Promoting Disability-Competent Care during COVID-19
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Promoting Disability-Competent
Care during COVID-19
Credit Information
§ If you are a social worker in a National Association of Social Workers (NASW) state and
would like to receive CE credits through NASW for this event, please complete the pre-test
posted here: https://www.surveymonkey.com/r/DCCCOVIDPreTest
§ You will also be required to complete a post-test; a link to this test will appear at the end of the
presentation.
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https://www.ResourcesForIntegratedCare.com
April 22, 2021
Promoting Disability-Competent
Care during COVID-19
April 22, 2021
1:30 – 3:00 PM ET
https://www.ResourcesForIntegratedCare.com
Overview
§ This session will include presentations, followed by
a live Q&A with presenters and participants
§ Video replay and slide presentation are available
after each session at:
https://www.resourcesforintegratedcare.com
2 https://www.ResourcesForIntegratedCare.com
Accreditation
§ Individuals are strongly encouraged to check with their specific
regulatory boards or other agencies to confirm that courses taken
from these accrediting bodies will be accepted by that entity.
§ The National Association of Social Workers (NASW) is accredited to
provide continuing education for social workers.
3 https://www.ResourcesForIntegratedCare.com
Continuing Education Information
If You Are A: Credit/Contact Hour Options Requirements
National Association of Social Workers
The National Association of Social Workers designates this 1. Complete the pre-test at the
webinar for a maximum of 1 Continuing Education (CE) credit beginning of the webinar
hour. 2. Complete the post-test with
a score of 80% or higher by
Social Worker
Please note: New York, Michigan, and West Virginia do not 11:59pm April 23, 2021
accept National CE Approval Programs for Social Work. New
Jersey, Idaho, and Oregon do not recognize NASW National
Approval.
4 https://www.ResourcesForIntegratedCare.com
Support Statement
§ This webinar is supported through the Medicare -Medicaid Coordination
Office (MMCO) in the Centers for Medicare & Medicaid Services (CMS)
to help beneficiaries dually eligible for Medicare and Medicaid have
access to seamless, high-quality health care that includes the full range
of covered services in both programs. To support providers in their efforts
to deliver more integrated, coordinated care to dually eligible
beneficiaries, MMCO is developing technical assistance and actionable
tools based on successful innovations and care models, such as this
webinar.
§ To learn more about current efforts and resources, visit Resources for
Integrated Care at: https://www.resourcesforintegratedcare.com or on
Twitter @Integrate_Care
5 https://www.ResourcesForIntegratedCare.com
Introductions
■ Chris Duff
Disability Practice and Policy Consultant
■ Jose Hernandez
Participant, United Spinal Association
6 https://www.ResourcesForIntegratedCare.com
Introductions
■ Gabriel Uribe, DSW
Director of Community Health, Inland Empire Health Plan (IEHP)
■ Anna Edwards, DNP
Clinical Director of Care Management, Inland Empire Health Plan
(IEHP)
7 https://www.ResourcesForIntegratedCare.com
Introductions
■ Stephanie Rasmussen
Director, Vice President of Long-Term Services and Supports
(LTSS), Sunflower Health Plan
8 https://www.ResourcesForIntegratedCare.com
Learning Objectives
§ Define the Disability-Competent Care (DCC) model and recognize
its core values and supporting functional area pillars
§ Recognize the unique challenges and risks that individuals with
disability face during the COVID-19 public health emergency
§ Describe the effects of social isolation and interventions to
promote connectedness
§ Describe strategies for identifying, monitoring, and addressing
caregiver and care partner availability and back-up as needed
§ Identify strategies for increasing access to in-person and virtual
health and social services to accommodate the diverse needs of
individuals with disability, including telehealth considerations
9 https://www.ResourcesForIntegratedCare.comWebinar Outline § Polls § Review of the Disability-Competent Care (DCC) Model § Unique Challenges Experienced by Persons with Disability during the COVID-19 Crisis § A Health Plan Perspective on Promoting DCC During COVID-19 § A Managed Long-Term Services & Supports (MLTSS) Plan Perspective § Participant Response to Health Plan Perspectives § Audience Q&A § Evaluation § Resources § Upcoming Webinars 10 https://www.ResourcesForIntegratedCare.com
Review of the Disability-Competent Care
(DCC) Model
Chris Duff
Disability Practice
and Policy Consultant
11 https://www.ResourcesForIntegratedCare.comThe DCC Model
§ A participant-centered model, delivered by an
interdisciplinary team (IDT) that focuses on
Core Values
achieving and supporting maximum function
§ Participant-
§ Intended to maintain health, wellness, and life centered
in the community as the participant chooses
§ Respect for
§ A model that recognizes and treats each participant choice
individual as a whole person, not a diagnosis or and dignity of risk
condition
§ Elimination of
§ Structured to respond to the participant’s medical and
physical and clinical needs while considering institutional bias
his or her emotional, social, intellectual, and
spiritual needs
12 https://www.ResourcesForIntegratedCare.comPillars of the DCC Model 1. Understanding the DCC Model 2. Participant Engagement 3. Access 4. Primary Care 5. Care Coordination 6. Long Term Services and Supports 7. Behavioral Health 13 https://www.ResourcesForIntegratedCare.com
Unique Challenges Experienced by Persons
with Disability during the COVID-19 Crisis
Jose Hernandez
Participant, United
Spinal Association
14 https://www.ResourcesForIntegratedCare.comCOVID-19 Challenges
§ Availability of home care workers
§ Workers abruptly stopped working or became sick
§ Challenges hiring new workers
§ Proper access to PPE for member and home care personnel
§ Obtaining information about COVID-19 in multiple languages
§ Accessing healthcare services
§ Obtaining appointments that need to be in-person
§ Access to internet, computer, or smart device for virtual appointments
§ Using technology such as computers, or smart devices
§ Transportation issues
§ Valuing the lives of persons with disability when resources are
scarce
15 https://www.ResourcesForIntegratedCare.comCOVID-19 Vaccination Challenges
§ Education regarding importance of being vaccinated and the
availability of appointments
§ Assistance booking appointments for vaccinations
§ Transportation to and accessibility of vaccination sites
§ Information regarding the quality of the vaccines and their
potential side effects
§ Having information available in multiple formats and languages
16 https://www.ResourcesForIntegratedCare.comA Health Plan Perspective on Promoting DCC
During COVID-19
Gabriel Uribe, DSW Anna Edwards, DNP
Director of Community Clinical Director of Care
Health, Inland Empire Management, Inland Empire
Health Plan Health Plan
17 https://www.ResourcesForIntegratedCare.comAbout Inland Empire Health Plan
§ Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid
health plans and the largest not-for-profit Medicare-Medicaid Plan in the
country
§ With a network of more than 6,400 providers and more than 2,000
employees, IEHP serves more than 1.3 million residents in California’s
Riverside and San Bernardino counties who are enrolled in Medicaid or
Cal MediConnect Plan (Medicare-Medicaid Plan)
§ As of March 1, 2021 – 30,378 dually eligible members
18 https://www.ResourcesForIntegratedCare.comIEHP Dually Eligible Membership Profile
Demographics Percentage
Members with Disability ~44%
Language – Limited English Proficiency 33%
Female 57%
Gender Top SDOH
Male 43%
Concerns
Hispanic 43% § Food
§ Housing
White 25% § Gas
Race/Ethnicity
African American 11% § Utilities
Other or not listed 20%
Diabetes 45%
Top 3 Chronic Pain Management 41%
Conditions
COPD 27%
19 https://www.ResourcesForIntegratedCare.comAddressing Food Insecurity
§ Food insecurity identified as a population health area of focus for IEHP
§ 10% of Inland Empire member population (2019 data)
§ Known facts:
§ Food insecurity is more prevalent among vulnerable populations
§ Persons with disabilities may have additional unique challenges relating to food access
§ Medicaid recipients are more likely than non-Medicaid recipients to experience food
insecurity
§ Medicaid recipients are more likely to have multiple unmet social needs and chronic
conditions
§ Food insecurity negatively impacts health outcomes
§ Impact of COVID-19 further exacerbated food insecurity
§ Increased unemployment
§ Larger number of people qualifying for Medicaid
§ More people competing for resources to address food insecurity
(MACPAC, 2014; ODPHP, n.d.)
20 https://www.ResourcesForIntegratedCare.comIEHP’s Response to the
Growing Food Insecurity Problem
§ Implemented the Food Insecurity & Resource Linkage
Program in June 2020
§ Major program components include:
§ Training care management department on using:
§ Standardized Screening Tool (Hunger Vital Sign™)
§ Decision-Support Algorithm
§ Resource Tool: Programmed by zip code and county for ease of
use
§ Standardized documentation process
§ Capture evaluation data
§ Strong community partnerships to secure food resources
21 https://www.ResourcesForIntegratedCare.comIEHP’s Response to the Growing Food Insecurity Problem (cont.) 22 https://www.ResourcesForIntegratedCare.com
Innovative Member Outreach Strategies
§ Multiple call campaigns to high-risk members (well-check,
education)
§ Follow-up calls post-hospitalization
§ Call campaigns to assist members age 75+ with vaccine
appointments
§ Greeting card campaigns for members in Skilled Nursing Facilities
(SNFs)
§ Cheer Parades outside SNFs
§ Virtual Classes through our Community Resource Centers
§ Partnering with county and providers to staff vaccination sites with
IEHP employee volunteers
§ IEHP Vaccination Super Site
23 https://www.ResourcesForIntegratedCare.comIEHP Cheering on our Members in LTC 24 https://www.ResourcesForIntegratedCare.com
IEHP’s Card Campaign 25 https://www.ResourcesForIntegratedCare.com
Supporting Caregivers during COVID-19
§ Recognizing the important role of caregivers:
§ Training Team Members on “Caring for the Caregiver”
§ Providing hand sanitizers for In-Home Supportive Services (IHSS)
Public Authority caregivers
§ Partnering with the IHSS Public Authority caregiver registry to provide
funding for differential pay to emergency back-up caregivers
§ Assessing caregivers and providing resources:
§ Screening for caregiver burn out
§ Providing resources if caregiver is stressed
§ Providing in-home and out-of-home respite for the caregiver & LTSS
resources
26 https://www.ResourcesForIntegratedCare.comSupporting Caregivers during COVID-19 (cont.)
§ Providing education and resources to caregivers:
§ Providing trainings at the IEHP Community Resource Centers
§ Caregiver Toolbox training by Inland Caregiver Resource Center
§ Alzheimer’s training by Alzheimer’s Association
§ Curating caregiver resources, tools, videos, and guides and
making them available to caregivers (and Team Members)
§ Educating providers about caregiver resources:
§ Notifying providers when members screen positive for cognitive
impairment
§ Educating providers on long-term services and supports
(LTSS) that can help our members and caregivers
27 https://www.ResourcesForIntegratedCare.comAddressing Social Isolation
§ IEHP partnered with La Sierra University’s (LSU) Social Work
program to provide seniors and persons with disability linkage to
social activities in virtual environments
§ IEHP sponsored Chromebooks for local Independent Living Centers
and SNFs to distribute to isolated seniors and persons with disability
§ LSU students provided tech support hours for users
§ LSU students established a Staying Connected Calls program
§ Supported by 9 college students
§ Students trained on referral process to social and health plan resources
as needed
§ Virtual engagement included reading clubs, zoom events/calls, Netflix
watch parties, and most recently, engagement with faith communities
of choice
28 https://www.ResourcesForIntegratedCare.comLeveraging Technology to Address Social Isolation
§ Partnership with Pyx Health to leverage a
technological intervention to address loneliness
in targeted populations (Pilot 100K Members):
§ Dually eligible members
§ High-risk members with depression or anxiety
§ Other high-risk Medi-Cal populations
29 https://www.ResourcesForIntegratedCare.comKey Considerations for Health Plans
§ Explore innovative interventions
§ Partner with the community to address social issues, such as
hunger, to foster trust and develop organic touchpoints that lead to
incremental care opportunities
§ Use data to identify disparities
§ Address disparities by implementing creative interventions and
programs
§ Build a culture of enthusiasm within your organization and across
partners
30 https://www.ResourcesForIntegratedCare.comA Managed Long-Term Services & Supports
(MLTSS) Plan Perspective
Stephanie Rasmussen
Vice President of Long-Term
Services and Supports
(LTSS), Sunflower Health
Plan
31 https://www.ResourcesForIntegratedCare.comAbout Sunflower Health Plan
§ Medicaid: 155,575 members including approximately the following:
§ Medicare:
§ Medicare Advantage: 750 of which 16 are aligned; and 6 are aligned for HCBS
§ DSNP: 1,676 of which 1,067 are aligned; and 416 are aligned for HCBS
32 https://www.ResourcesForIntegratedCare.comCOVID-19 Challenges
§ Lack of access to:
§ Convenient and easy to understand educational material
§ Personal Protective Equipment (PPE) and cleaning/sanitizing supplies for both
formal and informal caregivers
§ Connectivity, equipment, and education/support for using different telehealth
platforms
§ Caregivers when planned emergency backup supports were unavailable
§ COVID-19 vaccines for participants and their caregivers:
§ Inaccessible locations and/or unable to leave home
§ Required proof of front-line worker status for self-directed caregivers
§ Limited ability to:
§ Receive needed daily care in a different setting or from fewer people
§ Receive extra, needed supports while in an inpatient setting
§ Quarantine/isolate while receiving needed daily supports
33 https://www.ResourcesForIntegratedCare.comStrategies to Address Unique Challenges
§ Virtual Meetings with LTSS Stakeholders
§ Bi-weekly virtual meetings with LTSS member advocates, provider
associations, and other stakeholders to collaborate and share information on
current needs
§ Regular communication to:
§ Identify changing barriers
§ Discuss potential solutions
§ Develop strategic partners between the state, MCOs, providers, and other
organizations
§ Strategic Partnerships for Distributing Supplies
§ Partnerships with community developmental disability organizations and Aging
& Disability Resource Centers to supply PPE, tablets, and food/supplies to
HCBS providers and nursing facilities
§ Organizations were flexible with how they distributed items such as directly
mailing items to Sunflower members and hosting drive-thru pickup locations
34 https://www.ResourcesForIntegratedCare.comSunflower Health Plan’s Supply Distribution 35 https://www.ResourcesForIntegratedCare.com
Strategies to Address Unique Challenges In July 2020, a small nursing facility in western Kansas identified that over half of its residents and several staff were positive for COVID-19. The facility was in dire need of PPE, and not able to access it quickly. Sunflower contacted the providers with which we partnered to distribute PPE. We were able to gather 30 boxes of gloves and ship them overnight to the facility. The facility Director of Nursing let us know they appreciated all of the extra support. In September 2020, one of Sunflower’s employees delivered a food box to one of our members in need. The member handed her a present. Our employee thanked her, but said that she couldn’t accept a present. The member laughed and said, “It’s ok. There’s no monetary value associated with this present. In the bag are 3 painted rocks. I’ve paid nothing for them. I find them in the dirt, paint them, and give them as gifts. I use this as therapy during the quarantine of this pandemic.” 36 https://www.ResourcesForIntegratedCare.com
Strategies to Address Unique Challenges
§ COVID-19 Education
§ Offered multiple formats and tools for educating both participants and direct caregivers regarding
COVID-19 (e.g., websites, brochures/flyers, recorded and live virtual seminars)
§ Covered a variety of topics: signs & symptoms, safety guidelines, vaccine information, access to
healthcare, access to PPE, access to in-home care, changes in covered services, use of telehealth
§ Partnered with the National Council on Independent Living (NCIL) to develop a series of written
guides and videos on the COVID-19 challenges for persons with disabilities to help educate both
participants and providers
§ Emergency Backup Services
§ Care coordinators contacted each senior and individual with disability receiving HCBS to confirm the
availability of each participant’s emergency backup supports to provide support in an emergency
§ Centene/Sunflower offered a $100,000 grant in Kansas to implement emergency backup worker
services for persons who self-direct their care
§ Two Centers for Independent Living (CILs) offered the service in 3 counties (2 rural and 1 urban)
§ CILs worked with Sunflower Health Plan care coordinators to educate members who self -direct on the
availability of this service and how to access it through calling a hotline number
§ CILs employed on-call direct care workers to offer back-up support
37 https://www.ResourcesForIntegratedCare.comStrategies to Address Unique Challenges
§ Flexible Options for IDD Services
§ Day service providers closed temporarily and/or moved to alternative schedules
§ Partnered with the Kansas Department of Aging and Disability services to identify the
flexible service options needed for persons with I/DD
§ Receive I/DD day services in a home or residential provider home setting
§ Receive paid supports from family members
§ Receive home-delivered meals, which were previously not covered
§ Receive HCBS while in an inpatient hospital setting
§ Educated members with I/DD about new options through telephonic contact
§ Changes to HCBS
§ Family members who were previously prohibited from being paid caregivers can be paid
§ Paid family members are exempt from the requirement to use Electronic Visit Verification
§ Services can be received while in a hospital setting when needed to participate in care
§ Individuals can receive some types of therapy services through telehealth
38 https://www.ResourcesForIntegratedCare.comStrategies to Address Unique Challenges
§ Remote Care Coordination Visits
§ Virtual care coordination visits are offered using video conferencing and telephone
§ Many members in HCBS face challenges with access to connectivity and/or equipment or are
not comfortable with using video conferencing
§ Vaccine Access
§ Educated members about the COVID-19 vaccines and access through telephonic communication
§ Posted vaccine information on plan website and share information in LTSS stakeholder meetings
§ Members in nursing facilities have had opportunities to receive the vaccine in their facility settings
§ Provided assistance to persons who self-direct by providing caregiver employment information so
caregivers could prove frontline worker status during Phase I of the vaccine
§ Collecting information on statewide locations that are offering in-home vaccine options
§ Sharing this information with members and during LTSS stakeholder meetings
§ Working on obtaining a supply of the vaccine to pharmacies that are willing to hold events at I/DD
Residential and Day Services congregate setting locations
§ Pharmacies that are offering to assist with events have had some success with getting a supply and have
scheduled a few vaccine events
39 https://www.ResourcesForIntegratedCare.comKey Considerations for Health Plans Supporting Dually Eligible Individuals with Disability § Facilitate regular communication with regulators and stakeholders to determine the ongoing barriers faced by persons who are dual and/or have disabilities § Offer a variety of easy-to-understand educational materials and methods such as member phone calls, brochures, websites, and videos § Develop strategic partnerships to acquire and distribute needed equipment and supplies, including using national contracts to procure needed items § Work with state and federal regulators to make sure that the necessary changes to covered benefits can be made on a temporary basis to meet member need, or consider implementing grant-funded or pilot projects to cover these needs § Partner with providers to make the vaccine available where the member is located, and/or offer other accessible locations or means of getting the vaccine § Have resources in place to implement quick changes to covered benefits, to facilitate ongoing communication, or to meet other urgent needs § Have a willingness to think outside of the box and go beyond traditional, standard processes 40 https://www.ResourcesForIntegratedCare.com
Participant Response to Health Plan
Perspectives
Jose Hernandez
Participant, United
Spinal Association
41 https://www.ResourcesForIntegratedCare.comQuestions and Answers
Chris Duff
Disability Practice and Policy
Consultant
Gabriel Uribe, DSW
Director of Community Health,
IEHP
Anna Edwards, DNP
Clinical Director of Care
Management, IEHP
Stephanie Rasmussen
Vice President of LTSS, Sunflower
Health Plan
Jose Hernandez
Participant, United Spinal
Association
42 https://www.ResourcesForIntegratedCare.comThank You for Attending!
§ The video replay and slide presentation will be available at:
https://www.resourcesforintegratedcare.com
§ If you are applying for NASW CE, you must complete the post-test in
order to receive credit:
§ https://www.surveymonkey.com/r/DCCCOVIDPostTest
§ You must earn a score of 80% or higher on the post-test to receive
NASW CE. You may take the post-test multiple times.
§ If you complete the requirements to earn NASW CE, we will email you a
certificate of achievement.
§ Questions? Please email RIC@lewin.com
§ Follow us on Twitter at @Integrate_Care to learn about upcoming
webinars and new products!
43 https://www.ResourcesForIntegratedCare.comWebinar Evaluation Form § Your feedback is very important! Please take a moment to complete a brief evaluation on the quality of the webinar. The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation. § We would also like to invite you to provide feedback on other RIC products, as well as suggestions to inform the development of potential new resources: https://www.research.net/r/MVGNWVJ 44 https://www.ResourcesForIntegratedCare.com
Resources
§ CDC: COVID-19 and People with Disabilities: https://www.cdc.gov/coronavirus/2019-
ncov/need-extra-precautions/people-with-disabilities.html
§ Centene and National Council on Independent Living (NCIL):
§ COVID-19 and People with Disabilities: https://youtu.be/s_iIqI1jnQc
§ Essential Services: Maintaining Access to Personal Attendants During the COVID-19 Epidemic:
https://youtu.be/FUqDKagWCX4
§ IEHP LTSS and Caregiver Resources: https://iehp.org/en/members/medical-long-term-
services-and-supports
§ IEHP LTSS and Caregiver Video: https://youtu.be/v2n1YDZz010
§ National Council on Independent Living COVID-19 Resource Site: COVID-19 Information,
Resources, and Opportunities (ncil.org)
§ National Direct Service Professionals COVID-19 Resource Site: https://nadsp.org/covid-
19resources/
§ Self Advocacy Resource and Technical Assistance Center (SARTAC) COVID-19 Guides:
https://selfadvocacyinfo.org/resource/a-self-advocates-guide-to-covid-19/
§ Sunflower Health Plan COVID-19 Page for Members:
https://www.sunflowerhealthplan.com/member-coronavirus-information.html
45 https://www.ResourcesForIntegratedCare.comResources (cont.)
§ HHS Published New Legal Guidance and Resources to
Ensure and Expand Access to COVID-19 Vaccines for
People with Disabilities
§ See Guidance from the Office of Civil Rights (OCR)
§ See Guidance Fact Sheet from OCR
§ See Strategies and Best Practices from ACL
§ See Issue Brief on Potential Barriers to Accessing the COVID-
19 Vaccine for Homebound Older Adults from ASPE
46 https://www.ResourcesForIntegratedCare.comUpcoming Webinars
§ Diabetes Care Assessment, Planning, and Management
during COVID-19
§ May 5, 2021 12:00-1:30pm ET
§ Supporting The Preventive Health Care Needs Of Dually
Eligible Women With Disability
§ May 12, 2021 1:00-2:30pm ET
47 https://www.ResourcesForIntegratedCare.comYou can also read
