Every good care plan starts with the evaluation or assessment. In the past, care plans for LTSS focused on managing symptoms, decreasing hospitalizations, and complying with recommended treatments. Less emphasis was put on the needs, hopes, goals, and preferences of the individual. Today, the Centers for Medicare & Medicaid Services (CMS) emphasizes person-centered care planning that promotes independence and quality of life. As a result, LTSS delivery has shifted towards individuals receiving services in their homes or community versus institutional-based settings.
- Beneficiary preference to receive services at home or in their communities
- Commitment by government policymakers to provide beneficiaries with increased choice
- Creates efficiencies that drive down costs while promoting independence
From the White Paper: Although less expensive than institutionalized care, HCBS poses a major financial burden
How are HCBS Delivered?
Services are delivered through state-specific HCBS waiver programs that provide beneficiaries and their caregivers assistance with skill development, respite, transportation, and other support services.
How is Eligibility Assessed?
State Medicaid agencies, and their partners, rely on functional assessment tools to make coverage and eligibility decisions and to create individualized care plans. Assessment results are then used to create a person-centered care plan that recognizes individuals’ specific strengths and abilities, and identifies supports needed to achieve more independence.
How is Telligen Different?
Person-Centered: Telligen’s experienced assessors understand the unique needs of the LTSS population, and the importance of employing a person-centered approach approach. This means that from assessment to service delivery, we’re helping individuals drive their own care – from picking their support teams, to indicating likes and dislikes about assessment approaches, to identifying the supports that will help them achieve their goals. Working as collaboratively as possible, we’re helping them carve out opportunities to live productive lives based on their strengths.This person-centered approach isn’t about the needs/goals of family members, providers, or support team. It’s about helping the individuals successfully achieve their defined goals, while remaining as independent as possible, no matter what their age.
Conflict-Free: Telligen offers our state partners a conflict-free case management process free from conflicts of interest. Conflicts arise when interested parties performing assessments and/or developing the care plans opt for convenience and revenue over person-centered care. Our next article will go into more detail about avoiding and recognizing these conflicts of interest.
Experienced: Telligen has more than 35 years’ experience conducting level of care reviews for Medicaid waiver programs, including prior authorizations for waiver services. This experience includes:
- Managing the varying benefits and eligibility requirements of Medicaid populations in Iowa, Oklahoma, Maryland, and Idaho.
- Conducting more than 35 training sessions (since 2014) for providers, beneficiaries, family members, case managers, and advocates.
- Performing more than 25,000 assessments each year for intellectual and developmental disabilities (IDD), physical disabilities, brain injuries, HIV/AIDS, the elderly, and mental health populations
“I just want to thank you for yesterday. Katy was quite upset by this whole process, and you did a great job of reassuring her. The most challenging part is that she understands she has a disability, but really does not want to have one. She just can’t come to terms with her limitations — especially when laid out for her in one assessment. It was nice to work with you.”
“[Telligen assessor] has made this evaluation process very comfortable and understandable. She was very thorough when explaining the purpose of the evaluation, listening, and acknowledging individual needs and circumstances. She demonstrates that she hears them. She asks the questions in a sensitive manner, and allows time for thoughtful, informative responses. She articulates the questions in a way the individual and all team members understand. It was so nice to see a person take a genuine interest in truly wanting to get to know the person.”