Hello everyone,
We are very excited to announce that we have finalized the agenda for the April 24, 2017 ALW Provider Forum, and would like to share the extended agenda with you all.
We are extremely grateful to Adina Gres with Financial Concierge, LLC for underwriting a portion of the Forum and to Lee Sommars with Lockton Insurance
Brokers, LLC for also underwriting a portion of the Forum! Without underwriters such as Adina and Lee, we would not be able to host a Forum such as this, so from the bottom of our hearts, we thank you both tremendously for your involvement and continued support.
FORUM OVERVIEW
Check-In, Light Continental Breakfast and Beverages: 8:30 a.m. to 9:00 a.m.
Opening Activities: 9:00 a.m. to 9:15 a.m. – Mark Cimino, Presenter
A. Introduction of Program
1. Introduction of Continuing Education Program
2. Introduction of Presenters
B. Overview of Topics to be discussed
Part I: 9:15 a.m. to 9:30 a.m. – Mark Cimino, Presenter
C. ALWP Eligibility Requirements:
1. Assisted Living Waiver (ALW) eligible individuals are those who are enrolled
in Medi-cal and meet the level of care provided in a nursing facility due to
their medical needs.
2. Individuals with Medi-cal benefits that include a share of cost are not eligible
to enroll in the ALW opportunity.
3. Determination of care needs is determined by a registered nurse (RN)
employed by the Care Coordination Agency (CCA).
Part II: 9:30 a.m. to 10:30 a.m. – Karli Holkko, Presenter
D. ALW Care Coordination Benefits
1. Care Coordination Agencies (CCA) assist participants in gaining access to
needed waiver and other state plan services.
2. This waiver benefit is designed to evaluate the need for care coordination
services prior to any successful transition from a hospital or skilled nursing
center to an assisted living or board and care home.
3. Care coordination also benefits the participant by ensuring his or her needs
are met throughout their program enrollment.
4. Care coordination is ongoing for the duration of the time the participant is
enrolled in the waiver program. If a participant leaves the program due to
hospitalization, the care coordinator will continue to follow the participants
up to 30 days for purposes of ensuring the return to the assisted living or
board and care setting.
5. Assessment are completed by the care coordinator using the ALW
Assessment Tool at least every 6 months or more frequently if a change in
condition is indicated.
6. Care Coordinators must verify Medi-Cal eligibility as well as include the
participants and families in the development of an Individualized Service
Plan (ISP).
7. Care Coordination Agencies enrolled as providers in the ALWP are
professionals whose duty is to provide a safe, smooth transition from
hospitalization or nursing home settings to an assisted living or board and
care environment.
Part III: 10:30 a.m. to 11:00 a.m. – Karli Holkko, Presenter
E. Description of required ALW Services
Services that are required by state statues and regulations to be provided or
coordinated must include, but are not limited to:
1. 24-hour awake staff necessary to meet the needs of residents (24-hour
awake staff is NOT required for RCFs with 6 beds or less).
2. Assistance with activities of daily living.
3. Health related services including: medication management, treatments,
wound care, etc.
4. Social Services – emotional support as necessary for resident and other
resource offerings.
5. Recreational activities – Meaningful activities that include social, educational
and other stimuli based on the residents level of care and other psychosocial
needs.
6. Meals – 3 meals per day minimum.
7. Housekeeping and laundry services.
8. Provide or arrange for transportation to and from medical and other
necessary appointments.
9. Medi-Cal payment considered payment in full.
Each resident has the right to make choices and receive services in a way that will
promote the resident's dignity, autonomy, independence and quality of life. These
services shall be determined by written contract between the provider (facility) and
resident.
Additional services to be provided shall include:
1. Assisting in the development of the residents ISP (Individualized Service
Plan), which outlines the type and frequency of intervention to be provided.
The participants or their responsible parties shall sign their own ISP.
2. Maintaining the facility in a clean, sanitary order.
3. Provide intermittent skilled nursing services as required by resident – this
may include coordination with appropriate outside agencies.
4. In accordance with State law, provide assistance with the self-administration
of medications, or as necessary administering medications by an RN or LVN.
5. Provide a response system that enables the participants to summons for
assistance from the personal care provider.
6. Keep consistent communication with CCA's.
Part IV: 11:00 a.m. to 11:30 a.m. – Mark Cimino, Presenter
F. How the ALWP can truly benefit nursing rehab centers, seniors and RCFEs
simultaneously
1. ALW can take residents from a long term nursing home setting and allow for
placement into a secured, home-like environment with a good food,
activities, socialization and a continuum of care.
2. RCFE's will have less struggle to fill their beds with quality residents.
3. Seniors will benefit from a psychosocial and physical standpoint as they
receive needed close knit supervision and care of their specific needs.
4. Nursing Rehab Centers benefit by discharging a lower paid client and filling
their bed with a high paying Medicare and/or HMO client.
Part V: 11:30 a.m. to 12:00 p.m. – Mark Cimino, Presenter
G. The Future of ALW: Managed Care vs. Fee-For- Service Model
1. Managed Care negotiates fixed rates in one lump based on level of service.
2. Fee for Service is designed to pay the provider as a service is performed.
3. A positive impact on RCFE providers of ALW: If managed care contracts
can extend to ALW providers by offering a certain feasible rate for care of
their clients, this may help keep RCFEs full and decrease risks of re-
hospitalizations.
4. A benefit to the insurance company: A higher likelihood of decreased
costly medical interventions for individuals since they will be receiving the
proper delivery of care in the residential setting.
5. Huge focus today is on decreasing re-hospitalizations. All managed care
companies and those offering fee-for service will be looking at options
designed to save them time and money. This comes on the heels of general
increases in medical costs and the huge influx of baby boomers who will
flood the market with an array of medical issues including dementia,
diabetes, drug and alcohol abuse and heart disease. The ALW program can
play a pivotal role in helping this situation if presented and utilized
appropriately in the future.
Working lunch offering from 12:00 p.m. – 12:45 p.m.
Part VI: 12:00 p.m. to 12:45 p.m. – Tina Mayes, Presenter
H. Common findings, concerns, corrections, and program expectations pertaining to
the ALWP with an open discussion with all presenters following shortly thereafter.
Part VII: 12:45 p.m. to 1:30 p.m. – Adina Gres, Presenter
I. How to best navigate billing residents who are enrolled in the ALWP.
1. Describe the relationship with Xerox and the ALW Program.
2. How the provider can get paid.
3. Billing dates and how the provider’s submission affects the outcome.
4. Common mistakes made with regard to billing and how to correct said
mistakes.
5. The benefits of hiring an outside person do billing.
Part VIII: 1:30 p.m. to 1:45 p.m. – Mark Cimino, Presente
J. Closing statements and thank you to those who attended and presented.
Lastly, this is just a reminder to those who have not yet R.S.V.P.’d to the April 24, 2017 ALW Forum that will be held in Los Angeles, CA, the seats are filling up very quickly, so please be sure to R.S.V.P. through Erin Stone at Erin.Stone@CiminoCare.com at your earliest convenience!
Sincerely,
Mark J. Cimino,
Chief Executive Officer
Erin Stone,
Director of Marketing
