adding a CCI rate category for assisted living would also provide an elegant workaround for the Assisted Living Waiver which has many intractable problems including long waitlist and a limited pool of providers.

Rebalancing long-term care from institutions to assisted living settings will have a significant impact on care professionals, including case managers and social workers, who coordinate hospital discharge planning when:

1) Medicare estimates 1 in 5 seniors recycle back to hospitals within one month of discharge (many due to inadequate care at home) and hospitals pay penalties for hospital readmissions;

2) Long-term custodial care Medi-Cal SNF beds are difficult to find since Medicare pays a much higher rate for short-term rehabilitation than Medi-Cal pays for long-term residents;

3) Patients unable to receive adequate care at home could be directly discharged to assisted living settings where they could receive short-term rehabilitation services in the same setting where they intend to reside long-term.

Hospitals that have state contracts to provide Medicare services and subcontracts with CCI MCOs (e.g., Kaiser) to provide Medi-Cal services will especially benefit from LTSS rebalancing. Assisted living homes are far more affordable than expensive SNFs; coordinating short- (Medicare) and long-term (Medi-Cal) services in the same setting provides cost savings, and low participation in Cal MediConnect (28% throughout California) becomes a non-issue since the MCO already manages both the Medicare and Medi-Cal components.

CCLTSS is still waiting for DHS to respond to their letter. In the meantime, now is the time for stakeholders, including social workers, to show their support for this crucial issue.

For more information about the Open Bridges campaign see: www.carehomefinders.com/olmstead. Background articles about Open Bridges written for the National Association of Social Workers can be found at Twisted Logic and Broken Bridges.

Jason Bloome is owner of Connections–Care Home Referrals, an information and referral agency for care homes for the elderly in Southern California. More information can be found at www.carehomefinders.com.

Definition:

Dual-Eligible: a person receiving Medicare and Medi-Cal services

Cal MediConnect: a dual-eligible who chooses to have Medi-Cal and Medicare managed by the same state contracted MCO.

Sources:

CCLTSS letter to DHS.

CCI Enrollment data.