Agenda - 09-06-1983 - Laserfiche WebLink

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Recommendation 9: Use a sliding fee scale to improve access to long—term care services for those parsons who do not meet categorical eligibility requirements. ICE_b.AEI?_IILINAUBE_C I_EFEEEI. IH _IV_IIMAELIYEBx_QF_A_GRQWING NUMB_AND_SGQEE_QE UEV ICES Although inrhome services currently account for a small share of total health expenditures, they constitute one of the fastest growing segments of health services. In FY 81-82, North Carolina spent over $15 million in public funds for such services. In order to support the needed and anticipated growth in these services, it will be necessary to develop funding mechanisms which (1) do not have an institutional bias, and (2) are tied to regulations which strictly prohibit both the ineffective provision of and inappropriate care. l Ciadmillism-AccOsol02 Mandatory preadmission screening has been viewed as one method of avoiding inappropriate institutionalization of individuals with functional impairments. Many states have instituted programs requiring preadmissionn screening for all Medicaid eligible clients who are at risk of being institituionalized. In North Carolina, House Bill 405. passed in 1981, established the Community Alternative Program (CAP) which includes voluntary prescreening, assessment and case management. Three counties, Catawba. Durham. and Moore. have chosen to implement CAP and five more, Asher Guilford, Hertford, Mecklenberg, Wake. and Watauga. are implementing prescreening and supporting expanded services to the extent that funds are available. Under HB 405!r a skilled nurse/social worker team screens elderly persons who are about to be admitted to an institution. In cooperation with clients' physicians, the team assesses the clients' functional levels to determine whether in—home services might meet their needs. thus preventing unnecessary institutional placement. This assessment is required for (1) adults who apply for admission to a skilled nursing or intermediate care facility whose care is to be paid for by Medicaid and (2) for thosolwho voluntarily request the assessment and are able to pay a fee. Counties may also choose to screen (1) adults applying for admission to a skilled or intermediate care facility who are likely to become eligible within six months; (2) adults applying for admission to a domiciliary home whose care is to be paid for by state/county special assistance. and (3) adults age 60 and over and disabled persons applying for other long—term care services funded under other sources. 4uanC1LYa:.EUDSltaa..tl1Cbaoia @Y In 1982, North Carolina applied for and was granted a Medicaid waiver (Section 2176) which allows Medicaid reimbursement of certain 11