OSS Updates

Division of Community and Facility Services – Nursing Facility, Home Again, Home Health, Hospice, Nurse Aide, and OSS

OSS is an entitlement program that is a state supplement to a person’s Security Income (SSI/ SSA).

The purpose of this program is to provide reimbursement to enrolled Community Residential Care Facilities (CRCFs; also known as assisted living facilities) who provide room and board and a degree of personal care for eligible consumers. OSS is NOT a Medicaid program; it is funded at 100% state funding.

OPTIONAL STATE SUPPLEMENTATION (OSS)

3

• Number of Consumers 3,420 (OSS &

OSCAP)

• CRCF Medicaid enrolled facilities: 332

• OSCAP Facilities: 80

Consumer Payment Source :

• SSA: 43%

• SSI: 59% ($733)

• 54% Female & 46% Male

• Personal Needs Allowance (PNA)

– $65 SSI

– $85 SSA

Quick Facts

• 65 years or older, or 18 years of age or older and blind or disabled

• Be a U.S. citizen or qualified noncitizen

• Have a Social Security number

or file for one • File for any other benefits to

which they may be entitled • Meet net income limit of

Current OSS Rate: $1,416

• Can’t exceed resource limit of $2,000 for an individual

Eligibility Criteria

• The Optional Supplemental Care for Assisted Living Participants (OSCAP) service provides an enhance payment of $207 to the CRCF for providing additional services to OSS residents in need of physical and cognitive assistance, in order to complete activities of daily living and remain in the community.

Services available

OSS- Assistance with a degree of personal care

OSCAP-Two functional dependencies or a cognitive and a functional dependency

Intermediate - A person requiring assistance with more than two functional dependencies, but does not meet skilled level of care

Levels of Care

• Referrals for CLTC, Nursing Home, OSS, or Incontinence Supplies can be made through Phoenix at https://phoenix.scdhhs.gov/initial_electronic_referrals/new – Please document all Referral Confirmation Numbers

– Please don’t send multiple referrals on the same applicant. It will delay the approval process

• Looking for a Medicaid enrolled or Private Nursing Home or OSS Facility please visit Bed locator www.nfbl.sc.gov

Helpful websites

OSS Contact Information

Program Manager

• Alexis Martin, MBA

• 803-898-1060

martina@scdhhs.gov

Program Coordinator II

Terrell McMorris, MSW

803-898-1810

Terrell.McMorris@scdhhs.gov

• Donna Perry, RN

– Pee Dee

– PERRYD@scdhhs.gov • 843-616-2255

• Hope Hopkins, RN

– Midlands

– Hope.Hopkins@scdhhs.gov • 803-542-6966

• Sandra Jones, RN

– Coastal Region

– Jonessa@scdhhs.gov • 803-605-7129

OSS and OSCAP Nurses

Questions

Complex Care Program

Overview SCDHHS

Community & Facility Service

4.2015

Complex Care

• The Complex Care Program is a patient assessment system that targets Medicaid eligible hospital patients who no longer require hospitalization , but meets the nursing facility level of care.

Complex Care

In order to meet Complex Care criteria an individual:

• Must be Medicaid eligible

• Must meet either Skilled or Intermediate level of care

• Must have at least two Complex Care Medical needs.

– Wound/decubitus care- (must be Stage IV)

– Tracheostomy Tube/Cannula

– Oral Suctioning

– Extended duration of parenteral fluids

– Disruptive behavior(s)

(at least 60% of time)

– Diagnosis of HIV (RX costs and IV meds

– Medicaid only who require goal directed therapies (OT, PT, ST)

– Dialysis

– Ventilator dependent (on life sustaining ventilator, six or more hours a day)

– Total care as defined by skilled long term care criteria

– Exception: Morbid obesity (must meet LoC criteria only)

Complex Care Medical Needs

Ronica Tolliver (Program Manager) • mccrayr@scdhhs.gov • 803-898-7216

Kimberly Walker (Registered Nurse) • Kimberly.walker@Scdhhs.gov • 803-898-0388

Hope Hopkins (Registered Nurse) • Hope.Hopkins@scdhhs.gov • 803-542-6962