The state agencies responsible for PASRR in Delaware have inspired an air of collaboration and cooperation through proactive outreach and engagement. Representatives from the State Medicaid Agency (Division of Medicaid and Medical Assistance, DMMA) work closely with the State Mental Health Authority (Division of Substance Abuse and Mental Health, DSAMH) and the State Intellectual Disability Authority (Division of Developmental Disabilities Services, DDDS), as well as with the state’s two Managed Care Organizations (MCOs).
This collaboration has strengthened Delaware’s PASRR programs in two specific ways. First, DSAMH is leveraging DDDS’ experience in participating in care-planning at nursing facilities to join the care planning processes as well. Secondly, the two MCOs are active partners in developing a PASRR process that promotes diversion, continuity of care, and transition from nursing facility to community.
Managed Long-term Care began in Delaware in April 2012. With this change, after nursing facility individuals are evaluated by the State Medicaid Agency (Division of Medicaid and Medical Assistance, DMMA), and the Pre-admission Screening Long-term Care Services Unit, services are provided by two managed care organizations contracted by DMMA. Prior to the implementation of Managed Long-term Care, DMMA implemented a comprehensive outreach plan to solicit buy-in and support from key stakeholders. This included the managed care providers and the nursing facility administrators and residents.
For example, DMMA hosted a webinar to assist providers in understanding the rationale for the change and use of the state’s new forms and processes in making referrals to the Medicaid Pre-admission Screening Unit. The webinar and the forms described therein are housed on the DMMA website and intended for public distribution. In addition, a second webinar was created and uploaded to the nursing home association website to educate their reimbursement staff about the goals and responsibilities of DMMA and the Delaware Medicaid Patient Index Reimbursement System. The DMMA outreach effort earned the support of the nursing facility and hospital populations such that, according to the state, 3,000 individuals in nursing facilities were successfully transitioned to Long Term Care Medicaid.
Managed Long-Term Care is now making a seamless transition from DSHP Plus to PASRR. Statewide monthly meetings began in December 2012 to bring together representatives of the Division of Medicaid and Medical Assistance (DMMA), the Division of Substance Abuse and Mental Health (DSAMH) and DDDS. The meetings were intended to impress on the participants the importance of the work they are engaged in, and for each agency to educate the other agencies about its role and responsibility in the PASRR process. Specifically, DDDS described its role in attending care-planning meetings in nursing facilities, the barriers they initially faced, and how they overcame those barriers as a result of joining the care-planning team. Over the course of these meetings, DDDS has agreed to partner with DSAMH in attending care-planning meetings that DSAMH has not historically been a part of. The barriers faced by DDDS will, therefore, be less daunting to DSAMH as they join care-planning team meetings in nursing facilities.
Proactive outreach and engagement with long-term care stakeholders is also helping Delaware ensure that that needed services are provided to individuals at the right time and in the least restrictive setting. Engaging the managed care providers prior to conversion was beneficial beyond simply soliciting their buy-in and support for the new process. Because DMMA engaged the managed care providers in early discussions on how to improve the PASRR process for individuals, MCO providers will be part of the conversation in Delaware as the state considers the evolving understanding of specialized services. A strong sense of mutual commitment between DMMA, its sister state agencies and the MCOs will encourage the likelihood that the right services are provided to individuals at the right time and that individuals are diverted from nursing facility admission as appropriate.