Department of Economic Security long term care system

              Select Committee on Funding Systems
for Long Term Care
Long Term Care System
Select Committee on Funding Systems
for Long Term Care
Department of Economic Security
Long Term Care System
April 4,1988
April 4, 1988
Select Committee on Funding Systems
for Long Term Care
C/ O Senator Greg Lunn and
Representative Bart Baker
1700 West Washington
Phoenix, Arizona 85007
Ladies and Gentlemen:
Enclosed are twenty copies of our report on the Department of Economic
Security Long- Term Care System dated April 4, 1988. The financial information
included in this report was accumulated from various sources as indicated. We
did not apply auditing procedures to the financial information and accordingly
we do not express an opinion on it.
Please extend our thanks to the members of the Select Committee, Area Agencies
on Aging, Department of Economic Security, AHCCCS and the provider community
who willingly and quickly assisted us in completing this project in a very
short timeframe. If we can be of any further assistance to you, please do not
hesitate to call.
Very truly yours,
TABLE OF CONTENTS
Page
I . EXECUTIVE SUMMARY ................................................ 1
I1 . PROJECT APPROACH ................................................. 7
I11 . CURRENT DES LONG TERM CARE SYSTEM ................................ 9
o Overview of DES Delivery System ............................... 9
oo O1v9e8r6v/ i1e9w8 7o fE xDpEeSn dFiutnudriensg . . S. o. u. r. c. e. s. ................................................................ 1113
o Estimated 198711988 Expenditures .............................. 14
o 1986/ 1987 Utilization of Services ............................. 15
o Estimated 198711988 Utilization of Services ................... 16
IV . AHCCCS IMPACT .................................................... 17
o Description of Studies Conducted .............................. 17
o Estimated Population Shift to AHCCCS Program .................. 18
o Available Funds Resulting from Population Shift ............... 19
o Proposed " Cap" Issue ........................................ 21
V . EXPENDITURE ALTERNATIVES ........................................ 22
o Alternative I: Cover Projected SPP Increases ............... 22
o Alternative 11: Fulfill Waiting Lists ....................... 22
o Alternative 111: Fulfill Unmet Need .......................... 23
o Alternative IV: Fund Other Programs or Develop Systems ...... 23
VI . ISSUES AND RECOMMENDATIONS ....................................... 24
VII . APPENDICES ....................................................... 26
EXECUTIVE SUMMARY
The Select Committee on Funding Systems for Long- Term Care contracted with
Arthur Andersen & Co. to conduct a financial analysis of present and proposed
Long- term Care funding. The three primary objectives of this study were to:
o Determine the amounts of federal, state and all other monies
currently expended on Department of Economic Security ( DES) Long- Term
Care Services ;
o Determine the amounts of federal and state monies that will become
available at DES due to a shift of eligible persons into the Arizona
Health Care Cost Containment System ( AHCCCS) Long- Term Care system
beginning October 1, 1988; and
o Present detailed options for the expenditure of these available
federal and state monies.
The key findings of this study are summarized on the following pages.
EXECUTIVE SUMMARY I
EXHIBIT I- A
DES LONG TERM CARE SYSTEM I
FISCAL YEAR 1988
( BUDGET) I
USDA
TITLE XX ( SSBG) $ 550,478
$ 3,562,764
OTHER FEDERAL
NON- FEDERAL IN
$ 371,107
2 %
PROGRAM INCOME
OAA MATCH STATE HC/ CM $ 552.477
$ 1 83,122 $ 2,716,800
1 % 15 %
3 %
KIND
TOTAL: $ 17,896,587
SOURCE: APPENDIX E
1
I
1
8
R
EXECUTIVE SUMMARY
CURRENT SOURCES AND USES OF FUNDS
In fiscal year C19 87, $ 15,325,942 was reported as expended on DES long- term care services. This expenditur ? amount was comprised of approximately 43%
federal, 41% state and 16% locally- reported funds. In fiscal year 1988, the
budget for DES long- term care services totals $ 17,896,587. Refer to Exhibit
I- A for an overview of the funding sources. A brief identification of these
funding sources follows.
FEDERAL SOURCES
Title I11 - Older American's Act: This federal funding source is used to
provide a number of services to the elderly. Title I11 was a catalyst in
establishing the DES long- term care system in place today.
United States Department of Agriculture ( USDA): This funding source
provides cash and commodities to provide meals to elderly persons.
Title XX - Social Services Block Grant ( SSBG): The federal funds utilized
from Title XX for long- term care are only about 10% of all services
covered by Title XX. This study only documents Title XX funds associated
with delivering long- term care services to the elderly and physically
disabled.
Other Federal: This includes funds received by individual providers from
Title V of the Older American's Act and the Community Service Block
Grant. These funds are used to support operations primarily through
employment of elderly individuals.
STATE SOURCES
Supplemental Payment Program ( SPP): This study focused on two SPP
components - institutional care and home and community- based care. The
institutional care component provides fixed payments for eligible
individuals who reside in a private nursing home, county operated nursing
home, supervisory care home, or adult foster care home. The home and
community- based component provides funds for eligible individuals to cover
housekeeping, home health and visiting nurse services.
Older American Act's ( OAA) Match: This is the state match to federal
monies received through Title 111.
State Home Carelcase Management ( HCICM): This state appropriation is
utilized to provide home health aide, visiting nurse, housekeeping and - .
case management services to elderly and physically disabled adults.
EXECUTIVE SUMMARY I
EXHIBIT I- B
DES LONG TERM CARE SYSTEM
USE OF 1988 FUNDS
HOME HEALTH AU) HOUSEKEEPING
13 % OF FUNDS 27 % OF FUNDS
1 70,122 UNITS 427.8 1 6 UNITS
3,417 AVG CASELO 7,648 AVG CASELOAD
VISITING NURSE
4 % OF FUNDS
21,467 UNlTS
1,3 1 1 AVG CASELOAD NURSING CARE INSTITUTIONS
1
5 % OF FUNDS
12 MONTHLY PAYMENTS
8 1 4 AVG CASELOAD
1
HOME DEINERED MEALS
27 % OF FUNDS SUPERVISORY CARE/
I
868,748 MEALS ADULT FOSTER CARE
5,086 AVG CASELOAD 2 % OF FUNDS
12 MONTHLY PAYMENTS
I
609 AVG CASELOAD
ADULT DAY CARE CASE MANAGEMENT
8
6 % OF FUNDS
16 % OF FUNDS
296,324 UNlTS
101,857 UNlTS
577 AVG CASELOAD
9,473 AVG CASELOAD I
UTILIZATION DATA DOES NOT INCLUDE REGIONS VII AND Vlll - NATIVE AMERICANS I
SOURCE: APPENDIXES J AND K
EXECUTIVE SUMMARY
LOCAL SOURCES
Program Income: These are the funds that are reported by Area Agencies on
Aging and individual providers. The funds are obtained primarily through
client contributions.
Non- Federal Cash: These are revenues that Area Agencies and providers
report as received through such sources as third party reimbursement and
United Way.
Non- Federal In Kind: This is the value of commodities and volunteer time
contributions reported by the Area Agencies and providers.
The focus of this study was on long- term care services provided in the DES
system that will be covered under the AHCCCS program for AHCCCS eligibles.
These long- term care services include:
o housekeeping
o home health aide
o visiting nurse services
o home delivered meals
o adult day care
o case management
o services provided in skilled and intermediate nursing care
institutions
The DES long- term care system currently serves about 9,500 persons on any
given day. For an overview of how the DES funds are used, refer to Exhibit
I- B. For each service, the following is provided:
o Percent of funds expended for the service.
o Number of services provided. This is reported as meals, monthly
payments or units. A unit is one hour of service.
o The average caseload of persons served. - Over fifty percent of funds are used to provide housekeeping and home
delivered meals.
AHCCCS IMPACT
To determine the potential DES population shift to the AHCCCS long- term care
this report. The results of these studies indicate that between 10% and 20%
of the DES population being served in the home and community- based programs
program. Our analysis involved three studies which are described in detail in
could be AHCCCS eligible. For the DES clients receiving SPP payments for
institutional care, we assumed that all persons residing in nursing care
institutions could be shifted to AHCCCS.
EXECUTIVE SUMMARY I
EXHIBIT I- C
POTENTIAL RANGE OF POPULATION SHIFT FROM DES TO AHCCCS I
Low Midpoint High
Home and community- based clients 853 1,279 1,705
SPP clients in nursing care institutions 813 813
----- ----- 813 # -----
Total clients 1,666 2,092 2,518
---------- ---------- ---------- 1
EXHIBIT I- D
POTENTIAL RANGE OF AVAILABLE FUNDS
FUNDING SOURCE LOU
- - - - - - - - - * - - - - - - - - - - ----------------
FEDERAL
TITLE 111 $ 209,047
TITLE XX 225,134
U S A 23,035
OTHER FEDERAL 22.635
STATE
O M MATCH 12,301
STATE HC/ CM 220,235
SPP 219,442
LOCAL
PROGRAM INCOME 36,831
WON- FEDERAL 121,213
NOW- FEDERAL I N KIND ---------- 1- 1-, 5- 6- 6- -
TOTAL HOME 8 COMMUNITY BASED FUNDS S1,101,439
--- M-- ID-- P- O-- IN- T-- -- ------ H- IG-- H- -----
SPP 1NSTITUTIONAL CARE FUNDS 526,890 602,160 602,160
- - - - - - * - - - - - - - - - - - - - - - - - * - - - - - - ---------------
TOTAL AVAILABLE FUNDS ---------- S--- 1--,- 6-- 2-- 8-,- 3-- 2-- 9-- ---- --------$-- 2--,-- 5-- 9-- 0--, 3-- 4-- 2-- ---- -------- S-- 3--,-- 1-- 1- 9-,-- 7-- 3-- 5- -----
ASSUMPTIONS:
X HOME 8 COMMUNITY BASED
POPULATION SHIFT
X SPP NURSING HOME
POPULATION SHIFT
ENROLLMENT PERIOD 5 MONTHS 3 MONTHS 3 MONTHS
BEGINNING OCTOBER 1, 1988 ( Due to d e l a y in
l e g i s l a t i o n )
EXECUTIVE SUMMARY /
The potential range of the population shift from the DES long- term care system
to the AHCCCS program, is shown in Exhibit I- C. The low estimate is based on
a population shift of 10% of the DES home and community- based clients. The
mid- point is based on a shift of 15% and the high is based on 20%. All three
estimates assume 100% of SPP clients residing in nursing care institutions
will shift. In summary, the potential population shift from DES to AHCCCS
ranges from 1,666 to 2,518 clients.
When the population shift occurs, funds will become available in the DES
system. These funds become available because they will no longer be used to
cover the care provided to the DES population which shifts to the AHCCCS
program. The potential range of available funds is shown in Exhibit I- D. The
mid- point was selected to project available funds for use in analyzing
expenditure alternatives. The midpoint available funds are $ 2,490,342 which
include $ 1,376,980 in state appropriated monies.
EXPENDITURE ALTERNATIVES
Several alternatives exist for expenditure of the funds that may become
available in the DES long- term care system due to the population shift to the
AHCCCS program. Available federal funds generally must be spent in accordance
with approved state plans for Titles I11 and XX. Alternatives for expenditure
of the $ 1,376,980 in state monies are detailed in our report. The Select
Committee may wish to pursue any combination of the alternatives presented or
pursue alternatives not described. A brief description of these alternatives
is provided below.
Alternative I - Cover Projected Increases in SPP for Home Care:
Approximately $ 624,938 of new funding will be required in fiscal year 1989
to cover a projected growth in SPP clients requiring home care services.
Alternative I1 - Fulfill Waiting Lists: A survey of Area Agencies on Aging
identified 1,472 people on waiting lists for long- term care services. The
demographics of people on the waiting lists are described in our report.
The cost to fulfill these waiting lists is projected at $ 602,592 for
fiscal year 1989.
Alternative I11 - Fulfill Unmet Need: An estimated 6,300 people are in
need of some form of formalized, long- term care services. Over ten
million dollars would be required to fully serve this population. Options
available within this alternative are to set certain penetration levels.
For example, the cost to fulfill 10% of the unmet need is $ 1,008,000.
EXECUTIVE SUMMARY
Alternative IV - Fund Other Programs or Develop Systems: Our alternatives I focus primarily on continuing to serve the elderly population in need of
long- term care services. The available state appropriated monies could
also be used for other non- long- term care purposes or to develop a needed I long- term care automated system. However, the Select Committee needs to
be aware that if these available funds are diverted elsewhere and the
projected availability of funds is not achieved, then reductions in DES
I long- term care services will have to be implemented.
ISSUES AND RECOMMENDATIONS
u During the course of this study, our project team identified several issues
that the Select Committee may wish to explore. These issues and related
recommendations are briefly outlined below.
Issue: The current DES long- term care program is managed with
information collected in a manual intensive manner. This
causes difficulties with management of clients, providers
and funds. With the implementation of the AHCCCS program,
it will become critical to have greater control over
payment and client identification data.
I Recommendation: A statewide automated long- term care system should be
developed to manage the total long- term care population and
Issue:
all funding sources.
Current methods of reimbursing providers and Area Agencies
for services do not encourage control over utilization and
expenditures.
Recommendation: Alternative reimbursement systems should be explored
I including those based on case- mix and fixed capitations.
Issue: The current administrative structures in place for planning
and distribution of funds have overlapping responsibilities
in several areas.
Recommendation: Procedures for streamlining the planning and distribution
of funds should be explored at bbth the- state and local
levels. 7
Issue: Under current laws there will be overlap in payment for
services for individuals who are both AHCCCS and SPP
eligible.
legislation should be passed to assure that duplicate
payments are not made by SPP and AHCCCS.
EXECUTIVE SUMMARY
It is possible that DES clients may not apply for AHCCCS
eligibility. This would have the effect of reducing the
amount of funds projected to be available in this report.
Recommendation: Legal analysis should be performed and consideration given
to mandating that DES clients which are potentially
eligible apply for AHCCCS coverage.
Issue : Several different methods and forms are used in assessing
DES clients. This makes it difficult to maintain a uniform
statewide database.
Recommendation: One statewide instrument for client assessment should be
utilized that incorporates the AHCCCS preadmission
screening requirements as well as any DES specific
requirements.
It has been a pleasure to work for the Select Committee. We wish to express
our appreciation to all the people who have participated in this effort.
PROJECT APPROACH
The Select Committee on Funding Systems for Long- Term Care contracted with
Arthur Andersen & Co. to conduct a financial analysis of present and proposed
Long- term Care Funding. The three primary objectives of this study were to:
o Determine the amounts of federal, state and all other monies
currently expended on Department of Economic Security ( DES) Long- Term
Care Services;
o Determine the amounts of federal and state monies that will become
available at DES due to a shift of eligible persons into the Arizona
Health Care Cost Containment System ( AHCCCS) Long- Term Care system
beginning October 1, 1988; and
o Present detailed options for the expenditure of these available
federal and state monies.
Arthur Andersen & Co. organized a project team and an advisory panel which
worked in conjunction with the Select Committee and legislative staff in
completion of this study. Refer to Exhibit 11- A.
The work effort was organized into five major segments. These segments and
the major tasks involved were:
I. Organize and administer the project. This segment involved the
development of a detailed work program and assignment and supervision
of personnel.
11. Review current system information. This segment consisted of data
gathering and documentation of the current DES delivery system,
expenditures and utilization data. Data was gathered through
interviews with DES, Area Agencies on Aging and others and review of
existing documentation ( i. e. expenditure reports, laws, rules and
regulations, etc. ). Refer to Appendix A for a list of persons
interviewed during the course of this study.
111. Determine the AHCCCS long- term care program impact on the DES
system. An extensive effort was involved to determine the potential
DES population shift to the AHCCCS long- term care program. Our
analysis included:
- Review of a sample study conducted by AHCCCS and Maricopa and
Pima counties. In this study an analysis of 90 DES clients
using the AHCCCS Preadmission Assessment Screening ( PAS)
instrument was completed.
- Development of a computer model to analyze a statewide database
prepared by the University of Arizona's Long- term Care
Gerontology Center.
PROJECT APPROACH
- Utilization of a computer model jointly developed by the Region
I Area Agency on Aging and John C. Lincoln Hospital to assess
the functional requirements level of 400 DES clients residing in
Maricopa county.
- Analysis of service mix data in Maricopa County to estimate
utilization of services by the potential AHCCCS population.
- Development of a computer model to project the cost, utilization
of services and funding sources of the potential population
shift.
IV. Analyze alternatives for expenditure of long- term care monies. The
analysis of options for expenditure of available funds was completed
after quantifying the population shift and available federal and
state monies. This analysis included collection and analysis of
information concerning persons on waiting lists. We also projected
estimates of unmet long- term care needs.
V. Prepare the report. The preparation of this report included drafts,
reviews with committee members and final revisions.
The following report presents the findings of our study.
o Current DES System: This section documents the current expenditure
levels, services provided and population served in the DES long- term
care system. This information provides the basis for projections of
the AHCCCS impact on the DES System.
o AHCCCS Impact: This section contains our analysis of the potential
population shift from DES to the AHCCCS long- term care program. This
shift will result in funds becoming available in the DES system and
these estimated dollar amounts are documented.
o Expenditure Alternatives: This section explores options for
expenditure of the available funds. Focus is given to additional
needs in long- term care.
o Issues and Recommendations: This section discusses organizational,
administrative and policy issues raised during the course of this
study. Recommendations are made where appropriate.
CURRENT DES SYSTEM
OVERVIEW OF DES DELIVERY SYSTEM
The Department of Economic Security's long- term care system was fully
initiated with legislation passed in 1980. Legislative intent stated that the
goal of the system was " to provide ... a wide variety of coordinated services
that enable older Arizonans to maintain an independent lifestyle of their own
choice, avoid premature and unnecessary institutional care, and live in
dignity." Prior to this time, the only expenditure formally associated with
long- term care services in DES was the State Supplemental Payment Program
( SPP). SPP then, and still provides, payments for institutional and home
services to a limited population. For a more detailed description of SPP,
refer to " Overview of DES Funding Sources."
The organizational entities which comprise the DES long- term care delivery
system consist of DES, Area Agencies On Aging, Councils of Government, Tribal
Governments, Pima County Department of Aging & Medical Services and individual
health care providers. A conceptual organizational overview of this delivery
system is presented in Exhibit 111- A. The specific roles of these entities
are briefly described below.
Department of Economic Security - DES is designated as the single state
agency to administer the provisions of the Older Americans Act of 1965
( Title 111) and the Social Services Block Grant ( Title XX). Aging & Adult
Administration ( A& AA) is the specific administration within DES
responsible for:
o Developing a plan for providing long- term care services to the
elderly;
o Arranging contracts for and distributing Title 111, Supplemental
Payment Program ( SPP), and State home carelcase management
monies; and
o Monitoring and evaluating the long- term care services funded by
all federal and state sources.
Community Services Administration is a subdivision within DES responsible
to arrange contracts for and distribute all Title XX monies.
Area Agencies On Aging - There are eight Area Agencies designated by the
State to carry out the provisions of Title I11 of the Older American's Act
at the sub- state level. Each Area Agency plans for, establishes and
coordinates a delivery system in their individual planning and service
area ( PSA). The Area Agencies contract with, monitor and evaluate the
performance of healthcare providers.
EXHIBIT 111- B
ROMAN NUMERALS: NON- INDIAN REGlO
:. s.; ;: .+< INDIAN RESERVATIONS: INTER TRIBAL COUNCIL
OF ARIZONA PSA - REGION Vlll
@ NAVAHO INTERSTATE PSA - REGION Vll
CURRENT DES SYSTEM
For a map which identifies the eight Area Agencies by PSA/ Region, refer to
Exhibit 111- B. These Area Agencies must report all funding sources ( federal,
state and local) to DES to be in compliance with Title I11 regulations. The
funds reported also include expenditures reported to the Area Agencies by
contract providers.
Council of Governments ( COGS) - Arizona's six COGS provide the primary
mechanism for local planning for Title XX services. This planning
includes the identification of Title XX services for the elderly and
physically disabled as well as other needy populations.
Tribal Governments - The tribal governments, in coordination with Indian
Health Services and the Bureau of Indian Affairs, provide long term care
services for Native Americans. These tribal governments provide local
planning for Title XX services in their areas. In addition, tribal
governments serve as the Area Agencies in PSA/ Regions VII and VIII for
management of Title I11 funds.
Pima County Department of Aging & Medical Services ( AMS) - The Pima Courlty
Department of AMS has a home and community based system which utilizes
county, federal and state funding sources. DES contracts directly with
Pima County Department of AMS to administer Title XX and SPP funds for
PSAIRegion 11. The Area Agency in Region 11, Pima Council on Aging,
contracts with the Pima County Department of AMS to provide Title I11
funded long- term care services. In both roles, Pima County Department of
AMS provides and contracts for home and community based services.
Individual Health Care Providers - There are a number of public and
private health care providers which deliver long- term care services to the
elderly and physically disabled. These providers deliver housekeeping,
home health care, visiting nurse services, adult day care, meals in the
home and case management services. Contracts with these providers may be
made directly with DES and/ or the Area Agencies.
The specific focus of this study was on long- term care services delivered to
the elderly and physically disabled which will be covered under the AHCCCS
program for AHCCCS eligibles. Long- term care as used in this report is
defined as providing the following services:
- housekeeping - home health aid - visiting nurse services - home delivered meals
- adult day care
- case management
- services provided in skilled
and intermediate nursing care
institutions
For an overview of the availability of home and community based services by
region, refer to Appendix B. This study also includes the identification of
Supplemental Payment Program expenditures associated with institutional care.
EXHIBIT III- C
TITLE I11 FUND ALLOCATIONS
FOR ALL SERVICES
198?/ 1988
HOUR REPAIR ----- I
ADUINISTRATION
k PROGRAM DBVBI
CONGREGATE UEALS 12 X
TUNSPORTATION
LEGAL ADVOCACY
2 x
TOTAL: $ 9,460,208
SOURCE: DBS 1 0 8 7 / 1 0 8 8 BUDGET
EXHIBIT III--- D
TITLE XX FUNDING ALLOCATIONS
FOR ALL POPULATIONS AND SERVICES
1987/ 1988
9 7.
EMPLOYMENT RE
COUNSELING
UTED CASE UANAGEllENT/ COORDINATION
I 1 X
15 Z
13 X
TOTAL $ 35,559,967
SOURCE: TITLE XX STATE PLAN FOR FY
' RATION
CURRENT DES SYSTEM
It is important to note that the DES system of care includes other services
not specifically covered under AHCCCS and excluded from the scope of this
study. These services include, but are not limited to, congregate meals,
protective advocacy and legal services, education, employment services, and
job development. Transportation services are also excluded from this study
because the DES System primarily provides transportation for shopping and to
meals ( this will not be covered under AHCCCS).
OVERVIEW OF DES FUNDING SOURCES
The DES long- term care system is funded by a mix of federal, state and local
funding sources. Refer to Appendix C for an overview of the long- term care
services covered by each funding source. Each of these funding sources is
briefly described below.
FEDERAL SOURCES
Title I11 - Older American's Act: This funding source is used to provide
a number of services to the needy elderly. The amount dedicated to
long- term care services represents approximately 33% of all Title I11 fund
uses. Refer to Exhibit 111- C for an identification of all services
covered by Title 111.
Title XX - Social Services Block Grant ( SSBG): The funds utilized from
Title XX for long- term care are only a small portion ( approximately 10%)
of all Title XX funds. Refer to Exhibit 111- D for a summary overview of
services covered by Title XX. The populations to be served by Title XX
funds include children, elderly, developmentally disabled, physically
disabled, alcoholic and drug addicts, and other needy populations. For
purposes of this study, we have only documented Title XX funds associated
with delivering long- term care services to the elderly and physically
disabled.
United States Department of Agriculture ( USDA) Food Distribution Program -
This federal funding source provides cash and commodities to provide meals
to elderly persons.
Other Federal Sources - This includes funds received by individual
providers from Title V of the Older American's Act and the Community
Service Block Grant. These funds are reported by individual providers to
the Area Agencies and subsequently to DES. The funds are used to support
operations primarily through employment of elderly individuals.
EXHIBIT III- E
ELIGIBILITY REQUIREHENTS BY FUND SOURCE
< 65 y/ o ( 1001 SSI) ( SOX State Hcdlm) ( 7OX Stars Mcdlan) FUNCTIONAL
& Blind, Disabled or 51248 slnglc 57656 rlnrlc 510716 single NO SPECIFIC ASSESSMENT RESOURCE
FUND SOURCE Chronlcslly Mentally I11 60- 64 ylo >= 65 ylo 56381 coirple 510008 couple $ 11001 couple LIMITS REQUIRED REQUIREMENTS
-----------------............ .-.----.------------ -.-.--.-. ..-.- --.-------------- --.-------------- -------------------- --------------.- ----------------- I
Title 111 - 0 A A
Title M - 5 S B C
U S D A
S. P. P.
State HClCM
NO
YES
YES YES
YES YES
YES YES
YES - NO YES
Housekeeping,
Adult Foster Care
or Superv~ rory Care
On1 y
YES YES YES
YES YES NO LIMITS
PIHA COUNTY GILA, PMRAVE, PINAL W I N I N G YES NO LIMITS
COUNTIES COUNTIES
NOTE Actual delivery of services Is priorltired based on an Ind~ vidual's economic, social and functional need
SOURCES- Tltle I11 - 42 USCS 3027 - 3030.
Title XX - 42 USCs: 1397.
SPP - ARS 46: 251 - 253
YES NO NO LIMITS
YES $ 25,000 House
$ 2,200 PSIctl
for slnglt person
for couple
YES YES NO LIMITS I
CURRENT DES SYSTEM
STATE SOURCES
Older American's Act ( O M ) Match - This is the required state match to
federal monies received through Title 111.
State Home Care/ Case Management - This state appropriation is utilized to
provide home health aide, visiting nurse, housekeeping and case management
services to elderly and physically disabled adults.
Supplemental Payment Program ( SPP) - SPP has two program components. The
mandatory SPP component provides payments to any person who received
monies under the old categorical federal aid grants to the States ( prior
to 1974) and is eligible for Supplemental Security Income ( SSI). There
are only three persons left in the mandatory SPP component and payments to
these individuals will not be affected by the AHCCCS long- term care
system. The second Optional SPP component provides funds for long- term
care services for individuals who meet specific eligibility requirements.
This Optional SPP component provides a fixed payment directly to the
eligible individual who resides in a private nursing home, county operated
nursing home, supervisory care home or adult foster care home. Payments
made to these individuals will be referred to in this report as covering
" institutional care." The optional SPP component also provides funds for
eligible individuals to cover housekeeping, home health and visiting nurse
services. These funds are distributed either through contracts with
providers or, for a certain number of clients requiring housekeeping
services, directly to the eligible person.
LOCAL SOURCES
Program Income - These are the funds that Area Agencies and providers
report as receiving primarily through client contributions.
Non Federal Cash - These are revenues the Area Agencies and providers
report as receiving through such sources as third party reimbursement and
United Way.
Non Federal In Kind - This is the value of commodities and volunteer time
contributions received and reported by the Area Agencies and providers.
The eligibility requirements for each of these funding sources varies. Refer
to Exhibit 111- E for eligibility requirements for federal and state fund
sources. Frequently a person is eligible for more than one fund source and
the actual source of payment for that individual's service may vary each month.
CURRENT DES SYSTEM
198611987 EXPENDITURES
In fiscal year 1987, $ 15,325,942 was reported as expended on DES long- term
care services. Refer to Exhibit 111- F. This expenditure amount was comprised
of approximately 43% federal, 41% state, and 16% locally- reported funds. As
can be seen, the funds received from SPP and Title XX comprise almost 50% of
total fund sources. For the detail of expenditures by fund source and service
refer to Appendix D.
All expenditures contained in this report are as reported by the Department of
Economic Security. It should be noted that the amounts are not audited by
Arthur Andersen 6 Co. as part of the preparation of this report.
EXHIBIT 111- F
DES LONG TERM CARE SYSTEM
FISCAL YEAR 1987
( EXPENDITURES)
TITLE XX
$ 3.533.038
USDA
$ 495,045
3 X
OTHER FEDERAL 23/ e ) X TlTLE Ill
SPP
$ 235, 7X2 9.964 h\\ p
~ 2& 39.51 8
NON- FEDERAL
;~,~; 4~~~ 9RAL CASH
11 X
PROGRAM INCOME
OAA MATCH STATE HC/ CM $ 479.276
$ 1 31,738 $ 2,503,239 3 7.
1 X 16 %
TOTAL $ 15,325,942
SOURCE: APPENDIX D
IN KIND
CURRENT DES SYSTEM
ESTIMATED 198711988 EXPENDITURES
The budget for DES long- term care services in fiscal year ending June 30, 1988
totals $ 17,896,587. Refer to Exhibit 111- G. This budget represents a 14%
increase over fiscal year 1987. The two largest sources of the increase are
Title I11 ( an increase of $ 873,549) and SPP for housekeeping ( an increase of
$ 653,959). For the detail budget amounts by fund source and service refer to
Appendix E.
To determine the reasonableness of budget amounts, we performed an analysis of
the first six months' expenditures. Appendix H reflects the expenditures
reported as of December 31, 1987, a straight- line projection for the year and
a comparison to contract. This analysis revealed projected deficits in
Regions I and 11. At the time of this report preparation, DES Aging and Adult
Administration was exploring budget amendments which would increase funds to
Regions I and 11. The exact dollar amounts and sources to fund the contract
amendment were not finalized. However, DES anticipates using currently
available internal funds. Without increased funding, Regions I and I1 will be
forced to reduce service levels or obtain increased funding from local sources
if these projections are realized.
EXHIBIT 111- G
DES LONG TERM CARE SYSTEM
FISCAL YEAR 1988
( BUDGET)
USDA
TITLE XX ( SSBC) $ 550,478
$ 3.562.764
OTHER FEDERAL
NON- FEDERAL IN
' Ir------ $ 371.107
2 X
ON- FEDERAL CASH
ROGRAM INCOME
OM MATCH STATE HC/ CM $ 552.477
$ 1 83.1 22 $ 2.71 6.800 .. - J X 1 X 15 Z
TOTAL: $ 17,896,587
SOURCE APPENDIX E
KIND
EXHIBIT 111- H
DES LONG TERM CARE SYSTEM
USE OF 1987 FUNDS
HOME HEALTH AID HOUSEKEEPING
14 X OF FUNDS 25 Z OF FUNDS
138,366 UNITS 343,703 UNITS
2.793 AVG CASEL 962 AVG CASELOAD
VISITING NURSE
3 X OF FUNDS
15,864 UNITS
928 AVG CASELOAD -- t NURSING CARE INSTITUTIONS
6 X OF FUNDS
12 MONTHLY PAYMENTS
832 AVG CASELOAD
HOME DEIIYERED M U
28 7: OF FUNDS SUPERVISORY CARE/
759,482 MEALS ADULT FOSTER CARE
4,373 AVG CASELOAD 2 X OF FUNDS
12 MONTHLY PAYMENTS
571 AVG CASELOAD
ADULT DAY CARE
CASE MANAGEMENT
4 Z OF FUNDS
18 X OF FUNDS
222.399 UNITS
82,355 UNITS
405 AVG CASELOAD
7.947 AVG CASELOAD
UTILIZATION DATA DOES NOT INCLUDE REGIONS VlI AND Vlll - NATIVE AMERICANS
SOURCE: APPENDIXES I AND K
CURRENT DES SYSTEM
198611987 UTILIZATION OF SERVICES
The data contained in this report is the result of manual compilation efforts
by DES Aging and Adult Administration, Area Agencies and providers. While
checks have been made for reasonableness, we could not attest to the accuracy
of this data due to the lack of an automated or an integrated manual reporting
system.
Estimated 198611987 utilization data for the total DES System is summarized in
Exhibit 111- H. For each service, the following is provided:
o Percent of funds expended for the service.
o Number of services provided. This is reported as meals, monthly
payments or units. A unit is one hour of service.
o The average caseload of persons served.
The utilization data shown does not include Regions VII and VIII. These
regions represent Native Americans and the data is unavailable due to the
difficulty posed to the Area Agencies in separating DES fund use from other
funds ( i. e., Bureau of Indian Affairs and Indian Health Services funds). In
addition, the contract for this study specifically excluded Native Americans
from detailed analysis.
Utilization data for home and community- based services by region is presented
in Appendix I. There are two population figures identified for each service.
The unduplicated persons served represents the total number of unduplicated
persons which are served during the course of the year in that particular
service. Average monthly caseload indicates approximately how many persons
are being served at any given point in time. The units and cost amounts for
both populations are estimated.
The rural areas ( Regions 111- VI) have a higher utilization of nursing services
compared to the urban. This may be due to the greater availability and use of
nurses in lieu of social workers in these areas.
The detail for institutional care ( nursing care institutions and
supervisory/ adult foster care) is shown in Appendix K.
CURRENT DES SYSTEM
ESTIMATED 198711988 UTILIZATION OF SERVICES
It was necessary to project 198711988 utilization of services to reasonably
estimate the cost impact of the population shift to the AHCCCS program. The
utilization data for 198711988 is based primarily on projections from the
198611987 experience. Refer to Exhibit 111- 1. A greater portion of the
elderly population in need of service is projected to be served in 198711988
due to increased funding.
Refer to Appendix J for the detail of the estimated 1987/ 1988 home and
community based utilization data. The utilization data for institutional care
is shown in Appendix K.
EXHIBIT 111- 1
DES LONG TERM CARE SYSTEM
USE OF 1988 FUNDS
HOME HEALTH AU) HOUSEKEEPENG
13 Z OF FUNDS 27 % OF FUNDS
1 70.122 UNITS 427.8 16 UNITS
3.417 AVG CAS 648 AVG CASELOAD
VISITING NURSE
4 Z OF FUNDS
21.467 UNITS
1.3 1 1 AVG CASELOAD NURSING CARE INSTITUTIONS
5 Z OF FUNDS
12 MONTHLY PAYMENTS
81 4 AVG CASELOAD
HOME DEWRED W
27 Z OF FUNDS SUPERVISORY CARE/
868.748 MEALS ADULT FOSTER CARE
5,086 AVG CASELOAD 2 % OF FUNDS
12 MONTHLY PAYMENTS
609 AVG CASELOAD
ADULT DAY CARE CASE MANAGEMENT
6 % OF FUNDS
16 % OF FUNDS
296.324 UNITS 101,857 UNITS
577 AVG CASELOAD
9.473 AVG CASELOAD
UTILIZATION DATA DOES NOT INCLUDE REGIONS VII AND Vlll - NATIVE AMERICANS
SOURCE: APPENDIXES J AND K
AHCCCS IMPACT
DESCRIPTION OF STUDIES CONDUCTED
To determine the potential DES population shift to the AHCCCS long- term care
program, our analysis involved three studies.
Sample PAS Pilot Study
AHCCCS Administration in conjunction with Maricopa and Pima Counties conducted
a study that involved administering the AHCCCS preadmission assessment
screening ( PAS) instrument to a reportedly random sample of 90 DES clients.
The PAS instrument collects functional, medical and financial information on
potential AHCCCS eligibles and will be used to determine AHCCCS eligibility.
The results of this study indicate that 19% of the DES population will be
AHCCCS eligible. Assuming that proper random sampling techniques were
employed, a 95% confidence interval results in a + 7.5% variance. This
indicates that 11.5% to 26.5% of the DES population will be AHCCCS eligible.
Comparison of U. of A./ DES Database to AHCCCS PAS Requirements
The University of Arizona's Long- Term Care Gerontology Center has developed,
under contract with DES, a statewide database on DES clients. Area Agencies
have participated in this effort by submitting client data. The database
includes functional, medical and financial information on over 7,000 clients.
Our project team developed a computer program which compared this data to
AHCCCS PAS requirements. For the comparisons made refer to Appendix L. While
there is no direct correlation between categories, there are similarities in
the areas being assessed. The results on 7,216 clients indicate that 846 or
11.7% will be AHCCCS eligible. There is minimal variance for this large of a
sample.
Sample of Maricopa Clients Utilizing Area AgencyIJohn C. Lincoln Model
The Area Agency on Aging in Region I and John C. Lincoln Hospital developed a
computer model which utilizes information from Maricopa County's assessment
form ( ASCAR) to determine the appropriate level of care each client needs.
Four levels of care are determined: alternate, supervisory, intermediate and
skilled. Refer to Appendix M for descriptions of these levels. The
intermediate and skilled levels of care most closely meet AHCCCS
requirements. Our project team, with the Area Agency's assistance, selected
400 DES clients at random and utilized the Area Agency/ John C. Lincoln model
to determine their needed level of care. Of the 400 clients, 52 clients or
13% were rated at the intermediate or skilled level. There is variance of
-+ 3.5% on a sample of this size for a 95% confidence level; this indicates a
range of 9.5% to 16.5%
The results of these various studies indicate that between 10% and 20% of the
DES population being served in the home and community- based programs will be
AHCCCS eligible. For the purpose of this study, we have selected a midpoint
of 15% to project the availability of federal and state monies.
AHCCCS IMPACT
This estimate is conservative from the DES viewpoint and when the AHCCCS
long- term care program is implemented the population shift may be closer to
the 20% mark due to differences in the skill, judgment and attitudes of
personnel that administer the assessments compared to historical experience.
The population shift presented above is for the DES population which resides
in their homes. For the DES clients receiving SPP payments for institutional
care, we estimate that all persons residing in nursing care institutions will
be eligible for AHCCCS. We have assumed that none of the DES clients residing
in supervisory care homes and adult foster care homes will be AHCCCS eligible
for two reasons. First, the level of care is not intensive enough to meet
AHCCCS requirements. Second, assessment data on these individuals is not
available.
ESTIMATED POPULATION SHIFT TO AHCCCS LONG- TERM CARE PROGRAM
Due to the variability of the results among the studies conducted, a range of
the potential population shift is shown in Exhibit IV- A. The low estimate is
based on a population shift of 10% DES home and community- based clients, the
midpoint is based on 15% and the high is based on 20%. All three estimates
assume 100% of SPP clients residing in nursing care institutions will shift.
In summary, the potential population shift from DES to AHCCCS ranges from
1,666 to 2,518 clients.
EXHIBIT IV- A
POTENTIAL RANGE OF POPULATION SHIFT FROM DES TO AHCCCS
Low Midpoint High
Home and community- based clients 853 1,279 1,705
SPP clients in nursing care institutions 813 813 813 ----- ----- -----
Total clients -- 1--, 6-- 6-- 6-- -- 2--,-- 0-- 9-- 2 -- 2-,-- 5-- 1-- 8-
The projected population shift for SPP clients in nursing care institutions is
detailed in Appendix N. For the detail which reflects the midpoint population
shift for home and community- based clients by region refer to Appendix 0.
AHCCCS IMPACT
AVAILABLE FUNDS RESULTING FROM POPULATION SHIFT
We have projected three scenarios detailing the amount of funds which may
become available in the DES system with the implementation of the AHCCCS
long- term care program. These funds become available because they will no
longer be used to cover the care provided to the DES population which shifts
to the AHCCCS program. The three scenarios are reflected in Exhibit IV- B.
EXHIBIT IV- B
POTENTIAL RANGE OF AVAILABLE FUNDS
FUNDING SOURCE
- - - - * - - - - - - - - - - - - - - -
FEDERAL
TITLE I 1 1
TITLE XX
USDA
OTHER FEDERAL
STATE
OAA MATCH
STATE HC/ CM
SPP
LOCAL
PROGRAM INCOME
NON- FEDERAL
NOW- FEDERAL I N KIND
TOTAL HOME & COMMUNITY BASED FUNDS
SPP INSTITUTIONAL CARE FUNDS
TOTAL AVAILABLE FUNDS
ASSUMPTIONS:
% HOME & COMMUNITY BASED
POPULATION SHIFT
% SPP NURSING HOME
POPULATION SHIFT
- - - - - - L- O- U- - - - - - - - --- M-- ID-- P-- O- IN-- T- -- ----- H-- IG- H-- -----
ENROLLMENT PERIOD 5 MONTHS 3 MONTHS 3 MONTHS
BEGINNING OCTOBER 1, 1988 ( Due to delay i n
legislation)
AHCCCS IMPACT
The midpoint scenario was selected to project available funds for use in
analyzing expenditure alternatives. This midpoint scenario is further
detailed in Exhibit IV- C. The amount of dollars which are state appropriated
totals $ 1,376,980.
EXHIBIT IV- C
A- V- AIL- AB- L- E - FU- ND- S - DU- E . TO- P- O- PU- LA- TIO- N- S- HI- FT* .-----------------
W E
HEALTH VISITING
FUNDING SOURCE HOUSEKEEPER AID NURSE ....-.-.-.-.----- ---.- --- - - - . - - * . - - - . - - - - - * . - - -----.-.----
fEDERAL
TITLE 111
TITLE XX
USDA - - - - ..-- --.-
OTHER FEDERAL 14, 303 S1.114 S5.111
STATE
OM MATCH S2,722 U, 368 51,361
STATE HClCH S89,406 Sl82.928 142,527
SPP S243 190 S96. & 8 136.348
LOCAL
PROGRhM INCOME 14,989 16,339 56.997
WOW- FEDERAL $ 14,672 U4.873 S33.431
WON- FEDERAL IN KIND S2.683 11,043 S116 --------.-.------ -.-----.
TOTAL WE 8 C ~ ~ U N I T I BASED FUNDS ~ 437,973 S488.672 $ 177,065
I = = = I E E I I = i = i - ... l l l l i i i = I L . . S . I E l i i i l i
nmE
DELIVERED
MEALS -.---.------..
Sll2.908
563,989
139,188
$ 7.063
56,647 --.- ----
$ 26.036
$ 74,553
---- S1- 4.* 51- 6 ---.---
S345.199
===.=*===*
ASSMPTIONS 8 wares:
( 1) Assunes the saw distribution of funds by service as e ~ i s t si n FY1988.
( 2) Assunes 15% of DES clients residing i n their hune w i l l s h i f t t o the AHCCCS program.
( 3) Assunes enrollment i n the AHCCCS program w i l l require three months time beginning October 1,
ADULT
DAY CASE
---- C- A- R- E- ---- - MA. N- AG- EM- EN- T ------
$ 71.646 130.277
M4,878 $ 122,072 --.- ----
S21.126 t86
14,208 S1,782 ---- $ 62.685 ---- ----
S18.181 5597 .--- 540.265 ..-- Sl. 469 -----------.----. -------
S180.038 S259, ZU
. ii... L= IIII .= 1...==. 1= 5
nm L C~ M~ NITY BASED FUNDS
SPP INSTITUTIOWAL CARE FUNDS
TOTAL AVAILABLE FUNDS
-- T- O-- T- A- LS- ---
S358.367
S385.945
S39.488
S38,803
s21.088
$ 377,546
S376,186
563,139
5207.795
-- S- 19-, 82.7 .-----
S1,866,181
I= Si. IzSii. i.
S1.888,181
.-% 0- 2-, 16- 0 ----*.
s2,490,342
=:=* s===== z
STATE
A- P- P- R-- O- P- R- IA- T- E- D-All
three scenarios are based on several assumptions including:
o Utilization of nurse and home health aid services is higher than the
average for the potential AHCCCS population due to the severity of
illness of these clients
o Inflation will be limited to projected consumer price indices
o All clients that are AHCCCS eligible will apply for AHCCCS coverage
and shift to the AHCCCS program.
It should be noted that the actual amount of available funds will be reduced
by approximately $ 1,190 for each person which does not enroll in the AHCCCS
program.
AHCCCS IMPACT
PROPOSED CAP ISSUE
A cap on expenditures for AHCCCS home and community- based services is
currently under negotiation with the Federal government. We were unable to
perform extensive analysis since the nature of the cap was not fully defined.
However, any cap imposed on the AHCCCS program will potentially affect the
impact that AHCCCS has on the DES long- term care system ( including the amount
of available funds).
Two potential ways a cap may be imposed include:
1. Limit the number of AHCCCS eligibles that may receive home and
community- based services; and/ or
2. Limit the range of services covered under the AHCCCS home and
community- based program.
In the first case, the number of DES clients projected to shift to the AHCCCS
program may not be realized. For each projected person that does not shift to
the AHCCCS program, available funds will be reduced by approximately $ 1,190.
In the second case, funds projected to become available for a given service
may not be realized. For example, if AHCCCS eliminates housekeeping from its
home and community- based coverage, then approximately $ 437,973 in funds will
not be realized. Refer to Exhibit IV- C on page 20 to identify available funds
by service.
The analysis presented above assumes that the AHCCCS eligible population
and/ or service will continue to be covered in the DES system of care. It is
possible that the Area Agencies may decide not to continue providing services
to persons eligible for the AHCCCS program.
We recommend the following steps be taken during the negotiations of the
AHCCCS cap:
o The DES population figures presented in this report should be
considered in developing projections of the potential AHCCCS home and
community- based population.
o The cost and utilization data contained in this report should be
considered in estimating the cost of care for AHCCCS home and
community- based services.
o The potential ability of Area Agencies to discontinue serving AHCCCS
eligibles should be explored and considered.
EXPENDITURE ALTERNATIVES
Several alternatives exist for expenditure of the funds that may become
available in the DES long- term care system due to the population shift to the
AHCCCS program. Federal funds will be spent in accordance with approved state
plans. These state plans were developed according to Federal regulations and
are based on public hearings. The funds may or may not be spent to serve
additional clients in long- term care.
Alternatives for expenditure of the $ 1,376,980 in state appropriated funds are
described below. The Select Committee on Funding Systems for Long- Term Care
may wish to pursue any combination of the alternatives presented or pursue
alternatives not described below.
ALTERNATIVE I: COVER PROJECTED INCREASES IN SPP FOR HOME CARE
DES has submitted a budget request for fiscal year 1989 for the Supplemental
Payment Program which is $ 1,001,124 greater than fiscal year 1988. These SPP
funds are to continue to provide home care services to eligible clients. This
projected increase, however, is based on the growth of the current population
and has not been adjusted for the shift of SPP home care clients to the AHCCCS
program. The shift associated with SPP clients is estimated at $ 376,186.
Refer to Exhibit IV- C on page 20. Therefore, a net increase amount of
$ 624,938 will be needed to support projected growth of the SPP population.
ALTERNATIVE 11: FULFILL WAITING LISTS
A survey of the Area Agencies identified current waiting lists for long- term
care services. Refer to Exhibit V- A for a detail of the number of people
waiting for each service. We were able to obtain detailed demographic
information on 1,019 of the 1,472 waiting list clients. This information was
obtained through the Maricopa County Department of Health Services computer
system which maintains data on Region I clients. Refer to Appendix P for
detailed information. Key demographics are summarized below:
o Ax: Of the 1,019 clients, 91.5% are over age 60.
o Marital Status: Thirty- six percent are married, three percent are
separated and sixty- one percent are unmarried.
o Ethnicity: Of the 1,019 clients, about eighty- six percent are
caucasian, seven percent are hispanic, seven percent are black and
less than one percent are American Indian.
o Household Composition: Almost forty- nine percent of the 1,019
waiting list clients live alone. The remainder live with either
their spouse, relatives or nonrelatives.
EXPENDITURE ALTERNATIVES
EXHIBIT V- B
ESTIMATE OF UNMET NEED
POPULATION PARAMETER # OF PEOPLE SOURCE
-------.--------------------------- -..-..-..-..-..-..-..-.. .....................
Population >= 65 years old 438,531 DES Population Statistics Unit
Projection for 1988
December 1986.
Less: Population without need ( 363,980) P r i t z l a f f Comnission on Long- term Care
for assistance ( 83%) July 1984, page 22.
Less: Population i n nursing ( 11,000) Peat Marwick Report to AHCCCS
homes December 1986, Vol. I, page 31.
Less: Board & Care residents ( 2,800) DES Aging & Adult Administration
Estimate.
Less: Population receiving
informal services from
family & friends ( 75%)
Equals: Populat ion >= 65 years
old i n need of formal
services
Plus: Severely impaired
population < 65 years old
( 47,407) Pri t z l a f f Cmission on Long- term Care
July 1984, page 35.
2,000 DES Aging & Adult Administration
Estimate.
Equals: Total population i n need 15,344
Less: Current average monthly ( 9,000)
case l oad
Equals: U m t need
EXPENDITURE ALTERNATIVES
o Sex: Sixty- nine percent are female, thirty- one percent are male.
0 - Inc ome: Sixty- seven percent of the 1,019 waiting list clients have
incomes less than eighty percent of the state median. This
translates to annual incomes of $ 12,240 for a single person and
$ 16,008 for a couple. This is roughly equivalent to 300% of
Supplemental Security Income.
The cost to fulfill this waiting list is projected at $ 602,592 for fiscal year
1989 based on the fiscal year 1988 cost per person adjusted for inflation. It
is important to note that these clients are not eligible for SPP and will not
be covered under Alternative I.
ALTERNATIVE 111: FULFILL UNMET NEED
There are varying estimates of the population that is 65 years or older and in
need of long- term care services. Refer to Exhibit V- B. Based on the
information presented, approximately 6,300 people are currently in need of
some form of formalized, long- term care service. Over ten million dollars
would be required to fully serve this population ( based on an average annual
cost of $ 1,600 per person). Options available within this alternative are to
set certain penetration levels as follows:
Penetration No. of Persons Cost
ALTERNATIVE IV: FUND OTHER PROGRAMS OR DEVELOP SYSTEMS
We have assumed that the Select Committee desires to utilize available state
monies to continue serving the elderly population in need of long- term care
services. The available state appropriated monies could be used for other
non- long- term care purposes or to develop needed automated systems to support
long- term care. However, the Select Committee should be aware that if these
available funds are diverted elsewhere and the projected availability of funds
is not achieved, then reductions in DES long- term service provision must be
implemented.
ISSUES AND RECOMMENDATIONS
During the course of this study, our project team identified several issues
that the Select Committee may wish to explore. These issues and, where
appropriate, our recommendations are described below.
LACK OF AN AUTOMATED LONG- TERM CARE SYSTEM
The current DES long- term care program is managed with information collected
in a manual intensive manner. The lack of an automated system that integrates
statewide client, financial, eligibility, provider and utilization data makes
it difficult, if not impossible, to achieve the following:
o Assure that payments are not made for ineligible clients.
o Detect and manage cases of overutilization of services.
o Identify duplicate billings to different funding sources for the same
item of service.
o Project trends in costs and utilization.
o Monitor provider contract compliance and performance.
With the implementation of the AHCCCS long- term care program, control over
information becomes critical due to the greater potential for duplicate
payments .
RECOMMENDATION: A statewide automated long- term care system should be
developed to manage the total long- term care population and all fund
sources.
CURRENT REIMBURSEMENT MECHANISMS DO NOT ENCOURAGE COST MANAGEMENT
The current method of reimbursing providers for services on a
" fee- for- service" and/ or cost- reimbursement basis does not encourage control
over utilization and expenditures. Under the current payment mechanisms, the
greater the amount of services provided the more reimbursement - until the
contract ceiling is reached.
RECOMMENDATION: Alternative reimbursement systems should be explored
including those based on case- mix and fixed capitations.
ISSUES AND RECOMMENDATIONS
ADMINISTRATIVE STRUCTURE HAS OVERLAPPING RESPONSIBILITIES
The current administrative structures in place for planning and distribution
of funds have overlapping responsibilities in several areas which are as
follows :
o Planning for use of funds to serve the elderly population is not
centralized. For example, COGS do planning of Title XX funds and
area agencies do planning for Title 111. While several COGS and area
agencies are the same entity, there are regions with different
entities doing planning.
o In Region 11, two entities administer and contract for Title I11
monies.
o Two administrations within DES distribute funds to the same providers
for similar services. This practice will be discontinued beginning
July 1, 1988.
RECOMMENDATION: Procedures for streamlining the planning and distribution
of funds should be explored at both the state and local levels.
STATE SUPPLEMENTAL PAYMENT PROGRAM WILL PROVIDE DUPLICATE
COVERAGE WHEN AHCCCS LONG- TERM CARE PROGRAM IS IMPLEMENTED
Under the current laws, there will be overlap in payment for services for
individuals who are both AHCCCS and SPP eligible.
RECOMMENDATION: Legislation should be passed to assure that duplicate
payments are not made by SPP and AHCCCS.
DES CLIENTS MAY NOT APPLY FOR AHCCCS COVERAGE
It is possible that DES clients may not apply for AHCCCS eligibility. This
would have the effect of reducing the amount of funds projected to be
available in this report.
RECOMMENDATION: Consideration could be given to mandating that DES
clients appearing to be potentially AHCCCS eligible apply for AHCCCS
coverage.
CURRENT METHODS OF ASSESSING DES CLIENTS' FUNCTIONAL
IMPAIRMENT VARY ACROSS THE STATE
Several different methods and forms are used in assessing DES clients. This
makes it difficult to maintain a uniform statewide database.
RECOMMENDATION: One statewide instrument for client assessment should be
utilized that incorporates the AHCCCS preadmission screening requirements
as well as any DES specific requirements.
APPENDICES
LIST OF APPENDICES
Page
LIonntge rTveiremw sC aCroen duScetrevdi ce. . M. a. t. r. i. x. . b. y. . R. e. g. i. o. n .-. .1.9.8.7./. 1.9.8.8. ...................... 3207 Long Term Care Service Matrix by Funding Source - 1987/ 1988 ... 31 DES Long Term Care System Expenditures - 1986/ 1987 ............ 32 DES Long Term Care System Budget - 1987/ 1988 .................. 33
DES Long Term Care System Expenditures by Service
Fiscal Years - 1987 and 1988 ................................ 34 DES Long- term Care System Budget by Region - 1987/ 1988 ........ 35
Summary of Projected LTC Expenditures for Contract
Services by Region - 1987/ 1988 .............................. 36
Long Term Care System Utilization Data by Region - 1986/ 1987... 40
Long Term Care System Estimated Utilization Data
by Region 1987/ 1988 ........................................... 44
SPP - Institutional Care Utilization Data ..................... 47
Comparison Between AHCCCS PAS and University of
Arizona/ DES Database......................................... 48 Region I/ John C. Lincoln Cetegories of Assessment ............. 51
Estimate of DES Population Shift For SPP
Institutional Clients ....................................... 53
Estimate of DES Population Shift By Region for
Home and Community Based Clients ............................ 54
Region I Waiting List Demographics ............................ 55
APPENDICES
Kaushik Amin
Long Term Care Division
Arizona Health Care Cost
Containment System ( AHCCCS)
APPENDIX A INTERVIEWS CONDUCTED
Representative Bart Baker
Arizona House of Representatives
Diana Edwards
Area Agency on Aging
( Region 11)
Pima Council on Aging ( PCOA)
Kathleen Heard
Area Agency on Aging
( Region VI)
South Eastern Arizona Governments
Organization ( SEAGO)
Betty Jeffries
Population Statistics Unit
Department of Economic Security
Julie Layman
Data Entry Supervisor/ Programmer
Long Term Care Division
Maricopa County Department of Health
Services
David Lowenberg
Arizona Health Care Cost Containment
Sys tern ( AHCCCS)
Joseph P. Anderson
Schaller Associates, Inc.
Mabel Chen, M. D.
Long Term Care Project
Administrator
Arizona Health Care Cost
Containment System ( AHCCCS)
Gretchen Evans
Management Analyst
Department of Economic
Security
Ruth R. Houghton
Executive Director
Area Agency on Aging
( Region I)
Leonard J. Kirschner, M. D.,
M. P. H., Director
Arizona Health Care Cost
Containment System ( AHCCCS)
Richard Littler
Aging & Adult Administration
Department of Economic
Security
Senator Greg Lunn
Arizona Senate
APPENDICES
APPENDIX A INTERVIEWS CONDUCTED ( CONTINUED)
Marian Lupu
Area Agency on Aging
( Region 11)
Pima Council On Aging ( PCOA)
Nola Mussen
Management Information Systems
Maricopa County Department of Health
Services
Tom Rex
Business Research Division
Arizona State University
Richard Romero
Area Agency on Aging
( Region V)
PinallGila Council for Senior
Citizens
Eddie Sissons
Senate Legislative Staff
Richard Stavneak
Principal Fiscal Analyst
Joint Legislative Budget Committee
Julie Stratman
Computer Programmer
Area Agency on Aging
( Region I)
Jose Mercado
Aging & Adult Administration
Department of Economic
Security
Debbie Patrick
Area Agency on Aging
( Region 111)
Northern Arizona Council of
Governments
Robert Robb
Case ManagementIAssessment
Services
Long Term Care Division
Maricopa County Department of
Health Services
Elaine Rousseau, Ph. D.
Director of Research
University of Arizona
Long Term Care Gerontology
Center
Mike Slattery
Acting Assistant Director
Division of Social Services
Department of Economic
Security
Jimmie Stewart
Arthur Andersen & Co.
New York Office
Joyce Verschoor
Area Agency on Aging
( Region IV)
Western Arizona Council of
Governments
APPENDICES
APPENDIX A INTERVIEWS CONDUCTED ( CONTINUED)
Laurie Wakefield
House Legislative Staff
Donald Yesukaitis
Arthur Andersen & Co.
Office of Federal Services
Louise Wolverton
Area Agency on Aging
( Region 111)
Northern Arizona Council of
Governments
APPENDICES
APPENDIX B
LONG TERM CARE SERVICE MATRIX
BY REGION
1987/ 1988
SERVICE
PLANNING
SERVICE AREA
HOME ADULT
HOUSE HOME VISITING DELIVERED DAY CASE
KEEPER HEALTH AID NURSE MEALS CARE MANAGEMENT
REGION I X X
REGION II X X
REGION Ill X X
REGION IV X X
REGION V X X
REGION VI X X
REGION VII X -
REGION Vlll X X
X - SERVICES PROMDED - = SERVICES NOT PROVIDED
SOURCE: APPENDIX G
APPENDIX C
LONG TERM CARE SERVICE UTRM
BY FUNDING SOURCE
1987/ 1988
HOME ADULT
INSTITUTIONAL HOUSE HOME VlSlnNG DELIVERED DAY CASE
CARE KEEPER HEALTHAID NURSE MEALS CARE MANAGEMENT
SOURCE
TITLE Ill
TITLE XX
USDA
OTHER FEDERAL
OAA MATCH
STATE HC/ CM
SPP
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL IN KIND - X X X X X X
X = SERVlCES NNDED - = SERVlCES NOT NNDED
SOURCE: APPENDIX E
APPENDICES
APPENDIX D
DEPARTMENT OF ECONOMIC SECURITY
LONG TERM W SYSTEM EXPENDITURES
( in dollars, unaudited)
198611987
............................ CONTRACT SERVICES .............................................
FUNDING SOURCE HOUSEKEEPER ................................. ----------- .
FEDERAL
TITLE I11 - O M $ 261,065
TITLE XX - SSBG 511,847
USDA ----
OTHER FEDERAL 51.490
HOME
HEALTH VISITING
AID NURSE .--------- ---------
HOKE
DELIVERED
MEALS -----------
ADULT
DAY CASE
CARE MANAGEMENT .-------- ----------- TOTALS .-----------
STATE
O M MATCH
STATE HClM
SPP
LOCAL
PROCRAn INCOME 50,001 26,705 7,975 341,019 53,217 359 479,276
NON- FEDERAL CASH 159.9L6 175,525 38,528 924,403 ---- 417,257 1,715,659
NON- FEDERAL IN KIND 7,032 1,230 925 197,451 ---- 9.749 216,387 ----------- ----------- --------- ----------- --------- ----------- ------------
TOTAL FUNDS FOR CONTRACT SERVICES $ 2,218,857 $ 2,145,129 $& 83,818 $ 4,254,028 $ 562,700 $ 2,716,698 $ 12,381,230
PIZIl- PIPL- LPS - - PILID
TOTAL FUNDS FOR CONTRACT SERVICES .............. $ 12,381,230
SPP DIRECT PAY - HOUSEKEEPING .................. 1,690,290
SPP DIRECT PAY - INSTITUTIONAL CARE ............ 1,254,422 ------------
TOTAL DES LONG TERW CARE EXPENDITURES .......... $ 15,325,942
___ U-SOURCES
:
- DES Final BY198611987 Expenditure Report For Area Agency Contracts, ( C- 15). - DES SSBG and State HCICM disbursements for home care and case management, ( C- 41). - O M match formula for long- term care services. - DES final report on SPP and SPP direct pay expenditures, excludes developmentally disabled clients, ( C- 30). - SSBG expenditure report for Adult Day Care for Regions I1 L 111. - DES 1989 SPP Budget Request for Family Assistance Administration
for SPP for institutional recipients.
ABBREVIATIONS:
O M - Older American's Act
SSBG - Social Services Block Grant
USDA - United Stater Department of Agriculture
STATE ECIM - State Bome CarelCase Management
SPP - Supplemental Payment Program
DES - Department of Economic Security
APPENDIX E
DEPARTMENT OF ECONOMIC SECURITY
LONG TERM CARE SYSTEM BWGET
( i n dollars, unaudited)
1987/ 1988
FUNDING SOURCE .................................
FEDERAL
TITLE 111 - OAA
TITLE XX - SSBG
US0 A
OTHER FEDERAL
STATE
OAA WATCH
STATE HC/ CW
SPP
LOCAL
PROGRAM INCOME
NOW- FEDERAL CASH
NOW- FEDERAL IN KIND
TOTAL FUNDS FOR CONTRACT SERVICES
HOME
HEALTH
HOUSEKEEPER AID ......................
.. CONTRACT SERVICES ...............................................
HOME ADULT
VISITING DELIVERED DAY CASE
NURSE MEALS CARE HAWAGEMENT TOTALS ......................................................
TOTAL FUNDS FOR CONTRACT SERVICES ................... $ 14,283,748
SPP DIRECT PAY - HOUSEKEEPING ....................... 2,344,249
SPP DIRECT PAY - INSTITUTIONAL CARE ................. -- 1,2- 68-, 5.90- ------
TOTAL DES LONG TERM CARE EXPENDITURES ............... $-- 1-- 7--,-- 8-- 9-- 6--, 5-- 8-- 7-- ----
SOURCES:
- DES 1987f1988 Revlsed Budget for Area Agency Contracts dated 02/ 23/ 88. - DES SSBG and State HClCM allocations for home care and case management, ( C- 42). - OAA match formla. - SPP Projection of payments excluding developnentally d~ sabledc lients. - SSBG budgets for Adult Day Care I n Regions 11 8 - DES 1989 SPP Budget Request for Family Assistance Administration
for SPP for rnstitutional reclprents.
ABBREVIATIONS:
OAA - Older American's Act
SSBG - Social Services Block Grant
USDA - United States Department of Agriculture
STATE HC/ CM - State Home Carelcase Management
SPP - Supplemental Payment Program
DES - Department of Economic Security
APPEXDICES
APPENDIX F
DES LONG TERM CARE SYSTEM
EXPENDITURES BY SERVICE
FISCAL YEARS 1987 & 1988
DO~ URS upmom
5.500,000
l Y P € f f ~ #
nsw i 987 ( m ~ )
APPENDICES
APPENDIX G
DEPARTMENT OF ECONOMIC SECURITY
LONG TERM CARE SYSTEM BUDGET
( i n dollars, unaudited)
1987/ 1988
.......................... CONTRACT SERVICES ...........................................
HOME HOME ADULT
HEALTH VISITING DELIVERED DAY CASE
R.. E. G. IO.. N. .......................... H_ O__ U_ S_ E_ KE_ E_ P_ E_ R_ ____ A__ ID_ ____ - _ N_ UR_ SE_ _ _____ M_ E- A- L- S- ---__ _ C- A- R- E- _ - - - - M- A- N- A- G- E- M-- EN- T- - -- TO- T- AL- S -----.-
REGION I $ 991,884 $ 726,531 $ 52,483 $ 1,320,160 $ 502,317 $ 1,515,539 85,108,914
REGION I1 182,537 815,708 91,534 942,836 316,408 726,772 3,075,795
REGION 111 348,525 240,504 201,127 506,870 133,318 228,582 1,658,926
REGION 1V 358,643 92,271 47,056 312,566 128,748 109,368 1,048,652
REGION V 188,905 202,906 87,755 212,236 0 126,162 817,964
REGION V I 316,635 243,466 142,158 382,436 0 140,753 1,225,448
REGION V I I 50,000 0 0 911,558 0 40,908 1,002,466
REGION V I I I 107,790 5,000 2,500 223,534 0 6,759 345,583 _____---_--_______--_-. -_---- -- _ _ _ _ _ - _ _ _ __ __ - _ _ _ _ _ _----- - - - - - - - - ------------
TOTAL FUNDS FOR CONTRACT SERVICES $-- 2----, 5-- 4-- 4--,-- 9-- 1-- 9-- -- $_- 2-_,- 3-_ 2- 6-_,- 3-_ 8- 6_- -_ -$--_ 6-- 2--_ 4---,-_ 6-- 1-- 3-- -- $-_ 4--,- 8_- 1-_ 2-,- 1-- 9-- 6-- _-- -$--- 1-- ,-- 0-_ 8_ 0_,- 7-- 9-- 1-- _--- -$-- 2---,- 8-- 9-- 4--,-- 8-_ 4- 3-- --- $-- 1-- 4---,- 2-- 8-- 3--,-- 7-- 4-- 8-- --
TOTAL FUNDS FOR CONTRACT SERVICES ................ $ 14,283,748 SPP DIRECT PAY - HOUSEKEEPING .................... 2,344,249
SPP DIRECT PAY - INSTITUTIONAL CARE .............. 1,268,590 - - - - - - - - - - - -
TOTAL DES LONG TERM CARE EXPENDITURES ............$-- 1---- 7--, 8-- 9-- 6--,-- 5-- 8-- 7-- --
SOURCES:
- DES 1987/ 1988 Revised Budget for Area Agency Contracts dated 02/ 23/ 88. - DES SSBG and State HC/ CM allocations for home care and case management, ( C- 42). - OAA match formla. - SPP Projection of payments, excluding developnentally disabled clients. - SSBG krdgets for Adult Day Care i n Regions I - DES 1989 SPP Budget Request for Family Assistance Administration
for SPP for institutional recipients.
ABBREVIATIONS:
OAA - Older American's Act
SSBG - Social Services Block Grant
USDA - United States Department of Agriculture
STATE HC/ CM - State Home Care/ Case Management
SPP - Supplemental Payment Program
DES - Department of Economic Security
APPESDICES
APPENDIX H
FUND SOURCE
..................................
EGION I
( Notes :, 5,6,8) TITLE I11 I0. A. A. MATCH
TITLE XX ( SSBG)/ STATE HCICM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
YON FEDERAL CASH IN KIND
SPP
USDA
TOTAL
XEGION II
( Notes 2,5,7,8) TITLE 111 1O. A. A. MATCH
TITLE XX ( SSBG) lSTATE HCICM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
TOTAL
XEGION III
( Notes 3,5,7,8,10) TITLE 11: I0. A. A. XATCH
TITLE XX ( SSBG) ISTATE HCICM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPY
USDA
TOTAL
REGION IV
( Notes 1,5,6,10) TITLE 111 1O. A. A. MATCH
TITLE XX ( SSBG)/ STATE HCICM
OTIER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
TOTAL
S 5 W Y OF ? ROJECTED LTC IXPENDITLFSS
FOR CONTRACT SEXVICES
BY RIGION FOR FYI988
LTC PROJECTED
EXPENDITURES LTC LTC
( 07- 12187) EXPENDITURES SUDGET
----------- ----------- -----------
PROJECTED
SURPL'JS I
( DEFICIT)
----------
APPENDIX H ( CONTINUED)
SUMMARY OF PROJECTED LTC EWENDITWS
FOR CONTRACT SERVICES
BY REGION FOR FYI988
LTC PWJECTED PROJECTED
SURPLUS I
( DEFICIT)
----------
EXPENDITURES LTC
( 07- 12187) EXPENDITURES
LTC
FUND SOURCE BUDGET
..............................
WGION V
( Notes 1,5,6,9) TITLE I11 1O. A. A. MATCH
TITLE XX ( SSBG)/ STATE HClCM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
SON FEDERAL CASH IN KIN3
SPP
USDA
TOTAL
' LEGION VI
( Notes 1,5,6,13) TITLE I11 1O. A. A. MATCH
TITLE XX ( SSBG) ISTATE HClCM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
TOTAL
REGIOH VII
( Notes A ,5,6) TITLE 111 1O. A. A. MATCH
TITLE XX ( SSBG)/ STATE HC/ CM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
TOTAL
REGION VIII
( Notes 4,5,6) TITLE I11 1O. A. A. MATCH
TITLE XX ( SSBG)/ STATE HClCM
OT? iER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
197,455
53,008
0
0
7,500
27,250
LO, 000
20,370
TOTAL 172,792 345,583 345,583 0
FUND SOURCE ...................................
TOTAL CONTRACT SERVICES FOR ALL REGIONS
TITLE I11 1O. A. A. MATCH
TITLE XX ( SSBG) lSTATE HClCM
OTHER FEDERAL
PROGRAM INCOME
NON FEDERAL CASH
NON FEDERAL CASH IN KIND
SPP
USDA
TOTALS
S'JMMARY OF PROJECTED LTC EX? SNDITURES
FOR CONTRACT SERVICES
BY REGION FOR FYI988
LTC
EDENDITURES
( 07- 12187)
-----------
? ROJECTED
LTC
ZXPENDITURE S
-----------
LTC
BUDGET -----------
PROJECTED
SURPLUS I
( DEFICIT) ----------
NOTES :
1 LTC Expenditures for Regions I, IT?, V and VI are from DES Reported
Area Agency Expenditures as of December 31, 1987.
2 LTC Expenditures for Region I1 are from two sources. Expenditures
related to home delivered meals are from DES Reported Area Agency
Expenditures as of December 31, 1987. Expenditures related to remaining
services are as reported by the Area Agency of Pima County Department of
Aging and Medical Services expenditures. Two sources were requlred because
a one- month lag occurs In reporting Plma County expenditures to the Area Agency.
3 LTC Expenditures for Reglon 111 are from two sources. Expenditures for
all servrces except aault day are are from DES Reported Area Agency
Expenditures as of December 31, 1987. Expenaitures related to adult day
care are budget amounts due to inaaequate documentation at the time of
report preparation.
4 LTC Expenditures for Regions VII and VIII are budget amounts due to
unavailability of current reported expenditures.
5 Projected Expenditures are straight- line projections of the
LTC Expenditures.
6 Budget amounts for Regions I, IV, V, VI, VII and VIII are from DES Area
Asency Budgets.
7 Budget amounts for Regions I1 and 111 are from two sources. Budget
amounts for a11 services except adult day are are from the DES Area
Agency Budgets. Budget mounts related to adult day care are from SSBC
budgeted contracts due to the separate contracts for this service.
APPENDICES
8 It should be noted that deficits are only projections based on the first
six months experience. Deficits may not be incurred if service levels are
reduced, voiume drops significantly or additional local fund sources are
received.
9 The area agency in Region V states that its reported expenditures as of
December 31, 1987 are understated due to unreported expenditures from a
major provider. Region V is expected to meet its budget amounts fully
with little, if any, surplus.
10 Regions 111, IV and VI expect to end the year on budget with Little, if any,
surplus. These Area Agencies expect to expend local monres at a greater
rate than the first six months of the fiscal year.
APP- EN- D IX I
LONG TERM CARE SYSTEM
UTILIZATION DATA
BY REGION FY 1987
------.--------------- S- ER- V- IC- E- S ------
------------ HOME CARE-------------------
HOUSE- HOME VISITING
KEEPER HEALTH AID NURSE
------------ ------------ ------------
- - - - - - - - - - - - -
HOME
UE: L. IVERED
MEALS
- - - - - - - - - - - - -
ADULT
DAY
CARE
CASE TOTAI.
MANAGEMENT EXPENDITURE
------------ -------------
Undup persons served ( A)
Avg monthly caseload ( A)
# of units provided ( G)
# of rrnlts per undup person
# of t~ u~ tpse r avg monthly caseload
Total annual cost ( G)
Ulllt cost
Annual cost per lrndup person
Annnual cost per person in avg mo caseload
Monthly cost per undup person
Montl~ ly cost per person in avg mo. caseload
Avg % utlllzation for avg. mo. caseload
I RE(. ION I1
c. Undup persons served ( B)
0 Avg monthly caseload ( B)
I # of units provided ( G)
# of unLts per undup person
# of tlnlts per avg monthly caseload
Total annual cost ( G)
Unit cost
Annual cost per undup person
Annnval cost per person in avg mo. caseload
Monthiy cost per undup person
Monthly cost per person in avg mo. caseload
Avg % utilization for avg. mo. caseload
REGION 111
Undup persons served ( C)
Avg monthly caseload( C)
# of units provided ( G)
# of units per und~ rp person
# of units per avg monthly caseload
Total annual cost ( G)
Unit cost
Annr~ ni cost per ~ l~ lduppe rson
Annnual cost per person in avg mo. caseload
Montllly cost per utidup person
Monthly cost per person in avg mo. caseioad
Avg % utilization for avg. mo. caseload
LONG TERM CARE SYSTEM
UTILIZATION DATA
BY REGION FY 1987
--.----------------------------------------------------
HECIOII 1V
Undup persons served ( D)
Avg monthly caseloarl ( D)
# of u n i t s provided ( G)
# of u n l t s per undup person
# of u n i t s per avg monthly caseload
Total annual cost ( G)
Unit cost
Annual cost per ~~ rlduppe rson
Annrlual cost per person i n avg [ no. caseload
Morlthl y cost per undup person
Mor~ thly cost per person i n avg mo. caseload
Avg X u t i l i z a t i o n f o r avg. mo. caseload
I HE(: ION V
Undup persons served ( E)
Avg monthly caseload ( E)
# of u n i t s provided ( G)
# of i ~ n i t sp er undup person
# of u n i t s per avg monthly caseload
Total annual cost ( G)
Unit cost
Ar~ nual cost per undup person
Annnual cost per person i n avg mo. caseload
Monthly cost per undup person
Monthly cost per person i n avg mo. caseload
Avg % u t i l i z a t i o n f o r avg. mo. caseload
REC. ION VI
Undup persons served ( F)
Avg monthly caseload ( F)
# of u n i t s provided ( G)
# of u n i t s per undup person
# of u n i t s per avg monthly caseload
Total annual cost ( G)
Unit cost
Atlniral cost per undup person
Annnual cost per person in avg mo. caseload
Monthly cost per undup person
Monthly cost per person i n avg mo. caseload
Avg % u t i l ~ z a t i o nf o r avg. mo. caseload
--------------------------------- SERVICE - - - - - - - - - - - - - - - ------------
------------ HOME CARE------------------- HOME ADULT
HOUSE- HOME VISITING DELIVERED DAY
KEEPER HEALTH AID NURSE MEALS CARE
CASE
MANAGEMENT
- - - - - - - - - - - - -
TOTAL
EXPENDITURE
LONG TERM CARE SYSTEM
UTILIZATION DATA
BY REGION FY 1987
------------------------------- SERVI- C- E- S- ---------- . . . . . . . . . . . . . . . . . . . . . . . . . -------------
------------ HOME CARE----------------- HOME ADULT
HOUSE- HOME VISITING DELIVERED DAY CASE TOTAL
KEEPER HEALTH AID NURSE MEALS CARE MANAGEMENT EXPENDITURE
------------ ------------ ------------ ------------ ------------ ------------ -------------
T0TAI. S AND AVERAGES
Undup persons served
Avg monthly caseload
# of units provided
# of units per undup person
# of units per avg monthly caseload
Total annual cost
Unit cost
Anmlal cost per undup person
Atltlnilal cost per person in avg mo. caseload
Mol~ thly cost per undup person
Molltl~ ly cost per person in avg mo. caseload
TOTAL EXPENDITURES FOR CONTRACT SERVICES AND SPP DP HOUSEKEEPING . . . . . . . . $ 13,080,437
PRIVATE PAY PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 97,998
REGIONS VII AND VIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 893,075
SPP DP INSTITUTIONAL CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,254,422
------------
TOTAL DES EXPENDITURES ( H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,325,932
---- - --- - -- --- -- -.-- -- -- .
NOTFS :
A) Rrglorl I: Undttp persons for HSK, HHA, VN, HDM, ADC S CM are as reported by the AAA. ( C- 71)
Undup persons for HSK also includes SPP direct pay clients. ( C- 101)
Avg mo caseload for CM is as reported by the AAA. ( C- 72)
Avg mo caseload for HHA, VN, HDM, b ADC is estimated based on the experience for CM between undup and avg mo. This
translates to a 57.8% turnover factor.
Avg mo caseload for HSK is based on the 57.8% turnover factor applied to the undup persons plus the SPP DP caseload. ( C- 72 h C- 101)
Average percent utilization for avg. mo. caseload 1s the avg. mo. caseload for the service divided by 90 percent of the avg. mo. caseload for CM
R) K~. c: ion 11: Undup persons for HSK, HHA, VN, HDM, ADC S CM are as reported by the AAA. ( C- 73)
Undup persons for HSK also includes SPP direct pay clients. ( C- 101)
Avg mo caseload for ADC h VN is as reported by providers. ( C- 74)
Avg mo caseload for HHA, HDM, 6 CM is estimated based on the Region I factor.
Avg mo caseload for HSK is based avg mo reported by providers plus the SPP DP caseload. ( C- 74 S C- 101)
Average percent utilization for avg. mo. caseload is the lesser of 100 percent or the avg. mo. caseload for the service divided
by 90 percent of the avg. mo. caseload for CM.
1;) Hel: lon I11 Undup persons f o r BSK, HHA, h VN a r e a s rep0rtf. d by the AAA ( C- 75)
Undup persons f o r HSK a l s o includes SPP d l r e c t psy c l ~ e n t s ( C- 101)
Undup persons f o r HDM h CM are as reported through the Qusrterly Soclal Servlces Report from the AAA ( C- 76)
IJr~ dup persons f o r ADC i s as reported by t h p~ ro vlrler ( C- 77)
Avg mo caseload f o r HHA, VN, HDM, h ADC 1s e, tli112ted blsed on the RegLon I f a c t o r
Avg mo caseload for CM IS based on the r a t l o LII Reg~ ou1 11 between undup p e r s o n s l ~ v gm o f o r tlSK T h ~ sw as done t o assure a l l persons ~ 1 1 1
be covered by CM. The Region I f a c t o r woulrl h? ve been too low
Avg mo caseload f o r HSK is based on the 57 8% turnover f a c t o r applied t o the undup persons plus the SPP DP caseload ( c- 75 h C- 101)
Average percent u t i l i z a t i o n f o r avg. mo caseload 1s the l e s s e r of 100 percent Or the avg nlo caseload f o r t h e s e r v i c e divided
by 90 percent o f the avg mo. caseload for CM
1)) I( r2$ lon IV Undup persons f o r HSK, HHA, HDM, h CM a r e a s reported by the AAA and p r o v ~ d e r s ( C- 78 S C- 79)
Undup persons f o r HSK a l s o lncludes SPP d ~ r e r tp ay c i l e n t s ( C- 101)
Undup persons f o r HDM 6 CM a r e a s reported throi~ gh the Quarterly Soclal Services Report from the AAA ( C- 76)
Avg mo caseload f o r HDM h CM i s estimated based on the Reglon I f a c t o r
Avg mo caseload f o r HHA h VN is as reported by p r o v ~ d e r s ( C- 79)
Avg mo caseload f o r HSK i s based avg mo reported by providers plus the SPP DP caseload ( C- 79 h C- 101) ,
Average percent u t i l i z a t i o n f o r avg mo caseload 1s the l e s s e r of 100 percent or the avg mo caseload f o r t h e s e r v i c e divided
by 90 percent o f the avg rno. caseload for CM
E) I t r p ~ v nV U~ idi~ ppe rsons for HSK, HHA, HDM, h CM are as 11- ported by p r o v ~ d e r s ( C- 80)
Undup persons for HSK a l s o itlcludes SPP d ~ r e r tp ay c l l e n t s . ( C- 101)
Avg mo caseload f o r HHA, VN, h HDM i s as reported by p r o v ~ d e r s ( C- 80)
Avg mo caseload for CM is based on the r a t i o In Region V between undup personslavg mo f o r HSK. This was done t o assure a l l persons " 111
be covered by CM. The Region I f a c t o r would have been too low.
Avg mo caseload f o r HSK is based avg mo reported hy providers plus the SPP DP caseload. ( C- 80 h C- 101)
Average percent u t i l i z a t i o n f o r avg. mo. caseload i s the avg. mo. caseload f o r the service divided by 90 percent o f the avg. mo. caseload f o r CM.
I F') I ? + . i : i o r k VI: lJ~ idt~ ppe rsons f o r HSK, HHA, HDM, h CM are as I-<, ported by the AAA. ( C- 81)
Undup persons f o r HSK a l s o includes SPP d i r e c t pay c l i e n t s . ( C- 101)
Avg mo caseload f o r HHA h VN is as reported by providers. ( C- 82)
Avg mo caseload f o r HDM h CM i s estimated based 011 the Region I f a c t o r .
Avg mo caseload f o r HSK i s based avg mo reported hy providers plus the SPP DP caseload. ( C- 82 h C- 101)
Average percent u t i l i z a t i o n for avg. mo. caseload i s the avg. mo. caseload f o r the service divided by 90 percent of the avg. mo. caseload for CM.
6) The anriusl cost and # of u n i t s provided were obtained from the f o l l o w ~ n g sources:
DES F i n a l r e p o r t on SPP and SPP d i r e c t pay expenditures.
SSBG expenditures f o r Adult Day Care i n Regions I1 C I11
DES Final FY1986/ 1987 Expenditure Report f o r Area Agency Contracts ( C- 15).
H) The s l i g h t d i f f e r e n c e i n t o t a l expenditures reported a t the s t a t e l e v e l i s due t o rounding
ABBREVIATIONS:
AAA: Area Agency on Aging
ADC: Adult Day Care
Avg. mo. caseload: Average monthly caseload
CM: Case Management
DES. Department of Economic Security
ADM: Home Delivered Meals
HHA: Home Health Aid
HSK: Housekeeper
SPP: Supplemental Payment Program
SPP DP: Supplemental Payment Program - Direct Pay
SSBG: Social Services Block Grant
Undup person: Unduplicated person
VN: V i s i t i n g Nurse
-------------- 4 ----------------------------------------
REGION I !
Undup persons served ( D)
Avg monthly caseload ( D)
# of units provided ( C)
# of units per undup person
# of units per avg monthly caseload
Total annual cost ( A)
Unit cost ( B)
Annual cost per undup person
Annnual cost per person in avg mo. caseload
Monthly cost per undup person
Monthly cost per person in avg mo. caseload
Avg % utilization for avg. mo. caseload
REGION I1
I Undup persons served
. b
Avg monthly caseload
. b # of units provided
# of units per undup person
# of units per avg monthly caseload
Total annual cost
Unit cost
Annual cost per undup person
Annnual cost per person in avg mo. caseload
Monthly cost per undup person
Monthly cost per person in avg mo. caseload
Avg % utilization for avg. mo. caseload
REGION I11
Undup persons served
Avg monthly caseload
# of units provided
# of units per undup person
# of units per avg monthly caseload
Total annual cost
Unit cost
Annual cost per undup person
Annnual cost per person in avg mo. caseload
Monthly cost per undup person
Monthly cost per person in avg mo. caseload
Avg X utilization for avg. mo. caseload
LONG TERM CARE SYSTEM
ESTIMATED UTILIZATION DATA
BY REGION FY 1988
A- PPE- NDI- X J
--------------------------------- SERV- I- C- E-- ---------- --------------
------------ HOME CARE------------------- HOME ADULT
HOUSE- HOME VISITING DELIVERED DAY
KEEPER HEALTH AID NURSE MEALS CARE
CASE TOTAL
MANAGEMENT BUDGET
------------ -------------
LONG TERM CARE SYSTEM
ESTIMATED UTILIZATION DATA
BY REGION FY 1988
--------------------------------- SERVICES ---
------------ HOME CARE-------------------
HOUSE- HOME VISITING
KEEPER HEALTH AID NURSE
------------ ------------ ------------
.......................................................
REGION IV
Undup persons served 456 185 350
Avg monthly caseload 366 146 214
# of units provided 29,431 4,541 2,171
# of units per undup person 64.59 24.48 6.20
# of units per avg monthly caseload 80.31 31.04 10.16
Total annual cost $ 393,496 $ 92,271 $ 47,056
Unit cost $ 13.37 $ 20.32 $ 21.67
Annual cost per undup person $ 864 $ 498 $ 134
Annnual cost per person in avg mo. caseload $ 1,074 $ 631 $ 220
Monthly cost per undup person $ 72 $ 41 $ 11
Monthly cost per person in avg mo. caseload $ 89 $ 53 $ 18
Avg % utilization for avg. mo. caseload 100% 44% 64 %
REGION V
1 Undup persons served 608 691 384
Avg monthly caseload 473 382 295
C-Cn
# of units provided 29,341 18,649 3,534
I # of units per undup person 48.24 26.98 9.21
# of units per avg monthly caseload 62.06 48.83 11.98
Total annual cost $ 326,277 $ 202,906 $ 87,755
Unit cost $ 11.12 $ 10.88 $ 24.83
Annual cost per undup person $ 536 $ 294 $ 229
Annnual cost per person in avg mo. caseload $ 690 $ 531 $ 297
Monthly cost per undup person $ 45 $ 24 $ 19
Monthly cost per person in avg mo. caseload $ 58 $ 44 $ 25
Avg % utilization for avg. mo. caseload 74% 60% 46%
REGION VI
Undup persons served 916 739 771
Avg monthly caseload 544 349 269
# of units provided 36,263 16,134 4,069
# of units per undup person 39.60 21.83 5.28
# of units per avg monthly caseload 66.61 46.21 15.14
Total annual cost $ 467,792 $ 243,466 $ 142,158
Unit cost $ 12.90 $ 15.09 $ 34.94
Annual cost per undup person $ 511 $ 329 $ 184
Annnual cost per person in avg mo. caseload $ 859 $ 697 $ 529
Monthly cost per undup person $ 43 $ 27 $ 15
Monthly cost per person in avg mo. caseload $ 72 $ 58 $ 44
Avg % utilization for avg. mo. caseload 64% 41% 32%
HOME ADULT
DELIVERED DAY CASE TOTAL
MEALS CARE MANAGEMENT BUDGET
LONG TERM CARE SYSTEM
ESTIMATED UTILIZATION DATA APPENDIX J ( CONTINUED)
BY REGION FY 1988
--------------------------------- SERVI- C- E- ------------ --------------------------- -------------
------------ HOME CARE------------------- HOME ADULT
HOUSE- HOME VISITING DELIVERED DAY CASE TOTAL
KEEPER HEALTH AID NURSE MEALS CARE MANAGEMENT BUDGET
TOTALS AND AVERAGES
Undup persons served
Avg monthly caseload
# of units provided
# of units per undup person
# of units per avg monthly caseload
Total annual cost
Unit cost
Annual cost per undup person
Annnual cost per person in avg mo. caseload
Monthly cost per undup person
Monthly cost per person in avg mo. caseload
TOTAL BUDGET FOR CONTRACT SERVICES AND SPP DP HOUSEKEEPING.. $ 15,279,948
REGIONS VII AND VIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,348,049
SPP DP INSTITUTIONAL CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,268,590
TOTAL DES BUDGET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,896,587
--------------------------
NOTES :
A) Annual cost is current budget amount per DES FY88 budget lotus spreadsheet and SSBG budget for Adult Day Care in Regions I1 & 111.
B) Unit cost is actual unit cost per DES Expenditures to Date lotus spreadsheet
C) Number of units is calculated based on annual costlunit cost.
D) Unduplicated persons served and average monthly caseload is based on FY86187 units per person.
E) Region IV Adult Day Care persons are as reported by the Area Agency.
ABBREVIATIONS:
AAA: Area Agency on Aging
ADC: Adult Day Care
Avg. mo. caseload: Average monthly caseload
CM: Case Management
DES: Department of Economic Security
HDM: Home Delivered Meals
HHA: Home Health Aid
HSK: Housekeeper
SPP: Supplemental Payment Program
SPP DP: Supplemental Payment Program - Direct Pay
SSBG: Social Services Block Grant
Undup person: Unduplicated person
VN: Visiting Nurse
APPENDICES
APPENDIX K
SPP - INSTITUTIONAL CARE UTILIZATION DATA
Private Nursing Homes
Avg. mo, persons
Avg. mo. payment
Total annual cost
Public Nursing Homes
Avg. mo. persons
Avg. mo. payment
Total annual cost
Supervisory Care Homes
and Adult Foster Care
Avg. mo. persons
Avg. mo. payment
Total annual cost
Total Institutional Care
Annual Cost
COMPIRISON BETWEEN AHCCCS PAS AND UNIVERSITY Of IRIIONI/ DES DATABISE
FUNCl IONAL ASSESSMENT
_-____ P_ A_ S _ CA_ TE_ G_ OR_ Y_ _____--_---_----_- P- AS . R_ ANK _ 6 W_ EIG_ HTS ___..... ._. . ._. . . ._. . ._. . D._ E. S. . C.. A. T.. EG.- O. .. RY.- . .-. .-. .-. .-. ... ...-. ----- DES RANK - PRO- PO- SE- D - CO- M- PA- RA_ TIVE _ PO_ INTS_ 6 M_ ElM_ TlN_ GS ____---------~-----~-------~---.....~...
Psychosocial Behavior
level of consciousness Independent : 1
Minimal = 2
Moderate = 3
Impaired judgment Maximum = 1
Orrentatlon MAXIMUM POINTS 32
MAXIMUM OVERALL RATING: 4
WEIGHT: 4 times overall rating
MAXIMUM SCORE 16
Disturbances of perception
Disturbances of thought
Concerns
Social behavior
Wanders
Continency of bowl
Orientation ( ASCAR)
Memory ( ASCAR)
Unintentional self- harm ( State)
Cognition ( State)
Orientation ( ASCAR)
Probable hallucinations ( State)
Probable undue suspiciousness of others ( State)
Possible anxiety state ( State)
Emotional i n s t a b i l i t y ( State)
Verbal abuse ( State)
Physical assault against others ( State)
Public disrobing 6 public sexual behavior ( State)
Behavior ( ASCIR)
Wandering ( State)
Behavior ( ASCAR)
Continent = 1 Continency of bowel
lncontinent < weekly = 2
lncontinent weekly or more = 3
l o t a l l y incontinent = 4
MAXIMUM POINTS: 1
WEIGHT: 1 times total points
MAXIMUM SCORE: 1
Continency of bladder Continent = I Continency of bladder
lncontinent c weekly = 2
lncontinent weekly or more = 3
Totally incontinent = 4
nAxlwn POINTS: 4
WEIGHT: 1 times total points
MIXIRUM SCORE: 1
FUNCllONAL ASSESSMENT - MAXIMUM TOTAL SCORE: 54
nlNlrmn SCORE REWIRED. 11
ISCAR Scores :
Independent = 1
Minimal = 2
Moderate = 3
Marrrnua = 4
OF5 Scores
Y = Yes
N = No
ASCAR: Assign points in same manner as ASCAR
for the three catqorfes.
MXIWM POINTS: 12
MAXIMUM OVERALL RATING: Same as PAS
WEIGHT: Saw as PAS
MAX IMUM SCORE : Same as PAS
DES: Awrd points as f o l l w s :
Unintentional self- harm N = 1. Y = 3
Cognition N = I . Y = 2
Probable hsllucinrtions N = 1. Y = 1
Probable undue suspiciousness N = 1. Y = 3
Possible annlcty state N = 1 . Y = 2
Emotional instabil i t y N = l . Y = 2
Verbal abtse N = l . Y = 2
Physical assault N = l . Y = 4
Public disrobing 6 sexual N = 1. Y = 4
hndcring N = l . Y = 3
IUXIWM POINTS: 29
MXlWM OVERALL RATING: Sale as PAS
WEIGHT: Sew as PAS
MXIIIIM SCORE: Sane as PAS
Continent = 1 1 point
Periodic incontinence = 2 2.5 points
Complete incontinence = 3 4 points
HEIGHT: Saw as PAS
MAXIWM SCORE: Sale as PAS
Continent = I 1 point
Periodic incontinmcc = 2 2.5 points
Complete incontinence = 3 1 mints
HEIGHT: Saw as PAS
IUXIWM SCORE: Sale as PAS
FUWCTIOIII ASSESSMENT - MXIWM TOTAL SCORE: 54
MINIWM SCORE REWIRED: 11
PAS CATEGIIRY
Assessor's overall rat inq
nf medical condition
rOYFARlSON AFTWEEN AHCCCS PAS AN0 UNIVERSITY OF bRIIrINb / llF' Pfl'bRh: F
FUNCTIONAL ASSFSSMFNT
PAS RANU 6 WllGHTS
No problem - I
Mrnrmal nroblem = 2
Moderate problem = 3
lnt~ nse problem = 1
nAxrmla POINTS: 4
WEIGHT: 19 times assessor points
MAXlMIlM SCORE: 16
OES C41E60RY
. .-... .-- - - .---...---------- ----
ASSPSSOI overall rating not collected.
med~ cal condrtrons are collected
~ lcludrna hiqh risk one5
Stroke
As t hna
Chronrc ohstrutrive pulmonary drsease
Emphys-- ma
Broken bone fracture
AIDS
Chronrc pain
Commun~ cable disease
[ recub~ t?
Autism
Brain damage
Mult iplo scl~ rosls/ dystrophy
Qrhabr l i t a t ive nursing services Doesn't receive or need = 0 Information not collected
leaching/ traininq Receives = 0
Bowel/ bladder Needs = I
Turning/ positioninq
Range of mot im MAXIMUM POINIS: 5
R~ qtorativen ursinq WEIGHT: 1 t i m ~ st otal ~ o i n t s
MAXIMUM SCORE: 5
flladder/ borel services Doesn't receive or need = 0 Colostomy/ ilwstomy equipment
Cdtheter care Receives = 0 Foley cqtheter equipment
Octomy care Needs = I
MAxlnun POINTS: 2
WEIGHT: 1 times total points
MAXIMUM SCORE: 2
M~ drcaitm s/ monitorrnq Ooesn't receive or nerd = 0 M~ drcatronu se
Drug regulation Receives = 0
Drug administration Needs = I
nrxlnun POINTS: 2
WEIGHT: 1 times total polnts
MAXIMUM SCORE 1
MFOlCAl 475ESSMFNT - MAXIMUM IOTAL SCORE: 84
MINIMIIM SCORE REQUIRFQ 40
1nlAL ASSESSMENT - MAXlMn TOTAL SCORE: 138
MlNlMClMSCOREREQVIREO. 16
A- PPEND- - I X- - L ( CON- T. INUED)
DES RANK PROPOSED COMPARATIVE POINTS & Wf IGHIINGS
------------------ -----------------------..- ..... ... ------------...
Assign points as follows:
No at r i s k medical conditions OR
1 or more at r i s k medical conditions 6
a functional rating less than I 7 = 1 point
1 or more at r i s k medical cmditions 6
a functional rating of I1 to 27 : 2 points
I or more a t r i s k medical conditions b
a functional rating of 28 to 40 = 3 points
1 or more a t r i s k medical conditions b
a functional rating of 41 to 54 = 4 points
RXIMM POINTS: Same as PAS
WE IGHT : Same as PAS
MAXIMUM SCORE Same as PAS
No score
No needs . - 1 0 points
Has and i s OK = 2 0 points
Has and i s not OK = 3 1 point
Needs = 1 I point
Independent = 1
Assistance = 2
Oepend~ nt = 3
MAXIMUM POINTS: Same as PAS
WEIWI: Sam as PAS
MAXIMUM SCORE: Same as PAS
Mot comparable: no polnts or weight
MEDICAL ASSESSMENT - MAXIMUM TOTAL SCORE: 18
MINIMUM SCORE REQVIRFO. 31
TOTAL ASSESSMENT - nrxrmrn SCORE: 132
MINIMUM RE@ lIRED: 13
APPENDICES
APPENDIX M
REGION I/ JOHN C. LINCOLN CATEGORIES OF ASSESSMENT
jMaricooa Countv. Division of Lona Term Care Levels of Care)
CATEGORY ALTERNATIVE PERSONAL CARE INTERMEDIATE CARE SKILLED CARE
Characterized by one Characterized by one Characterized by one Characterized by one
or more of the or more of the or more of the or more of the
following: following: following: following:
MEDICAL Stab1 e medi cal Stab1 e medical Stab1 e medical Unstable medical
STATUS condition. condition. condition. condition or multiple
medical problems.
BEHAVIORAL/ Alert and oriented May require minimum
MENTAL appropriate s t a f f intervention
behavior f o r episodes of
confusion, memory
defects, impaired
judgment, or
agitation. May
require temporary
( 24 hours or less)
r e s t r a i n t s to control
a behavioral or
medical problem.
BLADDER Continent of bladder Continent of bladder
FUNCTION or self- care of or requi res minimum
catheter or stress assistance i n the
incontinence. care of a catheter or
stress incontinence.
May include routing
catheter and drainage
system change.
BOWL Continent of bowel
FUNCTION or self- care of
colostomy .
Continent of bowel or
requi res mi nimum
assistance i n the
care of an ostomy.
Staff may supervise
and/ or i n s t r u c t ,
and provide suppl ies
f o r maintenance.
May requi re moderate
s t a f f intervention.
May have periodic
emotional or mental
disturbances,
including combative-ness.
May need
restraints f o r
personal safety.
May requi re maximum
s t a f f intervention.
May be disoriented,
confused, combative,
withdrawn, or
depressed. May need
r e s t r a i n t s f o r
personal safety o r
protection of others.
Periodical 1 y incon- Total1 y incontinent
t i n e n t or may be or may requi re
continent at times maximum assi stance
with a bladder with t o i l e t i n g /
program. May require bladder program or
moderate assistance care of a catheter.
with t o i l e t i ng/ bl adder
program or care of a
catheter.
Periodical1 y incon- Total1 y incontinent
t i n e n t of bowel o r o f bowel at a l l
may be continent at times. May requi re
times with a bowel maximum assistance
program. May requi re with t o i l e t i ng/ bowel
moderate assistance or ostomy care.
wi th t o i l e t i ng/ bowel
program or care of
an ostomy.
PERSONAL Independent or needs May requi re minimum May participate i n Complete assistance
HYGIENE encouragement and/ or assistance with care, but requi re with getting i n and
supervision. getting i n and out moderate assistance out of tub or shower
of tub or shower, w i t h g e t t i n g i n and ( or bed bath), dress-dressing
and/ or out of tub or shower, ing and/ or grooming.
grooming. and/ or grooming.
FEEDING Independent. Able t o Independent with
prepare some portion feeding. May requi re
of small meal i f orientation or
necessary. assistance i n pre-paring
food p r i o r
to eating. Able to
learn special feeding
technique.
Requi res moderate Routi nel y requi res
assistance with feed- maximum assistance
ing. Hay require with feeding or
preparation of food speci a1 feedi ng
p r i o r t o eating, techniques.
encouragement, and/ or
periodic assistance.
May be able to learn
speci a1 feeding
techniques.
APPENDICES
APPENDIX M ( CONTINUED)
CATEGORY ALTERNATIVE PERSONAL CARE INTERMEDIATE CARE SKILLED CARE
MOBILITY Independent1 y Independent and/ or
ambulatory or usual 1 y requi res no
propels own more than standby
wheel chai r. assistance i n moving
from one place to
another w i t h o r
without the use of
a s s i s t i v e devices.
TRANSFERRING Independent. Independent and/ or
Transfers s e l f t o usual 1 y requi res no
wheel chai r, i f more than standby
necessary. assistance to trans-f
e r from bed, chair,
t o i l e t , or both with
or without assi s t i v e
devi ces.
May p a r t i c i p a t e Usual1 y does not
and/ or require the p a r t i c i p a t e and/ or
assistance of no more requires assistance
than one person i n of more than one
movi ng from one person i n moving
l o c a t i o n to another. from one l o c a t i o n t o
another or i s
bedfast.
May p a r t i c i p a t e and/
o r requires the
assistance o f no
more than one person
t o t r a n s f e r from bed,
chai r, t o i 1 et, or
bath, with or without
assi s t i v e devices.
or bath.
Usual 1 y does not
p a r t i c i p a t e . May
require assistance
o f more than one
person and/ or
assi s t i v e devices
t o t r a n s f e r from
bed, chair, t o i l e t ,
MEDICATIONS Sel f- administration Medication regime i s Medication regime i s Medication regime may
o f medication with stable. Administra- usually stable with be complex and/ or
supervision. ti on may i ncl ude occasional change( s) . unstable requi r i n g
crushing of medica- Receives medication close monitoring.
ti on and preparation r e q u i r i n g r o u t i n e
o f a l l i n j e c t i o n s s t a f f monitoring.
TREATMENTS/ Sel f- care o f mi nor Requi res simp1 e Requi res compl ex but Requi res mu1 ti p l e,
cuts and bruises. treatments/ dressings stable treatments/ frequent, and/ or
May require super- w i t h r o u t i n e dressings w i t h complex treatments/
v i s i o n . moni t o r i ng. r o u t i n e monitoring. dressings with close
moni t o r i ng.
RESPIRATORY Independent or Independent or Requi res assistance Requi res continuous
requi res reminder or requi res mi nimal wi t h regulatory monitoring of oxygen
supervision with supervi sion or oxygen or SVN t r e a t - or may require SVN
oxygen or SVN assistance with or ment a t l e a s t one treatment two times
treatments. without i n s t r u c t i o n time per eight hour per s h i f t . May
w i t h oxygen. May s h i f t . May s e l f - requi re tracheal
require SVN t r e a t - suction of trachea. suctioning regular1 y.
ment on PRN basis
but not more
frequently than
one time per eight
hour s h i f t .
APPENDICES
APPENDIX N
ESTIMATE OF DES POPULATION SHIFT FOR SPP
INSTITUTIONAL RECIPIENTS
ESTIMATED AHCCCS POPULATION SHIFT
PRIVATE NURSING HOME:
11 Clients
Available Funds
PUBLIC NURSING HOME:
11 Clients
Available Funds
TOTAL SPP INSTITUTIONAL CLIENTS 813
TOTAL SPP INSTITUTIONAL AVAILABLE FUNDS $ 602,160
ASSUMPTIONS:
1. Assumes 100% of SPP Institutional clients will be AHCCCS eligible.
2. Assumes enrollment in the AHCCCS program will require three months
time beginning October 1, 1988.
APPENDICES
APPENDIX 0
LTC PROJECT
ESTIMATE OF DES m P u T I o N s n ~ r ~
BY lEClMl FOR HUtE L m Y I T Y USED CLIRITS
CSTlMATEO AUCCCS POP. SBIFT 151
- - . - - - - - - . - - - - - - - - - - - - - - - - - - - ------------------ .--.---------------- .
------.----- RoI( E cm.---------.----.- I)( WE ADULT 198811989
HOUSE- HQ( E VISITING DUlVELED DAY U S E AVAIWLI 1989ll990
KEEPE~ llwrn AID mmsr lous CMI WDWII NMOS L ~ EIIEAFTEIL -----------.-------------------.-.--.---..---.----.-..--.- -.-.....-... -...---..---..-.-...-- -. --------------.-- ---- ---------.-----.---- ----- ----*.-..--...
116CIMl I
P. rc. nr of ..~ lc. urll1l. rlc. n 811 901 131 531 101 lo01
1. tlul. d I of MCCCS . llcLbl. p. r. 0". 501 558 81 331 62 620
Ar. II. bL. Fund, $ 21&. 29' $ 2L3 228 531.785 3 7 , 9 5 7 $ 94.588 $ 142.536 $ 864.389 $ l. ll6.502
REGION 11
P. rcmr of s. rvlc. urlllz. rlon
Eat1o. r. d I of AHCCCS ellslb~ p.~ c. o ns
Avall. bl. rundl
REGlWl 111
Pe~ c. nr of service utlll.. flon
E S ~ L N ~ . ~ I of AHCCCS ~ I L ~ I ~ I .
Arall. bl. Funds
RECION IV
Percant of S~ NLC. ut~ l~ z. t~ on
Isf1~ f. d I of AHCCCS elltlbl* persons
Av. II. bLe Funds
REGION v
P. rc= nr of servlc. utlllz. tLon
E. tluced I of AHCCCS . Ll. Lbl. p.., ons
A". ll. bl. Fund.
REGION VI
P* rc. nt of sarrlc= urlll~. rlon 641 901 901 581 01 lo01
Estl~ trd I of AHCCCS rllilble persons 82 I15 115 7 4 0 128
AvalL. bl. Funds $ 29.062 526. b21 $ 14.792 S20.770 $ 0 $ 7.642 $ 98.687 5127.170 ----------------------------..-....---.--.-.--.. -....-.....--...- .-...... ----..---. ---...--.----------- -- ------------ ------------- - ~ ~ ~ - - - - - - - ~ . AVERACE e UTILIZATION FOR TOTN POPULATION 831 901 L3I 571 101 I001
TOTN I OF PERSONS 1.061 1.151 5L7 131 120 1,279
TOTN AVAILABLE F U ~ O S FOR H W L MrmNlTY BASED CLIENTS Sl37.973 $ 688.672 S177.065 $ 345.200 $ 180,038 $ 259.23* $ 1,888,112 $ 2, b38.902
ASSIMPTIONS
111 cost flsurrl b r e been adjusted by a fLcfOr of 1 045
IAdjuscmc factor lnsluder b 5 paicenr = stLmated CPI Increase for FYI989 Health Scrvlces Sccror )
( 2 ) *. l-* 15 p. re. nc of OES sll. nrr r= sldlng In thrlr h- a rlll shlfr ro AHCCCS prosrun
131 ProJ- Cr. tor. 1 populstlon shlfr for each r. slon br . pplrlns I5 perccnr ro 901 of zh. * rer..* monthly cate1o. d for csse un*# urnr
( 10 Wre- nt of s. s* Lo* d 1s .= surd ro be on w* lrlnp Ilsr and only r= celvln. = a%. nan. 8- nr )
( 5) A**-, = nlollmt In the MCCCS pro6ru. vlll tegulrc three m t h s rlmt beslnnlns October I, 1988
( 6) Utllla. clon p. rs. ntr#. s for hous. k. epe~. h- d. LLrerrd n*. Ls, and case wnasm* or
. re b6s. d on rho . vsr... .. p. rl.,, ce for the total populaflon in l987ll988
UILLlI* IIon p. rcent. 6.~ for hone health . Id. vls11Lns nurse, and adult d. 7 caxr
* ze . atl~ led based on Reslon 1' s service mli for acute sll= ntr
( I) * v. il. bl. fund. are b..* d on th. . stL-. r. d nurber of * hlflln. cllenrs for each s- rrlc. rl.* s th. . nnu. L cost for the . r. ral. ronrhl? c. se1o. d . dJusr. d for
OnrOllnrnt p. rlod and 1nfl. rlon
APPENDICES
APPENDIX P
REGION I WAITING LIST DEMOGRAPHICS
( Prepared by Maricopa Department of Health Services)
Total % of Total
WAITING LIST CLIENTS 1,019 100%
ETHNICITY:
White
Hispanic
Black
AsianIPacific Islander
American Indian
Not Recorded
MARITAL STATUS:
Married
Separated
Never Married
Divorced
Widowed
Not Recorded
AGE :
Under 60
60- 74
75- 89
90- 99
loo+
Not Recorded
HOUSEHOLD COMPOSITION:
Lives Alone
With Spouse
With Relatives
With Non- Relatives
Not Recorded
SEX :
Male
Female
Not Recorded
APPENDICES
APPENDIX P ( CONTINUED)
LIVING ARRANGEMENTS:
House
Mobile Home
Apartment
Board and Care
Foster Care
Supervisory Care
Nursing Home
Not Recorded
INCOME LEVEL: % OF STATE MEDIAN:
0%- 34%
35 - 44
45 - 59
60 - 79
80 - 99
100 and Over
Unknown
Not Recorded
Total % of Total