HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE. Orientation to the Technical Assistance Exchange November 5, 2009

2 Orientation Agenda Overview of Aging and Disability Resource Center, Community Living Program, and Veteran Directed Home and Community Based Services Initiatives Program Descriptions, Reporting and Grant Requirements Technical Assistance Exchange Mission Organization Partners Offerings

3 AoA/CMS Vision for Coherent Systems Management

4 AoA CLP System & Service Elements System Elements Using Single-Entry-Point Programs to Ensure Streamlined Access for Consumers Infrastructure to Support Consumer-directed Service Approaches Quality Assurance Performance Measurement and Evaluation Service Elements Flexible Service Dollars that Follow the Needs of Individuals Targeting Individuals at High Risk of Nursing Home Placement Giving Consumers the Option to Use a Consumer- directed Model Targeting Individuals at High Risk of Medicaid Spend-down Complementing Caregiving and Individual Resources

5 Technical Assistance Exchange Technical Assistance Resources  Weekly Electronic Newsletters  Websites  Resource Materials  Examples from the Field  Grantee Surveys Building a Grantee Community  Teleconferences/Webinars  National Meetings  Online Forum

6 Mission of the Technical Assistance Exchange To make information and resources available to states and community organizations that are designing, implementing or expanding Aging and Disability Resource Centers (ADRC) and other types of single entry point systems, to assist recipients of the Community Living Program (CLP) initiative grants carry out successful programs, and to build a community of stakeholders involved in making changes to their long term care systems to exchange ideas, knowledge and best practices. The TA Exchange provides a forum for grantee-to-grantee information exchange on policy and program infrastructure development, and direct technical assistance to and between the grantees as they develop, implement, and evaluate their ADRC and CLP projects.

7 Perspective from the Outside Inside

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9 Overview: Community Living Program Diversion Strategy Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Nursing Home/Medicaid Diversion Spend-down to Medicaid

10 Overview: Veteran Directed Home and Community-Based Service Program (VDHCBS) Piloted in AAAs in CLP states Package of services that the VA purchases from AAAs on behalf of eligible veterans Opportunity to self-direct long-term supports and services that enable them to avoid institutionalization and continue to live independently at home AAAs will assist with assessment and care planning, arrange fiscal management services, and provide ongoing options counseling and support

11 HI AK MT ID WA CO WY NV CA NMAZ MN KS TX IA WI IL KY TN IN OH MI ALMS AR LA GA FL SC WV VA NC PA VT RI ME NH OR UT SD ND MO OK NE NY CT MA DC Community Living National Landscape Veteran Directed Home and Community Based Services Programs DE Indicates that VDHCBS site is operational

12 Reporting and Grant Requirements Semi-Annual Report Due each year on April 30 and October 31 State and local level data elements to be combined into one web-based system in April 2010 Prior reports posted on website Grants Monitoring Calls with AoA Semi-annual Conducted about halfway between written reports Attendance at National Meetings (Save the Date - February 22-24, 2010 in Alexandria, VA) ADRC Five Year State Plan CLP/VDHCBS “Ticker” – number of enrolled individuals reported to TAE monthly VDHCBS Readiness Review for AAAs

13 TA Leads Assigned to Each State - All Grants Roger Auerbach MO, OR Cindy Gruman CT, GA, MA, MI, NH, NJ, NY, ND, SD Amy Herr CO, IN, IL, IA, ME, MD, MN, MT, WA Barbara Ettner AK, CA, FL, ID, NV, NC, OH, SC, VT, VA, WI

14 TA Leads Assigned to Each State - All Grants Sarah Lash AL, AR, KS, LA, MS, TN, TX Gilbert Thompson AZ, DE, DC, GU, HI, KY, NM, CNMI, PA, RI, WV Lauren O’Reilly NE, OK, UT, PR

15 TAE Website – Primary Mechanism to Disseminate & Exchange Information Calendar of Events Background materials for upcoming TA events Grantee Profiles Service Coverage Maps Online Discussions Summaries of Past TA events Surveys of grantees Materials grantees want to share Grantee Online Community Registered and public users

16 Monthly Teleconferences Topics based on grantee needs Monthly all-grantee calls a generally held on on 1 st Thursday and 2 nd Wednesday of every month at 3:00 p.m. Eastern. Topics and call-in information announced in the Newsletter. Expert or grantee representatives featured Summary, including questions and answers, posted on website after call Selected topics planned in FY2010 Targeting Consumers at Risk of NH Placement and Spend-down Hospital Discharge Planning Models – Best Practices IT Development and Maintenance Cultural Competence / Working with Tribes

17 TAE Trainings On-line through live webcasts, recorded webcasts available for download, and “build your own” training resources Courses are designed in two formats: lecture and virtual roundtable Continuing Education Units (CEUs) from NASW are available for many courses Offerings planned in FY2010 Overview of ADRC Program Making a Profit in a Non-Profit World The Art of Options Counseling Creating Successful Aging and Disability Partnerships Program Evaluation /Continuous Quality Improvement for ADRCs and CLP Care Transitions

18 Other Support Activities On-Site Technical Assistance High level strategy sessions Engage / energize stakeholders Facilitate meetings Make presentations Staff trainings Individualized assistance with specific objectives Annual National Meetings Save the Date - February 22-24, 2010 in Alexandria, VA In-person technical assistance Exchange among grantees

The National Resource Center for Participant-Directed Services (NRCPDS) We are a non-profit organization with the mission to spread the availability of quality consumer-directed programs to all persons Work both with AoA and the VHA to advance this mission CLP Team: Consumer Direction Technical Assistance (TA) Suzanne Crisp – Lead for CLP TA Dianne Kayala – Director of New Initiatives Sandy Barrett – TA Consultant

NRCPDS (continued) VD-HCBS Team: Readiness Reviews and Technical Assistance (TA) Dianne Kayala – Lead for VD-HCBS Suzanne Crisp – Director of Program Development Sandy Barrett – TA Consultant Mollie Grotpeter – FMS Lead Mark Sciegaj and Casey Sanders – Training Leads 20

NRCPDS Role Specialize in consumer-directed program development, implementation, contracting and monitoring Linkages to online and published resources Professional experience and expertise of the team Provide a series of Consumer Direction Webinars Collaborate with Lewin in the routine TA Call provision with specialty in consumer direction issues Conduct VD-HCBS Readiness Reviews and provide any needed assistance in their completion 21

General Resources to Get Started Developing and Implementing Self-Direction Programs and Policies: A Handbook Located with other valuable resources at: Materials on the Cash & Counseling Demonstration and Replication Program including research findings on consumer direction can be found online at:

Consumer Direction Webinar Series Webinar A Week of 12/14/09 Audience: CLP, VD-HCBS, and ADRC Grantees What is Consumer Direction? Different Perspectives of Consumer Direction Participant Involvement Additional Tools and Resources Webinar B Date TBD Audience: Case Managers Consumer Direction Program Design Principles Paradigm Shift Challenges Additional Tools and Resources for Case Managers Webinar C Date TBD Audience: Administrative Staff Consumer Direction Prevalence in Existing Programs Political Challenges Health, Welfare, and Managing Risk Concerns Quality Management Practices Administrative Lessons Learned and Promising Practices Additional Tools and Resources Webinar D Date TBD Audience: CLP, VD- HCBS, and ADRC Grantees Open discussion with two successful Grantees to summarize their programs and discuss challenges and accomplishments Additional Tools and Resources

Readiness Review Contacts: Suzanne Crisp (AR, IN, MA, NH, and VA) Sandy Barrett (AL, FL, GA, MI, MT, NY, OH, OR, SC, and WA) Dianne Kayala (CT, HI, IL, LA, ME, MD, MN, NJ, VT, and WI) If this is your first contact with us for TA, please contact Elizabeth Maguire at or

25 More TAE Partners! National Association of State Units on Aging ( Bernice Hutchinson, National Council on Independent Living ( Jason Beloungy,

26 Getting Started: Critical Lessons Learned Think big - across programs at all levels - state, local, individual Integrate processes in systems across programs, especially IT Include all consumer and disability groups in planning right from the start, even if they will not be part of your initial target population Seek out partnerships, both obvious and less obvious Develop metrics by which you know your programs are operating efficiently and you are achieving your goals - measure against those metrics!