|
|
Barthelemy Successes and Chanllenges
Barthelemy v. Hood is a class action
suit that was filed in 2000 on behalf of people living in nursing homes
and people at imminent risk of entering a nursing home who preferred
and could benefit from home and community based services.
The Barthelemy class is defined as persons with disabilities
who are receiving Medicaid funded services in nursing facilities, or
who are at imminent risk of being admitted to a nursing facility to
receive such services, who have applied for home and community based
waivers and have not been determined ineligible for the waivers.
Successes
As result of the Barthelemy lawsuit:
-
The numbers of persons receiving home and community based
services has increased:
When the Barthelemy suit was filed in April, 2000, there were 679 slots
allocated for the Elderly/Disabled Adult (EDA) Waiver. These have
been or will be increased by:
- 600 slots in 2002, for a total of 1379 slots
- 700 slots in 2003, for a total of 2079 slots
- 200 slots in 2004, for a total of 2279 slots
- 100 slots in 2005, for a total of 2379 slots
As of the last reporting date (2/13/04), 1913 people have had
their plans of care approved and 206 others were in the approval
process for the EDA waiver.
When the Barthelemy suit was filed in April, 2000, there were 124 slots
allocated for the Personal Care Attendant (PCA) Waiver. These
were increased by:
- 25 slots in 2002 for a total of 249 slots
- 125 slots in 2003 for a total of 374 slots
- 25 slots in 2004 for a total of 399 slots
- 25 slots in 2005.for a total of 424 slots
As of the last reporting date (2/13/04), 319 people have had
their plans of care approved and 68 others were in the approval process
for the PCA waiver.
When the Barthelemy suit was filed in April, 2000, there were 500 slots
allocated for the Adult Day Health Care (ADHC) Waiver. These were
increased by:
- 75 slots in 2001-2002 for a total of 575 slots
- 125 slots in 2003 for a total of 650 slots
- 25 slots in 2004 for a total of 675 slots
- 25 slots in 2005 for a total of 700 slots
As of the last reporting date (2/13/04), 545 people have had
their plans of care approved and 119 others were in the approval
process for the ADHC waiver.
Waiting lists for all above listed Waivers are moving at faster pace.
The objective is that by the end of December, 2005, any person
determined eligible for these Waiver services will not wait more than
90 days from the date of their completed eligibility application to
date when services begin.
In January 2004, the state began implementation
of Long-term Personal Care Services as a Medicaid service, which can
provide up to 56 hours/week of personal care services. Waiver Reimbursement Rates increased:
- PCA Waivers are now reimbursed at $11.00/hour as opposed to $10.05/hour
when Barthelemy was filed.
- The daily cap for the Elderly Disabled Adult Waiver was raised from $35.00 to $55.00.
- An increase in the personal care attendant rates
on both Waivers to $12 per hour, and a services cap of $60.00 per day
for the EDA waiver, have been submitted to CMS (the federal Medicaid
agency) for approval.
People are better informed about options for
community based long-term care services.
- The Department of Health and Hospitals printed
brochures, flyers and posters describing community-based alternatives
to long-term care, which are all available on the DHH website.
- The Department of Health and Hospitals has
broadly disseminated information about home and community based
services for the elderly and disabled to senior service organizations,
advocacy organizations, independent living centers, family resource
centers, local government offices, among other agencies. (The
PowerPoint presentation used by DHH is on their website.)
- The Department of Health and Hospitals provided
training to employees of medical facilities, social workers, and others
involved in referring people for post-hospital care or other long-term
care.
- All nursing home residents are to be advised of
the community based service options for delivery of long-term care
services, and assured that their choice of community services will not
prejudice their receipt of nursing facility services if they remain in
the nursing home pending community services.
As a result, despite the additional slots available, the
waiting list for the EDA Waiver has grown. In June of 2003, there
were 1987 people on the waiting list for the EDA Waiver. In
December, 2003, despite the fact that over 380 additional people were
given EDA Waiver slots, there were 3248 people on the waiting list.
DHH is using and developing a new Assessment
Process.
The Barthelemy agreement called for the development of a new assessment
procedure for people seeking home and community based services to
determine what types of services they will require to live in the
community. An advisory committee jointly appointed by the
Advocacy Center and DHH researched the best processes used in the
country and made recommendations. DHH adopted their
recommendations, and now is using the Resident Assessment Inventory-
Home Care to assess people interested in receiving long-term care in
the community. This assessment is used internationally and has been
tested for validity and reliability.
DHH has contracted with the developer of the RAI-HC at the University
of Michigan to further adapt the assessment tools and procedures for
use in Louisiana.
DHH has developed a Quality Assurance Plan
DHH is implementing a Quality Assurance Plan that addresses home and
community based services. The Plan calls for consumer
satisfaction surveys, as well as monitoring agencies providing home and
community based services.
Challenges
Making sure persons who may be able to benefit from
Barthelemy learn about their long-term care options.
Income limits for Waivers are higher than
regular Medicaid.
ALL REQUESTS FOR WAIVER SERVICES SHOULD BE DIRECTED TO THE BUREAU
OF COMMUNITY SUPPORTS AND SERVICES (BCSS) at: 1-800-660-0488
Long Term Care-Personal Care Service is now
available to Medicaid eligible class members. There is no waiting
list, and a person does not have to receive a waiver slot.
TO GET LONG TERM CARE-PERSONAL CARE SERVICE, CALL TOLL-FREE
1-866-229-5222
Making sure there are no barriers to taking advantage of home
and community based services.
- The Advocacy Center is trying to follow up
to make sure people in nursing homes are advised of their options for
home and community based services. In the first six months of 2003,
only 44 people moved out of nursing homes, while 5544 people were
admitted to nursing facilities. While the Barthelemy agreement does not require DHH to move to a “single point of
entry” for long term care services, it does state that DHH “expects” to
do this, and that it should have had a pilot program up and running by
now. This has not happened.
- The Advocacy Center is
concerned that when the name of someone in a nursing home comes up to
the top of one of the Waiver waiting lists, they tend not to respond at
a much higher rate than people living in the community.
- The Advocacy Center also needs to monitor any
delays and dislocations in the process of being assessed and approved
for eligibility for home and community based services. If you
encounter anyone who is having trouble accessing Waiver services or
Long-Term Care Personal Care Services, please contact the Advocacy
Center, 1-800-960-7705.
Update on the Barthelemy lawsuit - 4/16/07
On January 19, after
a status conference, the Court extended the settlement agreement in
Barthelemy v. Louisiana Department of Health and Hospitals through June
30, 2007. The Advocacy Center is trying to get DHH to reduce the
wait time for services under the Elderly and Disabled Adults and the
Adult Day Health Care waivers down to 90 days or less. According
to figures received from DHH in March, current wait time is 34 months
for the EDA waiver and approximately 90 days for the ADHC waiver.
DHH has recently begun to give priority for waiver services to persons
actually living in nursing homes. One action DHH must take is to
request sufficient additional waiver slots from the Legislature.
Only 375 slots are being requested by DHH, while over 8,200 people were
on waiting lists as of December 31, 2006. The Advocacy Center
will be working during the upcoming legislative session to try to get
more money allocated for new waiver slots. A hearing is set for
June 27, 2007, to determine if the lawsuit will be extended further.
|
