Long Term Care (LTC) Unit

Of the new LTC Medicaid applications processed during the month, the % that were processed within 45 days of receipt

96.0%May 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 is a measure of how well staff are processing applications relative to the current timeliness standard.

Long Term Care (LTC) Medicaid applications must be processed within the 45-day federal timeliness standard. Some clients cannot access long term supports and services until their LTC application has been processed.  Other clients are admitted to nursing facilities (NF) prior to submission of their LTC application. The NF’s depend upon timely processing as they need to know if the client is LTC Medicaid eligible.  Additionally, delays in payments for Medicaid eligible LTC services can create revenue issues for the facilities.

Sometimes applications are delayed because the Department of Aging & Independent Living (DAIL) cannot find a clinical placement for the applicant. Sometimes clients do not submit all verification documents within their initial verification due date which requires the worker to send a second verification request.  Other delays are the result of the client needing additional time to submit verification documents for the five year look back period (LBP).  Finally, since launching the electronic asset verification system (eAVS), LTC workers have experienced higher workloads as explained above.

Applications exceeding 45 days processing time which can be directly attributed to one of these types of delays are not included in this performance measure because the financial eligibility worker has no control over those delays.

The percentage of applications processed within the 45-day federal timeliness standard reflects Vermont’s level of compliance with that federal rule. The higher the level of compliance, the lower the risk of financial penalties related to payment errors for exceeding the federal timeliness standard. This measure receives extensive focus from the LTC Unit, as staff seek to continuously improve in this error through business process efficiencies, worker training and review of casework. Staff workload levels make it very difficult to achieve a 45-day timeliness standard on all LTC cases due to the complex work associated with these cases.

A goal of 100% was established in July 2018 for this performance measure.

CMS suspended 45-day processing time rule requirement for COVID 19 Emergency Period which started on March 1, 2020.

 

Last updated:  06/15/2020

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 ten day standard.  Expectations are that the contracted eAVS solution will give increasingly more results within the ten day Vermont standard.  When that happens, the duplicative work associated with paper requests for 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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