TennCare Programming Changes Face of Long-Term Care
Options are always more fun than ultimatums.
When the Tennessee Legislature unanimously voted to pass the Long Term Care Community Choices Act of 2008, lawmakers hoped to provide a broader range of options to seniors and those with disabilities. In July 2009, Tennessee officials received word that the Centers for Medicare & Medicaid Services had given the green light to the state’s request to amend the TennCare waiver to allow managed care organizations (MCOs) to coordinate the full spectrum of care for its members including medical, behavioral and long-term care.
“It allowed us to go forward with fundamentally changing the way we deliver long-term care services in Tennessee,” explained Kelly Gunderson, director of communications for TennCare.
By March 2010, the CHOICES program debuted in Middle Tennessee with the rest of the state coming online in August of that year. At its most fundamental level, CHOICES gives appropriate elderly and disabled TennCare members just that — a choice in how … and more importantly where … they receive services.
“Long-term care was primarily delivered through nursing facilities,” Gunderson said of life before the TennCare waiver. “Over the years, we had made some progress in home and community based programming,” she continued, adding that CHOICES really ramped up those efforts.
For More Information
Those seeking more information on CHOICES and the MFP program should call the toll-free hotline at 866-836-6678 to be put in touch with their local Area Agency on Aging & Disability (AAAD) or go online to www.tn.gov/tenncare/CHOICES.
Gunderson said that in 1999, only 1 percent of elderly and disabled TennCare members in need of assistance with daily activities received that help through Home and Community Based Services (HCBS). By 2009, 10 percent of that population had shifted to the home-based model of care.
When CMS approved the expanded TennCare waiver, however, the state experienced even more growth. On March 1, 2010, Gunderson said enrollment was approximately 82.5 percent in nursing facilities and 17.5 percent HCBS. In April 2011 — 13 months after Middle Tennessee went live with CHOICES and only eight months after the rest of the state rolled out the program — the numbers shifted to 74.3 percent in nursing facilities and 26.7 percent HCBS enrollment.
Gunderson was quick to say there is no “magic number” TennCare is trying reach for HCBS and that all services must be delivered within the state’s existing budget. “It can be very expensive to keep someone in the home; but for the most part, it is less expensive,” she noted. The bottom line, Gunderson added, is the program opens up more options for those in need of assistance, but safety and cost effectiveness are still the mitigating factors.
While some of these community-based services were already available, Gunderson said the landscape is changing and businesses are diversifying to meet the growing need. Before, the only viable option for a person who required assistance with meals might have been a residential nursing facility. Rather than completely lose a significant portion of their business, some of those same facilities have expanded their operating model and have begun offering home delivery meal plans and other services in the community.
CHOICES covers a range of HCBS options including short personal care visits, attendant care when longer visits are required, respite care to give normal caretakers a breather, adult daycare services, homemaker services, delivered meal plans, some assistive technology, personal emergency response system technology, minor home modifications and alternative community-based residential options. Other services are also available, and some services do have cost caps or frequency limitations.
MFP Kicks Off Oct. 1
Beginning this month, TennCare is launching a demonstration project under the CHOICES umbrella — the ‘Money Follows the Person’ (MFP) program. “We’re ramping up to go live on Oct. 1, and it’s a five-year grant,” Michelle Morse Jernigan, MFP director, said of the program that is funded through 2016 but has the potential to be extended to 2020.
According to Jernigan, the MFP program “is the federal government’s way to help states make a greater shift from nursing facility care to home and community based care.” She added the state’s CHOICES program gives Tennessee an advantage in terms of experience in transitioning appropriate individuals back to the community. “It’s going to make that aspect of the CHOICES program more robust.”
Jernigan noted that even prior to MFP, nursing facilities were required to survey residents annually to identify those who have indicated they would like to move back into the community. With this new program, TennCare has contracted with the MCOs in each of the state’s three grand regions. Those MCOs have employed care coordinators to work with nursing facilities and discharge planners to evaluate individuals interested in alternative residential options. “They will be screened and assessed to determine if HCBS are appropriate for them. Along with HCBS CHOICES services a person may be eligible for, their care coordinator will make sure they have the natural resources and supports necessary to be successful in the community,” she noted.
Scott Bowers, chief executive officer of the Tennessee Health Plan for UnitedHealthcare Community Plan, said his group covers approximately 560,000 TennCare members statewide with a little more than 15,000 covered lives in the CHOICES program. “We’ve been focusing really hard on care coordination. Part of the MFP demonstration is taking a lot of the successes and effective processes and protocols that are working in the CHOICES program and trying to expand upon that.”
He continued, “Those patients who want to take their care into the community from the nursing facility, it really adds additional resources, incentives, alignment to help transition those patients into the community.”
Jernigan said the initial target is to identify and move approximately 2175 people out of nursing facilities and back into the community through the CHOICES MFP program. Furthermore, she added, that target number is split close to evenly between seniors and adults with physical disabilities. Jernigan added that the program would also serve people with intellectual disabilities.
“We’re excited because it will bring more attention than we already have to the CHOICES program and because it will bring more money to the state,” she said.
Jernigan said the only way to participate in the MFP program is to have resided in a qualified institution for a minimum of 90 consecutive days before being successfully transitioned back into the community setting. Participants also have to agree to be part of the MFP program, as the state must track their progress. Gunderson hastened to add, however, that an individual’s decision about whether or not to participate has no bearing on the benefits received. “They’ll still get the same exact services anyway … even if they say ‘no’ to MFP,” she said.
Of course, TennCare officials hope eligible members agree to participate in MFP as the state draws down additional federal dollars for the program. “If we support you and help you successfully stay in the community, we get an enhanced match for those days, which will help us build housing options and workforce capacity for others who may want to move back to the community but do not have the ability otherwise,” Jernigan said of the benefit to the state.
Gunderson added that the win/win program aligns with most people’s desire to be part of the community, helps prevent the erosion of an individual’s natural support systems that were in place prior to a hospitalization or stay in a residential facility, is typically the most cost effective option and generally enhances quality of life.