DLTC INFO MEMO 2008-10
STATE OF WISCONSIN
Department of Health Services DLTC Memo Series 2008-10
Division of Long Term Care Date: October 10, 2008
Index Title: Family Care Transition Guidance to County Long Term Support
Agencies
To: Listserv
For: County HS/SS/DCP Directors
LTS Coordinators
DD Coordinators
From: Sinikka Santala
Administrator
Subject: Family Care Transition Guidance to County Long Term Support
Agencies
This memo provides guidance specifically to those county long-term
support agencies that are going through the transition to Family Care and
IRIS and are in the process of providing enrollment counseling to current
waiver participants in accordance with their county transition plan. This
memo is intended to supplement and/or clarify technical assistance
material on enrollment counseling already made available.
Enrollment Counseling
Enrollment counseling is defined as assisting individuals who are found
eligible for publicly funded long-term care programs by educating them
about the available programs in their area and providing decision-making
support in the selection of a long term care program. All persons must be
offered a choice in how they wish to receive their publicly funded
long-term care services whether it be Family Care, Partnership (available
only in some areas) or IRIS (Include, Respect, I Self-Direct) the new
self-directed support waiver. In order to facilitate the transition of
clients from existing home and community based waivers to Family Care and
IRIS, county long-term support agencies provide enrollment counseling to
all current home and community-based waiver participants. During this
transition period, the local Aging and Disability Resource Centers
provided enrollment counseling to persons on the wait list, those who are
newly eligible for long-term care and to any managed care member who seeks
to disenroll from managed care.
The Department understands that the county support and service
coordinators/care managers who provide enrollment counseling to existing
waiver participants are taking on a new role with which they are not
familiar. These staff have a significant amount of new information to
learn and absorb in order to provide program participants with objective
non-biased information upon which to make a decision among new programs
and providers.
Making this decision is a big step for many waiver participants. People
need to receive accurate information, often multiple times before they can
make an informed decision and be comfortable with it. In the transition
that has occurred to date, concerns have been raised that some
participants may not be receiving adequate, accurate or unbiased
information about all options or in a way that enables them to understand
and process the information.
To assist county agencies and their staff in this process, the
Department requests that each county follow the best practice guidelines
described in this memo during its transition process. Additional
information on these practices and other guidance can be found in the
enrollment counseling materials on the Department's ADRC website (See
Helpful Links at end) or by contacting your local ADRC.
- Begin enrollment counseling as soon as possible depending on the
pace of the transition. The best practice guideline is to begin at least
four months before the scheduled transition date. This is especially
important for those counties that are transitioning all waiver clients one
day.
- Waiver case managers should not make a predetermination of the most
appropriate long-term care program for any participant based on previous
history or knowledge, objective enrollment counseling for each person is
important.
- Ensure that all staff doing enrollment counseling are sufficiently
informed about each of the options available in the county. The most
useful initial training that all staff responsible for enrollment
counseling should view is the web casts on enrollment counseling and IRIS
that can be found on the Department's website (See Helpful Links at end).
This is the minimum base of knowledge that each staff should have.
Additional written materials and face-to-face training opportunities are
also available from the Department. The managed care organizations that
will operate programs in your area may also have materials that you can
provide to participants as a part of enrollment counseling. There are also
materials available regarding IRIS.
- If PACE and/or Partnership will be available staff should become
knowledgeable and should understand the timing issues related to the
Medicare component of these programs. Case managers can become
knowledgeable about these specific requirements by reading enrollment
counseling technical assistance documents (located at http://dhs.wisconsin.gov/ltcare/Generalinfo/RCs.htm
)
and MCO member handbooks, watching enrollment counseling web casts and
participating in enrollment counseling trainings.
- In addition to the web-based training and other materials available
from the Department, make sure to provide sufficient training and support
to staff to increase their expertise in this new role. Those methods could
include shadowing another staff person, role play, teaming staff, or other
mentoring strategies.
- Use only Department approved enrollment counseling materials that
are available from the DHS web to ensure that people receive complete,
consistent, accurate and objective information.
- Ensure that people receive unbiased enrollment counseling. Some
strategies to ensure this include:
- Whenever possible try to assure that staff who are expected to be
employed by, or working on behalf of, a particular provider or program are
not providing enrollment counseling. Support and service coordinators/care
managers who will be moving to the Aging and Disability Resource Center or
staying with the social or human service agency in some other capacity
should be used as much as possible to provide enrollment counseling.
- Try to keep future affiliations of care managers with managed care
organizations out of the conversation. Participants may be inadvertently
influenced based on knowledge of the relationship of their current care
manager with a particular program or provider. If asked by a participant
the counselor should respond honestly, but advise the participant that
there is no assurance that he/she continue as the participant's care
manager and that the care manager's future position should not influence
his/her choice.
OR
- If that is not feasible, have staff disclose to participants in the
early part of the discussion any future affiliations with agencies that
will be operating long-term care programs.
- Schedule enrollment counseling to allow time to meet deadlines for
submitting centralized enrollment documents or to allow the participant to
meet with the IRIS Independent Consultant to develop the support and
service plan in time for the scheduled transition date(s). (See attached
timeline.) If transition decisions are made as early as possible all
partners can be prepared to ensure a smooth transition. It is important
that the waiver participants do not feel pressured to make a decision in
an unreasonable timeframe. Persons choosing IRIS may be referred to the
Independent Consultant Agency (ICA) at the time they reach their decision
to select IRIS or to explore that option more thoroughly through a
referral to the ICA.
- Provide more than one opportunity for each individual to receive
enrollment counseling. Some people will need additional time to absorb
information and others may have follow-up questions or concerns they wish
to discuss.
- Remind persons that participating in any of the long-term care
programs remains voluntary. People may change programs at any time.
Reminding people of this option may ease the decision process for many.
The Department remains committed to ensuring that people have continuity
of services when they change from program to program and to assure that an
existing plan of care will not end until the new plan begins.
- Enrollment Counseling activities for people participating in the
Medicaid Home and Community-Based Services Waivers are consistent with
required support and service coordination/care management contacts. This
includes, enabling the person to receive a full range of appropriate
services and supports consistent with his/her assessed needs in a planned,
coordinated, efficient and cost effective manner. Providing unbiased
information about future support needs; service and provider options; and
other long-term support information are all allowable activities. County
long-term support agencies are encouraged to have their staff document
these interactions to meet face-to-face and collateral contact
requirements and in order to secure waiver reimbursement for staff time
spent on these activities.
IRIS Monthly Allocation
Persons interested in IRIS must be informed of their monthly budget
allocation as calculated by the Long-Term Care Functional Screen (LTCFS).
This calculation is generated automatically for any screen that has
eligibility calculated on or after July 14, 2008. At present this amount
only includes on-going long term care expenses. Individuals should not be
told they must spend this amount. It is an estimate within which they will
create a support and service plan with their IRIS Independent Consultant.
The individual should be informed that he/she may be eligible for Medicaid
Card services such as personal care in addition to the IRIS services that
are funded from his/her individual budget. This monthly allocation amount
may be adjusted either for ongoing expenses or for infrequently used
services or goods such as home modification through the DHS review
process. The ICA assists persons who need to access this review process
after they have been unsuccessful to create a support and service plan
within their monthly allocation amount as noted in the LTCFS.
Enrollment/Referral Process
Family Care, Partnership, PACE Enrollment. The centralized enrollment
process applies only to current waiver participants who choose to enroll
in Family Care, Partnership or PACE and who meet certain criteria or to
persons on the wait list who already receive Medicaid. Please make sure
that the staff involved in enrollment counseling are knowledgeable about
the timing requirements for this process and schedule the enrollment
counseling to meet these timeframes. (See attached
timeline.)
IRIS Enrollment. Persons who choose IRIS cannot be referred using the
centralized enrollment process. The referral is documented by selecting
IRIS from the HCB waiver dropdown box in the LTCFS and entering the
referral information into the DHS Program Participation System (PPS).
(Long-term support agencies may want to coordinate with their local ADRC
to enter the individual into PPS.) A signed referral form together with
other needed information is sent via facsimile to the IRIS ICA. If
counties need technical assistance with this process, they should contact
the ICA at 1-888-515-4747.
Transition Plan Flexibility
The Department reminds counties that the transition plan developed by the
county and approved by the Department is intended to outline a fiscally
balanced transition process. Although the plan is based on the transition
of actual individuals who are on the current waivers, counties should not
interpret the DHS approval as a requirement that the specific individuals
must transition as noted in the plan. As long as the county maintains a
fiscally balanced month-by-month schedule as is described in the plan, the
county has the flexibility to respond to individual needs or concerns by
re-arranging the timing of people's transitions.
For example, current participants may have compelling circumstances
that require modifications to the county transition plan in order to
accommodate them. The county should make every effort to accommodate these
circumstances. The earlier that support and service coordinators/care
managers begin enrollment option conversations with participants the
sooner counties will be aware of these circumstances and will be able to
incorporate them into planning. Persons choosing IRIS should be referred
to the ICA as described above. They do not need to wait until their
transition month to be referred for service planning.
Thank you to waiver care managers and their supervisors
We recognize that provision of enrollment counseling to existing waiver
participants by waiver care mangers represents an increase in workload and
requires learning a great deal of new information. We also recognize that
care managers are often doing the enrollment counseling under
circumstances where their own future role and employment future may be
unclear. However, we also know that the waiver care managers are deeply
committed to ensuring that each and every waiver participant has the
information they need to choose their future long term care program. And
we are deeply grateful for that commitment as we move ahead in reforming
Wisconsin's long term care system.
We appreciate the work that care managers/support and service
coordinators do on enrollment counseling and want them to feel
knowledgeable and prepared to carry out these important conversations with
waiver participants who have to make critical decisions for themselves. If
you have suggestions for additional tools that could make this transition
smoother, please convey that to your regional area administration contact
or e-mail to DHFSRCTeam@wisconsin.gov
.
Thank you again for your hard work and deep commitment!
Helpful Links
General ADRC
website: http://dhs.wisconsin.gov/ltcare/Generalinfo/rcs.htm
Enrollment
counseling TA document: http://dhs.wisconsin.gov/LTCare/pdf/rcd08-3.pdf
Enrollment Counseling Web cast: http://dhs.wisconsin.gov/ltcare/Generalinfo/Webcast/adrcwebcastLTCEnroll.HTM
IRIS Web cast and other IRIS materials: http://dhs.wisconsin.gov/ltcare/Generalinfo/Webcast/adrcwebcastIRIS.HTM
IRIS information:
http://dhs.wisconsin.gov/ltcare/Generalinfo/iris.htm
PPS training Web casts:
http://dhs.wisconsin.gov/ltcare/Generalinfo/pps.HTM
Transition
information:
http://dhs.wisconsin.gov/managedltc/transition/index.htm
CENTRAL OFFICE CONTACT: Maurine Strickland
Information & Assistance Program Specialist
Office for Resource Center Development
Bureau of Aging and Disability Resources
608-266-4448
MEMO WEB SITE: http://dhfs.wisconsin.gov/dsl_info/
Attachment: Enrollment Counseling Timeline
(PDF, 87 KB)
cc: ADRC Directors
Area Administrators
Janice Smith, ORCD
Beth Wroblewski, BLTS
Monica Deignan, OFCE
Independent Consultant Agency
Last Revised: November 26, 2008 |
