18 Miss. Code. R. 2-1-VI
The MDHS DAAS will empower older people in the state to stay healthy and active through the Older Americans Act services and the new prevention benefits under Medicare by educating the public on new Medicare preventive health reform changes. Additionally, MDHS DAAS will continue to ensure the rights of older people and prevent abuse, neglect and exploitation. By expanding and enhancing the Long-term Care Ombudsman Program's advocacy and education on long-term issues, older persons will live with dignity by promoting senior's rights and reducing abuse, neglect and exploitation. The respect for residents is the fundamental quality to ensuring quality of life; therefore the Ombudsman Program is partnered with the Division of Medicaid to implement the revision of the Minimum Data Set (MDS 3.0) for Nursing Homes that took effect October 1, 2010. The MDS 3.0 gives residents a voice through the direct interview items on the assessment form.
Mississippi recognizes the importance of consumer directed care and is working on an initiative through the Aging and Disability Resource Center (ADRC) that will create a partnership between the Aging network and the health care industry. DAAS is working with one Area Agency on Aging (AAA) in the central part of the state as a pilot site for a Care Transitions program and a Veteran Directed Home and Community Based Services program. Through a Memorandum of Understanding (MOU), the AAA pilot site will work with a local healthcare provider and a local hospital. The hospital will refer patients that are being discharged with diabetes and another chronic condition to the AAA. The AAA will work with the client to identify a chronic disease self management program workshop where the client will learn how to improve their quality of life. The client will also be assigned a community health worker to identify the services needed to remain independent. The community health worker will be a trained options counselor through a partnership with a local university (Jackson State University). In addition to the community health worker, the AAA will hire a registered nurse to complete annual wellness visits to all Medicare eligible clients to develop a preventive health plan. The preventive health plan will identify services the client needs to remain independent and out of a long-term care facility. The services available include all Title III support services, home delivered meals, and congregate meals.
The care transitions pilot project is designed to leverage resources in the Aging network and health care industry to reduce hospital readmissions and overall health care costs by reducing institutional placement. The partnerships created will enhance the ADRC and create sustainability for the CDSMP.
Mississippi is also working with the G.V. (Sonny) Montgomery VA Medical Center on a Veteran Directed Home and Community Based Services program to provide consumer directed care to veterans. The VA will refer clients to the local AAA for home and community based services. The partnership will increase the number of veterans receiving care without duplication of care services. The AAA and VA will work through a MOU to define eligibility criteria. Eligible veterans will choose needed services and will work with the local AAA's care coordinator to design a plan within the allocated budget. The program will decrease institutional placement and increase the veteran's quality of life.
18 Miss. Code. R. 2-1-VI