Indiana Division of Aging Update for HEA 1391

In 2014, the General Assembly passed House Enrolled Act 1391. Section 7 of the bill requires the Office of the Secretary of Family and Social Services, in conjunction with the State Department of Health, and the Office of Management and Budget, to provide a written report to the Indiana General Assembly before October 1, 2015, regarding various issues concerning delivery of long term services and support in Indiana (click here for details). The report is not yet complete, but there have been multiple drafts, and the latest draft was just released for review.

The latest draft supports reliance on a two-year CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) pilot program, for which will be available in 2017. The CHOICE pilot program is a two-year program implemented in four regions of the state, Ares 1, 4, 13 and 14. The pilot program is intended to evaluate the impact of changes in the CHOICE program. The changes include lessening eligibility requirements to one Activity of Daily Living (ADL) impairment, which will allow individuals to receive services before their needs become extensive. The asset limit is reduced to $250,000 and an increase in cost share participation by basing it on assets as well as income in an attempt to be applicable to more individuals. The pilot program also puts focus on a needs based assessment process to identify community and personal resources for the individual’s needs, potentially without the use of public dollars. There is also more flexibility in the utilization of case management dollars for the initial assessment and screening stages. This pilot program could potentially change performance metrics such as: nursing facility admission rate in pilots versus non-pilots; reduction of wait lists or time spent on wait list; reduction of expenditures per person served; increased informal supports; and improved quality of life as measured in a new survey tool. The draft does address the issue of low occupancy rate in nursing facilities and credits the passage of the moratorium to help occupancy rates rise. The draft also discusses the FSSA’s perspective that Indiana needs to rebalance long term services and supports spending towards more Home and Community Based services. Tennessee’s managed care was used as a positive example for how nursing facility and long-term care costs can be contained relative to growth in the population over age 65. There is also an entire section dedicated to telemedicine physician coverage in nursing facilities. Telemedicine provides numerous ways in which to improve health outcomes through the use of two-way, real-time interactive communication between the patient and a remotely located physician or medical practitioner using audio and video equipment. Although Telemedicine is being used in some nursing facilities, it is not yet required, but possibly could be in the future. To see the entire draft please click here.