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Date ArticleType
12/7/2016 INCAL
INCAL Update

On November 30th, the INCAL Advisory Committee met for the final time in 2016 discussed both the Home and Community Based Services rule and transition plan, and the NCAL Quality Initiative.

• HCBS Rule and Transition Plan
The committee welcomed guest presenters from the Indiana Division of Aging.  Yonda Snyder, Director, and Debbie Pierson, Deputy Director, spent nearly 2 hours with the advisory committee and other interested INCAL members discussing the Home and Community Based Services (HCBS) rule and transition plan.  Yonda and Debbie presented this summary of the HCBS rule and transition plan, and a lot of discussion ensued with members related to how Assisted Living communities will be able to serve the Medicaid population in the future design of HCBS programs.  The current direction of CMS is clear, where the model is housing first with health care and other services second based on a person centered plan, rather than a standard set of health care and support services provided uniformly in a non-patient centered manner.

Specific issues that were discussed were whether an how licensed residential care facilities will be permitted to participate in a future HCBS program, how increasing acuity with residents that age in place can be handled from a lease termination perspective, and how the Division envisions creating a separate provider certification program for Assisted Living providers to participate in HCBS programs.  Based on the dialogue, IHCA/INCAL believe that some Residential Care Facilities will be able to participate in a future waiver program, but significant modifications to the existing ISDH licensure rules as well as operational changes for these facilities will need to occur.  Related to this, because Federal HCBS rules essentially preclude discharge procedures based on increasing resident acuity, there is significant uncertainty about how to interact with and serve a resident that refuses care or is a danger to themselves, yet the facility will have more limited options in moving that resident along the care continuum.  In addition, memory care within secured units is still a grey area and providers that seek to provide that service will be required to go through a heightened scrutiny process, which is not yet defined.

Suffice it to say that for those Assisted Living facilities that desire to serve the Medicaid population, much is up in the air.  The Division is working with a group of providers, advocates, association representatives, housing experts, and related state agencies on answering these and other questions.  For more information about this process, please see the Division of Aging’s section of the Statewide Transition Plan at http://www.in.gov/fssa/da/4917.htm.

• Quality Initiative
The INCAL Advisory Committee also discussed the national Quality Initiative.  Both programs are benefits accessed through our national partners at the National Center for Assisted Living.  The NCAL Quality Initiative focuses on 4 elements (1) Staff Stability, (2) Customer Satisfaction, (3) Hospital Readmissions, and (4) Antipsychotics. More information about this quality improvement program and tools to help your center start on its quality journey can be accessed at https://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/default.aspx

At the next meeting, the committee will learn more about using AHCA’s Long Term Care Trend Tracker online tool to help with quality improvement initiatives, and have a robust discussion about other education programs and services Assisted Living communities want to see from IHCA/INCAL staff!  If you are interested in participating in the INCAL Advisory Committee, please email kniehoff@ihca.org.