4 th State Units on Aging Nutritionists & Administrators Conference August 29, 2006 Baltimore, Maryland Greg Case Center for Planning and Policy Development U.S. Administration on Aging

Choices for Independence Choices for Independence Using HHS research to empower seniors to take more control of their health. PREVENTION Bringing transparency and choice to long-term care. TRANSPARENCY Diverting seniors from nursing home care and spend-down. MEDICAID Helping seniors understand and access their MMA benefits. MEDICARE Consumer Empowerment Helps individuals make informed decisions about their care options and streamline access. Community Living Incentives Gives States more flexibility to help individuals remain at home and avoid or delay nursing home placement and spend-down to Medicaid. Healthy Lifestyle Choices Assists seniors to make behavioral and lifestyle changes that have proven effective in reducing the risk of disease and disability. Advancing the Secretary’s Priorities

Long-Term Care Systems Change u Swift Implementation of the Olmstead Decision  An Executive Order – Community-based Alternatives for Individuals with Disabilities - was issued directing key federal agencies to evaluate and recommend ways to expand community-based services for qualified individuals with disabilities: –The Department of Health and Human Services has implemented a number of grant programs to assist states in the design and implementation of reforms to promote community living and create a greater balance in long-term care between community- based and institutional support.

Systems Change Vision

Why Single Point of Entry access? u Navigating the long term care system can be confusing and frustrating for persons with disabilities of all ages and their family members u For some, institutional placement occurs due to lack of awareness or difficulty accessing HCBS u To create community-wide systems of services that reduce consumer confusion and build consumer trust and respect by enhancing individual choice and informed decision-making u To breakdown barriers to community based living

Empowering Individuals South Carolina Lt. Governor’s Office on Aging

One-Stop Access One-Stop Access Home and Community Based Services Nursing Homes Disease Prevention Health Promotion Employment Services Nutrition Education Private Services Public Programs

CMS & AoA Vision for ADRC u To have Aging and Disability Resource Centers in every community serving as highly visible and trusted places where people of all incomes and ages can get information on the full range of long term support options and a single point of entry for access to public long term support programs and benefits.

Components of the ADRC Single Point of Entry Model u Integrated and seamless access to information, assistance and services to long-term care u Meaningful partnerships with Aging, Disability & Medicaid Agencies and stakeholder groups u Investments in MIS that support streamlining data to enhance single entry model u Linkages to critical pathways to institutional care to provide community based alternatives u Working towards one comprehensive assessment and eligibility determination (financial and functional) process

Awareness & Information  Public Education  Information on Options Assistance  Options Counseling  Benefits Counseling  Employment Options Counseling  Referral  Crisis Intervention  Planning for Future Needs Access  Eligibility Screening  Private Pay Services  Comprehensive Assessment  Programmatic Eligibility Determination  Medicaid Financial Eligibility Determination  One-Stop Access to all public programs CONSUMER ACCESS AWARENESS & INFORMATION ASSISTANCE Empowering Individuals ADRC Key Components

ADRC Early Results Empowering Individuals 2003 & 2004 Grantees  Eight of the 43 ADRC grantees will have state/territory wide service areas by the 3rd year of their grant  Over 70% of the 43 grantees are planning MOUs/MOAs to formalize the partnerships between aging network, disability network and Medicaid and nearly 50% have them in place All Grantees  62 pilot sites currently operating/56 Additional Pilot Sites Planned  There are over 250 unique partnerships that have developed across the 24 ADRC projects funded in 2003 and 2004  All pilot sites have begun implementing activities designed to streamline access to publicly funded long-term care

ADRC Grantees

Partnerships Cut Across Different Types of Organizations Over 250 Unique Partnerships

New Jersey – 2003 Grantee u 2 AAA Pilot sites selected through RFP process  Atlantic County AAA (urban )  Warren County AAA (rural) u Initiated new assessment instruments, a computerized universal application and a global budget for both institutional and HCB services. u Developed 12 state planning workgroups: clinical eligibility; financial eligibility; consumer direction; MIS/IT; cultural competency; customer service etc. u Congregate and home-delivered meals seen as primary gateways to LTC services and intake process for nutrition programs fully integrated into ADRC

Massachusetts – 2003 Grantee u Executive Office of Elder Affairs (partnering with Medicaid and Rehabilitation Commission) u Original Pilot, Two urban/suburban counties – Year 3 Expansion, Three additional counties u Serving persons of all ages with disabilities u Equal partnership between two well- established organizations: a AAA and a CIL u Statewide web-based Virtual Gateway allows ADRC to initiate Medicaid financial eligibility

Florida – 2004 Grantee  Utilizing AAA to pilot ARCs/ADRCs in two locations across the state to serve the elderly and individuals with severe mental illness  The Florida Legislature passed statutory changes to implement Aging Resource Centers (ARCs) statewide ($3 million dollars in their FY07 Budget).  Established a single administrative structure accessible through multiple locations (seniors centers, AAAs, housing authorities, mental health centers)  Since the co-location of ADRC and Medicaid Waiver staff, the average amount of time it takes to process a waiver application has decreased from 13.7 days to 3.3 days.

Alaska – 2004 Grantee u Alaska Housing Commission lead entity overseeing ADRC initiative in Alaska u Regional resource centers operated by Independent Living Centers in each of the 5 regions u Targets adults with disabilities of all types u Division of Senior and Disability Services will take the lead in project management this year u Develop MIS system for tracking client intake, assessment, care plans, utilization costs

Virginia – 2005 Grantee  No wrong door approach to expand capacity of existing providers in 3 pilot regions initially and expanding to 9 pilots by end of grant  Private sector partner, Senior Navigator, offers web based I&R database for the elderly and persons with disabilities  More than a dozen various intake and eligibility forms are being analyzed and integrated with the GetCare system to streamline functional and programmatic eligibility  Local power company as partner assisting with funding of pilot sites

Idaho – 2005 Grantee u Idaho Medicaid – lead agency – to pilot an on- line application process at ADRC (where shorter forms will be developed with quicker turn-around times) u ID CareLine as single point of entry u State level Integrated Access Team will assess consumers referred by and provide case management u Community Resource Team at the pilot level will ensure client is connected with local resources

Continued Support of the ADRCs In FY ’06 u 2003 ADRC grantees (original grant expires in ’06) - opportunity to apply for two-year grants to expand and enhance their efforts to streamline access to long-term supports. u 2004 ADRCs - opportunity to apply for two-year Competitive Supplemental grants to support project Replication and Enhancement. u States that have not received an AoA/CMS ADRC grant had the opportunity in 2006 to apply under the “access goal” of the CMS System Transformation Grant opportunity

Comprehensive Technical Assistance  Technical Assistance Resources Website Resource Materials (e.g. Issue Briefs) National Meetings Weekly Electronic Newsletters Surveys of grantees TA Tracking Tool Reports  Building a Grantee Online Community Monthly Teleconferences/Web casts Bi-monthly Workgroup Teleconferences On-line Discussions Electronic Bulletin Board