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.

1. REWARDS AND
CHALLENGES OF
PROVIDING MEDICAID
ASSISTED LIVING IN OK
OKAHSA
March 2010

2. Presented By Joyce Clark
405.812.9089

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. ADvantage ASSISTED LIVING
 Assisted Living Providers
Must Be OSDH Licensed.
And Then
 Assisted Living Providers
Must Be ADvantage Program
Certified by OKDHS.

5. REWARDS
Much easier for Medicaid
certified nursing home to
implement than private pay
assisted living community.

6. REWARDS
Intrinsic
New service option that
promotes independence,
avoids early institution, and
slows health decline.
Expands continuum of care.

7. REWARDS
Enlarges target market.
Diversifies
resident and
revenue base.
Increases opportunity to
maintain 100% occupancy.

8. REWARDS
Assistswith supplements
and supplies.
Independent
case
management.

9. CHALLENGES
 Industry
and community wide lack
of awareness & understanding.
 Bureaucracy.
 Increasesstaff cost and operation
expenses – especially for private
pay assisted living provider.

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. CHALLENGES
 Additional regulations and
survey.
 Threats of funding cuts.
 Interagency differences.
 Physical plant requirements.
 Qualification process.

12. FYI…
 OKDHS & OSDH Partnership
 Physical Requirements
Lockable Doors
Private Rooms
Private Bathroom

13. Kitchenette
Minimum Square Footage:
Built Prior to 1/1/08 = 250 sq. ft.
Built After 1/1/08 = 360 sq. ft.

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. 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. 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. 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. SERVICES TO MEET CONSUMERS
NEEDS MAY INCLUDE:
Personal Care
Housekeeping
Laundry
Meal Preparation

19. SERVICES TO MEET CONSUMERS
NEEDS MAY INCLUDE:
 NursingEvaluations and
Supervision.
 Nursing Care.
 Medication Administration.
 Assist
with Transfer or
Ambulation.

20. THANK YOU!

21. Achievis Services Include:
•DEVELOPMENT
•PROJECT MANAGEMENT
•FEASIBILITY ANALYSIS
•MARKETING & MANAGEMENT

22. Joyce Clark
(405) 812-9089
achievis@cox.net