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Rewards and Challenges of Oklahoma Medicaid Assisted Living feb 2010


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General info and review of challenges and rewards to offering Medicaid assisted living in Oklahoma. This is a new program that began in 2010 in Oklahoma.

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Rewards and Challenges of Oklahoma Medicaid Assisted Living feb 2010

  2. 2. Presented By Joyce Clark 405.812.9089
  3. 3. ADvantage PROGRAM  1915(c)Home & Community Based Medicaid Waiver that Serves Medicaid Eligible Persons Who Meet NF Level of Care.  Resident must also meet other qualification criteria to be eligible for assisted living services.
  4. 4. ADvantage ASSISTED LIVING  Assisted Living Providers Must Be OSDH Licensed. And Then  Assisted Living Providers Must Be ADvantage Program Certified by OKDHS.
  5. 5. REWARDS Much easier for Medicaid certified nursing home to implement than private pay assisted living community.
  6. 6. REWARDS Intrinsic New service option that promotes independence, avoids early institution, and slows health decline. Expands continuum of care.
  7. 7. REWARDS Enlarges target market. Diversifies resident and revenue base. Increases opportunity to maintain 100% occupancy.
  8. 8. REWARDS Assistswith supplements and supplies. Independent case management.
  9. 9. CHALLENGES  Industry and community wide lack of awareness & understanding.  Bureaucracy.  Increasesstaff cost and operation expenses – especially for private pay assisted living provider.
  10. 10. CHALLENGES  No reimbursement when resident is out of building (hospital, travel, rehab).  No pending or retroactive reimbursements.  Tierof Care is determined by OKDHS prior to IDT. Necessary modifications can be time consuming process that delays resident from move-in.
  11. 11. CHALLENGES  Additional regulations and survey.  Threats of funding cuts.  Interagency differences.  Physical plant requirements.  Qualification process.
  12. 12. FYI…  OKDHS & OSDH Partnership  Physical Requirements Lockable Doors Private Rooms Private Bathroom
  13. 13. Kitchenette Minimum Square Footage: Built Prior to 1/1/08 = 250 sq. ft. Built After 1/1/08 = 360 sq. ft.
  14. 14. ROOM & BOARD PAYMENT The member is responsible for room and board costs. The ADvantage Assisted Living Services provider is allowed to charge a maximum for room and board that is no more than 90% of the SSI Federal Benefit Rate (Currently $606.60).
  15. 15. REIMBURSEMENT RATE  Three tiered based on each consumer’s assessed need via independent UCAT assessment not associated with the AL but based on ADL-IADL need.  Does Not Pay For Room and Board.
  16. 16. PER DIEM RATE STRUCTURE Standard = $42.24 (estimated 20% ADv AL consumers) Intermediate = $57.00 (estimated 50% ADv AL consumers) High = $79.73 (estimated 30% ADv AL consumers)
  17. 17. DEFINITION OF ADvantage ASSISTED LIVING Assisted living services are personal care & supportive services furnished in a homelike, non-institutional setting including 24-hour on- site response capability to meet needs & provide supervision, safety and security.
  18. 18. SERVICES TO MEET CONSUMERS NEEDS MAY INCLUDE: Personal Care Housekeeping Laundry Meal Preparation
  19. 19. SERVICES TO MEET CONSUMERS NEEDS MAY INCLUDE:  NursingEvaluations and Supervision.  Nursing Care.  Medication Administration.  Assist with Transfer or Ambulation.
  20. 20. THANK YOU!
  22. 22. Joyce Clark (405) 812-9089