0 Aging and Disability Resource Centers: Changing Systems, Changing Lives

1 Overview of ADRCs ► Welcome ► Introductions ► Logistics ► Follow-up

2 Overview of ADRCs ► Understand the purpose and vision of the ADRC program ► Explain the five operational components of ADRC programs:  Information, Referral & Awareness  Options Counseling and Assistance  Streamlined Eligibility Determination for Public Programs  Person-Centered Transition Support  Quality Assurance & Continuous Improvement ► Examine strategies for developing sustainable ADRC programs in the current financial climate Learning Objectives

3 Overview of ADRCs ► Module IBackground and Purpose of ADRC ► Module IIADRC Core Operational Components ► Module IIISustainability

4 Background and Purpose of ADRC Service System Challenges ► Increase in demand ► Reduced service budgets ► Fragmented systems ► Hard to access ► Confusing ► Lacks focus on consumer ► Institutional bias Why do we need ADRCs?

5 Background and Purpose of ADRC ADRC Solutions ► All populations and income levels served ► Seamless system from consumer perspective ► Integration of/coordination across aging, disability, Medicaid service systems ► Formal partnerships ► High level of visibility and trust ► Options counseling ► Proactive intervention into LTSS pathways What’s different about ADRCs?

6 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 Background and Purpose of ADRC AoA Vision of Coordinated LTSS

7 Background and Purpose of ADRC ► Catalyze broader systems change ► Promote participant-direction ► Build stronger partnerships across siloed LTSS system ► Intervene during care transitions from hospitals and other acute care settings ► Assist with institutional transitions ► Implement new initiatives (e.g., Veteran-Directed Home and Community Based Services, MDS 3.0 Section Q) AoA and CMS view ADRCs as the platform to:

– Developmental Disabilities Assistance & Bill of Rights Act 1973 – Rehabilitation Act 1990 – Americans with Disabilities Act (ADA) 1999 – Olmstead Decision 2001 – New Freedom Initiative (NFI) 2003 – Aging and Disability Resource Centers 2006 – Older Americans Act Reauthorization 2007 – Community Living Program 2008 – Veterans-Directed HCBS 2009 – Year of Community Living 2010 – Affordable Care Act 2011 – Systems Integration Grants ADRCs on the LTSS reform continuum Background and Purpose of ADRC

9 More a network than a place or an entity. Partnerships Background and Purpose of ADRC ADRCs have an average of: 14 formal partnerships with individual organizations at program/local level Formal partnerships with 14 different types of organizations at the state level

10 What does Formal Partnership mean? Background and Purpose of ADRC ► Funding shared ► Written contract or agreement ► Written referral protocols ► Co-location of staff ► Regular cross-training of staff ► Routine collaboration to better serve individual clients ► Use of same or compatible IT systems ► I&R resources are shared ► Client data are shared ► Joint marketing and outreach activities

11 ADRC Role: One-Stop Access from the Consumer’s Perspective Background and Purpose of ADRC Home and Community Based Services Nursing Homes/ Institutions Options Counseling Health Promotion Employment Services Peer Counseling Private Services Public Programs One-Stop Access

12 Common ADRC Operating Entities and Partners Background and Purpose of ADRC ► State Units on Aging and Area Agencies on Aging ► State Independent Living Councils and Centers for Independent Living ► State and Local Disability Services Departments ► County Human Services Offices ► State Medicaid Agencies and Local Medicaid Offices ► State Health Insurance Assistance Program (SHIP), 2-1-1, Adult Protective Services ► Critical pathway providers (e.g., hospital discharge planners, physicians) ► Quality Improvement Organizations ► Public & private aging and disability service providers ► Long term supports and service providers (e.g., home health agencies, nursing facilities)

13 Background and Purpose of ADRC Massachusetts  Equal partnership between ASAPs and CILs  All partners use a common intake form and information and assistance procedures and can access the same resource and services database Texas  Each ADRC has a minimum of 8 partnering organizations, with some sites involving over 40 different organizations to administer ADRCs  Electronic system for sharing resources and/or client data Virginia  Co-employment model for Options Counselors at AAA and CIL  Universal assessment instrument Best Practice State Examples: Partnership

14 Recent AoA Grants: Integrating Systems Background and Purpose of ADRC ► AoA awarded 16 states funding in 2010 to implement and evaluate evidence-based care transitions interventions. ► AoA is engaged in a collaborative process with 19 grantee states to develop national minimum standards for options counseling. ► Georgia, Minnesota, New York, and Ohio received Systems Integration grants to enhance their state systems to better streamline access to older adults, people with disabilities, and their caregivers.

15 AoA Vision Aging and Disability Resource Centers… every community in the nation highly visible and trusted people of all incomes and ages information on the full range of long term support options point of entry for streamlined access to services Vision for ADRCs Background and Purpose of ADRC

16 Background and Purpose of ADRC ADRC Coverage as of October 2011

17 What is the Key Take Away Message? Background and Purpose of ADRC

18 Overview of ADRCs ► Module IBackground and Purpose of ADRC ► Module IIADRC Core Operational Components ► Module IIISustainability Course Modules

19 ADRC Operational Components ► In which of the five operational components of an ADRC is your organization or state the strongest?  Information, Referral & Awareness  Options Counseling and Assistance  Streamlined Eligibility Determination for Public Programs  Person-Centered Transition Support (Care Transitions)  Quality Assurance & Continuous Improvement Participant Poll

20 ADRC Operational Components ► Outreach and Marketing ► Systematic Processes Across all Operating Partners ► Comprehensive Resource Database  Includes information about the range of long term support options, providers, programs, and services available  Established Inclusion/Exclusion policies  Accessible to the public via searchable and accessible website  Consistent and Uniform Information available across sites  Centralized maintenance and statewide coverage are preferable ► Marketing to and Serving Private Paying Populations ► Follow-up Information, Referral and Awareness

21 ADRC Operational Components South Carolina  Universally accessible, web-based searchable database  Developed and maintained at the state level  Web-based client management and services system with electronic exchange of resources and client data among partners Arkansas  State-wide 800 number operated by state employees  Provide I&R/A, some preliminary options counseling, and can assist callers with beginning the application process for Medicaid and other programs  If more in-depth options counseling needed, call center staff connects them to local ADRC partners including AAAs, CILs or regional Medicaid offices. Information, Referral and Awareness: Best Practice State Examples

23 ADRC Operational Components (True or False) ► Providing quality Options Counseling includes development of an action plan. Participant Poll

24 Definition (from draft National Options Counseling Standards)... An 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. Options Counseling ADRC Operational Components

25 ADRC Operational Components Essential Components of Options Counseling include: ► a person-centered 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, as requested, to develop an action steps plan or LTSS plan that is directed by the individual, ► connections to services and supports when requested, and ► follow-up. Options Counseling

26 Options Counselor Competencies 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. Options Counselor Potential Cross Project Applications Options Counseling ADRC Operational Components

27 ADRC Operational Components Consumers shouldn’t have to: ► Go somewhere else or call another organization or agency ► Repeat same information over and over ► Worry about getting “lost in the system” ADRCs provide : ► A single, standardized entry process ► A coordinated process for determining both financial and functional eligibility ► Uniform criteria across sites to assess risk of institutional placement ► Tracking of applications in process ► Follow-up to individuals on service waiting lists ► Follow-up after eligibility determination for both approved and denied applicants Streamlined Eligibility Determination for Public Programs

28 FunctionProgress Resource database 37 states have statewide web-based directories available to consumers and service providers Functional eligibility40% of ADRCs have co-located Funct. Elig. staff Financial eligibility25% of ADRCs have co-located Fin. Elig. staff Medicaid application34 states have applications available on-line Medicaid application submission 7 states allow applications to be completed on- line and submitted electronically Consumer decision tool Available on-line in 16 states; 15 states developing technology Portable technology 8 states use laptops in the field; 3 include portable document scanners and photography Streamlined Eligibility Determination for Public Programs: Best Practice State Examples ADRC Operational Components

29 ADRC Operational Components New Jersey  Automated MiChoice Community Services Screen  I&R Specialist completes 20-question screen, which identifies level of service need and triggers home visit/assessment  Information from screen populates Comprehensive Assessment Tool  Comprehensive assessments conducted by ADRC case managers  Eligibility automatically calculated, transmitted electronically for approval  Hospital-based pre-admission screen pilot, checklist of “At-risk Criteria for Nursing Facility Placement” Streamlined Eligibility Determination for Public Programs: Best Practice State Examples

AoA & CMS Framework Access to LTSS 2007 CMS RCSC Person Centered Planning 2008 CMS QIO 14 Care Transition Sites 2008/2009 Person Centered HDM Program States EB CT Models Strategies to Support Care Transitions Community-based Care Transitions Program (Sec. 3026) 2011 System Integration Grants ADRC Operational Components

Hawaii * Alaska * MT ID* WA † CO † WY NV CA *† NM AZ  MN TX † KS * IA WI IL †  KY TN † IN † OH  MI ALMS AR LA FL † SC * WV VA NC* PA † VT RI † NH † OR * UT SD ND MO * OK NE NY † CT † MA †  DC ADRC Care Transitions Activities DE Guam Northern Mariana Islands 35 States with ADRC program sites currently conducting care transitions through formal intervention (Total of 97 active sites with an additional 49 sites within active states currently planning to conduct care transitions) 10 States with ADRC program sites currently planning to conduct care transitions through formal intervention (Total of 13 sites currently planning care transitions activities within states with no active sites) GA  9 States not reporting current or planned care transition activities Puerto Rico * 10 states with CMS Hospital Discharge Planning Model grant † 16 states with 2010 ADRC Care Transitions grant  6 states participating in CCTP MD *† NJ ME † 

32 Source: "Navigating Across Care Settings: Choices for Successful Transitions (NACS)"- Care Transitions Sample Flow Chart Massachusetts Care Transitions Operating Model ADRC Operational Components

33 ADRC Operational Components ► ADRCs play a critical role in nursing facility transitions under the Money Follows the Person Demonstration (MFP) in 37 of the MFP states. ADRCs are involved in nursing facility transitions in another 4 states. ► Local Contact Agency for MDS 3.0 Section Q  ADRC is only LCA in 12 states  ADRC has been designated as one LCA among many in 39 states ► ADRC role includes:  Screening, Identifying and assessing candidates  Providing Options Counseling  Establishing service plans & coordinating services  Implementing service plans and facilitating access to HCBS  Establishing/ strengthening quality assurance and CQI  Strengthening infrastructure to facilitate transitions  Educate/outreach to state agencies and NFs about MDS 3.0 Section Q Person-Centered Transition Support (Institutional Transitions):

34 GoalIndicator TrustConsumers rate the assistance they receive as reliable, objective and comprehensive. VisibilityPeople in the community are aware of the ADRC. Ease of AccessPeople are able to access ADRC services in multiple ways – in person, by phone, by , through a website. ResponsivenessStaff listen to consumers’ concerns and take into account their unique needs and circumstances. EfficiencyConsumers report a reduction in the number of times they had to repeat information when accessing services. EffectivenessConsumers report that they receive the services they need help them remain in the community. ADRC Operational Components ► ADRCs establish and track performance goals and indicators related to their ADRC activities. Quality Assurance and Evaluation

35 Quality Assurance and Evaluation: Best Practice State Examples ADRC Operational Components Continuous Quality Improvement (Wisconsin)  Care Large sample of consumers interviewed  Each ADRC must develop a goal for the following year about how they will improve in any area where results showed they needed growth. Cost-Effectiveness (Michigan)  LTCCs can be expected to generate sufficient savings in long term care costs to fully support their operations Diversion (Maine and Massachusetts)  Several states are looking at the impact of ADRC programs on diversion National ADRC Evaluation (IMPAQ, LLC)  A national evaluation of ADRCs is underway  Seeking OMB clearance for process and outcome measures

36 Overview of ADRCs Participant Poll ► In which of the five operational components of an ADRC is your organization or state the strongest?  Information, Referral & Awareness  Options Counseling and Assistance  Streamlined Eligibility Determination for Public Programs  Person-Centered Transition Support (Care Transitions)  Quality Assurance & Continuous Improvement

37 Overview of ADRCs ► Module IBackground and Purpose of ADRC ► Module IIADRC Core Operational Components ► Module IIISustainability Course Modules

38 12 states, 8 sites, 2% of pop. 24 states, 42 sites, 8% of pop. 43 states, 81 sites, 13% of pop. 43 states, 147 sites, 30% of pop. 43 states, 201 sites, 39% of pop. 47 states, 300 sites, 49% of pop. 51 states, 344 sites, 54% of pop. 51 states, 386 sites, 60% of pop. Growth in ADRC Coverage Sustainability

39 Sustainability ► 33 states have passed ADRC legislation, developed exec. guidance, and/or contributed state funds to enhance and expand ADRCs ► Received approximately $43M in financial support from public and private sectors for program development and expansion. ► Developed new partnerships to enhance program activities. ► Expanded to multiple pilot sites and statewide in many states. Sustainability

40 Common Federal Funding Sources Sustainability ► Older Americans Act Titles III-B, III-D, III-E and IV ► Rehabilitation Services Act ► Medicaid Administrative ► State Health Insurance Assistance Program (SHIP) ► Medicare Improvements for Patients and Providers Act (MIPPA) ► Senior Medicare Patrol ► Money Follows the Person Demonstration (MFP) ► AoA Grant Funding (e.g., ADRC, OC, CT, CDSMP, EBDP) Great future potential: CMS Community Care Transitions Program, CMS Balancing Incentive Payment Program, Veterans Affairs VD-HCBS

41 Average Annual ADRC Budget Revenue Sources Sustainability

42 Lessons Learned: What facilitates ADRC sustainability? Sustainability ► Leadership that is willing to break down bureaucratic barriers ► Viewing the ADRC as a catalyst for positive systems change ► Being sensitive to political climate ► Being open to spontaneous partnership opportunities ► Board members and consumers who are vocal champions ► State and local sites working collaboratively ► Designating organizations as ADRCS with functions, missions, and priorities that match the federal vision ► Melding ADRC activities with ongoing systems reform and related community initiatives

43 Overview of ADRCs ► Discussed the purpose and vision of the ADRC program ► Explained the five operational components of ADRC programs:  Information, Referral & Awareness  Options Counseling and Assistance  Streamlined Eligibility Determination for Public Programs  Person-Centered Transition Support  Quality Assurance & Continuous Improvement ► Examined strategies for developing sustainable ADRC programs Recap

44 Overview of ADRCs Questions

45 Overview of ADRCs Explore: Evaluate: Please complete the course evaluation that will appear when you exit the webinar.