Overview of the Division of Senior & Disabilities Services
Senior and Disabilities Services (SDS) provides access to long-term services and supports for low-income seniors and people with physical, intellectual and developmental disabilities.
Services are funded through Medicaid, the federal Older Americans Act and state general funds (GF), and provide the choice of nursing home care or home and community-based services that allow the individual to remain in their home and community for as long as possible.
The division provides some services directly to the public, but most division-funded services are provided through social service agency partners.The majority of long-term services and supports for low-income Alaskans are delivered via Medicaid waiver and Personal Care Assistance programs. Waiver programs allow the state to “waive” some of the federal rules governing Medicaid so that people can receive the services in their own homes and communities instead of in institutional settings.
Alaska has four Medicaid waiver programs: Adults with Physical Disabilities (APD), Children with Complex Medical Conditions (CCMC), individuals with Mental Retardation and Developmental Disabilities (MRDD) and Older Alaskans (OA).
To qualify for a waiver program, an individual must be both financially eligible for Medicaid and be assessed as needing an institutional level of care. For the OA and APD waivers, that is the level of care available in a nursing home. The Division of Public Assistance determines financial eligibility.
The SDS Assessment Unit performs the level of care assessments statewide with nurses based in Fairbanks, Anchorage, Wasilla, Juneau, Bethel, Homer, and Soldotna. In the third quarter of FY09, 954 individuals were assessed for waiver eligibility.The assessments for the waivers vary in type, but they all determine initial and ongoing eligibility. They determine the person’s functional abilities and whether or not they meet the admission criteria. The assessments are conducted by Licensed RNs for the CCMC, OA, and APD waivers as well as for the Personal Care Assistance program. Qualified Mental Retardation Professionals conduct assessments for the MRDD waiver.
Assessments are conducted when people apply.
Program participants have annual re-assessments.
Currently, the waivers serve more than 3,500 individuals with a variety of home- and community-based services and supports including care coordination, home health care, chore service, habilitation and respite.
The division currently has a backlog of approximately 1,856 re-assessments.
The Personal Care Assistance (PCA) program
More than 3,100 Alaskan seniors and individuals with disabilities receive Personal Care Assistance (PCA).
PCA services provide personal support such as help with bathing and eating as well as practical activities such as shopping and light housework.
PCA is provided statewide through private agencies or through a “consumer-directed” model, where consumers manage their own care by selecting, hiring, firing and supervising their own PCA. There are currently 68 active PCA providers statewide.
The PCA program was established in 1986 and was expanded in 2001 to allow consumers to choose their own personal care assistant.
The program grew from $8 million to $80 million between FY00 and FY05.
Faced with an unsustainable growth rate, in 2005 the Legislature directed the department to control and reduce costs associated with the PCA program.
Personal care regulations were rewritten in early 2006. After public comment, they went into effect in December 2007.
The growth of the program slowed. From FY06 to FY07, spending decreased 7 percent.
Part of the regulations changes effective in April of 2006 required Senior and Disabilities to complete functional assessments for every individual applying for and receiving PCA services. These assessments help ensure that clients receive the help they need to stay in their homes and communities.
Centers for Medicare & Medicaid Services Review
We reported our backlog to the Centers for Medicare & Medicaid Services (CMS), and in May 2009 CMS conducted a focused review of the waiver programs. This is in addition to a regular annual general review set for July 2009.
CMS directed the division to stop taking applications for Medicaid waiver programs while the state addresses the backlog.
Factors contributing to the backlog include Alaska’s size, lack of highway infrastructure and inclement weather; the jump in the number of assessments needed once the PCA program was added to the list of programs requiring assessments, and difficulties recruiting nurses to perform assessments during a nationwide nursing shortage.
Senior & Disabilities Services Next Steps
Effective June 27, 2009, as per CMS instructions, the state cannot accept new applications for the waiver and PCA programs, so will not do assessments until further notice.
People interested in applying are encouraged to take advantage of other division programs until the division starts taking applications again. One such program is the Aging & Disabilities Resource Centers, which helps connect people with services regardless of age or income; 1-877-6AK-ADRC (1-877-625-2372) toll-free. There are also several State Independent Living Councils around the state, and people can call 211 for general social service information and referral help. People already receiving services through the division’s waiver and PCA programs have their needs reassessed annually. Reassessments will continue during this time.
Division staff will attend CMS waiver training, then develop a work plan and timeline to implement a quality-improvement strategy and end the moratorium.
The division is hiring for two positions that will be key to expanding the division’s pool of assessors in order to bring down the backlog of assessments, and improving the division’s quality assurance processes.
The division has been working to update its technology and streamline its data collection practices, which will allow it to better track and demonstrate the services Alaskans receive:
- SDS is developing a telemedicine program to link assessors and waiver applicants living in remote or inaccessible regions of the state.
- A digitized assessment tool, the E-CAT, is being field tested by assessors. This tool will streamline the assessment process and significantly improve accuracy, the collection of data and assessment timeliness.
- The division is expanding a new data-base, “DS3,” to give providers quick access to the status of their client applications and assessments, and use mapping software to streamline assessment planning and reduce driving time and mileage costs.
Possible future improvement steps include expanding the types of medical professionals eligible to perform assessments.
By September 2009, the division will submit its plan to CMS for approval.