1. Update on the Balancing Incentive Program and Uniform Assessment Tool “Make Medicare Work” Summit Kelly Cunningham, Deputy Administrator Healthcare and Family Services April 11, 2016 1

2. What is the Balancing Incentive Program (BIP)? Section 10202 of the Patient Protection and Affordable Care Act provides financial incentives to States (enhanced Medicaid matching funds) to increase access to non-institutionally-based long-term services and supports (LTSS). Assist States in transforming their long-term care systems by lowering costs through improved systems performance and efficiency, creating tools to facilitate person-centered assessment and care-planning, and improving quality measurement and oversight. Provides new opportunities to serve more individuals in home and community-based settings and continues federal focus on “rebalancing.” In exchange for the enhanced federal match, BIP states were required to implement 3 structural changes by September 30, 2015. 2

3. Balancing Incentive Program (BIP): At A Glance No Wrong Door/Coordinated Entry Points Conflict Free Case Management Core Standardized Assessment 3

4. States participating in BIP must ensure their LTSS systems include three structural elements NO WRONG DOOR— COORDINATED ENTRY POINT SYSTEM CONFLICT-FREE CASE MANAGEMENT SERVICES CORE STANDARDIZED ASSESSMENT INSTRUMENTS Development of a Statewide system to enable consumers to access all long-term services and supports through a coordinated network of agencies. A toll-free BIP Call Center will be operational. Implementation and training plans are under development. The new LTSS BIP website is being built and content gathered. Develop a service plan, arrange for services and supports, support the beneficiary in directing the provision of services and supports for the beneficiary Conduct ongoing monitoring to assure that services and supports are delivered to meet the beneficiary's needs and achieve intended outcomes. State is currently developing plans to carry out and implement strategies related to the Consumer Bill of Rights and related policy changes. Determine beneficiary's needs for training, support services, medical care, transportation, and other services, and develop an individualized, person-centered service plan to address such needs CSA must address the 5 core data sets domains, including activities of daily living (ADLs), instrumental activities of daily living (IADLs), medical conditions/diagnoses, cognitive functioning/memory/ learning, and behavior concerns. 4

5. What is the Uniform Assessment Tool? The Uniform Assessment Tool (UAT) is a standardized and uniform process across community-based programs to determine eligibility, identify support needs and inform person centered planning. The UAT contains screening and assessment components which includes a core set covering five domains: ▫ activities of daily living (ADLs) ▫ instrumental activities of daily living (IADLs) ▫ medical conditions/diagnoses ▫ cognitive functioning/memory/learning ▫ behavior concerns 5

6. Why Do This? The Illinois goal is to advance better health, improve health care quality, and provide value throughout the long term services and supports system (LTSS). Illinois’ UAT will improve access to community- based settings and advance diversion and transition from institutional settings. Illinois’ UAT will result in greater efficiency, transparency, consistency and effectiveness across Coordinated Entry Point (CEP) sites and assessors regardless of program. 6

7. Who Will Be Impacted by the UAT? Illinois’ UAT will directly impact programs operated by HFS, DDD, IDoA, DRS and indirectly impact programs operated by DMH and DASA. Illinois’ UAT will support all persons age 18 and over potentially eligible for Medicaid and State- funded LTSS. 7

8. Desired Outcomes of the UAT 8 Shared data with potential to break down system silos. Integrated systems and protocols across agency programs, resulting in greater coordination of care. Individuals are connected to the right services at the right time based on their needs and preferences. Expanded partnerships with key referral, coordination and direct service providers (e.g. CILs, DD and MH interface). High quality person-centered planning and service delivery. Assessors are trained to use the UAT to assess for an individual’s strengths, needs, and preferences. Service Coordinators/Case Managers for all Medicaid adult waiver programs will use the results of the UAT to inform service planning using person-centered practices.

9. UAT Program Re-Launch Building upon the work of the BIP Advisory Group, an Interagency team (with representatives from HFS, DoA, DHS- DDD, DRS, DMH, & DASA) worked with an IT vendor to modify and develop an automated UAT using the ICAP and interRAI suite as the core data set. Worked relaunched under a contract with Lewin and Associates in January, 2016. The interRAI* Community Health Assessment (interRAI CHA) instrument and its accompanying supplements is an assessment system which helps professionals identify the needs, strengths and preferences of individuals and inform decision-making, resource allocation, best practices and quality initiatives. This tool will be used for all programs except programs supporting persons with ID/DD. * interRAI is an international consortium of healthcare researchers who have developed multiple suites of assessment instruments across multiple population domains. 9

10. UAT Program Re-Launch Continued The Inventory for Client and Agency Planning (ICAP) is a behavioral assessment tool currently used within the ID/DD system and will continue to be used for the ID/DD system, but will be built into an electronic tool using the same software solution as the interRAI CHA tool. The BIP Stakeholder group will be convening in May, 2016, though a firm date has not yet been set. 10

11. What is the basis for the IL UAT? 11 IL UAT (software solution developed by interagency BIP Policy Group and IT vendor) InterRAI Community Health Assessment (CHA) Non-ID/DD Determination of Need (DON) built into the CHA Inventory for Client and Agency Planning (ICAP) ID/DD – behavioral assessment tool

12. IL UAT: Wave One Components Screening and assessment for Community-Based Waiver programs providing support to persons over the age of 18 Core Data Set including: activities of daily living (ADLs) instrumental activities of daily living (IADLs) medical conditions/diagnoses cognitive functioning/memory/learning behavior concerns A mental health supplement A Level 1 screen to identify potentially eligible persons in need of LTSS Business processes that will coordinate with a No Wrong Door System including 1-800 call line, new LTSS website, and IDoA Call Center Ability to drive care and service planning 12

13. UAT Implementation Business Process Mapping Workflow Meetings Development of desired workflow and operational manual/toolkit for future implementation of UAT Wave One Participant Training In-Person and Online Training Wave One Assessors Use UAT and engage in User Acceptance Testing Wave One Assessors provide user feedback on training materials and overall process Wave One process revised (if necessary), UAT software solution finalized based on user feedback and training materials/ approach finalized UAT “live” with Wave One Participants 13

14. UAT Implementation Overview Continued All Medicaid waiver assessors will use the UAT (CHA) to assess for strengths, needs and preferences. Service Coordinators/Case Managers for all Medicaid adult waiver programs will use the results of the UAT to inform service planning. 14

15. Relationships and Integration LTC/LTSS Rebalancing HHS Transformation LTSS/Housing Innovation Accelerator Program MLTSS 15