SDS e-Alert
09/11/2008
Alaska Resource Rebate and Assisted Living Homes
Department of Health and Social Services
Fact Sheet for Assisted Living Homes
Regarding Resource Rebate
As Alaskans anticipate the receipt of the $1,200 Resource Rebate shortly, questions have come up about how assisted living homes might avail themselves of these funds. The Department of Health and Social Services would like assisted living homes to be aware of the following policies. These polices essentially prevent assisted living homes from collecting these $1,200 payments from their residents.
Under Chapter 2, 4th Special Session Laws of Alaska 2008 (Ch. 2, 4SSLA 08), individuals who qualify for a 2008 Permanent Fund Dividend will also receive a $1,200 Resource Rebate. Also, certain veterans and their dependents who were eligible, but did not apply, for the PFD, may also apply for and receive a resource rebate. While much of the legislative discussion about the rebate suggested that Alaskans would use this additional money to meet their energy costs, nothing in the law that passed requires recipients to do so.
Depending on how an assisted living home resident’s care is being paid for, a different combination of program policies may apply. All assisted living homes are subject to licensing regulations; homes receiving payments for General Relief Assisted Living or Medicaid Home and Community-Based Waiver Services are subject to those regulations as well.
Licensing
Two licensing regulations and statutes pertain to this situation. First, 7 AAC 75.340, mandates that assisted living homes give residents or their representative, the licensing agency, and any service coordinator 30 days notice before imposing a rate increase or requiring any advanced payment of charges.
Second, AS 47.33.030 prohibits assisted living homes from imposing any advance payments “except as security for performance of the contract or as advance rent for the immediately following rental period as the rental period is defined in the contract”.
Collecting funds as a general offset against increased energy costs is not allowable within the statutory purposes of an advanced payment. Any increase in rates must be preceded by advanced notice of 30 days. These two provisions severely limit the ability of an assisted living home to require payment of any of a resident’s resource rebate to the home.
General Relief Assisted Living
Under 7 AAC 47.450(a), the countable income of an assisted living resident covered under the General Relief program is used first for their personal needs allowance and the remainder is to be paid toward the cost of the assisted living home care. Under 7 AAC 47 450(c), the Department of Health and Social Services is responsible for informing homes of the resident’s cost of care obligation under General Relief.
Because Ch. 2, 4SSLA 08 contained a specific provision preventing public assistance programs from counting the resource rebate as income or assets, assisted living home residents on General Relief will not have to use the $1,200 payment toward the cost of their assisted living home care. Furthermore, under 7 AAC 47.450(d), assisted living homes are prevented from requesting or accepting from or on behalf of an individual who receives General Relief any payment beyond what the Department has identified under 7 AAC 47.450(c).
Therefore, an assisted living home may not accept any portion of a resident’s resource rebate as payment for assisted living care if the resident is on General Relief.
Medicaid
Medicaid makes payments for assisted living services to individuals eligible for Medicaid home and community-based waiver services. Medicaid pays for the service component provided to the assisted living home resident, but is prohibited from paying for room and board. In addition to paying for their own room and board costs, some Medicaid eligible residents may also have to pay the assisted living home for a portion of their cost of care, as determined by the Division of Public Assistance. These payments result in a dollar for dollar reduction of the Medicaid payment.
As with General Relief, Ch. 2, 4SSLA 08 prohibits the Medicaid program from counting the resource rebate as income or assets. Therefore, receipt of the resource rebate will not affect an individual’s eligibility for Medicaid or the amount of their cost of care obligation.
Under 7 AAC 43.050, a provider accepting Medicaid payment for services must accept it as payment in full for services, except for the Medicaid recipient’s cost sharing obligation. Therefore, assisted living homes cannot require residents to use their resource rebates to offset the cost of any Medicaid services provided to them.
While Medicaid regulations do not govern assisted living home practice with regard to room and board charges, assisted living home providers should remember that compliance with assisted living licensing regulations is a condition of participation in Medicaid. Any changes in room and board charges for Medicaid recipients must still comply with 7 AAC 75.330 and 7 AAC 75.340 limiting advance payment and requiring 30 days notification of changes.
In determining whether an assisted living home has violated 7 AAC 43.050, the Department will consider whether any room and board rate increases:
- were made in compliance with licensing regulations,
- are reasonably related to the cost of providing room and board for the residents, and
- have been applied to all residents equally, whether they are Medicaid recipients or not and whether they received the resource rebate or not.
* * *
If you have any questions regarding licensing, contact Jerri VanSandt at 269-3640. For questions on General Relief Assisted Living, contact Teresa Clark at 269-3666. For questions regarding Medicaid home and community-based waivers, contact Carol Downey at 269-3666.
08/29/2008
Alaska Medicaid Long-Term Care Plan Community Forums
The consulting firm HCBS Strategies is assisting the Alaska Department of Health and Social Services develop a plan for improving their long term care system.
Community Forums are scheduled to gain input on the draft version of the Long Term Care Plan Recommendations. During these Community forums, HCBS Strategies will present an overview of the draft Long Term Care Plan and take feedback from stakeholders. The series of forums are taking place in Anchorage, Juneau, and Fairbanks. The Dates and locations are listed below.
Individuals are welcome to participate in person or through a web-enabled conference call that will allow them to view materials on their own computer.
Tuesday, August 26th, 1:00-4:00 pm at the Downtown Anchorage Marriott - Anchorage
Wednesday, August 27th, 5:00-8:00 pm at Centennial Hall Convention Center - Juneau
Friday, August 29th, 1:00-4:00 pm at the Westmark Fairbanks Hotel - Fairbanks
Please visit www.AKLTC.com for more information or to register for the webinar.
Senior Information Office Medicare Training
The Senior Information Office is providing its three-day annual MEDICARE training September 24, 25 and 26, 2008 at the Hampton Inn/midtown Anchorage. The target audience includes volunteer counselors from Senior Centers, hospital admissions/discharge staff, ADRC and other information/referral people and new counselors who are committed to assisting seniors and others on Medicare to make the most of their health insurance. The training will include information on enrollment, eligibility, the many parts of Medicare, how it interacts with Medicaid, Prescription Drug Plan, Medigap, etc. We are specifically seeking applications from Korean, Tagalog, Spanish, Hmong, Samoan, Tongan or other bi-lingual people who are proficient with email and the internet and can assist non-English speaking Medicare recipients in their community.
Applications and a draft agenda are available on the Senior Information Office Volunteer Counselor webpage at http://hss.state.ak.us/dsds/shipmedicare.htm – you have the option to attend the first day big-picture overview of MEDICARE only.
08/07/2008
Responsibility for Provider Rates has moved to the Office of Rate Review
As part of the joint efforts of Providers of HCBS services, DHSS and the Legislature, the responsibilities for determining rates of reimbursement for services is now housed in the Office of Rate Review (ORR) in the Division of Health Care Services. In preparation for this change, the Office of Rate Review has hired two fulltime positions and one fulltime position from Senior and Disabilities Services is moving into the unit as well. The ORR is managing the Myers and Stauffer, Cost Methodology contract which after many public rounds of review and refinement is in providers’ hands to complete by the end of September. It can be downloaded with instructions and help desk contact information from the SDS website: http://hss.state.ak.us/dsds/costsurvey.htm
Sandy Sandusky of SDS will be working with the ORR as a liaison regarding health/safety and other programmatic issues. Jack Nielson is the unit manager which includes: Randall Schlapia, Kevin Perron, and Leigh Frazier.
Assisted Living for Family Members
In recent months it has come to the attention of SDS that more and more assisted living homes are becoming licensed for the sole purpose of caring for an ailing parent. Because this practice seems to be occurring with increased frequency, it is SDS’s position that these current or potential assisted living homes are made aware of the following statute:
AS 47.32.900 (2) defines an Assisted Living Home as “a residential facility that serves three or more adults’ who are not related to the owner by blood or marriage, or that receives state or federal payment for services regardless of the number of adults served”
If the client chooses to remain in this assisted living home and wishes to have SDS reimburse this assisted living facility for the provision of waiver services, the family can pursue a guardianship proceeding under AS 13 in which the court may issue an order to allow SDS to reimburse the guardian for the provision of waiver services.
08/04/2008
SDS Cost Study – Update
The provider cost survey went into the mail last week! The development of this survey tool began with a group of providers representing all partners of SDS, affected by this study, developing the contract guidelines for this process. It has included multiple rounds of feedback from larger groups of providers and a voluntary provider pilot of the final draft survey tool. The details of how to complete the tasks involved and where to get help with them is at the following link: http://hss.state.ak.us/dsds/costsurvey.htm . The outcomes of this survey will be presented to providers in early December before being presented to the Legislature.
If providers have not received the survey in the mail by the end of this week, please contact Myers and Stauffer - Alaska Help Desk at 1-800-255-2309 or ak_cost@mslc.com
The survey may be accessed at the link above or by clicking the “Provider Cost Survey” tab at the main SDS website:
Long-Term Care Study - Community Forums
Here is the flyer for the upcoming community forums to elicit feedback from stakeholders of long-term care services in Alaska.
07/28/2008
Change in Leadership at SDS
Rod Moline is leaving his post as Director of Senior and Disabilities Services to return to his native Texas after more than 20 years in Alaska serving individuals with disabilities. His last day of service will be August 11, 2008. Rebecca Hilgendorf will fill his position as Acting Director upon his departure. Rebecca has been with SDS since its formation and has more than 25 years of service to people with disabilities in Alaska.
In an announcement to SDS staff Rod wrote, “Please welcome and extend congratulations to Rebecca Hilgendorf for the Governor's Office approval of the request from Commissioner Hogan appointing her as Acting SDS Director. I know Rebecca will step into the role with confidence, excitement, and vision for leading SDS into new spheres of accomplishment!”
07/09/2008
Additional 2% Increase for All Assisted Living Home (RSLA Providers) - Update
The Alaskan Legislature and Governor Palin approved an additional 2% increase, for one year, for Assisted Living Homes on top of a 4% increase built into the base rates. Below is an explanation of how this 2% will be added to payments made to providers of this service.
For procedure code, T2031 - Residential Supported Living/Assisted Living Homes, for services rendered between July 1, 2008 and June 30, 2009, an additional 2% will be added to payments. This process will begin in approximately 40 days and when programmed into the computer will allow for billings already submitted to be reprocessed and payments made for all days of service provided in Fiscal Year 2009 for this specific service.
Please note that providers will not see the additional increase until it has been programmed into the computer system and a notice will be sent via E-Alert at that time. Questions regarding the process of making payments for this one time funding may be directed to Linda.Walsh@alaska.gov .
Rate Setting Methodology – Update
Please find the attached tentative timeline for the rate setting methodology process being conducted by the DHSS Office of Rate Review and Myers and Stauffer.
07/02/2008
ICAPs for MRDD Renewals Reinstituted
This message is intended for those individuals providing care coordination to MRDD Waiver recipients.
Effective immediately, SDS will begin requesting ICAP packets for MRDD Waiver renewals, beginning with those renewing in October 2008. Designated agency contacts will receive an email request detailing required packets and deadlines. Any questions should be directed to Lynne Keilman-Cruz at 269-5606 or Lynne.Keilman-Cruz@alaska.gov
Critical Incident Policy and Procedure - Update
Based upon the preponderance of comment and concerns expressed over the proposed Critical Incident Policy; SDS will further it's review of this policy by convening a group of experts to ensure that the proposed policy comports with the state waiver plan approved by CMS, recent GAO directives, and CMS reporting requirements. Revisions to existing regulations may be necessary prior to implementation of this policy. Provider groups will be asked to suggest persons to represent their interests to Joanne.Gibbens@alaska.gov. Ms. Gibbens will coordinate a meeting in Juneau to include SDS staff, AG's office staff and provider representatives sometime in July. SDS will provide a stipend for travel costs for providers to participate in this effort.
SDS wishes to express it's appreciation for the valuable and timely comments from providers regarding the proposed policy.
Have a safe Fourth of July weekend!
07/01/08
Recipient Input Sought
The State of Alaska is currently engaged with its contractor, HCBS Strategies, Inc., in developing a plan for improving services to older Alaskans and Alaskans with disabilities. This project will result in recommendations designed to address the growing need for long term care services in Alaska, and to also improve the consumer experience in obtaining and using services. One important step for developing these recommendations is to ask for the opinions and input of consumers and their families.
Attached is a survey that we are asking consumers, or a family member or someone who can speak on behalf of the consumer, to complete. This survey may be returned by e mail, fax or by regular mail. Your opinion matters a great deal, and we hope that you will take a few minutes to share your thoughts with us.
It would also be very helpful if providers of long term care services and other organizations that have contact with consumers and their family members would print out copies of this survey make them available. We have also included a flyer that could be posted near a stack of surveys.
Provider Input Sought:
Attached is a survey that we are asking providers of long term care services to complete and return. This survey may be returned via email, fax or by regular mail. Because of the important role that providers play in making the system work for consumers of services and their families, we hope that you will take a few minutes to share your opinions with us.
05/06/08, Response of Myers and Stauffer to Provider Comments and Questions:
After meeting with providers regarding the draft cost survey tool Myers and Stauffer have provided written responses to the feedback providers have offered. The pilot of the draft cost survey tool will begin next week with 12 volunteer agencies.
05/06/08, Reminder Regarding ADRD Mini-Grants:
Attached you will find a Mini-Grant application. Beneficiaries are eligible to receive $2,500 for items that directly improve quality of life and/or increase independent functioning. Items can include dental care, vision or hearing services, medical supplies, accessibility improvements, and adaptive equipment. The program is funded by the Alaska Mental Health Trust.
To be eligible, the beneficiary must have a diagnosis of Alzheimer’s disease, Parkinson’s related dementia, stroke related dementia, Lewy Body dementia, Pick’s disease, or other progressive memory disorder. In addition, the item/service may not be covered by any other funding source (Medicare, Medicaid, Medicaid Waiver). Along with a completed application, the applicant must submit an estimate for the desired item/service to the Alzheimer’s Disease Resource Agency of Alaska; 1750 Abbott Road; Anchorage, AK 99507. The fax number is 907-561-3315.
For additional information; Call 907-235-3720. You can also access the mini-grant application online at www.alzalaska.org
04/29/08, Span Date Update:
After discussion with all parties and the realization that this action may adversely affect a small group of providers who span date bill for services, we will suspend the system change for six months while analyzing best ways to approach this issue. The Department will revisit the issue no later than November 01, 2008. SDS will hold at least one public forum to discuss this issue with concerned providers and work to come to a resolution which meets the needs of the Department’s for accountability and the providers needs to manage their resources. Look to the SDS E-Alerts for further details.