Quarterly Webinar for ADRC Grantees Part B Grantees Jan 24, :00 PM - 3:00 PM Eastern

Overview of ADRC Enhanced OC Grant Technical Assistance Structure for Part B Grantees Update on Key Areas for Part A Lessons Medicaid Resources for Part B Grantees Options Counseling Training Plans ADRC National Evaluation Overview Next steps Agenda 2

Understand required deliverables for ADRC grantees Where to turn for technical assistance Present latest updates on Part A lessons learned Medicaid resources for Part B Grantees Options Counseling training plans Understand key activities and roles for ADRC National Evaluation Overview Outline upcoming resources and events Objectives of Today’s Call 3

Administration for Community Living, Center for Medicare & Medicaid Services, Veterans Health Administration 2012 Aging and Disability Resource Center Awards American Samoa Guam N. Mariana Islands Puerto Rico Virgin Islands DC HI MD DE NJ CT RI MA NH VT ME MT ID CO WY NV CA NM AZ MN KS TX IA IL WI TN IN OH MI AL MS AR LA GA WV PA OR UT SD ND MO OK NE NY SC NC KY FL VA AK WA Indicates States Awarded Part A (8) States & Territories Awarded Part B (36) Indicates States & Territories Not Eligible for Part B Funding Indicates States & Territories that Did Not Apply for Part B Funding

ADRC Enhanced Options Counseling Program Functions 5

In collaboration with states, develop a National No Wrong Door Options Counseling Program for all populations and all payers which is person centered, financially sustainable and high quality that supports individuals to achieve their goals for community living. 6 AIM Statement

Medicaid Reimbursement James Toews Eric Weakly VA & HCBS Opportunities Kevin Foley Lori Gerhard Care Transitions & MFP Caroline Ryan Elizabeth Leef OC Training & Certification Linda Velgouse Eric Weakly ADRC Business Model & Sustainability Caroline Ryan Kevin Foley Evaluation & Performance Measurement Bob Hornyak Susan Jenkins ADRC Part A Team Leads 7

8 Activities to be completed by end of Year 1  Agreement with the State Medicaid Agency to utilize Medicaid funds for certain ADRC functions.  Plan for implementing the state’s quality improvement process for its ADRC Options Counseling Program.  Delivering evidence-based care transition program in at least one area of the state.  Provider Agreement between a VA Medical Center and a ADRC  Ensure that a plan is in place to have all ADRC Options Counselor in the state trained and certified  Develop baseline data which captures key ADRC functions within a NWD system  A description of the formal agreements that the ADRC Program has entered into with the entities within the state having lead responsibility for implementing the various ACA initiatives Activities to be completed by end of Year 2  A fully developed business model approved by ACL that documents the long-term sustainability of the state’s ADRC Options Counseling Program using Medicaid, VA, OAA, Medicare and other financing sources. Activities to be completed by end of Year 3  Statewide coverage of a NWD ADRC system serving all LTSS populations and all LTSS payers  All Options Counselors trained and certified which adhere to national Options Counseling Standards; and  Statewide agreement and/or coverage for delivering Veterans services through ADRC and have identified the data elements and data sources that could be used to document program outcomes. Required Deliverables Part A

Within 12 Months of receipt of funds have one of the following in place: 1) a formal agreement with the Single State Medicaid Agency with the end goal of making some of the tasks performed by the ADRC Options Counseling Program eligible for Federal Medicaid reimbursement; or 2) a signed Provider Agreement between a VA Medical Center and a ADRC in at least one area of the state which has identified the data elements and data sources that could be used to document Veteran Directed HCBS program outcomes; and the projected annual revenue from VHA for the ADRC administrative expenses; or 3) 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. 9 Required Deliverables Part B

Technical Assistance Structure For Part B  Continuous Updates via TAE Website  Planned quarterly calls for Part B grantees going forward to share lessons learned from Part A grantees  ACL Project Officer – Your First Point of Contact for All Technical Assistance 10

Recent Activities and Lessons Learned Medicaid Options Counseling Training 11

Medicaid 12

13 Baseline ADRC Budget

14 StatesMOUMethod for TrackingFunctions CTNo 5 positions with 100% of time dedicated to Medicaid OC, Outreach, Intake/ screening, Application assistance, and Follow-up MDNo TBDIntake, Assessment, Support planning MANo Existing but not reportedClinical Eligibility Determination, Clinical Assessments for LTSS Program Eligibility, Transition Planning for Members Living in Nursing Facilities, Service Coordination, Quality Assurance, Concurrent Review of Services NHNo N/AOC ORYes Random day samplingOutreach, Information, OC assistance with application, and LOC assessment VTNo 100% quarterly time study- AAAs document 100% of time on Medicaid and non-Medicaid activities one week per quarter Medicaid Outreach, Streamlining application process and Coordination with Duals Initiative WAYes Time studiesOutreach, Screening, Facilitating application, Assisting clients to utilize Medicaid services, Interagency coordination WIYes 100% time tracking spent on Medicaid/ non-Medicaid. Aggregates time data monthly-determines amount of time to Medicaid activities Outreach and Facilitating application, Medical service coordination, LOC/ Functional screen admin, Functional screen/updates, Training and Quality

15 Capturing Best Practices – Medicaid Example Change Framework Wisconsin Examples Strategies:Tap diverse funding sources to expand and sustain ADRC model statewide Change TacticsIntensive face-to-face training of all OC, 100% time allocation method, mandatory reporting Measure Success Baseline – WI ADRCs increased Medicaid reimbursement from average 12% of budget to 28% within two years.

Medicaid 16 CMS Informational Bulletin This informational bulletin was developed in follow-up to ACL’s 2012 funding announcement supporting the use of Medicaid funds to sustain ADRCs. This is a powerful tool as ADRCs work with Medicaid to build support for the effort Funding Announcement : Attachment G Attachment G of the 2012 ADRC funding announcement provides state examples of Medicaid administrative funds used to support ADRC operations. The Centers for Medicare and Medicaid Services (CMS) reviewed and approved this roadmap to receiving Medicaid funds. TAE Fact Sheet This two page technical assistance document provides some basic introductory guidance to ADRCs on receiving Medicaid administrative funds. Box of Resources Medicaid Funding Page Medicaid Funding Page

Options Counseling Training 17

Options Counseling Training & Certification  Create shared vision for a national workforce of Options Counselors using person centered practice skills to support all individuals to get the right services at the right time in the right place  Build consensus on core components of a national Options Counseling Training Program  Develop, test, and finalize national training program  Develop a certification program 18

Training Development Build on state experiences, prior work, and experts Review state grantee training programs/courses Standards and Competencies developed with 19 Option B grantee states (2010) Experts in training and implementation Fit with ADRC EOC announcement/requirements OC Training Team ACL staff State grantee ‘faculty’ representatives CMS, VA BU CADER, SDA Inc., Lewin 19

Options Counseling Training Development Survey of states re OC training courses/programs Develop consensus on core OC job functions and competencies Develop course content based on functions and competencies Person Centered Practice – first course – pilot test in MD in March Spring 2013 – complete development of 2 or more core courses and begin pilot testing Process for finalizing courses o Incorporate feedback of pilot participants, OC “faculty” in all Part A states, and national level advisors and stakeholders o All courses to be available in web based format Summer/Fall 2013 – begin offering core training in all Part A states o Track participation and participant experience o Collect feedback on process and content 20

Options Counseling Certification Conduct environmental scan of certification programs Convene broad stakeholder group to provide input in key design elements of certification programs Stakeholders to include federal agencies, associations, foundations, and technical experts 21

Some Questions About OC Training What is difference between Participant Direction and Person Centered Practice? How will training already in place be integrated into new training? Will person centered practice course be more of a broad concept or will it focus on OC ? 22

ADRC Evaluation 23

ADRC Evaluation 24 Evaluation Goal: Produce generalizable outcomes about the degree to which ADRCs are meeting the Long Term Service and Support needs of the aging and disability populations Approach: Process evaluation to document implementation and an outcomes evaluation to document consumer results

ADRC Evaluation 25 Data Collection The Spring 2013 SART will be used to collect process data 23 ADRC will be randomly selected to help recruit consumers into the outcome study during the spring/summer of 2013 Benefits to your ADRC A customized report containing the outcome and process data for your site that can be used to support management decisions and to attract funding

Next Steps 26 April 2013 Next Quarterly Call (Care Transitions) (VA Opportunities including VD-HCBS) (Performance & Evaluation) Continuous Updates via TAE Website ACL Project Officer – Your First Point of Contact for All Technical Assistance