Performance Improvement 1999. Disability, Aging, and Long-Term Care Policy

02/01/1999

TITLE: Institute on Consumer Directed Services (Long-Term Care Infrastructure)

ABSTRACT: This research, technical assistance and dissemination project, jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration on Aging (AOA), is designed to: (1) facilitate the ability of people with disabilities to exercise choice and control over the provision of the home and community based care (HCBC) they receive; (2) educate consumers or their representatives who want to use independent providers of personal assistance services, (PAS) about effective strategies for recruiting, training and managing independent providers; (3) educate consumers, their representatives and program personnel about consumer participation in care planning, on-site supervision of agency-employed workers and ways to work with case managers and agency personnel to modify care plans; and (4) provide information to States and communities to help them evaluate the outcomes and costs of strategies involving consumer choice and consumer directed services, and to develop and implement cost-effective policies and programs.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6162

PERFORMER ORGANIZATION: National Council on Aging, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 10/20/98
 

TITLE: Client-Directed In-Home Care/Personal Assistance Services

ABSTRACT: This project will conduct a survey of personal assistance services clients, workers and case managers in order to compare measures of quality of care, quality of life, client satisfaction and worker satisfaction across modes of service provision. The modes of service provision to be compared include: (1) independent and supported-independent providers (client-directed modes), and (2) agency-employed providers (professionally-managed modes). The study will also compare the outcomes associated with use of family, friends and neighbors as independent providers, as compared to services provided by aides previously unknown to the client. The study is being carried out in the context of California's In-home Supportive Services program with the assistance of State officials.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6173

PERFORMER ORGANIZATION: University of California at Los Angeles, Los Angeles CA

PROJECTED DATE OF COMPLETION: 3/1/99
 

TITLE: National Study of Assisted Living for the Frail Elderly

ABSTRACT: The aging of America has significant implications for the nation's long-term care system. Assisted living is seen by many as one logical response, at least conceptually, to this population growth, which is likely to be accompanied by an increasing need for assistance with chronic diseases and disabilities. This study will focus on how assisted living fits in the long-term care system and its potential for addressing the needs of the elderly and persons with disabilities. It will examine the role of assisted living from the perspective of consumers, owners, workers, regulators, developers and investors, and others who have a stake in the nation's long-term care system. Issues to be addressed are: (a) the supply of assisted living facilities, (b) barriers to development, (c) existing regulatory structures, (d) principles of consumer autonomy and choice in supportive residential settings, and (e) impact on persons who live and work in assisted living facilities.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 4719.7

PERFORMER ORGANIZATION: Research Triangle Institute Washington, DC

PROJECTED DATE OF COMPLETION: 12/31/99
 

TITLE: Study of Private Long-Term Care Insurance Claims

ABSTRACT: This study will examine formal and informal home and community-based long-term care (LTC) services use among private insurance policy holders "in claim" (i.e., those who are receiving insurance benefits). It will compare patterns of formal and informal services use among these insurance claimants with those of a nationally representative sample (from the 1994 National Long-Term Care Survey) of disabled elders living in the community. Statistical processes will be employed to match claimants with particular characteristics (e.g., age, marital status, disability level) to elders in the national sample. The purpose of the comparison will be to measure the effects of private long-term care insurance on access to formal home care services and to determine whether or to what extent insurance-financed formal services supplement or substitute for informal family care. The study will also examine the interaction between insurance financed home care and the use of Medicare home health services.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6399

PERFORMER ORGANIZATION: Lifeplans, Waltham MA

PROJECTED DATE OF COMPLETION: 3/1/99
 

TITLE: Study of Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: This project will study the experiences of elderly Medicare beneficiaries with disabilities and chronic illnesses in a managed delivery system (MDS) at four separate sites. An MDS is broadly defined as a health care system that integrates the financing and/or delivery of primary, acute and long-term care of persons for the purpose of controlling costs and improving access to, and coordination of, services across a continuum of providers. The specific goals of the study are to: (1) foster a better understanding of the unique characteristics and health/long-term care needs of elderly persons with disabilities and chronic illnesses among health plan administrators, providers and policymakers; (2) assess how managed care delivery systems meet the needs of this population and the factors that promote or impede success; and (3) describe the health care experiences of disabled elderly Medicare beneficiaries in MDS.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 6391

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Plainsboro, NJ

PROJECTED DATE OF COMPLETION: 6/30/99
 

TITLE: Analysis of Employer-Group Long-Term Care Insurance

ABSTRACT: This project will first survey employers offering their employees long-term care insurance benefits, identifying the existing group market and how if functions. Because most of the long-term care insurance market is composed of individual products--and because much of the employer information on long-term care insurance is fairly recent and not well explored--not much is known about the benefit packages, price, or design of these group products. The goal here is to identify quantitatively the "best practices" in the industry. Secondly, the project will examine designs for possible long-term care insurance benefits for Federal employees (and presumably their spouses, parents and retirees as well). Reviewing market survey data to identify important elements of existing employer groups, several long-term care insurance coverage options for Federal employees will be developed. The project will inform the primary Federal policy makers (such as the Office of Personnel Management) as to progress on this research and the accompanying design options.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Cutler

PHONE NUMBER: 202-690-6443

PIC ID: 6718

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 6/30/99
 

TITLE: A Primer for States and Consumers on Medicaid Home and Community-Based Services

ABSTRACT: Medicaid, the principal source of financing for long-term care services, has frequently been said to have an "institutional bias," because State spending on nursing homes and institutions outweighs spending on home and community-based supports by a ratio of approximately 80 to 20. Many States have, however, demonstrated that it is possible to work within a Medicaid framework to expand home and community-based services, (HCBS) providing consumers with greater choice and control. Decreased dependence on unnecessary institutional long-term care and the expansion of consumer responsive home and community-based long-term care options are important policies of both the White House and the Secretary for the Department of Health and Human Services. To address this priority, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) proposes to develop a "primer" on existing long-term care options in Medicaid that promote consumer choices in long-term care. The primer will be an important and useful development tool for State Medicaid and aging policy and program staff, consumers and their representatives, and providers interested in the expansion of choices in long-term care, including the promotion of home and community-based options.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7162

PERFORMER ORGANIZATION: The George Washington University Medical Center, Center for Health Outcomes Improvement Research, Washington, D.C.

PROJECTED DATE OF COMPLETION: 7/20/99
 

TITLE: Synthesis and Analysis of Medicare Hospice Benefit

ABSTRACT: The rapid rise in Medicare hospice expenditures, particularly on behalf of nursing home residents, has drawn the attention of a wide variety of health policymakers and the Office of the Inspector General (OIG). The OIG has advanced recommendations to modify how Medicare and Medicaid will pay for these services. However, a larger study is needed to examine key hospice trends nationally and in selected States. Additional information on the Medicare hospice benefit, including trends in utilization and expenditures, who is covered, and where, will help inform health policymakers as they consider alternative hospice benefit and payment designs. This project will describe trends and issues with the Medicare hospice benefit, particularly with respect to nursing home residents who elect this benefit. Information will be gathered through a review of the literature, discussion with key informants, and an analysis of claims, assessment and provider data. This project will: (1) examine trends in Medicare and Medicaid hospice and non-hospice utilization and expenditures for hospice and other similar beneficiaries; and (2) compare the quality of care for hospice beneficiaries.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7154

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/20/99
 

TITLE: Evaluation of Five State Health Reform Demonstrations

ABSTRACT: The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of Medicaid 1115 waiver demonstrations in five States attempts to add a disability focus to the State of Tennessee. This supplement will focus on the experiences of disabled adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) and disabled children enrolled in the TennCare and TennPartners programs. The project will conduct: (1) in-depth qualitative analyses of the State's experience in enrolling individuals with disabilities into managed care systems, and (2) quantitative analyses to examine costs and utilization data for these populations. In addition, the supplement will conduct a survey of disabled consumers to examine issues of satisfaction, quality, health status and functioning. See PIC ID 6289, 6289.1, 6166, and 6166.1.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Hunter McKay

PHONE NUMBER: 202-690-6613

PIC ID: 6289.2

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Plainsboro, NJ

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Data Analytic Support for the Review of Long-Term Care Policy Options

ABSTRACT: This project will analyze data from the 1994 National Long-Term Care Survey to assist Health Care Financing Administration (HCFA) actuaries in estimating costs of the potential effects of eliminating or redefining the requirement that Medicare beneficiaries be "homebound" in order to access the Medicare home health benefit. It will also analyze data from the Community Caregiver Supplement to the 1996 Medical Expenditures Panel Survey Nursing Home Component. The purpose of this analysis is to understand the factors influencing decisions by severely disabled persons and their family members as to whether or not the disabled person should enter a nursing home. This analysis will guide the work of the HCFA/ASPE Task Force on Promoting Home and Community-Based Alternatives to Nursing Home Care. In particular, the analysis will help design a major demonstration project and technical assistance program for the States.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6677

PERFORMER ORGANIZATION: MEDSTAT Group Washington, DC

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Analysis of Patterns of Post-Acute and Chronic Care Services Use Among Disabled and Non-Disabled Medicare Beneficiaries: 1989-1994

ABSTRACT: This study uses the 1989 and 1994 National Long-Term Care Surveys to analyze factors that predicted growth in Medicare post-acute (i.e., home health and skilled nursing facility) benefits from the late 1980s through the mid-1990s.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6768

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: The FY 1997 contract modification allows a more focused review of how Medicare managed delivery systems address the needs of elderly persons with disabilities. This is accomplished in part through this contract modification which: (1) adds a longitudinal survey of elderly enrollees with targeted conditions, (2) limits the cross-sectional to elderly persons with disabilities, (3) adds a focus group of physicians, and (4) requires interviews with long-term care providers serving this population.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7155

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC

PROJECTED DATE OF COMPLETION: 12/20/99
 

TITLE: Analysis of the Disability Supplement to the National Health Interview Survey

ABSTRACT: The disability supplement to the National Health Interview Survey (NHIS-D) is the first comprehensive survey on disability in the United States. The survey is unique in that it focuses on several populations of persons with disabilities who are generally omitted or under-represented in national survey efforts: children, persons with mental retardation and other developmental disabilities and the working-age population. The goal of this project is to conduct a series of analyses and produce both short-term products and final reports that will inform ongoing Assistant Secretary for Planning and Evaluation (ASPE) departmental and administrative research and policy initiatives. The analyses will address a specific set of questions in four topical areas using the NHIS-D: (1) welfare receipt and disability (including chronic illness); (2) disability and chronic illness among low income populations; (3) childhood disability and chronic illness; and (4) employment and disability.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6613

PIC ID: 7153

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/27/00
 

TITLE: Medicare Home Health Practice Variations

ABSTRACT: The main goal of this study is to examine how patient, provider, agency and market/regulatory forces relate to variations in Medicare home health care practices and outcomes. Three key questions form the basis of the study: (1) What is the actual practice of home health care in terms of amount, type and decision-making? (2) How are decisions about care made in light of the Health Care Financing Administration's (HCFA) Medicare home health care coverage rules? and (3) What elements of practice are associated with long lengths of stay in the home health benefit? The study will use a range of quantitative and qualitative methods to address these questions, including longitudinal data collection on samples of home health agencies and home health patients at those agencies, focus groups, case studies and analyses of secondary data.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6720

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 3/31/00
 

TITLE: Research on Employment Supports for People with Disabilities

ABSTRACT: The objective of this study is to collect detailed information on the experiences of people with disabilities, their knowledge of work incentive policies and provisions, the events and factors affecting their employment decisions, the relative importance of specific factors, and the reasons for successful and unsuccessful employment attempts. The purpose to gain a better understanding of the supports people with significant disabilities currently use to successfully participate in employment, supports that would improve their employment outcomes, and supports that would improve the employment outcomes of those who are not employed. The collection of this information is intended to advance the understanding of the effect of supports and programs on the employment of people with disabilities. The project is designed to provide information that may be used by Federal agencies, states, social service agencies, advocates for people with disabilities, and consumers with disabilities to develop and inform policies that will promote the employment of people with significant disabilities.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Floyd Brown

PHONE NUMBER: 202-690-6613

PIC ID: 4917.2

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 4/20/00
 

TITLE: Evaluation of Practice in Care (EPIC)

ABSTRACT: From 1989 to 1992, there was a 210 percent increase in Medicare expenditures for home health services. This increase in utilization has generated policy interest in measures to control expenditures without compromising quality. Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. This study will: (1) analyze "episodes" of care under the Medicare home health benefit, (2) assess the actual practice of care, (3) determine the extent to which there is variation in practice between acute and long-term care patients, and (4) uncover the factors accounting for that variation. The study will also examine decision-making processes between patients, providers and physicians. The events that take place during a visit and between visits as "actual practice" have never been measured. Furthermore, the function of decision-making by various parties has not been observed in "actual practice". This effort to understand issues surrounding regional and practice variations of home health care delivery will aid the Department of Health and Human Services and the industry in combating fraud and abuse, as well as contribute valuable data to a future prospective payment system.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 5888

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 6/30/00
 

TITLE: Private Payers Serving Individuals with Disabilities and Severe Chronic Conditions

ABSTRACT: This project examines the experiences of persons with disabilities or severe chronic conditions in health insurance plans sponsored by selected large employers. A methodology was developed to identify such individuals using diagnoses from health care claims and encounter databases. This methodology was applied to data from the health plans of two large employers. The prevalence of disabilities and severe chronic conditions was estimated among employees, their dependents, and retirees. The choice of indemnity versus managed care plans, and associated service utilization and expenditures were analyzed. The performance of various risk adjustment models was tested for physical and mental conditions. This project will provide information on the factors influencing the choice of insurance plans, and the effect of managed care on service utilization and expenditures. It also estimates the extent of adverse selection across plans, and indicates how various risk sharing strategies can mitigate its effects.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 6398

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/28/00
 

TITLE: The Long Term Care Financing Model

ABSTRACT: The Long-Term Care Financing Model is a resource which has been extensively used by ASPE to project future long- term care utilization and expenditures and simulate various long term care policy options. These include expansions of public financing, such as those proposed during health care reform, as well as changes to Medicaid and Medicare. The model has also been used extensively to study private sector policy options, such as the impact of further growth on private long-term care insurance and the impacts of changing trends in disability rates on long-term care use and expenditures. Recent data on disability rates, nursing home use, and home care use will be used to update existing portions of the model. In addition, the model will be expanded to include acute care use, thereby increasing the Assistant Secretary for Planning and Evaluation's (ASPE's) ability to simulate a wide range of policy options. ASPE will use this computer model for projections and policy simulation and a series of policy simulations from the revised model will be presented in reports. In addition to its previous long-term care policy uses, the revised model will enable ASPE to address acute care issues, such as the combined burden of acute and long-term care spending on the elderly. Since the model simulates the income and assets of the population, including pension and Social Security payments, the model will also be used to study other aging-related issues, such as the impact of changes in employer-sponsored health insurance for retirees.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 7143

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/00
 

TITLE: A Study of Home Health Practice Variations Study

ABSTRACT: Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. What takes place during a visit and between visits as "actual practice" has never been measured. Furthermore, the extent to which various parties participate in the decision making process, is also unknown. Such information is needed to improve understanding about actual practice and explain its variations. This study will analyze variations in home health care services, focusing on patient characteristics, provider characteristics, agency characteristics and market characteristics. Primary data will be collected at the patient and agency levels. Data from this study and the Health Care Financing Administration's (HCFA) Outcomes of Home Care Study will be used to assess the relationships between the process of home health care and its outcomes and resource use.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 6168

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 12/20/00
 

TITLE: Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation

ABSTRACT: This study will employ a classical experimental research design (i.e. random assignment of participants to treatment and control groups) in order to test the effects of "cashing out" Medicaid-funded personal assistance services for the disabled. Arkansas and New York are expected to participate in the demonstration, with an option to expand to include New Jersey and Florida. Control group members will receive "traditional" benefits in the form of case-managed home and community-based services where payments for services are made to vendors. Treatment group members will receive a monthly cash payment in an amount roughly equal to the cash value of the services that they would have received under the traditional program. It is hypothesized that cash payments will foster greater client autonomy and that, as a result, consumer satisfaction (particularly among disabled persons under age 65) will be greater. It is also hypothesized that States will save Medicaid monies (mostly in administrative expenses) from cashing out benefits.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6161

PERFORMER ORGANIZATION: University of Maryland, Center on Aging, College Park MD

PROJECTED DATE OF COMPLETION: 1/20/01