January 2012 AoA’s Draft National OC Standards Revision #2

Design Considerations What should trigger or lead into options counseling? Who should receive options counseling? What is involved in options counseling? Who will provide it? Staff qualifications, training needs, etc. How will it be tracked and evaluated? How does options counseling contribute to streamlined access to supports? 2

What are you hoping to learn? Update on national standards Tools for person-centered options counseling Expectations for OC Format/guidelines for OC Successful strategies/best practices from grantees What is being looked at for tracking minimum standards? 3

What are you hoping to learn? Linkages with MDS section Q Implementation of OC training programs Tips for transitioning to full options counseling at the point of intake among all gatekeeper agencies Process of developing standards How are grantees funding OC? Rural issues in finding qualified staff 4

Learning Objectives Explore design and implementation issues related to developing an OC program. Reflect on your own organizational capacity to implement OC. Learn about some strategies and approaches other states have used in developing OC. Hear about tools you can use for training staff to deliver OC and for evaluating OC. 5

Management Information System Personal interview Decision Support Develop Action Plan Connect To Services Transportation CDSMP/EBDP HCBS Nutrition Housing Participant In Control & Directing Services Participant In Control & Directing Services No Wrong Door System Continuous Quality Improvement Vision of a Coordinated LTSS System 6

AoA Vision for Role of Options Counseling Options Counselor Specific Requirements Decision Support Person-Centered Planning Cultural Competency Communication Participant Direction Quality Options Counselor Specific Requirements Decision Support Person-Centered Planning Cultural Competency Communication Participant Direction 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 service providers. 7

Goals of National Standards Ensuring that there is a process in place so that individuals have streamlined access to supports Improving the consistency and quality of OC provided by ADRC networks including capacity to work with individuals who are seeking private as well as public supports; Providing a basis to determine the impact of OC on the LTSS system; Developing the groundwork for training and continuing education materials and programs related to OC; and Preparing the ADRC network to meet the demands of the next several decades as a growing aging and disability population base seeks assistance in navigating LTSS 8

Contents of Draft Standards Introduction Background Goals of the Standards Standard 1: Service Definition Standard 2: Service Design/Getting to Options Counseling Standard 3: Components of Options Counseling/Decision Support Standard 4: Staffing Standard 5: Partnerships Standard 6: Continuous Quality Improvement, Evaluation and Outcomes 9

Revision #2 Incorporates feedback from…  Federal Partners NCIL NASUAD NASDDDS TA Centers (Lewin, NRCPDS, NCOA)  Grantee draft standards  Individual calls with states to discuss standards, evaluation and progress 10

Standard 1: Service Definition (Draft) Options Counseling is a person-centered, interactive, decision-support process whereby individuals are supported in their deliberations to make informed long-term support choices in the context of their own preferences, strengths, and values. The process may include developing action steps toward a goal or a LTSS plan, and, when requested, assistance in accessing support options. It also includes following-up with the individual. Options Counseling is available to all persons regardless of their income or financial assets. 11

Standard 1: Service Definition ( Essential Components ) a personal interview, identification of desired and available options (including informal supports and public, and private resources), a facilitated decision-support process (weighing pros/cons of various options), assistance to develop an action plan or LTSS plan that is directed by the individual, connections to services and supports follow-up. 12

Standard 1: Service Definition: Target Populations “While the broad service population is the ideal, if ADRCs have limited funds, it is suggested that ADRCs consider targeting this service to the following categories of individuals due to the more immediate nature of their need for Options Counseling:  individuals transitioning from hospitals,  individual transitioning from skilled nursing facilities or extended care facilities, and  individuals at high risk for institutionalization.” AoA National Draft OC Standards 13

Standard 2: Getting to Options Counseling Initiation/Referral  Lists various scenarios that may indicate need for OC.  Calls for uniform protocol among all partners to offer OC to individuals. Delivery Setting  Should be in setting of preferred by individual. 14

Standard 3: Components of Options Counseling/Decision Support Process Personal Interview (formerly “assessment”) Exploring Options/Planning Decision Support (weighing pros and cons) Collaborating with Individual to Develop Action Steps Access to Community Supports Follow-up 15

Standard 3: Staffing Staffing Structure  Flexibility left to local level Staff Education and Work Experience  Local flexibility  Not entry level  Emphasis on skill set Staff Training  Mapping with AoA core competency project (NRCPDS) Supervisor/Manager Training  Importance of being able to support people in this work 16

Tools for Supervisors and Managers Options Counseling Training Resources and Tools Webpage  Training power point slides and handouts  Tools for Options Counselors Action plan template Motivational interviewing tools  Tools for Supervisors Call listening guidance Job descriptions 17

Standard 4: Partnerships Key Partners Partner Roles Emphasized in formal OC standards 18

Standard 5: Continuous Quality Improvement Documentation Tracking outcomes Quality improvement plan linked to outcomes At minimum need to monitor  individual satisfaction with options counseling such as assistance with informed decision making,  effectiveness in linking people to HCBS when requested by the individual, and  transition and diversion. 19

Revision #3 (Spring 2012) Will Focus on ….  Targeted feedback/buy-in from specific federal partners NASW AIRS N4a Department of Education (RSA)  Monthly calls with states to discuss standards, training, and evaluation 20

How is OC Funded? State funds Older Americans Act Rehabilitation Services Act funding State Health Insurance and Assistance Program (SHIP) and Medicaid Improvement for Patients and Providers Act funding (MIPPA) Medicaid administrative funding (FFP) CMS funding for programs operated by ADRCs that provide transition support to people moving back into the community after a hospital, nursing facility or institutional stay, (Money Follows the Person) Veterans Affairs Medical Center funding for options counselling and participant- directed services provided to Veterans Some states exploring fee for service and sliding scale structures/opportunities 21