ILOS RCFE Network Setup and Care Transition Services

ILOS for nursing home diversion/transition to assisted living homes

The Cal AIM proposal p. 204, Paragraph 4 allows Managed Long Term Support and Services (MLTSS) Managed Care Organizations (MCOs) to use In Lieu of Services (ILOS) to pay for the “assisted living” portion of residential care facilities for the elderly (RCFEs) and for the nursing home diversion/transition setup costs.

ILOS, according to the Centers for Medicare and Medicaid Services (CMS), are considered “accrued expenses” and can be counted towards the Medical Loss Ratio (MLR) for the annual capitated rate settings.

Connections - Care Home Consultants has been been providing information and referral to Southern California RCFEs for 31 years. We provide a one-stop shop for RCFE Network Set-up, Maintenance, Care Transition and member placement for MLTSS MCOs developing ILOS nursing home diversion/transition programs.

Our RCFE NETWORK SETUP AND CARE Transition services

30+ year RCFE placement specialists

SNF diversion/transition to RCFE program set-up

RCFE network set-up

RCFE/MLTSS MCO contract set-up

Home to RCFE, hospital to RCFE, SNF to RCFE care home referral and client placements

Transition management to RCFE from home, SNF or hospital (e.g. transportation services, durable medical equipment, moving expenses, etc.)

Inservices to MLTSS MCO care coordinators about our services

Inservices to hospital social workers/case managers for flagging eligible SNF diversion/transition candidates

Monthly follow-up with clients to measure patient satisfaction

Monthly Community Care Licensing checks to monitor RCFE network integrity

Customization of RCFEs to accept younger nursing home diversion/transition candidates

Medi-cal Cost Savings Estimates for SNF-RCFE transition

$21,600 annual Medi-Cal cost savings for each SNF resident on LTSS who transfers to RCFE: e.g. $5,300/month (CCI MLTSS Medi-Cal payment to SNF) - $3,500 (average cost of RCFE) = $1,800 x 12 = $21,600

Potential SNF diversion/transition candidates

62,000 SNF residents on LTSS

5,766 (9.3% of 62,000) SNF residents on LTSS have low level care needs which could be met by community-based care homes

11,785 new users of Medi-Cal LTSS would first receive services in the community rather than in a SNF

4,682 more people entering SNFs would be able to return to the community within 100 days.

4,678 more people who have been in a SNF for 90 days or more would be able to move back to the community.

5,112 IHSS recipients exited the program in 2018 to go to SNF. Of these, how many could have transitioned instead to a RCFE?

Sources:

Kaiser Health Foundation: Distribution of Certified Nursing Facility Residents by Primary Payer (2019)
AARP/SCAN LTSS California Report Card: Data Tables 2017 and 2020
Department of Social Services: 2018 IHSS report with program exit characteristics p.14
California Association Nursing Home Reform: Evaluating California’s Assisted Living Waiver Program of ALW Program p. 13 (May 2019)

Hospital, home or SNf to rcfe DIVERSION/TRANSITION CANDIDATES

RCFE Allowable health conditions:

1) Dressing, bathing and incontinence
2) Help out of bed or assistance in transferring
3) Catheter or colostomy
4) Dementia or Alzheimers
5) Wanderers
6) Ambulatory
7) Wheelchair or walker dependent
8) Stage 1 and 2 ulcers

RCFE non-allowable health conditions:

1) Stage 3 and 4 pressure ulcers
2) Nasogastric tubes
3) Ventilators
4) Bi-pad (without ability to self administer)
5) Wound vac therapy
6) Continuous IV/TPN
7) Active communicable tuberculosis
8) Restraints

For more information about partnering with Connections - Care Home Consultants for ILOS RCFE Network Set-up and Care Transition Services, please call us at 800-330-5993.

For articles we've written about ILOS AND MLTSS please see publications.