Long Term Care (LTC) Unit

# of new LTC Medicaid applications processed

208Sep 2020

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Partners

The Long Term Care (LTC) Unit has many internal & external partners.  The five most frequently contacted are:

  • LTC Applicant
  • Family members of applicant
  • Department of Disabilities, Aging and Independent Living (DAIL) staff
  • DVHA Staff Attorney for LTC
  • Area Agencies on Aging case managers 
Story Behind the Curve

This performance measure reflects the total number of Long Term Care (LTC) Medicaid applications which received an eligibility determination during the month.

LTC applications require a two-part eligibility determination: DAIL nurses perform a clinical determination and DVHA workers perform the financial eligibility determination.

The LTC Unit is responsible for the financial eligibility determination necessary to ensure that eligible Vermonters are able to access high quality long term supports and services. The LTC financial eligibility rules are complex. Many Vermonters hire elder law attorneys to help them with the LTC planning and application process. The LTC applications have gotten increasingly detailed and complex over time.  LTC financial eligibility rules require a five year look back period of the applicant’s financial documents.

The above trend line reflects the number of LTC applications that are processed in a given month. An application is considered “processed” after both the DAIL LTC clinical eligibility and the DVHA LTC financial eligibility determinations are completed. The number includes both LTC application approvals and denials.

The new electronic asset verification system (eAVS) was launched in January 2018.  While we get many of the eAVS financial results within the Vermont standard of 10 days, we continue to get many later than that.  For all applications where we do not get eAVS results for known bank accounts within 10 days, the LTC staff must send paper forms to banks requesting copies of the applicants bank statements.  In many cases, the staff will get ultimately get responses from both eAVS and copies of bank statements from the banks.  This process creates more work for eligibility staff. 

Due to updated information from LTC staff about the April LTC application processing, the final summary report for April compiled on May 8 is slightly higher than what was reported about April on May 1.  (On May 1, LTC reported 316 LTC applications processed and 692 applications in process.)

Last updated:  10/15/2020

Strategy

The LTC strategies are focused on making accurate eligibility determinations in a more efficient timeframe with the following methods:

  • Continue training staff to increase foundational knowledge of LTC rules and policies to ensure staff have knowledge necessary to efficiently process cases without supervisor or AOPs guidance.  Staff response to trainings have been positive.  They have conveyed that the trainings make their work more efficient as they have to do less research or consult their supervisor less as their breadth and depth of knowledge improves.
  • Continue working with PCG to increase percentage of eAVS results received within the 10-day standard.  Expectations are that the contracted eAVS solution will give increasingly more results within the 10-day Vermont standard.  When that happens, the duplicative work associated with requests for paper bank statements will diminish.  That will reduce work burden for staff and concomitantly increase worker efficiencies which will have a positive effect on this trend line.
  • Identify and improve efficiencies of the business environment for LTC workers.  An area where staff chronically complain their time is wasted is in the use of OnBase.  Because LTC workers have an extraordinary number of documents in their OnBase queues and because far too many of those documents have the exact same name (rather than the more granular names LTC has repeatedly requested), the LTC staff find themselves repetitively clicking and viewing numerous documents unnecessarily before finding the document they need to review.  We have started a LEAN Project where we have defined the problem as inefficiencies associated with LTC workers having to locate needed documents when in OnBase.
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