= New Jersey’s Tipping Point Department of Health and Senior Services Division of Aging and Community Services Patricia A. Polansky, Assistant Commissioner NCOA-ASA Conference March 26-30, 2008 “Aging in America” March 28, 2008

NJ EASE In 2002  Nationwide NJ EASE toll-free number ( ).  Available statewide – 21 counties.  Consumer accessed information through the 21 Area Agencies on Aging.

NJ ADRC Mission  Redesign access to NJ’s aging & disability long-term care supportive service delivery systems to establish a single pathway that provides access to services for individuals over their lifespan and allows them to age in place.

Re-Engineering NJ EASE  New Jersey had improved its service delivery systems for older adults, persons with disabilities and their caregivers.  Yet consumers still had to struggle through a maze of pathways to get information, determine financial and clinical eligibility and get services.  Aging and Disability were two long-term care systems.

Challenges Faced in Long-Term Care System Redesign under ADRC  NJ EASE was a county-driven system in a home rule state.  Consumers unaware of LTC support services, especially among ethnic communities and under-served populations.  No standardized clinical and financial eligibility determination process for HCBS.  No integration and coordination between state and federally funded programs.

New Jersey’s Reality  MIS/Data Management  State Budget Deficits  Funding and Sustainability  Personnel and Staffing  Leadership Changes

ADRC: No Wrong Door Approach  Responsive  Consumer Driven  Affordable  Appropriate  Flexible  Reliable  Standardized  Single Point of Entry  Trusted  Visible in New Jersey

Implementation Strategy ADRC Model Design Workgroups  Customer Satisfaction  Clinical Assessment  Financial Eligibility  MIS  Website Design  Public Awareness  Cultural Competency  SHIP Alignment  NJ211  Consumer Direction  Benefits Screening

What They’re Saying about ADRC?  More comprehensive service packages  Faster Access to services  Increased partnerships  Increased funding for home and community-based services  More efficient usage of Older Americans Act dollars  Working collaboration with disability network

ADRC Model & Client Pathway Infrastructure Organizational Preparation Initiate Client Pathway Identify One Client Pathway Identify Two Client Pathway Indicate Client Pathway Implement Client Pathway Listening and Data Gathering: First contact, listening and recording information Interactive Gathering, Clarifying Wants and Needs: Screening, Initial Assessment Counseling In-Depth Assessment: Financial, Clinical, IDT “Touch Base” Counseling: Negotiate Development of Service Plan, Client Self Directed, IDT Contact and Commitment Service Arrangement and Follow-Up: Arrangement of Services Care Management and on going contact INQUIRE

NJ Success Story: MI Choice Clinical Assessment Tool  Five Levels of Service Needs for All State & Federal Long-Term Care Supportive Services: 1.Information & Assistance 2.Homemaker 3.Intermittent Personal Care 4.Home Care 5.Nursing Home

NJ Success Story: Eligibility Screening Process  A predictor of the “most appropriate” Level of Service Needs  Actual placement is based on:  Consumer direction  Availability of informal care  Ability to ensure health and safety  Local availability of formal care options  Availability of financial resources:  What person can buy  Available state and local resources

NJ Success Story: Fast Track Eligibility Determination  Statewide process through which consumers who are clinically eligible for nursing home care and meet the Medicaid financial criteria receive home and community- based services for up to 90 days while they complete the full Medicaid application and eligibility.

 Deploying an integrated application (Social Assistance Management Systems or SAMS) statewide to advance the ADRC for intake, case management, service planning, service provision, service invoicing and the federal reports mandated under the Older Americans Act. Will also:  Create financial reports for the Office of Budget & Management to capture client service utilization and expenditure data and to measure and track funding parity.  Support a web-based client tracking system to support clinical eligibility determination, fast track financial approvals, service coordination and quality assurance.  Include licenses and hosting services from Synergy Technologies for 700 community agencies and 2100 end users. NJ Success Story: Computerized Client-Tracking System

NJ Success Story: Hospital PAS Pilot  State responsible annually for over 47,000 pre-admission screening assessments for level of care determination.  Hospital staff can screen/authorize placement for individuals seeking Medicaid admission into a nursing home or on Medicaid waiver.  Pilot initiative began in February 2006 and is now statewide.  Over 2,100 individuals have been assessed to date.

Putting Policy into Practice

ADRC Is The Building Block For: Real Choice Systems Transformation Grant CMS, 2006 Money Follows the Person Demonstration CMS, 2006 Nursing Home Diversion Modernization Grant AoA, 2007 Empowering Older People To Take More Control Of Their Health Through Evidence Based Prevention Programs AoA, 2006 Alzheimer’s Disease Demonstration Grant AoA, Mission Nutrition AoA, 2005

Pictured above is Governor Corzine signing New Jersey’s long-term care reform bill into law on June 21, It is the ADRC model (its partnerships, products and processes) that provides the framework underpinning the Act. Independence, Dignity & Choice and Choice in Long-Term Care Act (Act) continued…

Independence, Dignity & Choice in LTC Act 1.Develop and implement a process that rebalances the overall allocation of funding from institutional care to HCBS. 2.Develop and implement consumer assessment instrument that is designed to expedite process to authorize the provision of HCBS through fast-track eligibility prior to formal financial eligibility determination. 3.Develop and implement a client-tracking system. 4.Develop and implement a system of Statewide LTC service coordination and management. continued…

Independence, Dignity & Choice in LTC Act 5.Identify HCBS LTC services models that are efficient and cost-effective alternatives to home care. 6.Develop a comprehensive quality assurance process with clear and concise performance standards for those services. 7.March 1, 2007: Commence Executive Order 31 pilots in Atlantic & Warren that includes:  Computerized tracking system for Medicaid long-term care expenditures  Revised clinical assessment tool continued…

Independence, Dignity & Choice in LTC Act 8.Staff the Medicaid Long-Term Care Funding Advisory Council 9.Make information available to the general public on a Statewide basis 10.Commencing March 1, 2008 expansion of the services and measures identified above to the remaining counties

Global Budget Deliverables  Budget projection methodology  Rebalancing of total Medicaid expenditures  Funding parity between nursing homes and home and community-based services.  Rate reimbursement methodology  Individualized budgets  Consumer-directed model  Transitioning of individuals from Global Options for LTC instead of nursing home placement

YearState FundingFederal Match SFY06$15 million SFY07$15 million SFY08$13 million Proposed SFY09$13 million Dedicated Global Budget Funding

Office of Management and Budget (OMB) Supports Global Budget  Monthly meetings with OMB, Department of the Treasury  OMB representation on Medicaid LTC Funding Advisory Council  Consolidated Global Budget line item in SFY09 State Budget of 1915 (c) Medicaid waiver funding:  CCPED – $57.7 million  Assisted Living Waiver – $55 million  CAP – $10 million  GO – $26 million (nursing home transitions/ADRC)

Total Global Budget: $148.7 Million  Through Deficit Reduction Act, Medicaid Waivers are being consolidated  No more slots

 Gives participants control and choice of services and providers.  Provides continuity of funding regardless of setting.  Fosters individual participation in service planning and delivery.  Fosters viable, affordable and cost-effective options for long-term care supportive services.  Gives the state more flexibility and budgetary control. Global Options for Long-Term Care

Vision for SFY2013  Document and certify to the Governor and the Legislature that funding parity between nursing home care and alternative home and community-based services has been achieved.

NJ Department of Health and Senior Services Long Term Care Services Funding Allocation (State Share) Total LTC allocation was $591.7 million FY 1997 Home and Community 7.3% Nursing Homes 92.7% Home and Community Programs CCPED Respite Care Home Care Expansion Program Medical Day Care Older Americans Act Alzheimers Safe Housing and Transportation Congregate Housing

NJ Department of Health and Senior Services Long Term Care Services Funding Allocation (State Share) FY 2007 Home and Community Programs Global Options CCPED AL/AFC Respite Care Home Care Expansion Program Medical Day Care Older Americans Act Alzheimers Safe Housing and Transportation Congregate Housing JACC CAP Community Choice Home and Community 23% Nursing Homes 77% Total LTC allocation was $882 million

NJ Contact Information  Patricia A. Polansky, Assistant Commissioner  (609)  Division of Aging and Community Services  Nancy E. Day, Director  (609) 