Decision 1: Targeting Strategies
Guidelines for Decision Making
- Determination of who should be targeted for enrollment should be based on how well the county can address the consumer’s level of risk for nursing home placement and/or Medicaid spend-down, given the program’s per capita limitation and the capacity of the service network in the county.
- The intent should be to develop a targeting plan that seeks to find optimal matches for the program, e.g. those consumers who with program services would remain independent in the community and result in a cost savings to the county.
- Risk profiling should be used for identifying likely candidates for the program (i.e., those truly at risk of nursing home placement and/or Medicaid spend-down). At minimum, the county’s assessment tools for risk profiling must address the following 4 domains: functional status, health status, cognitive/emotional status, and informal support status.
Development of targeting strategy to avert nursing home placement
How will individuals at high risk of nursing home placement be identified and reached?
- Administration on Aging. Standards for Targeting Individuals at Risk of Nursing Facility Placement. Department of Health and Human Services. Retrieved December 23, 2008.
- Gaugler, J.E., Duval, S., Anderson, K.A., & Kane, R.L. (2007). Predicting nursing home admission in the U.S: a meta-analysis. Retrieved December 31, 2008.
- State Grantee: Arkansas (2008). Nursing Home Diversion Project Training (p. 18). Arkansas: Division of Aging and Adult Services.
What mechanisms will be used to ensure that the program’s focus is not either on those not at risk of nursing home placement or on those so at risk that intervention has little chance to be effective?
- Mollica, R. & Reinhard, S.C (2005). Determining Level of Care: Must Physicians have a Role in the Process? Centers for Medicare and Medicaid Services: Community Living Exchange. Retrieved January 8, 2009.
Are changes to the PRI and COMPASS, or in their administration, needed in order to more accurately assess high risk of nursing home placement?
- Gillespie, J. (2005). State Policy in Practice: Community Living Exchange Assessment Instruments in 12 States. Rutgers Center for State Health Policy. Retrieved December 23, 2008.
- State of Connecticut. (2000). Department of Social Services Modified Community Care Assessment. Retrieved December 23, 2008
- Agency on Aging of South Central Connecticut. (2004). Assessment Guide—Respite Programs.
- Georgia Department of Human Resources, Division of Aging Services Requirements for Non-Medicaid Home and Community Based Services. (2003). Guidelines for Client Assessment. Retrieved December 23, 2008 from:
- Minnesota Long Term Care Consultation Services. (2003). Assessment Form. Retrieved on December 23, 2008.
- MI-Choice Assessment. (2005). Washington DC: interRAI Corporation & Center for Information Management, Inc.
- Vermont Division of Disability and Aging Services. (2006). Vermont Independent Living Assessment. Retrieved December 23, 2008.
Development of targeting strategy to avert Medicaid spend-down
How will individuals at high risk of Medicaid spend-down be identified and reached?
- Administration on Aging. Standards for Targeting Individuals at Risk of Medicaid Spend Down. Department of Health and Human Services. Retrieved December 23, 2008.
- State Grantee: Arkansas (2008). Nursing Home Diversion Project Training (p. 11). Arkansas: Division of Aging and Adult Services.
What changes to NY Connects screening instruments are needed in order to accurately assess high risks of Medicaid spend-down?
- Administration on Aging. Standards for Targeting Individuals at Risk of Medicaid Spend Down. Department of Health and Human Services. Retrieved December 23, 2008.
What mechanisms will be used to ensure that the program’s focus is not either on those not at risk for spend-down or on those so at risk that intervention has little chance to be effective?
- State Grantee: New Mexico. (2008). New Mexico’s Service Standards (p. 12). Retrieved January 5, 2009.
- Mollica, R. (2005). Medically Needy Individuals. Centers for Medicare and Medicaid Services: Community Living Exchange. Retrieved January 8, 2009.
- Mollica, R. & Reinhard, S.C. (2005). Determining Level of Care: Must Physicians have a Role in the Process? Centers for Medicare and Medicaid Services: Community Living Exchange. Retrieved January 8, 2009.
How will cost sharing be approached?
- Aging and Disability Resource Center. (2004). FAQs: Cost Share. Retrieved January 8, 2009.
- State Grantee: Vermont. (2003). Long-Term Care Plan: A Demonstration Waiver Proposal to the Centers for Medicare and Medicaid Services (p. 22). Retrieved January 7, 2009.
- State Grantee: California. (2004). Demonstration Waiver: In-Home Supportive Services (IHSS) Plus (p. 12). Retrieved January 7, 2009.