Q&A Work Group Sessions Vision Person Centered System ADRC Options Counseling Program Introduction To ACL

"For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long- term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

This new HHS Operating Division brings together the Administration on Aging (AoA), the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD) This single agency is charged with developing policies and improving supports for seniors and people with disabilities.

Administration for Community Living U.S. Department of Health and Human Services, Administration on Aging, Washington DC PHONE | FAX | | WEB

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Management Information System Personal interview Develop Action Plan Connect To Services Follow-up CDSMP/EBDP Care Transitions HCBS Nutrition & SNAP Housing & Energy Transportation Individual Rights Lifespan Participant In Control & Directing Services Participant In Control & Directing Services NWD/ADRC System NWD/ADRC System Continuous Quality Improvement 9

An approach of providing services to assist an older individual with activities of daily living, in which: – (A) services are planned, budgeted and purchased under the direction and control of the individual; – (B) individual is provided with I&A as necessary and appropriate to enable individual to make informed decisions about care options; – (C) needs, capabilities and preferences of the individual are assessed; – (D) plan of service is developed together with the individual, family caregiver or legal representative; and – (E) the AAA or SUA provides oversight to ensure quality of services provided and appropriate use of funds

National Vision for ADRCs Aging and Disability Resource Centers … every community in the nation every community in the nation highly visible and trusted highly visible and trusted people of all incomes and ages people of all incomes and ages information on the full range of long term support options information on the full range of long term support options point of entry for streamlined access to services point of entry for streamlined access to services 11

2012 ADRC Funding Opportunity Just the Facts 3 Yr Grant Awards 56 States/Territories Eligible Est. Award $2.3 Million Up to 8 Awards Part A 1 Yr Continuation 48 States Eligible Est. Award $200,000 Up to 48 Awards Part B

2012 ADRC Funding Opportunity # 1 NWD Model Strengthening the capacity of ADRC Options Counseling Program to serve people of all ages, income levels and disabilities by adopting a “No Wrong Door” approach that involves a wide variety of community partners

2012 ADRC Funding Opportunity #1 - NWD Model? ADRCs are not about replacing existing organizations and networks. It’s about building a better, more coordinated network.

Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica September 2011 A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers This Scorecard finds that generally states with the highest level of performance have enacted public policies designed to:  Improve access to services and choices in their delivery by directing state Medicaid programs to serve more people in need and offer alternatives to nursing homes that most consumers prefer.  Establish a single point of system entry to help people find needed information and more easily access services.  Improve support for family caregivers by offering legal protections as well as other services to address caregiver needs.

Rapidly diffusing trained and certified ADRC Options Counselors throughout the funded states, and building stronger partnerships between health and LTSS 2012 ADRC Funding Opportunity #2 Trained/Certified Options Counselors

ACL Vision for Role of Options Counseling 18 Options Counselor Specific Requirements Person-Centered Planning Participant Direction Cultural Competency Communication Decision Support Quality Options Counselor Specific Requirements Person-Centered Planning Participant Direction Cultural Competency Communication Decision Support Quality VD-HCBS Support Broker VD-HCBS Support Broker Money Follows the Person Coordinator Money Follows the Person Coordinator Participant- Directed Counselor Participant- Directed Counselor Care Transitions Transitions Coach Care Transitions Transitions Coach *Options Counselors include case/care managers and service coordinators from AAAs, ADRCs, and other providers.

Stakeholders Centers for Medicare & Medicaid Services (CMS) State Units on Aging State Units on Disability Council for Social Work Education (CSWE) National Association of Area Agencies on Aging (n4a) National Association for Social Workers (NASW) National Association of State Directors of Developmental Disabilities Services (NASDDDS) National Association of State Mental Health Program Directors (NASMHPD) National Association of States United for Aging and Disability (NASUAD) National Autism Association (NAS) National Council on Independent Living (NCIL) Social Work Leadership Institute (SWLI) Through grant – AAAs, CILs

2010 OC Grant Timeline  11/10 – 3/11 Met with grant states to discuss “strawman” draft standards  4/11 State draft standards were due to ACL  8/11 State draft OC evaluation plans were due to AoA  9/11 State draft OC evaluation plans were finalized  10/11States began standards implementation  7-9/12States write-up evaluation reports/final comments on standards  10/12 Options Counseling Standards finalized 

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Developing financially sustainable ADRC models that include revenue from multiple programs to cover expenses associated with tasks such as: Outreach Screening/Assessing needs for LTSS Service plan development Assisting individuals in determining their eligibility for public programs 2012 ADRC Funding Opportunity # 3 Financial Sustainability

Current Status of ADRC Funding February 17, 2012 Source: The Lewin Group Analysis of October 2011 ADRC Semi-Annual Reports 23

Sustaining ADRC Activities Summary of Funding Pursuits Across 14 ADRC State Plans PossibleCurrentPossibleCurrentPossibleCurrent ADRC Grant, OAA SHIP, MIPPA State Funds, VD-HCBS

Section 10202: Balancing Incentive Program Effective October 1, 2011 Offers enhanced Federal match to States that make structural reforms to increase nursing home diversions and access to HCBS –2% if less than 50% LTSS spending in non-institutional settings –5% if less than 25% LTSS spending in non-institutional settings States must implement structural changes including “no wrong door–single entry point system,” conflict-free case management, and core standardized assessments

Section 2403: Money Follows the Person Provides for the extension and expansion of Money Follows the Person through 2016 Offers States substantial resources and additional program flexibilities to remove barriers More States have recently been awarded MFP grants CO, FL, ID, ME, MA, MN, MS, NV, NM, RI, TN, VT, WV received an additional $4.3B By April 2011, CMS expects to have at least 42 States and the District of Columbia participating

Managed LTSS States with Managed LTSS: Build on existing managed care experience Offers consumers more choice and better coordinated care Can provide more benefits & choice then FFS Better management of LTSS spending Can provide more cost effective system Improve quality of care measurement in each setting and across settings Move to full integration of Medicare and Medicaid services

2012 ADRC Funding Opportunity Attachments - Sustainability Attachment G: Medicaid Support for ADRC Functions Attachment H: Veterans Health Administration Opportunity for ADRCs Attachment I: Person-Centered Assessment and Planning Attachment J: Draft National Options Counseling Standards Attachment K: Elder Abuse Detection and Prevention Increasing ADRC Options Counseling Programs Role and Capacity Attachment L: Proposed National Evaluation Framework Attachment M: Other Federal Opportunities that May Align with ADRCs

2012 ADRC Funding Opportunity #4 National Performance/Outcome Standards Adopting national performance and outcome standards and aligning data collection and reporting methods across LTSS payers within a state

ADRC Options Counseling Program Functions

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32 Veteran-Directed Home & Community Based Services  The Veteran-Directed Home and Community- Based Services (VD-HCBS) program serves Veterans of any age who are at risk of institutional placement as well as their family caregivers.  VA Medical Centers (VAMCs) purchase these services on behalf of Veterans from:  State Units on Aging,  Area Agencies on Aging, and  Aging and Disability Resource Centers

Program Status Map 33

I don’t mind change…I just don’t want to be there when it happens. Adrian Monk Monk, USA Network

 An assessment and care planning assistance  Decide for themselves, or with a participant representative, what mix of goods and services will best meet their, and their family caregiver’s care needs  Manage a flexible, individual budget  Hire and supervise their own workers, including family or friends  Purchase items or services needed to live independently in the community  Have financial management and support services which facilitate service delivery The Veteran Receives 35

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