OT 504 week 1 introduction to Older Adult policies, Insurance and 4 M's
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86 Terms
What are the 4Ms of Age-Friendly Health Systems?
What Matters, Medication, Mentation, and Mobility.
what matters definition
Knowing and aligning care with an older adult's health goals, preferences, and priorities.
medication definition
Using age-friendly medications that do not interfere with mobility, mentation, or what matters.
mentation definition
Prevention, identification, treatment, and management of dementia, depression, and delirium.
mobility definition
Ensuring older adults move safely every day to maintain function and independence.
What does "What Matters" focus on?
an anchor: meaning, priorities, independence and QOL
What does the "Medication" component emphasize?
Using the right medication w/o duplicates and unnecessary medication, or serious side affects like fall risk or confusion
What does "Mentation" address?
brain health —>. cognition, mood, mental health
what three conditions does mentation treat?
dementia, depression and delirium
What does "Mobility" focus on?
safe meaningful movement —> transferes, balance, endurance
What does OTA stand for?
Occupational Therapy Assistant.
Who provides clinical supervision to an OTA?
An Occupational Therapist (OT).
Can an OTA provide administrative supervision to an OT?
Yes.
What is the goal of OT and OTA collaboration?
To deliver optimal client care.
In home health, what is a common OT/OTA model?
OT completes the evaluation; OTA implements the treatment plan under OT supervision.
When was the Older Americans Act (OAA) signed into law?
July 14, 1965.
Why was the OAA created?
Due to a lack of community social services for older adults.
What was the primary goal of the OAA?
To help older adults remain engaged in their communities and safely age in their homes.
What agency was established by the OAA?
Administration on Aging (AoA).
What services are funded through the OAA?
Health promotion, transportation, nutrition programs, caregiver support, employment programs, tribal grants, ombudsman services, and elder abuse prevention.
What age group primarily benefits from the OAA?
Adults aged 60 years and older.
Why is OAA funding important?
It helps older adults live independently and reduces reliance on costly nursing home care.
What percentage of older adults are projected to make up the U.S. population by 2030?
20%.
Is the OAA have enough money?
no it doesn’t have enough funding for services, it is underfunded
OAA provides how much money in grants and trusted state and local organizations?
2 billion
What does CARE stand for?
Caregiver Advise, Record, and Enable Act.
Why was the CARE Act developed?
To support family caregivers caring for hospitalized patients.
What are the three hospital requirements under the CARE Act?
Record the caregiver, notify the caregiver of discharge, and educate the caregiver on home care tasks.
What is the overall goal of the CARE Act?
To improve safe and efficient transitions from hospital to home.
what does SGRG stand for ?
Supporting Grandparents Raising Grandchildren
When was the SGRG Act signed into law?
July 7, 2018.
What is the purpose of the SGRG Act?
To support grandparents raising grandchildren.
What age group does the SGRG Act focus on?
Caregivers aged 55 and older raising children.
What does RAISE stand for?
Recognize, Assist, Include, Support, and Engage.
What major outcome resulted from the RAISE Act?
The first U.S. National Strategy to Support Family Caregivers (2022).
What center was funded through the RAISE Act?
The RAISE Resource and Dissemination Center.
the national strategy was developed jointly by which two advisory councils?
RAISE act, and SGRG act
What legislation created Medicaid?
The Social Security Amendments of 1965 (Title XIX).
Who jointly funds Medicaid?
Federal and state governments.
What population does Medicaid primarily serve?
Low-income individuals and families.
Why does Medicaid coverage vary by state?
States administer their own Medicaid programs within federal guidelines.
What is California's Medicaid program called?
Medi-Cal.
What determines Medicaid eligibility?
Income level based on the Federal Poverty Level (FPL) and state requirements.
What groups must states cover through Medicaid?
Children, pregnant women, families with dependent children, people with disabilities, and older adults.
What does LTSS stand for?
Long-Term Services and Supports.
What is LTSS?
Medical and personal care assistance needed due to aging, chronic illness, or disability.
Where can LTSS be provided?
Institutions (e.g., nursing homes) and home/community-based settings.
Who may provide LTSS?
Paid providers and unpaid family caregivers.
What is the primary funding source for LTSS?
Medicaid.
What is meant by Medicaid's "institutional bias"?
Medicaid historically spends more on institutional care than home/community services.
What are examples of personal care services under LTSS?
Bathing, grooming, meal preparation, and housework.
What are examples of medical services under LTSS?
Nursing, therapy, pharmacy, LTACH, SNF, and home health services.
What legislation created Medicare?
The Social Security Amendments of 1965 (Title XVIII).
Who primarily qualifies for Medicare?
Adults aged 65 and older
Can people younger than 65 qualify for Medicare?
Yes, under certain circumstances.
How does Medicare define a skilled therapy service?
A service that improves, maintains, or prevents deterioration of a patient's condition
What is an unskilled service?
Activities focused on general wellness, fitness, diversion, or motivation that do not require OT expertise.
What makes OT services billable under Medicare?
The service must require the skill and clinical judgment of a licensed OT.
What is the key documentation focus for Medicare reimbursement?
Reducing illness and injury, improving the ability to perform, functioning independently
The services of the therapist can only be billed and paid by which medicare?
Medicare part B
What are the four parts of Medicare?
Part A, Part B, Part C, and Part D.
What is Medicare Part A?
Hospital Insurance.
What is Medicare Part B?
Medical Insurance.
What is Medicare Part C?
Medicare Advantage.
What is Medicare Part D?
Prescription Drug Coverage.
What is Medigap?
Medicare Supplement Insurance.
what are additional supplemental insurance?
private/commercial insurance, Medi-cal(Medi/Medi), Workers compensation and/or union plans
What does Medicare Part A cover?
Inpatient hospital care, skilled nursing facility care, hospice, and home health.
what does medicare part A emphasize?
any skilled services that are medically necessary,
Medicare A does not cover
custodial care, dental care, eye exams, cosmetic surgery, acupuncture, hearing aids, foot care
In inpatient care in SNF, for medicare A, which days are covered and which are not?
day 0-20 are covered, day 21-100 have to pay a certain amount of coverage
when does the coverage reset in medicare part a?
after 60 days
What does Medicare Part B primarily cover?
Outpatient services.
Does Medicare Part B cover OT services?
Yes.
What other services are covered by Medicare Part B?
DME, mental health services, preventive services, and wellness visits.
What is another name for Medicare Part C?
Medicare Advantage.
Who offers Medicare Advantage plans?
Private insurance companies approved by Medicare.
What extra benefits might Medicare Advantage plans offer?
Vision, hearing, and dental coverage.
What does Medicare Part D cover?
Prescription medications.
s Medicare Part D mandatory?
No, it is optional.
What factors influence Part D costs?
Pharmacy used, plan selected, drug formulary, and medication tier.
What is dual eligibility?
Qualifying for both Medicare and Medicaid.
What is a common nickname for dual eligibility in California?
Medi-Medi.
What is an advantage of dual eligibility?
More options for healthcare coverage
What is a challenge associated with dual eligibility?
Potential for uncoordinated services.