New England Consortium:
Rhode Island Living RIte

Project Overview

General Approach: Living RIte is an initiative to enhance access to quality services that will result in improved health and wellness for the elderly and adults with disabilities. This will be accomplished through the added service care coordination that links community support services with acute health and long-term care services. Living RIte will feature three levels of Coordination, Assessment, Referral, Reassessment and Evaluation (CARRE) Centers, available to anyone regardless of funding source. CARRE Centers will help seniors and their family/friend caregivers navigate multiple public and private resources, practice guidelines, and collaborative professional relationships. Some Centers may serve special populations, such as traumatic brain injury while others may develop into fully integrated service delivery systems. It is anticipated that many existing providers will link together to form CARRE Centers.

• CARRE Centers I's will provide linkages to statewide information and referral networks and One-Stops, access to basic community supports such as snow removal and shopping and primary preventative services such as wellness programs.
• CARRE Center II's or CARRE Networks based on a community support model, will help consumers navigate public and private funding sources and provide care coordination across the continuum of social service long-term care and acute care provider-partnerships. The provider team's care/service coordinator can be from among a variety of social service or medical professions. Care plans are developed with a consumer who has a medium to high level of community support needs and a low to medium level of medical needs. People will be provided secondary prevention benefits such as screening for early prevention.
• CARRE Center III's of Connect CARRE based on a medical model, will offer fully integrated services that provide care coordination across the continuum of social service long-term care and acute and chronic care provider-partnerships. This can be accomplished by either using a centralized approach like PACE or a decentralized approach like the our Chronic Care Coordination demonstration Connect CARRE. Consumers will be helped navigating public and private funding sources and. The provider team's care coordinator will be a nurse manager or someone in another medical profession. Care plans are developed with a consumer who has a medium to high level of medical needs and a medium to high level of community support needs. People will be provided tertiary prevention benefits that will slow the progression of an individuals chronic illness or disease.

Living Rite adds value to the current system of care. The program:

• Develops additional benefits and options for elders and people with disabilities, such as a managed fee-for-service health plan, CARRE Centers, and new support services;
• Provides a framework for the development of a fully integrated delivery system;
• Streamlines the process to access needed services and medical equipment;
• Links Medicare and Medicaid clinical and financial information;
• Develops new outreach materials, such as hospital "welcome" and "discharge" kits.

Waiver Authority: The need for waivers will be assessed once the program design has been completed.

Eligible Population: The program will be voluntary and available to all Rhode Island seniors and people with disabilities.

Initial Scope: The Level I CARRE Centers are expected to be operational first, followed closely by the Level II Centers. Initial scope will be based on services provided by these Centers.

Benefit Package: Living Rite is a complex interaction of current Medicare and Medicaid benefits, service coordination, information and referral, and new benefits such as chore services. These new services will be available to the non-Medicaid population either on a sliding scale basis.

Delivery System: In the medical arena, consumers will have three options:

• Fee-for-service;
• Managed fee-for-service; or
• Managed care integrated service delivery systems.

The design of the managed fee-for-service system of care will ensure that everyone has the option of selecting a lead physician who can monitor ongoing health status and intervene as necessary. The lead physician will be linked to a CARRE Center selected by the consumer. The linkage between CARRE Centers, physicians, and other providers will offer consumers a seamless and efficient access point to any needed service.

Coordinating complex care will be entrusted to interdisciplinary teams of providers. The teams will cross all sites of care: primary care and specialty services, community based sources of care, clinics, hospitals, urgent care centers, home health agencies, nursing homes and adult day care.

Recent Accomplishments:

• Developed and analyzed an all-beneficiary Medicare database for 1992 through 1997 and a Medicare/Medicaid Linked Database for 1995 through 1997;
• Developed state plan amendment utilizing the preventative service option in Medicaid to design a package of benefits for CARRE Center IIIs.
• Fall 2001: A demonstration version of CARRE Center III, Connect CARRE began enrolling participants in the Fall. Connect CARRE is a voluntary program for adults with disabilities and or multiple high risk chronic conditions under age 64. Eighty percent of those targeted are on Medicaid and 20% are dual eligible.

Next Steps

Winter 2001: Working with State Legislature on Long Term Care reform. One of the goals is to receive legislative authority to develop a Medicare and Medicaid waiver for Living RIte. Another goal is to finalize CARRE Center I and CARRE Center II certification standards and develop financing mechanisms for CARRE Center II and III Dual Eligible Participation.

Spring 2002: Invite providers to submit requests to be certified as Level I and Level II CARRE Centers and begin CMS negotiations on Medicaid/Medicare waivers.

Contact Information

Elaina Goldstein
Rhode Island Department of Human Services
Office of the Director
600 New London Avenue, Building 57
Cranston, RI 02920
(401) 464-2121 (Voice)
(401) 464-3677 (FAX)
Email: egoldste@gw.dhs.state.ri.us

Website: http://www.dhs.state.ri.us/