Informing Long Term Care Choice - MDS 3.0 Section Q Training - Section Q Pilot Test Discussion

Uploaded by CMSHHSgov on 30.09.2010

MDS 3.0 - Section Q
Pilot Test Discussion
[Dan Milne]
So I thought for this panel I'd start asking some basic questions and -- so if
you could, describe who was on your Section Q implementation team, who
participated and how did you get organized. So let me start with Dawn.
[Dawn Lambert]
In Connecticut, we went through -- worked through the Nursing Home Associations
to identify nursing facilities that might like to partner with us and from that,
three facilities were identified. One of them wasn't able to participate because
the Department of Public Health called a surprise inspection the first week --
we won't go there.
But anyway, they decided not to -- they declined to participate although they're
working with us now. And the other two facilities, one was a facility very eager
to work with us. The facility's administrator is here today and working in the
workshops, Martha Gill [spelled phonetically], and she's also co-chair of the
Money Follows the Person steering committee and she has been involved ever since
2001 when the first round of Real Choice System Change grants were involved. The
other one is a facility called Kindred Health. It's a chain in the state of
Connecticut. They have facilities also in Massachusetts. Both of them
participated but we work through the association to get that [unintelligible]
[Dan Milne]
Marc in Texas, how did you get organized?
[Marc Gold]
Yeah, I wanted to say two things. One, I have a -- I brought out a handout,
about 38 pages and it covers information letters, how to work with relocation
specialists within a nursing facility environment, has assessment tools that
relocation specialists use as they try to assess that individual, it has
individual responsibility agreements that works with individuals between the
Home Health Agency and the -- there's a lot information, plus the new
re-procurement [spelled phonetically] for doing for relocation contract, I give
you a link if you want to look that up. I couldn't have a full thing but I
brought about 50 of these and I brought about 75 cover letters to get
information. And I want to thank the American Healthcare Association affiliate
in Texas, the Texas Healthcare Association, for working with us. And in the
state of Texas, I contacted Tim Graves, who is the executive director of the
Texas Healthcare Association, and working with them in relationship with our
relocation specialists, our managed care organizations, and our caseworkers,
they were all part of this team.
We selected three nursing facilities that were through the Texas Healthcare
Association and they asked for volunteers. I asked for one to be in an urban
area, one to be in a suburban area, and one to be in a rural area to see if
there's any sort of differentiation. We met and talked in an ongoing basis to
ensure that if they had any questions, or the team was working as a team
throughout that process.
[Dan Milne]
Mary in New Jersey, how did you get organized?
[Mary Malec]
We started a little bit before that. We met with our own administration -- can
you hear me now?
Okay, from here it works. I met with my administration and pulled in all the
stakeholders on the state side, the ADRC [spelled phonetically], you know,
touched base with DDD [spelled phonetically], MFP. We talked about how we were
going to do this. We already have a presence in the nursing homes with the
Community Choice Initiative which we've had out there since 1998 but we knew
this was an expansion beyond the usually counseled Medicaid or potentially
Medicaid eligible individuals. So we needed to figure out -- we weren't sure how
many referrals we would get, how we'd be doing that -- so we had to talk it out.
Were we going to use the ADRC staff? Did we have the financial resources? Did we
have the staff resources to this? In the end we decided it was a natural
outgrowth of the counseling we were already doing in the nursing facilities, so
we went that route. It did not require more funding. We just expanded the roles
of the Community Choice options counselors.
We then went on to meet with the New Jersey Hospital Association. Their
long-term care unit worked with us and the Nursing Home Associations for profit
and non-for-profit. We talked about the program. I took PowerPoint's and all
kinds of education materials about Section Q with me and talked it out. And they
agreed to canvass the state for a candidate and someone called me, lo and
behold, the very next day, very eager to participate, went out and did the road
show and talked about it. The wanted a few days to think about it and called me
a few days later and said, "Yep, we're on." Went out and did the more intensive
training. Called Dan Millmann [spelled phonetically] by teleconference so we
could talk about it. Also went out to our long-term care field office, the local
contact agency, talked about the processes, how we were going to make referrals,
how were we going to track them. So after we had the initial meeting with
nursing home, we came back and talked about all the processes and how we were
going to make this happen and focused more on the paper work, the tracking and
everything else. That's really how we got our foot in the door with the pilot.
[Dan Milne]
Ellen, how did you get organized?
[Ellen Speckman-Randall]
What I did was -- we already had a robust transition program so I selected three
of the waiver agents that we work with under the transition program and I too
tried to get the urban, suburban, and rural. And you can tell I'm from Michigan
because they were over here, here, and up here so we had the whole state
covered. And we asked them each to select a nursing facility in their area with
whom they would like to work. And I didn't choose our top performers because I
wanted to see how this work played out with some of the less stellar performers.
And so we just actually completed it a couple weeks ago.
[Dan Milne]
All right. Well the second toss-up question, I guess, is for each of you. How
did you organize the collaboration between nursing facilities and the local
contact agencies at the local level? And I guess did these entities already have
a working relationship prior to this? We'll start with Dawn.
[Dawn Lambert]
They did already have a working relationship but as the beginning point for
collaboration going back to the first implementation of transition services --
dedicated transition services in the state -- we did require that the local
entry points go and meet with the administrators at the nursing facilities and
before that we sent out a Medicaid letter to all nursing facilities letting them
know what was going to be, what kinds of services were going to be now available
within that. So the first step was to contact, from the Medicaid agency, a
letter to all nursing homes. And the second one was a, letting them know that
they were going to be approached by the local entity about new services
available and the second was the accountability on the organization -- local
level organization, to go and meet with that particular administrator and then
report back to us that in fact it was done. So that was the beginning for
[Dan Milne]
Ellen, same question.
[Ellen Speckman-Randall]
I pretty much answered. They had their relationship before we started this
because the waiver agents actually select the nursing home that they worked
[Dan Milne] All right. Marc?
[Marc Gold]
Well, in the state of Texas, we have relocated our twenty thousandth person so
we've had a long relationship between relocation contractors and nursing
facilities. And so the question really was more selecting the nursing facility.
Once they selected a nursing facility, we pretty much told a relocation
contractor they're going to participate in the rest of the relationship.
[Dan Milne]
I think Mary Sayles [spelled phonetically] from California is not here. She sent
me her notes last night so I'm sort of speaking from a California perspective.
They chose the aging disability resource centers to do the Section Q transition
coordination and they learned a big lesson about that. And that was, in
California, the ADRC's did not have a prior working relationship with nursing
facilities. They've been focusing on hospital discharges and so on and working
there. So this was sort of a new phenomenon for them. Their other lesson was
they didn't really do any training about this and, as a matter of fact, we gave
them a terribly short time period to get organized and started and sort of
skipped the training part. And the lesson was, you really can't do this without
sort of working on developing that collaborative relationship between nursing
facilities and local contact agencies and doing some training of that staff.
And I think Mary Malec from New Jersey talked about sort of the several episodes
and conversations and getting people together to do training and so on so a
strong lesson from California was if it, if you don't do -- develop that
collaborative relationship, if you don't do training, it's broken from the
start. But they used a pilot test with three facilities instead of the hundreds
and hundreds of facilities across the state to sort of work the bugs out for
them so it was an important lesson for all of us. Okay.
My next question is basically a little bit about outcomes, sort of how did the
Section Q process work in your state? So we'll start with Mary.
[Mary Malec]
We had over 200 interactions, MDS interactions, and we were very surprised that
it only generated five referrals to the local contact agency. And we tried to
analyze that a little bit. We weren't sure if maybe the discharge planners
weren't as enthusiastic as we were. Maybe they were matter-of-fact in asking the
questions and not explaining, you know, what a referral to a community agency
might mean now plus the fact that, as a result of pre-admission screening, many
of these individuals entering the nursing home already have been seen by the
Community Choice counselors and have already had the options counseling
presented to them.
Something else we thought, maybe there's a little bit of distrust with
individuals if they're going into sub-acute [spelled phonetically], you know,
maybe asked some of these questions, they don't want to divulge their financial
information. You know, they may feel like, "I'm going home, I'm going to
convalesce from this, I'm going home, I don't need any help and I don't need to
be talking to the government about what my income and assets are." So you know,
there are some different things we thought might have played into that but, you
know, that was our only big surprise, it only generated that many and, you know,
when we look at the statistics we're -- the hospitals alone are discharging
about a hundred thousand individuals a year to nursing homes in New Jersey. So
it remains to be seen what happens when we roll this out state-wide but we are
going to use our existing resources, our existing staff, to go in and do the
counseling and hopefully it won't overwhelm us too much so --
[Dan Milne]
Why don't we go down the row. Marc?
[Marc Gold]
Well it's amazing, like I stated, we relocated 20,000 people and we too have
generated not as many relocations from this process. And so I guess there's
always some lessons to be learned here. Now state of Texas has a very stringent
medical necessity. I don't know how the rest of your states define it. Ours is
you need a date, you need the intervention of a licensed nurse on the daily
basis, so it's very stringent to get in in the first place. There's a high level
of need. I, personally, think there's a number of issues going on. Even though
we've had a system now for the last decade, there is turn over and there still
is -- and I'm not saying this in a negative connotation -- but there still bias
in the nursing facility staff that that is the most safe environment for that
individual. And even though they're asking the questions, I think there's a lot
of work and education that needs to be done with the nursing facility staff,
with whoever is asking the questions and looking for that response. Many people
have said -- a lot of people said they felt very uncomfortable asking the
question, should somebody go home? When in fact they thought that the person
would never go home and so they were setting up some false expectations. So that
is a big problem there.
I think another issue is when there's family intervention. The family finally
got that person to finally go into that nursing facility and here you are the
state or there is a new process really working hard to get that person back out
of that facility. So again, I think there's a lot of education that needs to be
done not only with the families but also with the attending physicians.
Attending physicians, too, have been a significant problem for us throughout all
of our relocation.
There's also Home Health Agencies, again depending on how your home health
licensure rules work and how individuals have to take in a person. Many people
feel there's a liability here, there's also an issue about 24/7
[unintelligible]. We actually have a complex needs initiative going on trying to
educate the Home Health Agency. In that packet I talked about has an agreement
there where you can sort of talk about those issues.
So it's a combination of all those different little factors that we have --
we're learning about and it's going to take I think a lot of education, a lot of
training. I think to use a sort of psycho-babble sort of term but it really is a
different mindset and I think that's where we're trying to get at.
[Dan Milne]
Okay. Dawn?
[Dawn Lambert]
In the state of Connecticut, the nursing facilities did a great job of making
sure that every person who entered the facility did receive the new Section Q.
They completed 60 assessments of the two-month period out of 60 assessments, 75
percent of the folks who participated indicated they had an expectation that
they would return to the community which is a fairly high number and reflecting
some concerns on the part of the administrators because many of the folks were
responding that they had an expectation to return to the community think that
the social work staff and the nursing facilities wasn't sure that that was going
to be a viable option. That raised some concerns that perhaps we'll address at a
different point during this panel discussion.
Out of the total number of people that they gave -- that they offered the
Section Q to and asked questions, 15 percent were referred to the local
agencies. Now one of the things that I learned when the very first set of
reports came back, since 11 people at that point had been referred to the local
agency and Medicaid agency in our state is the entry point for that and I hadn't
gotten any of them, that kind of signified that that was a bit of a
communication problem. And what was happening was the nursing home social
workers were just normally using the home health agencies, VNA
[spelled phonetically], whatever they normally use as their local contact. And
so the question that came up was, for us as a system, was that okay? And at what
point did we want to impose a more formal requirement to use some single point
of entry when the existing formal networks, the relationship that exists between
the VNA and the nursing home is working just fine. That took us to another point
in Connecticut to say how will we help nursing home facilities to find at what
point they need to access the transitional supports versus just use the existing
supports that are in place know that we don't have the infra-structure within
state government to have everybody go through that single entry point and, in
fact, it would slow down the transition work.
So that's some of the things that we learned, identifying who gets referred,
when they get referred, whether it's going to be a requirement, things you're
going to have to respond to in your own states before you impose an additional
infra-structure over what already exists.
[Dan Milne]
Okay. Ellen?
[Ellen Speckman-Randall]
Yes. Michigan already has, as I mentioned, a robust transition program. In fact,
this year we're on track to transition 1500 individuals and so we kind of had
the process in place. And we were surprised at how few referrals we received
from this as well. We did over 200 of these and received nine referrals only
four of which were Medicaid.
And Michigan has been very involved in working with the Q and A. We use these,
with the SILS [spelled phonetically] we provide these to the Q and A names to
the SILS and we keep -- receive data. We have a Q and A resolution form that
they submit and so I ran some of this data just before I came. In fact, I do
have a handout out there and it's probably still warm. But I looked at two of
the SILS and what we would have received under the 2.0 and the first nursing
home -- and it's for the same time period -- for the first nursing home, we
received two referrals. We would have received 32 under -- 12 of which would
have been Medicaid under the 2.0. And for the second one, we received four and
we would have gotten 21 when we ran it using the current method. And the third
one we got three but for some reason their MDS data is lost in cyberspace. So I
tried to track that down. They're still tracking -- my staff is out there
tracking it down right now.
And I looked at what happened with these Q and A's and one of the problems that
we found was that many of them had left before we got there but that was a
simple matter of taking -- the SILS would receive these because we have a DUA
with them -- and they would take it to the nursing home and say who's still
here? And so of 308 names for these two SILS, 196 had left before they were
contacted and 23 had died before contact was attempted. So that left 89 but out
of those, 24 transition cases were opened or they were referred to another
agency -- a waiver agent for transition services -- 29 chose not to transition,
24 had declined in health or ability, 10 had DPOA or guardian issues, and two
went home without agency assistance. But for those -- that still is 24 out of
The other thing that we found was that there was a lot of value, and I think
Mary Merkel [spelled phonetically] alluded to it in the video earlier. She said
that she had heard somebody talking to somebody else and frequently what they do
is they pick up the roommate or somebody at their table, but we were concerned
that -- and we looked at this to see why there were so few referrals. And it
looks like it's because the skip pattern takes so many people out of answering
the question. And I had the forms for 157 of the participants. The rest are
still in the mail and when I get back, I'll have the rest of those. But of the
157 participants, only 36 were actually asked the question, do you want to talk
to someone about the possibility of returning to the community? Because the skip
patterns took everybody else out. But actually 27 of these 36 individuals were
incorrectly asked because the skip pattern was not followed. So had the skip
pattern been appropriately followed, only nine participants would have actually
been asked whether they wanted to talk to someone about the possibility of
leaving; that's like 10 percent.
And so what we did, my staff and I had a meeting just before I got on the plane,
and we were talking about is there a query we could run to capture some of these
people like we are getting under the MDS 2.0 and we couldn't find a query
because would we ask for people where it was feasible? We're not sure. I think
with the discussion today, what we need to look at is what are we getting and
what is the, if you will, enforcement I guess for them saying no, they don't
have a plan, yes, it's feasible, no, we did not make a referral. And to see what
happens with those and make sure those referrals actually do happen because
additional referrals could come from that. And so I think it's just going to
take additional work with this and attention to it to make sure. Because without
that attention, I'm afraid that actually we might lose the resource of the
current Q and A which is then helpful, at least in Michigan.
[Dan Milne]
So, I think Ellen raises a good point about the application of this process and
how the Section Q is just sort of one tool to be used in identifying candidates
for transitioning. And it needs to fit with the existing processes of nursing
homes in looking for discharging individuals. And the skip patterns were really
set up to say if a person has a discharge plan already in place, then this
question doesn't get triggered because they're already moving in that direction
and maybe you don't need to call in additional resources to supplement that.
But I think, as Mary Beth Rebar was saying this morning, part of that's a
judgment call and sometimes you might want to call extra resources even though Q
500-B isn't triggered by this, it's just sort of common sense application and so
I think some of these things are going to need to be worked out. Unfortunately
these states have sort of developed long-standing relationships that are working
on these processes already and this is sort of another tool that's going to be
used as well.
[Marc Gold]
May I make a comment? I mean, you cannot think of this as the only thing for
relocation. I mean, this is one of many different activities that goes on and I
think also maybe what's missing in the Question Q right now which can be
incorporated as the individual has to know that at any time they change their
mind, to let the discharge planner know, to let the relocation contractor know
and to ask for relocation activities. This isn't just going to be you have this
one opportunity or you have this opportunity once every three months. That at
any point in time that you can ask for relocation support. So the Q, and again,
we use the Q-1A [spelled phonetically], we use it every month -- there's only a
17 percent response rate there -- it's just one aspect of relocation.
[Mary Malec]
And I'd like to also add that with the presence in New Jersey, the Community
Choice counselors, they're in the nursing homes all the time doing pre-admission
screening and options counseling. And very often the social worker will tell
them, okay, you can go up and see Mrs. Such-and-such. We had physical therapists
approach our staff and refer individuals. We've had roommates refer individuals.
So it's not just, you know, generated as a result of a question on the MDS.
[Ellen Speckman-Randall]
Oh, you absolutely cannot rely on that or you're not going to have much of a
[unintelligible] transition program. But it has been a nice tool that the
transition agents have been able to use to -- as an entrée into some of the
nursing homes. And part of the package that I have out there are a couple
letters. Two of them are signed by our Medicaid director and one of them was
sent to all the nursing home administrators in the state because -- in some
areas, this certainly is not all of them -- but some of them have been reluctant
to let the transition agents in and some of them have escorted them out. And
this is basically to say that they need to work with them. And then there's also
a letter that was sent to the SILS and the waiver agents, which are the agencies
that house the transition agents and then there's a letter specific to Q and
A's. And so it's kind of nice to have that for when you go out if you encounter
some resistance. And it's not a hammer or anything, it just basically says that
-- it talks about Olmstead and so on.
[Dan Milne] Great. Well, maybe the first part of a two-part question that is as
part of your pilot test process, what did you find that worked well? I'm going
to start with Marc.
[Marc Gold]
Yeah, I mean, having said all that, it is really wonderful to see this Q and A
beefed up. I think that is a really important part. And as important as the
question itself is -- again, it's going to be about sort of a culture change. We
use the term person-center planning a lot with the DD [spelled phonetically]
population and never use that as much on the nursing facility side and so I
think culturally we're getting -- instill in the process of a person-center
planning that's an involvement of the individual and more of a discussion of
what they want and what opportunities that they have. So I think that part went
really well. They said that it took maybe 10, 15 minutes to actually administer
the Q and A and if anything can start that part of that conversation with an
individual and get to know each other more than just the MDS and filling out
forms and check boxes -- that you're engaged in a conversation, I think that is
one of the best things to come out of this in addition to the more expansive
part of the Q and A. Thank you.
[Dan Milne]
Okay. Mary?
[Mary Malec]
Yes, I have to agree also. You know, there may be individuals that are missed
that this would give them the opportunity to get some more information. And you
know, what worked? We built on existing infrastructure. It worked very well. We
already have good working relationships with most nursing homes so, you know, we
feel like it was successful and look forward to rolling it out to the rest of
the states.
[Dan Milne]
Ellen, what worked well in Michigan?
[Ellen Speckman-Randall]
Yeah, I guess I like the fact that there is a linkage. The last question is, did
you make a referral? And so I think it does create a communication path between
the nursing home and the waiver agents and SILS in their region of the state so
they know who they are. And it does build a relationship and not only for these,
the Section Q referrals, but for other referrals because the transition agents
do have resources that the nursing homes don't have. And I know that sometimes
nursing homes do want to transition somebody but there's barriers that they
can't overcome such as even a ramp. I got a call from U of M Rehab Center and he
said, "Can you help us with ramps? Because I can't tell you how many people we
have stuck here because they don't have ramps." So we can help with things like
that and build those bridges.
[Dan Milne]
Okay. Dawn? Same question.
[Dawn Lambert]
Yeah. I think what worked well was just the awareness that for the very first
time there was an expectation on the institutional side put in place
systemically giving the resident a voice to be able to answer for him or herself
after admission to the nursing home, would you like to return to the community?
And by definition, connecting that voice to the information that might give them
the opportunity to create an informed choice. I mean, that is absolutely the
best thing out of all of this in addition to being able to provide relationships
with the nursing facilities. But just a systemic change -- that might sound like
it's not a lot but it's huge. There are some nursing facilities who don't --
while we have great relationships with most, we do not have great relationships
with all. There are some nursing facility administrators who don't see
themselves as part of the change. They don't understand the vision. They're not
even on the fence. This particular tool in those facilities is going to make, I
think, a very big difference, at least saying it's happening. It's going to
happen. So --
[Dan Milne]
Okay. I guess the other half of that question is what didn't work so well and
maybe what would you do differently? And why don't we start with Mary.
[Mary Malec]
I think that what we realized we need to work on is a better way to communicate
the outcome of the options counseling. Building on what we already had, we
usually in there doing pre-admission screening primarily for individuals on
Medicaid, soon to be Medicaid eligible within six months, and the transition
information is included in the assessment so this was new to us to go out and
talk to the private-pay individuals although we did on occasion. We never said
no to anybody that wanted information. It was outside the range of what we
usually did so we have to do a better job of communicating the outcomes,
following up with those individuals.
[Dan Milne] Okay. Marc?
[Marc Gold]
Well what I recognized when I was thinking about being on this panel was, we did
a great job and my orientation is more Medicaid although we have Title 3 dollars
we overlook. We're going to have to reach out to the individuals who are
non-Medicaid. We have about four million dollars in general revenue that we
allocate for the relocation activity. The state of Texas, a thousand miles by a
thousand miles. We're two different time zones, maybe 1100 nursing facilities
and that four million dollars is supposed to cover. So there we have in our
contract and, again, you can read our criteria, when we have a relocation
individuals work in most complex needs and we define complex needs along about
nine or ten different criteria there. So we're going to have to learn and work
better with our triaging partner. Again, some people aren't going to need the
assistance of a relocation specialist, they can provide [unintelligible]
outreach and education.
Where we're really going to have to work hard finding, either through the ADRC's
or through the other stuff in network, how we deal with the Medicare population
and those on private pay who happen to be in a certified facility and are
entitled to the service also? And so I think there's going to be a lot more
training that's going to be involved in a lot more education and, again, through
all the various partners. Again through managed care, fee for service,
relocation specialists, all the various different authorities we have in the
state. And then how do we start getting the non-Medicaid population invested in
the system also?
[Dan Milne]
Okay. Dawn?
[Dawn Lambert]
There are a lot of things that didn't go all that well during those two months.
The first question is we are a Medicaid agency and of course a lot of the
referrals were for Medicare as Marc was just mentioning. So there's a question
of what do we do with that? Do we spend Medicaid resources if they're Medicare?
And that's one more question that had to be answered, and will we state-fund
those coordinators to get --? Well, anyway, which we are. State fund now to be
able to address the needs for those folks who are not Medicaid eligible. There's
a state resource.
The second one was there's a confusion on local contact agencies. We thought we
had communicated very clearly about all this and we were clearly wrong. So --
but that raised the next question: at what point do you refer to this local
contact agency that you're going to find is the Medicaid agency and at what
point do you let nursing facilities use those informal connections or formal
connections that they already have to the VNA, the Home Health Agency or
We also had a communication problem. We had nursing facility social workers who
were -- who had made the referrals to us, we did get four in the Medicaid
agency. But when the coordinators went out, they didn't announce that they were
going out, the nursing facilities social workers didn't know that. There was no
coordination. There wasn't any attempt. From that, we then developed a couple of
tools to require that our local agencies would communicate and evidence that
they communicated with the nursing home prior to going out letting the social
worker know and a challenge check list so that check list is completed by both
our transition coordinator on the Medicaid side and the nursing home social
worker and it creates the kind of foundation for that team process respecting
what the social worker also has to offer in terms of the barriers that they see
for that person. So that's the way that we solved the problem but the problem
once again was lack of communication. It did not just happen. We needed to
create additional structure to help that happen.
And then from there came the question of the capacity issue on the local level
side. Because if we're going to require, and we did -- I think that Marybeth
mentioned there has to be an expectation for how soon you're going to get
somebody out there for that face-to-face. It's one thing to say contact us. It's
another thing to have the capacity to be able to create a reasonable expectation
across your own state. And if you have many local level partners, which in
Connecticut we have eleven, creating a standard process and expectation across
all those so that when we say to nursing facilities, "This is what we're going
to do," that expectation is actually met on the community side.
From that, we actually had to develop a fast track, what we call fast track
mechanism. That gave the coordinators enough information to be able to get out
there in an expeditious way. They're required to phone the person within three
days and be out within 10 days for a face-to-face conversation with the
individual and they're accountable for doing that. We had to create some
structure for them to be able to do it because if they had a case load of 25,
the first thing they're going to say to us is, "We don't have time to do that.
So we had to give them, to figure out a way for case management that would give
them permission to be able to meet the expectation but also be able to manage
the existing case loads.
So those are all things that we had to work through and are in the final stages
of right now.
[Marc Gold]
Yeah, we expect -- we have a requirement to be there within 14 days and to make
a phone call, again, within that first week for the basic affairs
[spelled phonetically].
[Dan Milne]
Okay. Ellen?
[Ellen Speckman-Randall]
I guess our experience was pretty much the same, particularly working with the
non-Medicaid populations because both our waiver agents and our SILS are -- we
have contracts with them to work with Medicaid but with one of the requirements
being that they be Medicaid. So they had to scramble a bit to come up with
resources to share with those who were not Medicaid-eligible and were not going
to be Medicaid eligible. And that's something we're really going to have to work
on as a state and make resources available. Some of them are local so our local
partner is going to have to determine what they have there. But it might be that
we're going to have to create a brochure at the state level that can be shared
with the non-Medicaid.
[Dan Milne] I think -- let me speak to California's experience and lessons
learned and what they would do differently from the notes Mary Sayles sent. And
that is the state agency that volunteered to operate the pilot test in
California was their health department, which is responsible for nursing home
surveying. And the Medicaid agency that's responsible for community-based care
programs is an entirely different department. And they usually don't talk to
each other. This example was probably no exception.
They did get together and worked to identify volunteer nursing facilities. But
sort of the well-established kind of programs and direction and working with
community resources and those kinds of things weren't there. And so I think
their big lesson learned was it's important sort of which agency is sort of
conducting the program.
And CMS is asking Medicaid agencies to sort of take the leadership role in
working to designate the local contact agencies, working with developing those
collaboration relationships with nursing facilities because the Medicaid
agencies need to modify their data-use agreements, as Melissa was saying, so
they have sort of some responsibility in naming the parties in those data-use
agreements. So CMS is sort of giving them a leadership role in doing this.
So I think the lesson is sort of working collaboratively with all the
stakeholders at the table. Getting the local agencies to collaborate in that
designation process and sort of get all your ducks lined up.
We gave these individuals about three to four weeks from, "Hi, I think I'll
volunteer to do this," to start up. You all have six months. It's a huge,
difficult task you're undertaking so these folks just sort of jumped in and did
it fairly quickly.
One of the other lessons you've heard a little bit about is training is
important. And we gave these folks almost no time to do any training or
deliberations or work out the protocols and fortunately they were watching and
monitoring and listening about the process and said, "Oh, we need to develop
another tool here or another relationship there or we need to have meetings
between the local partners here to sort of cure some of these issues." And I
think those are important lessons for all of you that you know about now. You
can plan ahead. You can read the information in the interim pilot test report
about some of these lessons from these folks and sort of craft your own paths to
putting this together.
So if you could join me in thanking the panelists for their courage and hard
[end of transcript]
CMS: MDS 3.0 - Section Q, Pilot Test Discussion 1 9/29/2010
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