WELCOME TO OUR REGIONAL MEETING

LEADINGAGE MICHIGAN SPONSORS

TECHNOLOGY EXPO – FEBRUARY 27, 2020

LEADINGAGE MICHIGAN TEAM

Ellie DavisMember Communication

Liaison

Laura FullerExecutive Director of Education Foundation

Laura FunschDirector of Regulatory

Strategy

Dalton HerbelDirector of Public

Policy

Bobbi KuyersExecutive Assistant

Deanna MitchellExecutive Director of

Senior Care Resources

Dennis SmithAccountant

Blake WellerBusiness Partner &

Member Engagement Coordinator

STRATEGIC PLAN

MICHIGAN IN REVIEW AND POLICY BRIEFS

LTSS System Design

The State of Managed Care

Primer on the Provider Tax

The Not for Profit Difference

MICHIGAN IN REVIEW:

Long Term Care Services and Supports – August 2019

MEMBER ENGAGEMENT – BOARDS, COMMITTEES AND TASKFORCES

Board of Directors

Public Policy Taskforce

Member Awards Committee

Political Action Committee

Networks and Education

Human Resource

Fund Development

Business Partner

Assisted Living, SNF and DON

COUNTDOWN TO PDPM

Webinar:

We will be hosting a LIVE WEBINAR on Friday, September 13, from 1:30 – 2:30pm

PDPM expert, Leah Klusch will be our facilitator

Open Forum Q & A:

We will be hosting an open forum Q & A with Leah Klusch on Wednesday, September 25, from 10:30am – 12:00pm.

This will be a quick update on all things PDPM and a time for everyone to get their questions answered by the expert.

Michigan’s Cone of

Budget Uncertainty

DISPOSITION OF MICHIGAN REVENUES FY 2018

MICHIGAN IS CHANGING

Michigan’s Largest Employers - 2019

Crain’s Publications 2019

Company Top Executive Michigan Employees

20192018

World Wide Employees

General Motors Mary Barra 52,02752,113

167,440180,000

Ford Motor Company Jim Hackett 46,00048,009

NA

State of Michigan Gretchen Witmer Gov 45,09344,680

95,61980,865

FCA US LLC (Chrysler) Michael Manley 36,83533,863

51,20349,797

University of Michigan Mark Schlissel 36,14834,904

51,20349,797

US Government NA 29,24428,782

2,002,3632,085,449

Beaumont Health John Fox 27,58728,038

27,59127,055

Henry Ford Health System Wright Lassiter 26,01725,514

NA25,554

Trinity Health Richard Gilfillan 24,30423,063

NA131,000

McLaren Health Corporation Philip Incarnati 22,61322,850

NA23,201

James E. Orlikoff is president of Orlikoff & Associates, Inc., a consulting firm specializing in health care governance and leadership, strategy, quality, and organizational development.

“If policymakers are celebrating economic success for your state and your largest employers are hospitals, universities and/or government entities …..your state is facing economic trouble.”

“I don’t mean to be glib, but the answer is we wait for the great reckoning. Which, I think like Hemingway said about bankruptcy, happens gradually and then suddenly.”

LeadingAge Annual Conference 2017

MICHIGAN RANKS 34TH IN OVERALL HEALTH

Michigan’s Cone of

Budget Uncertainty

NATIONAL PERSPECTIVE OF MEDICAID MLTSS

Source: Center for Health Care Strategies

MICHIGAN’S POPULATION OUTSIDE MANAGED CARE

MANAGED CARE IN LTCSS

By September 30, 2015, the department of community health shall identify all remaining populations eligible for managed care, develop plans for their integration into managed care, and provide recommendations for a performance bonus incentive plan mechanism for long-term care managed care providers that are consistent with other managed care performance bonus incentive plans. (PA 107 of 2013)

By July 1, 2018, the department shall explore the implementation of a managed care long term support service. (Conference Committee)

MI HEALTH LINK

MDHHS Goals: Access to high-quality services in the setting of one’s choice, better integration of LTSS with physical and behavioral health care, improved person-centered care coordination, and the ability for individuals to live independently in their homes and communities.

Concerns for the Michigan program also include poor care coordination, poor integration of services, and structural issues around conflict-free options counseling, standardized processes and quality measures across each health plan.

CHRT/HPM recommends an overall timeline of five years as a starting point to guide MDHHS’ next steps for global LTSS improvements and MLTSS planning. The first step is for MDHHS to extend the MI Health Link demonstration for an additional three years beyond the 2020 end date.

The MDHHS has issued a draft waiver renewal application that extends the program for five years, essentially ‘as is’.

Michigan is still waiting for the MI Health Link final report that will be completed by RTI – the Research Triangle Institute – due to be completed later this year.

THE LTSS FEASIBILITY STUDY– HB 4674

Requires MDHHS to perform an independent feasibility study and actuarial model of options for people to access and afford Long Term Supports and Services

Would look at creating an affordable LTSS benefit model in Michigan

Would examine the existing programs and gaps that exist

Would analyze workforce issues

LTCSS COALITION

MICHIGAN PROVIDER TAX PROGRAM

2019 - unexpected increase in number of Medicaid bed days; provider taxes are based on estimates for each year

State fell short of funds to make QAS payments for this year because revenues were based on smaller estimates

MDHHS increasing the provider tax for August and September 2019

Increase from $26.15 to $32.45 for the middle tier

Upper tier moves from $19.25 to $23.45

The current program is set to sunset October 1, 2019. We are working on SB 0444 (Hertel) extending to 2023.

QUALITY IMPROVEMENT INITIATIVE - QMI

QMI provides payments to NFs based on average CMS quality domain rating and submission of information about their satisfaction survey Must send all questions in the survey and summary of results

No protected health information

Number of residents residing at time of survey and number of responses

The number of completed surveys a) completed by residents, b) completed by guardian or representative, c) the total number of surveys completed, d) survey date range (date sent to date due), e) survey frequency, f) entity that conducted survey, g) survey data collection method, and h) an explanation of how the provider uses the data to improve services.

Survey must occur no earlier than 12 months prior to the due date (May)

Changes to the Provider Tax affects the QMI payments as well 1 Star = $800

$368.69 for each additional star now moved to $391.85

Hopefully, this will offset additional QAAP payments

79%

80%

81%

82%

83%

84%

85%

86%

87%

88%

89%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

MICHIGAN and US NURSING HOME OCCUPANCY 2003-2015

Michigan

US

380

390

400

410

420

430

440

450

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Total Number of Michigan CertifiedNursing Facilities 2003-2015

MICHIGAN NUMBER OF NURSING HOME BEDS

44000

45000

46000

47000

48000

49000

50000

51000

52000

1995 2000 2013 2018

NOT FOR PROFIT TRANSITIONS• 11 % of the Skilled Nursing Facilities in

LeadingAge Michigan have been SOLD in the last five years• There has been one closure• Eight facilities have been sold to For Profits• Five of the Nine were single site properties

• Three other LMI members in the Grand Rapids market are moving away from Skilled Care.

City View in the Square, a new senior housing co-operative

27

Life Plan Communities 30 Registered under the Act - application pending9 of the 31 offer both Entrance Fee Model or Rental

Continuing Care Community or Community means a retirementcommunity in which a person undertakes to provide or arrange for continuing care and which is one or more of the following:i. An adult foster care facilityii. A home for the agediii. An independent living unitiv. A nursing homev. A home health care services agencyvi. Hospicevii. A place that undertakes to provide care to a member for more than 1 year

28

PACE IN MICHIGAN

HOME AND COMMUNITY SERVICES NETWORK

Members:

A&D Home Care Waiver Division

MORC

Northern Michigan Healthcare Management

Reliance Community Care Partners

Senior Services

The Information Center

LTSS FUNDING

0

0.5

1

1.5

2

2.5

3

3.5

FY 2013 FY 2014 FY2015 FY 2016 FY 2017 FY 2018 FY 2019

Michigan Medicaid NF Funding and LTSS Non-NF Funding Trends

NF Budgeted Funding Non NF Budgeted Funding

Housing (Affordable)

Tax Reform Debate in Washington

Differences between the House and Senate

Qualified Allocation Plan – 2019 -2020 Seek an increase in the statutory set-aside of Not-for-Profit

Modify the scoring for walkable elder communities

Performing a Housing needs study

MICHIGAN IN REVIEW – FIVE AREAS OF FOCUS

Charitable Purpose

LTSS System Design and Managed Care

Regulatory Burden

Housing

Workforce

MICHIGAN IN REVIEW:

Long Term Care Services and Supports – August 2019

CHARITABLE PURPOSE

We must maintain support for our communities that are mission-driven with a higher purpose to serve. Local and other taxing agencies have been attacking not-for-profit charitable purpose based on the legal definitions here in Michigan. It is critical that we continue our ability to provide higher quality of care and prioritize quality of life over profit maximization.

Use the standardized CMS Quality Reporting Program measures for all state programs: homes for the aged, adult foster care, Home Help, MI Choice Waiver, MI Health Link

Create transparency in data across all LTSS programs; development of an annually published report that identify quality challenges, outcomes, spending for programs and any integrated models

Elevate and escalate the conversation about the efficiency and efficacy of the survey and certification process at state and federal levels – without undermining the capability of the state to deal with low-performing providers

Consider legislative solutions to guard against Tax Exempt Challenges

LTSS SYSTEM DESIGN AND MANAGED CARE

With the recent trends toward managed care in both Medicare and Medicaid, it is critical that we ensure that these programs work to support the provider in delivering an appropriate level of care and minimize cost shifting.

No further expansion or extension of MI Health Link until objective research demonstrates that it truly works for Michigan

A routine regional analysis of programs for access, quality, and cost across the state with specific attention to duplication of services and regional revenue streams for LTSS

The evaluation of MI Health Link must include how any savings were achieved and demonstrate how the MI Health Link population (55% of which is under age 65) is really comparable to other senior programs

Increased MI Choice funding to eliminate the waiting list

A moratorium on new nursing home construction

Review and analysis of access to affordable senior housing; adequate senior housing is a primary social determinant for positive outcomes

REGULATORY BURDEN

Incremental increases in regulatory burden over time have brought us to an almost crisis point. We need to elevate and escalate the conversation about what really works to protect residents.

Stop dependence on annual survey visits that can be anticipated; increase timing between annual visits for high performing providers

Utilize focused random visits for facilities who are trending poorly, using LTC ombudsman if necessary

Use a LTC Ombudsman across all venues

Improve reporting methods for facility reported incidents that include all the necessary information about follow up actions to the incident and any necessary reporting to public enforcement agencies to better prioritize need for on-site visits

Monitor performance trends over time to address poor performers who move in and out of significant compliance problems in consistent SQOC (Substandard Quality of Care) areas

Licensure and/or oversight of home health and personal care for participant safety

Consider litigation against LARA – Equal Protection under the law

HOUSING

Safe and affordable housing is one of the most important social determinants of health. Public funding is diminishing for the senior, and senior poverty overall is affecting their ability to find secure housing.

Increased MI Choice funding to eliminate the waiting list

A moratorium on new nursing home construction

Review and analysis of access to affordable senior housing; adequate senior housing is a primary social determinant for positive outcomes

WORKFORCE

To prepare for LTSS in the 21st century, it is important that Michigan form a vision for training and support to formal and informal caregivers. Specific initiatives must be developed to identify programs that will strengthen and support recruitment, retention, training, and mentoring.

Michigan support of initiatives that will review the breadth and depth of issues and validate what truly drives recruitment and retention issues across the industry

Protection of expanded Medicaid benefits and tax credits that allow direct care workers to obtain health insurance coverage

Revision to CNA Michigan training programs and onboarding requirements

Funding for successful training models, standards, and curricula for aides, through grants

Pilot training programs for certain conditions such as diabetes and Alzheimer’s

Processes to gather better data to measure Michigan workforce volume, stability, compensation, turnover, vacancy rates, wages, and benefits

Conference & Trade Show May 17-20, 2020Lansing Center / RadissonLansing

ANNUAL CELEBRATIONS

Michigan Night OutOctober 28, 2019 The Deck – Moonshine FlatsSan Diego, CA

Thank you for coming!