1 South Carolina ACCESS Plus (ARDC) Planning Retreat Susan C. Reinhard, R.N., Ph.D. Co -Director Rutgers Center for State Health Policy

2 Vision and Expectations for ARDC Administration on Aging (AOA) and the Centers for Medicare and Medicaid Services (CMS) Values and Principles Building Blocks of A Consumer Driven System Resource Center Expectations

3 Vision of Real Systems Change Initiatives: Community Living for All Emphasis on choice, dignity and independence Consumer involvement, consumer direction Improve access to affordable services and programs Encourage states to implement enduring improvements in home and community long-term care service systems

4 Key Building Blocks of a Consumer Driven System PERSON Philosophy of self-direction and individual control in legislation, policies, and practices Community Life Coherent Systems Management Access Comprehensive information, simplified eligibility, and single access points Financing A seamless funding system supporting individual choice Services Responsive supports across settings and provider types Quality Improvement Comprehensive systems that assure quality of life and services

5 Self Direction Philosophy Consumer Direction principles ensure that all people have the opportunity to: – develop skills – engage in productive work – chose where to live – participate in community life – manage their own care

6 Coherent Systems to Make Self Direction Philosophy a Reality Begins with ACCESS Comprehensive Information Simplified Eligibility Single Access Ports

7 Coherent Systems to Make Self Direction Philosophy a Reality Financing Needs to Change Unit of funding should be centered more on the individual than on providers Seamless funding stream supporting consumer choice and control

8 Key Concepts are Money Follows the Person and Rebalancing the Long-Term Support System Money Follows the Person = financing for services and supports moves with the person to the most appropriate and preferred setting. Rebalancing = reduced reliance on institutional options, increased community options.

9 Coherent Systems to Make Self Direction Philosophy a Reality Services Need array of choices for long term supports and services Consumer choice and control should be promoted

10 Coherent Systems to Make Self Direction Philosophy a Reality Quality Improvement Consumer’s Voice needs to be included Quality of Services Quality of Life

11 Key Building Blocks of a Consumer Driven System PERSON Philosophy of self-direction and individual control in legislation, policies, and practices Community Life Coherent Systems Management Access Comprehensive information, simplified eligibility, and single access points Financing A seamless funding system supporting individual choice Services Responsive supports across settings and provider types Quality Improvement Comprehensive systems that assure quality of life and services

12 ACCESS to the System & Services Information Information and Assistance Single Entry Points Comprehensive Access

13 Resource Center Expectations Must provide ACCESS for older adults and at least one of the following: persons with physical disabilities persons with developmental disabilities persons with serious mental illness

14 Resource Centers Must provide “One Stop Access” to all public programs for community and institutional long term support services under Medicaid, those OAA programs the state says will be devoted to long term support services, and others

15 Resource Centers Long term support services under Medicaid include: Home health, personal care, targeted case management, HCBS “waiver”programs, nursing facility and ICF/MR

16 Resource Centers Long term support services under OAA include: Personal care and other in- home services

17 Resource Centers Also serve as a resource to: PRIVATE PAY Individuals People planning for future needs Family Caregivers Professionals

18 Resource Centers Operational Configurations vary: Single location (locally based) Multiple sites and organizations Different access points for different populations

19 Resource Centers Must have a Management Information System to track: Client intake Needs assessment Care plans Utilization Costs

20 Single Entry Point (SEP) Known as “one stop shopping” A system that enables consumers to access long term care and supportive services through one agency or organization

21 “No Wrong Door” Also known as “one stop shopping” Not one location Virtual models like Hawaii Washington - can apply for services electronically (

22 States Define SEP in Different Ways Mollica & Gillespie, SEPs in 32 states and DC (including ‘split’ systems)

23 Expectations of SEPs Information about full array of services and financing options for all income levels Facilitate access to services Comprehensive assessment & eligibility decision Care planning and service authorization Monitoring and reassessment Coordination

24 SEP functions I&R 40 Web based I&A 19 Initial screen 38 NF PAS 24 Assessment 41 Financial elig 17 Functional elig 38 Develop care plan 43 Authorize service 41 Monitor services 43 Reassess 41 Protective services 9 Health promotion ?

25 Findings SEPs can be arrayed by functions performed, populations served & funding sources managed –Variations in extent of SEP activity Most likely for elders & people with disabilities Multiple funding sources available through a single organization Separating I&A and care management

26 Issues Pilot versus statewide Designate or select “Single” or “comprehensive” Critical functions Populations –Skills, expertise –Interest Capitation and financial risk

27 Key Program & Policy Issues Leadership Systems Design/Coordination & Data Collection Funding Personnel & Staffing Outreach & Promotion

28 Guiding Principles Change Dynamics Dialogue Consensus Courage Persistence

29 Contact Information Susan Reinhard Center for State Health Policy (CSHP) Rutgers, The State University of NJ 317 George Street, Suite 400 New Brunswick, NJ , ext. 230 (v) (fax)