- Report Published -
|Alzheimer’s Disease/Dementia Assisted Living Waiver Report Pursuant to the 2004 Appropriation Act, Item 326.SS|
|Department of Medical Assistance Services|
|Appropriation Act - Item 326 SS.2. (Special Session I, 2004)|
Item 326.SS of the 2004 Appropriation Act directed the Director of the Department of Medical Assistance Services (DMAS) to develop a Medicaid-funded Home and Community-Based Waiver for persons diagnosed with Alzheimer’s Disease or a related dementia. This Waiver will be piloted in some areas of the state and will serve 200 individuals. These individuals must reside in an assisted living facility, meet Virginia’s criteria for nursing facility placement, and be receiving an Auxiliary Grant. In order to participate in this Waiver, the assisted living facility must meet the criteria outlined in this proposal. Per the 2004 Appropriation Act, it was estimated that the Medicaid payment for each Waiver recipient would be approximately $50 a day. (See Appendix A for a copy of the legislation). This report addresses the issues related to implementing such a Waiver. DMAS must report to the Governor and the Chairman of the Joint Commission on Health Care by October 1, 2004, in order that the fiscal impact of such Waiver can be considered during the development of the 2005-2006 budget.
Individuals eligible to be placed on this Waiver are currently either (a) remaining at home where an adult child is typically serving as primary care giver; (b) residing in an assisted living facility without the benefit of specialized services, which are not provided in the base $30 per day rate; or (c) residing in a more expensive institutionalized nursing facility setting. Through the proposed Alzheimer’s Disease/Related Dementia Waiver, recipients would be able to receive an appropriate level of care within special care units of assisted living facilities.
While individuals admitted to this Waiver will receive services in assisted living facilities (ALF), it is important to remember that they must meet nursing facility admission criteria in order to receive Medicaid Waiver services. In addition, the individuals in this Waiver must be diagnosed with Alzheimer’s disease or a related dementia. Therefore, while current ALF regulations meet the requirements for people at the regular assisted living level of care they are not deemed to be sufficient to meet the health and welfare requirements for a Medicaid Waiver. DMAS must demonstrate to the Centers for Medicare and Medicaid Services that sufficient safeguards are in place to serve this vulnerable population.
DMAS used the following methods to conduct this study.
● DMAS formed an advisory group of stakeholders to collaborate on the development of a Waiver proposal. The advisory group consisted of representatives of the Virginia Department of Social Services, the Virginia Department for the Aging, State Long Term Care Ombudsman, the Alzheimer’s Association, the Virginia Association of Non-Profit Homes for the Aging, the Virginia Health Care Association, Virginia Association of Area Agencies on Aging, Virginia Association for Home Care, Virginia Association of Homes for Adults, Virginia Association of Personal Care Providers, Sunrise Senior Living, Sentara Life Care Corporation, two caregivers of individuals with Alzheimer’s disease, and DMAS.
● DMAS researched other states with Alzheimer’s disease/dementia units provided in assisted living facilities regarding qualifications of staff, training, and other relevant issues. Specifically, the state of Alabama’s approved Waiver was reviewed in detail.
● Not all of the members of the advisory group agreed with all of the requirements listed in this report. All suggestions were carefully considered; however, due to the requirements of a Medicaid Waiver, and health, safety, and quality standards that must be met, some suggestions were not accepted.
Summary of Findings
● Waiver services must be provided in licensed assisted living facilities that meet the requirements of a “safe, secure environment” according to DSS licensing regulations.
● DMAS will pre-approve each assisted living facility before that facility may provide services to individuals on the Waiver.
● Administrators of participating assisted living facilities must be licensed as nursing facility administrators, or licensed or registered as long term care administrators.
The Department of Health Professions is developing a Long Term Care Board to license or register assisted living facility administrators. Once this option is available, administrators of participating assisted living facilities must be licensed as a nursing facility administrator or licensed or registered by the Long Term Care Board of the Department of Health Professions.
● There must be sufficient staff, and staff with the appropriate credentials, to care for Waiver participants.
● Qualified staff must provide services. Services include personal care, homemaker, chore, attendant care, medication oversight, therapeutic and recreational programming, intermittent skilled nursing, and medication administration.
● This Waiver must meet Medicaid requirements for a Home and Community Based Services Waiver, which includes protections of health and welfare.
● Room and board are to be paid by an Auxiliary Grant, which is $1,058 for Northern Virginia and $894 for the remainder of the state, which is approximately $35 and $30 per day, respectively. (*1)
● Medicaid payment for this Waiver would be approximately $50 per day. (Medicaid payment is payment in full – the resident could not be charged extra for Medicaid-covered services)
● No Waiver funds will be used to pay for room and board in the assisted living facility.
● Of the 631 licensed assisted living facilities in Virginia, 106 have special care units with 2,931 residents. It is possible that some of these residents would be eligible for a Medicaid Waiver in addition to people who reside in nursing facilities or in the community. (*2)
(*1) Lloyd, Deborah. E-mail to the author. 2 September 2004.
(*2) Lloyd, Deborah. E-mail to the author. 30 July 2004.