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2. Agenda  ADRC / No Wrong Door Schematic  Updates and Resources ► Medicaid ► ACA Initiatives and Care Transitions ► VA & VD-HCBS  Options Counseling Training Progress  New Funding Opportunities 2

3. 3 The ADRC/NWD System

4. 4 4

5. Medicaid 5

7. 6 Broad Areas of FFP Activity 1. Outreach 2. Screening 3. Facilitating application 4. LOC assessment and/or determination 5. Service plan development 6. Quality improvement

8. Person Centered Options Counseling  Determines need/interest in OC Schematic ActivityAttachment G FFP Attachment G FMAP Determines interest/need for OC Outreach Supports immediate needs/personal interview – identify strengths and preferences OutreachWaiver case management Comprehensive review of private resources, informal caregiver supports, and screening for public programs Outreach/Screening for Medicaid and other public programs (includes level I screen under BIP) Pre-screening for NF admission Develops person-centered LTSS plan Potentially, if Medicaid eligible or Medicaid being considered Waiver case management

9. Streamline Access to Public Programs ActivityFFP FMAP Preliminary Functional Eligibility Assessment Facilitating applications Actual LOC assessment (HCBS and NF) Preliminary Functional Eligibility Assessment Facilitating applications Final Determination Functional Yes Final Determination Financial Yes

10. Follow up ActivityFFPFMAP Ensures service initiation as needed Yes On-going Care Coordination PotentiallyYes Participant Directed Support Initiate services through participant direction (potentially) Yes

11. Administration  Determines need/interest in OC Schematic ActivityAttachment G FFP Attachment G FMAP Management Information Systems - CQI (There is potential funding for activity through various initiatives but generally not an FFP or FMAP activity) Quality Assurance Program (including training on allowable activities, recording, monitoring and related activities) Yes State Administration/Governance and Financing Yes

12. ADRC Medicaid Funding Case Study: Wisconsin Year began claiming ActivitiesMethodologyAmount Claimed Annually 1999 1.Outreach and facilitating application. 2.Medical service coordination. 3.Level of Care/Functional screen admin 4.Functional screen – updates, training, quality Track 100% of time spend on Medicaid and non-Medicaid. Expect $14M Based on project statewide ADRC operating costs of $50M & FFP covering 28%. Prior to implementation of extensive training on how to track time, percentage was 12-14%. 12

13. Continuous Quality Improvement  CQI for FFP is critical so that staff know what is Medicaid related activity and what is not and how to record it  Look for posted documents from WI

14. ACA Initiatives and Care Transitions 14

15. Part B Deliverable  A formal agreement between the ADRC Options Counseling Program with a coordinated care delivery model and identification of ongoing Medicare or other Federal funding for ADRC operations. For example, documentation of a formal agreement(s) that the ADRC Program has entered into with the entities within the state having lead responsibility for implementing the various ACA initiatives and identified Medicare funding streams to support ADRC functions. 15

16. State Innovations Model (SIM) Initiative  GOAL: Test whether new service delivery and payment models will be more effective and produce better outcomes when they are implemented as part of a broad-based, Governor-led, statewide initiative that brings together multiple payers and stakeholders -- and uses the levers of state government to effect change ► $275+ million competitive funding opportunity for States ► Partner with states to develop and implement broad-based State Health Care Innovation Plans ► States engage a broad group of stakeholders in health system transformation ► Two types of awards:  Model Testing – over $225 million over three to four years for 6 states  Model Design & Pretest – up to $50 million for 19 states 16

17. State Innovations: Participating States 17

18. Stakeholder Engagement Plan  Elements ► Who will be involved? (names, roles, governance, organizations/affiliations) ► What will they be doing? (Action items, work groups, task forces, etc.) ► How, when, where will they interact? (face to face, conference calls) ► Process for accountability, follow-up  Logistics ► Due to project officer on May 1, 2013 ► Format is team-generated 18

19. Care Transitions Activity update  165 ADRC communities in 41 states are operating acute care transition programs  39,580 people served (2010-2012)  92 out of 102 CCTP sites are partnering with ADRC systems 19

20. ADRC Healthcare Partnerships 20

21. Consumer Story: Mr. P 21

22. Transitions Products and Resources  Template for Developing Success Stories* Template for Developing Success Stories  Aging Network and Care Transitions: Preparing Your Organization Toolkit Aging Network and Care Transitions: Preparing Your Organization Toolkit  Washington State’s ADRC Care Transitions Intervention Toolkit Washington State’s ADRC Care Transitions Intervention Toolkit  Resources for Partnering with Hospitals and Critical Pathway Providers Resources for Partnering with Hospitals and Critical Pathway Providers  Care Transitions Quarterly Work Group Call ► Date: July 15, 2013 ► Time: 1:00-2:30 p.m. ET ► Register Register *Submit success stories to Caroline.Ryan@acl.hhs.govCaroline.Ryan@acl.hhs.gov 22

23. VD-HCBS  (5 minutes)  (Update on progress/products or resources for Part B grantees) 23

24. Options Counseling Training Progress 24

25. Standards Personal Interview Exploring Options/Planning Decision Support Collaboration with Individual to Develop Action Steps or Long Term Support Plan Access to Community Supports Follow-up Job Duties Conduct One-to- One Person Centered Interview Develop Person Centered Plan Facilitate Streamlined Access to LTSS Ongoing Follow Up and Documentation Competencies Knowledge Skills/Abilities Training Build upon current best practice Design curriculum based on Standards, Job Duties and Competencies Certification Creation of National Advisory Council for guidance and input Leverage existing national certification efforts National Options Counseling Training and Certification Program Development

26. National Options Counseling Training Demonstration First Year Timeline Spring 2013 Last pilot of Person- Centered Thinking conducted. Training content and organization finalized based on feedback States identify and recruit participants. Summer 2013 Participants take short OC Intro course online. Participants take Person- Centered Thinking course in- person and Person Centered Planning via webinars Fall 2013 Participants complete additional courses online. Revisions to training made based on state and participant feedback. Share Framework/ Timeline for Certification Process

27. Person Centered Thinking and Planning Foundational Options Counselor Course  Develop skills that: ► Support each person’s choices, self-direction and control ► Enable counselors to understand what’s important to and important for each person ► Enhance listening and problem solving to help the person find the services and supports that work best for him/her  Course adapted for OC Training Program by Support Development Associates, LLC (SDA) ► In person 2 day course, online follow up

28. Results from first Person Centered Thinking and Planning Pilot Participants: training very effective improving their abilities in:  Encouraging information sharing from individual and family using a variety of discovery tools such as open ended questions, relationship maps, and communication charts. (21)  Using active listening to understand each person’s approach, views, what is important to and for each individual. (20)  Respecting each individual’s right to have as much control as they want in planning and using LTSS. (20)  Understanding that family, caregivers, and community may provide important informal and formal supports. (20)  Providing information that helps the individual identify and weigh the pros and cons of their options. (20)

29. Draft Options Counseling Training Curriculum  Enhanced Options Counseling in ADRC/NWD Programs and Systems – Introduction (online, piloted May 2013) ► What is ADRC/NWD System - overview ► OEC role and purpose in an ADRC/NWD system ► Duties/responsibilities of OECs (include documentation and follow up)  Person Centered Thinking and Planning ► Provide tools and skills to help people get the services and supports that work for them  Exploring Public and Private Options ► Part 1: Private Pay, Family and Community Supports ► Part 2: Key Public Programs including Participant Directed Options  Facilitate Streamlined Access to LTSS ► National, state, local programs ► Eligibility and enrollment issues  Serving All Populations ► Overview of aging and disability health and social issues, and culture and diversity

30. Draft Options Counseling Supplemental Training Courses Serving Unique Populations  Each course provide in depth knowledge for a unique population group  Unique populations include: ► Older adults ► People with physical disabilities ► People with intellectual or developmental disabilities ► People with specific conditions such as Alzheimer’s

31. New Funding Opportunities  Medicare Improvements for Patients and Providers Act: Medicare Savings Program, Low Income Subsidy & Prescription Drug Enrollment Assistance through the Aging Network, State Health Insurance Assistance Program and Aging & Disability Resource Centers. (June 20 th Due Date)  Creating and Sustaining Dementia-Capable Service Systems for People with Dementia and their Family Caregivers (July 17 th Due Date) 31

32. Wrap Up