Sign North Dakota Terms of Use Agreement Safe

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this will also be saved and archived um to our site so um we just like to start with a brief little intro of who we are um we are the north dakota brain injury network our website is ndbin.org and our phone numbers down below um we are considered the resource center for brain injury for the state of north dakota so um if you or caregivers or providers or anyone ever need any help just let us know um we um in 2019 legislation was passed in north dakota to allow us to be inclusive of all kinds of brain injury and so we have been partnering with the north dakota stroke and heart association and collaborating on with them on events such as this so um they are partnering with us to make these happen but please let me know if you have any topics or speaker suggestions there is my contact information there um or you can find that all on our website too so um we are excited to have today's presenters erica reiner with us she's from the department of human services aging services division and they have some new services we asked her to come and and talk about with us so we are going to let her take over and so erica if you just hit share screen down along the bottom of your okay and your uh rotation should pop up okay she is all right can you see my screen you can yes okay good all right so let me get in presenter mode here all right okay all right well thank you okay so um good afternoon as carly said my name is erica reiner i am a nurse administrator for the aging services division through the north dakota department of human services i just recently started there probably about a month and a half ago today i'm going to speak a little bit about our home and community-based services programs just a brief overview of kind of what we do as a division of aging services and then i will go into our new programs um what's being offered and then how to become a provider for those programs um so the overall this is kind of like the high umbrella department of human services what are overall i can see if i can get rid of that where overall mission is and so that's to provide quality efficient and effective human services which improve the lives of people so the you know the focus of the human services department is obviously on the people and providing services to them um quality services the principles for that you know services and care should be provided as close to home as possible we want to maximize each person's independence and autonomy preserve the dignity of all individuals and respect constitutional and civil rights these services should be provided consistently across service areas to help promote equity of access and citizen focus of delivery of the service for a given cost the number served at a service level aligned to need investments in funding in the department should maximize our return on investment for the most vulnerable through safety net services not support economic developmental goals they should be cost effective and as far as effective services they should help vulnerable north dakotans of all ages maintain or enhance quality of life so we want to support access to those social determinants of health economic stability housing education food community and health care those basic needs and then mitigating threats to quality of life such as lack of financial resources emotional crises disabling the conditions or inability to protect oneself so if we deal with some of those difficult situations for the aging services division our overall purpose is to administer home and community-based services that allow older adults and individuals with physical disabilities to remain in their own homes and community communities we protect the health safety welfare and rights of residents of long-term care settings and vulnerable adults in the community so all of the services kind of focus around that purpose our core functions for the aging services division um do you try to hit record from your end and so i just want to make sure we're getting this recorded for people sure let's see here um is it you can see my screen right is it down on the bottom down usually right next to the where it says share screen okay let's see new share pause start video let's see here recording to the cloud it says yes yeah carly it says it's recording it does okay okay hopefully anyway okay sorry i just know that's okay got it okay all right so our core functions um so see these are some of the services that the aging services division um administers so the older americans act services um many of you are probably familiar with these um these are the services that are provided for like congregate and home delivered meals so we contract with local providers for supportive and nutrition services um so like your your senior centers throughout the state that provide those services as well as helps to support family caregivers through the family caregiver support program and then the lifespan respite grant we also provide direct services through this division the aging and disability resource link some of you are probably familiar with and we'll talk about a little later in the presentation as well and then the family caregiver support program and we have case managers throughout the state that help with this program and connect family caregivers with available resources throughout the state and then the long-term care ombudsman services which provide consultation and regular site visits and help investigate complaints and long-term care and then also the vulnerable adult protective services which many of you are also probably very familiar with and have maybe filed reports in the past but this obviously the the overall goal is to safeguard the rights safety well-being of vulnerable adults in our community and then we also administer state and federally funded home and community-based services so those programs will go through a little bit briefly here our sped exped medicaid waiver technology dependent waiver and then the msp medicaid state plan programs and then also under the aging services division now is the supervision and training to home and community based service case managers so that's kind of the overall functions so home and community-based services there are both state and federal dollars that help to pay for these services if the client needs both functional and the financial eligibility so primarily these services serve our older individuals as we talked about before and those with physical disability your sped program or service payments for elderly and disabled that one is a program under which quality service providers are reimbursed to provide certain services and designed to help the individual remain in their home like all of the programs really xfed is a program which pays for in home and community services for people who would otherwise receive care in a basic care facility and then our medicaid waiver 1915 c waivers for the age to agent disabled this one enables the state to deliver services under um a waiver of several medicaid requirements um services to aged and disabled who would otherwise be at risk of institutionalization and then our tech dependent med waiver that one was for ventilator dependent clients so this next slide here home and community based services gives you the whole array of all of the services that are fall under those programs so adult day care foster care residential care memory care you know attendant care and i know you can read through some of these emergency response system are family home care and family personal care so sometimes individuals might have a family member that can be paid to care for them that falls under these services home delivered meals homemaker services non-medical transportation personal care and respite we have supervision supported employment and specialized equipment and transitional care so all of those pieces fall under the fall under those programs so um benefits to home and community based services i feel like often oftentimes are kind of obvious one of the big things that sticks out is you know it's often the preferred choice of care um for for individuals they they want to be in their homes they want to be in a in a setting that is least restrictive which these home and community-based services that one of the benefits is assisting in meeting our olmstead requirement of the most integrated setting so that requirement the americans with disabilities act requires public agencies to eliminate any unnecessary segregations of persons with disabilities and to provide services in the most integrated setting appropriate to the individual so like we said that that's often what people desire and want and we hope to delay institutional placement with those services too if that's the choice of the of the individual and it's also cost effective um the continuum of care this slide just kind of gives you an idea and i think we're all familiar you know you you've got your home-based services um sometimes clients then where people then move into your assisted living where you can still receive some of these home and community-based services along with basic care and then your skilled nursing facility um that's kind of the end end result so if you know for no longer able to remain in their home but hopefully we can delay some of those steps prior to getting to that level um with these services the last legislative session allowed for more help for people to access services in their home and so there was an increase in home and community based investments which is a great thing so one of the things that came through was an update in our sped program cost share fee schedule so meaning it allowed for more people to qualify based on income the income level was increased and as well as updated the functional eligibility so it's a little less restrictive so more people qualify for that program and can get those services in their home it also allowed for an expansion to our adrl to include a centralized intake so we this is still in the works but the goal is to have a central place for people to call to refer a person or to get connected with home and community-based services so that everyone knows where to go and who to call so that goal is to make a centralized intake with the adrl site and then this happened as well the specialized role of the home and community based service case managers they're all under the aging services division now and so hopefully it helps with some of the consistency and in implementing these services and giving them getting people connected and then the new services um that came into play under the hcbs waiver program so the medicaid waiver allowed for the companionship residential habilitation and community support so those are some of the new programs first we'll talk a little bit about companionship um this one it can be provided to an individual with a physical disability um it's non-medical care provided to someone who lives alone and maybe has no one else to provide this care um it's more companion tasks so you know maybe you know you're helping them make them meal or playing cards with them going on a walk with them um going on you know to a community event together those kind of things it must have a therapeutic component tied to it and it cannot exceed 10 hours per month so it can be provided by both an individual or an agency quality service provider so they have to have the cognitive endorsement on their enrollment but it can be both individual or agency and then the rate i included on there just because that's often a question and so for an individual it's 4.67 cents per unit which is um one unit is 15 minutes many of you are probably familiar with that and then the six dollars and 42 cents per unit for an agency um so an agency always has a little higher rate because of overhead costs then our next one was the residential habilitation so this one also it falls under the medicaid waiver program like i talked about before and i know sometimes this is a little confusing but um with that oh it went forward why sorry um with that the the person needs to be medicaid eligible needs to meet skilled nursing facility level of care so that's one of the big pieces and they must have like a daily need for services and needs skills training or restoration so this one kind of sets apart when i talk about the next service the community supports this one is more residential rehabilitation i would think of habilitation it's focused on skills restoration you're trying to maybe improve a skill or teach a person you know a certain skill again and maybe they are teachable um our target population would be someone with a tbi so traumatic brain injury stroke or early stage dementia someone like that would qualify for this service and some of the tasks can include what we say it's it's more all-inclusive so adaptive skill development some education and training assistance with your activities of daily living and the instrumental ones as well the iedl's community inclusion social and leisure skill development personal care and homemaker protective oversight and supervision so those are some of the things that would be included under this under this service um community supports so these both of these services like i stated they're they're the same idea this one is more custodial and maintenance care um you still need to be you know medicaid eligible and meet that skilled nursing facility level of care you need to have that daily need for services it's up to 24 hours per day but not meaning it will be and then complex medical needs high edl needs and your target population again is someone with a physical disability and complex health needs both of these services are meant to mirror um dd services that are already in place they have these already which a lot of you are also probably familiar with but um they're meant to to kind of be the same idea as those service tasks again are going to be the assistance with your adls and your iadls community inclusion some personal care protective oversight and supervision some of those pieces would be included in there so when you're taking a look at maybe a typical care plan for a client on one of these res hab or community supports maybe they're getting personal care like homemaking skills restoration like medication management some social integration so there's always care coordination involved and then this talks about the average cost so it's a daily rate but 30 an hour is the rate so again say you're doing 12 hours of care then 30 times 12 is 360 dollars so that'd be your daily rate for that client specifically residential habilitation and community sports can be provided in a couple different settings so of course a private home an apartment and then also agency adult foster care or that shared living environment so agency adult foster care what is it so it's a residential home which fosters care for adults and it's provided by professional staff so an agency must purchase or rent a home in a residential area and be providing these services res hab and community support so those services would be provided in this foster care and it can be provided for up to four adults um it's licensed so licensed home-like setting up to 24 hours per day care but not meant for just supervision so you know you might be providing care for 12 hours of the day but you know the 24 can't be just for supervision um and it's medicaid only again this is all under the waiver so medicaid only and then your maximum monthly room and board so that the agency can charge the consumer the person living there the 739 dollars that's the maximum amount it could be less than that but that piece is paid by the consumer so not included in the program so that would be that would be the maximum amount that could be charged for that piece um the provider requirements for these services are a little bit different than the regular homing community based services so for res had community support senior agency foster care you do need to be a qsp provider which we talked about in an agency um an individual cannot provide these services um so that sets it apart a little bit from that companionship so it's an agency cql accreditation which i know some people have already um this accreditation is required to pro ide these services as well and it's um it's an accreditation where they come they actually do do an on-site survey um after a year but initially they want to look at your policies and procedures they're focused you know on your person-centered practices and they focus on the the individuals that you're caring for making sure they have a positive experience i think they do some surveys with them um there's just different components that you have to get through and then you move to another level of it um each time so that piece would be required and the initial cost i said again is uh 2500 to the agency and then the rest is covered by the department so that would be the starter for that and um tbi modules so that is online learning and that's provided by the brain injury network and i would assist in connecting you to these things so the online learning the dementia modules too that's another piece that's more online learning these modules would be required to be completed by any staff that are going to be providing cure to these specific clients so the dementia modules i would be the one to assign those as well to the people needing them and then medication module and testing there's also a medication module basically like it's i would have to send it to you but it has just a bunch of information that the caregivers would have to go through on medications it's a module and then there's a proctored test after and then there's even a practicum as well so that would be signed off by the license nurse and this stuff can be talked about on the side i know there will probably be more questions related to this and it's going to be a little bit more agency specific depending what you already have um we just kind of got some of this stuff going with our covid stuff going on of course that delayed some of the some of the trainings and getting all that purchased so um but these will be the pieces that are required and again i would be the one to help hook you up to those all home and community based service providers must be enrolled as a qsp and they have to be able to build an mmis so this this wouldn't be any provider in general um provider requirements vary by service they must recertify every two years and must contain required documentation for all of these services there has to be you know care plans on file and any documentation that you're seeing the client must be on file must participate in audits and complaint investigations and then also must follow other provider criteria as required as well and so i included the contact information for aging and disability resource link just because this is a good connector if you do have questions with services or you need to connect with the case manager that kind of thing this has the phone number um there's the link or sorry the um 1 800 number and then the email and then also a link for the online site too and so um like i said before we're willing um to meet with anybody if you want to do a side phone call or email um if you have questions related to starting getting started um again it's all new so we're kind of working on making sure all of our processes are in place but we are needing providers we don't have any yet and so um you can filter any questions or send them my way and i would find out the answers if i don't know so my phone number is listed here and then i have my email also if anybody has more questions so um with that i don't know if anyone has any specific questions that i can answer i can take back if i'm unable to today please please let me know hi erica this is ashley acker can you hear me yeah i was just i jumped in the meeting here late i was on a call um i was just wondering if i could get a copy of the slide sent to my email at all most definitely yes okay thank you so much yeah i can um carly do you guys have all the people on here i mean i can or even if you however you want to do the slides do you want me to send them i can send them out to everybody um we if you're if you're comfortable with it you can share this era i have your slides and i will we can just put them on our website along with their phone reasons so they will be housed on our webinar wednesday site um or on our area under endeavon.org if you're looking for them that'd be perfect then everyone can get them that way thank you thanks yeah erica could you go back over because you went over it really quickly but sorry no that's fine access like client persona it's slide 15 actually if that helps you sure yeah right so i was trying to figure out like could you walk through that again sure so um this is say maybe a typical care plan for a client that would be on these services so maybe they're getting um yeah and i can i can see it's kind of confusing so like personal care maybe they're getting homemaking for their personal care piece um skills restoration maybe we're teaching them how to do their mat their medications or managing their medications again um that could be part of the skills restoration social integration could include care coordination like connecting to the physicians or maybe family members some of those pieces and maybe all of those hours would add up to 12. it would just it kind of depends on because you know your home and community based service case manager is the one that's going to go in there and kind of help determine the number of hours that are needed um and so they would be the ones to help figure that piece out so anyway with those services listed then say that took the 12 hours then times 30 dollars because that's the hourly or the hourly rate it's really paid at a daily rate but it's thirty dollars an hour um that person would be so that agency i guess i should say would be reimbursed to 360 at the daily rate for this client this type of a client just depending on what services they need how many hours erica this is jake um i'm wondering could you talk to the group a little bit about the care coordination piece that's required under um community and the rehab services um i'm not sure under community and rehab services well you know under residential habilitation and the community services um the provider has to provide care coordination sure i i guess i'm not sure exactly what do you have do you have information that you would share or that you know i just i just understand that part of each of those services is with with that higher rate that the uh the agency will be providing um care coordination air coordination which is to me such a critical part of each of these you know and i know there's a lot of case management staff on and sure they they just know they they have a job and they have a role but these folks are you know usually going to be of higher need and that care coordination piece will really track the day-to-day um success of the services and sure because you're really overseeing all that care yes when you're doing all-inclusive care like this there yeah there would be care coordination i see what you're you're meaning definitely um there would be that piece too you're you're overseeing all of the care mm-hmm so when when figuring out that daily date um so then like the residential habilitation community supports it has a whole daily rate but then in addition to that sorry rebecca you cut out a little bit what did you can you repeat so if you're figuring out like the daily rate for residential habilitation it's not a consistent rate no right it it'll depend on the number of hours that that client is in need of they need to have it needs to be a daily um daily need but they may have a different number of hours right so it's 30 per hour and it's paid at a daily rate but it depends on depends on the number of hours okay and is that something that is like just on the internet but it's not like a billable service type thing based on their need depending on their need yep okay and i don't know if anybody else had any questions um there was somebody that asked for everybody to make sure that they've muted their mic anybody else have any questions or anything is anybody that wants to say that they're interested in any of these services [Music] or yeah and if if there's more questions which i realize there probably will be and there's kind of a lot i mean we don't have any providers nobody's doing this yet so it's going to be a little bit of a learning curve at first um so when we do have a new provider we're gonna have to be working pretty closely with them to figure everything out and now see my director she's been speaking this language for a while so she's a great resource for me as well since i'm fairly new i'm just learning all of the pieces that go along with all of these services as well definitely reach out and let me know if you have more questions or give me a phone call i can definitely find the answers yes so and that's why i was excited to find out that erica was in this role and to be able to have her answer some questions for us um the residential habilitation um the agency foster care has been something that we've really been working on for many years from an advocacy perspective to bring here to north dakota for those of you familiar with minnesota minnesota does have a brain injury agency foster homes and they're ones in crookston minnesota in moorhead minnesota so they're right there and so a lot of times particularly those border cities i will have people ask well why can't i use the you know brain injury group home and warhead side and you know explain to them that that's just not a service we have here in north dakota um but now this is an option that we do have it as a service so um now it's just working through the case of actually getting a provider up and providing the service um i think for me one of the things that's helpful for this and will be up to providers to follow up with erica to get more information about is that funding please uh really get this like okay how could you set up you know a model a program around that um but having erica in this position and her willingness to offer that um wait so any provider that is interested uh you know this is that introduction piece of person to follow up with any other questions or comments no well i you know want to thank eric yes thank you for your time and thank all of you for joining us thank you guys so much yeah um and as we said we will have a recording of this available on our website along with the slides and we will have those online um for anybody that wants to follow up with the information [Applause] so okay that's it all right thank you thank you so much erica we appreciate it thank you so you