0. South Carolina Access Plus Planning Retreat
January 14-15, 2004
Karen Linkins and Sharon Zeruld, The Lewin Group Susan Reinhard, Rutgers Center for State Health Policy

1. SC Access Plus Planning Retreat
Introductions

2. Overview of SC Access Plus Planning Retreat
Goals
To develop a shared vision and values to guide ADRC design and operation
To identify, evaluate and decide on different design options
Outcomes
Partnership between the Aging and Disability communities
Common understanding about federal requirements and expectations
Shared expectations about ADRC outcomes
Identification of strengths and resources of all partners
Foundation for the local advisory board
Identification of next steps toward pilot implementation

3. Overview of SC Access Plus Planning Retreat, continued
Agenda
Day 1
Historical and current perspective of South Carolina’s system
Overview of AoA/CMS vision and expectations for ADRCs
Small group session: SC Values and Principles
Small group session: SC Vision Development
Day 2
Synthesis of SC’s shared visions and values
ADRC design options
Small group session: evaluation of design options, identification of resources, opportunities and challenges
Next steps toward implementation
Expectations of Small Group Discussion

4. SC Access Plus Planning Retreat
Where We’ve Been and Where We Are

5. SC Access Plus Planning Retreat
Overview of National Vision and Expectations

6. Overview: National Vision & Expectations
Context of Aging and Disability Resource Center (ADRC) Program
Background of collaborative initiative
Functions of an ADRC
National vision for ADRC program
National expectations

7. Context of ADRC Program
Person
Philosophy of self-direction and individual control in legislation, policies, and practices
Community Life
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
Coherent Systems Management
DHHS Systems Framework

8. Context of ADRC Program, continued
ADRC Activities Within AoA and CMS Initiatives and Goals
Initiatives
Systems Change Goals/Impacts
Access
Efficiency
Effectiveness
Consumer Focus
CMS
AoA
Real Choice System Change Grants
Systems Change Conference
Other CMS Programs/Initiatives
Community Living Exchange Collaborative
Visibility/Awareness Activities by CMS & AoA (websites, town forums, conferences)
Aging & Disability Resource Center Grants
Aging & Disability Resource Center Technical Assistance Exchange
Projects with the National Governor’s Association/National Conference of State Legislatures
NASUA I&R Support Center
AoA Prevention Initiative
RTI Case Studies
Current Long Term Support Services
Sustained by multiple funding streams
Administered by multiple agencies
Have complex, fragmented and often duplicative intake, assessment and eligibility functions (consumers are handed off from one worker to another, being asked the same questions repeatedly)
Confusing for consumer to know how to obtain services (public and private supports)
Consumers uninformed about long term support options other than institutional services
Value of an ADRC
Provide “one-stop shopping” for information, counseling, and access to long term support
A single point of entry for accessing public long term support programs and services
Minimize confusion and support citizen choice and informed decision-making
Improve a state’s ability to:
Manage public resources
Monitor program quality, cost and outcomes
Respond to system problems
Improve services
Limit unnecessary use of high-cost services, including nursing facility services

9. Background of Collaborative Initiative
ADRC Program announced March 2003
Grants issued as cooperative agreements by AoA and CMS
Joint effort that provides states with an opportunity to effectively integrate their long term support resources for consumers into a single coordinated system

10. FY 2003 ADRC Grantees Aging & Disability Resource Center Grantees
FY 03 Awardees: LA, ME, MD, MA, MN, MT, NH, NJ, PA, RI, SC, WV
Aging & Disability Resource Center Grantees

11. Definition of an ADRC
An ADRC is a visible and trusted place at the community level where people can turn for information and counseling on all available long term support options and a single point of entry to public long term support services. The ADRC program enables people to make informed decisions, provide streamlined access to long term supports, and organize the long term support system.

12. Functions of an ADRC Awareness & Information Assistance Access
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

13. National Vision for ADRC Program
To truly embrace the vision of the Americans with Disabilities Act (ADA) – serve all ages & income levels
To continue the vision of President Bush’s New Freedom Initiative
To create synergies between the Aging Network and CMS to implement consumer-directed care
To increase visibility of long term support within state government
To offer a variety of different models for other states to replicate

14. National Expectations for ADRC Program
Broad mandate
Information & Awareness, Assistance and Access
Serve people of all ages and income levels of identified target groups
Specific expectations
Seamless system for consumers
Integrated access – streamlined eligibility
Shift of institutional bias – critical pathways
Meaningful involvement of consumers & other stakeholders
Partnership between Aging Network and Medicaid
Investment in MIS that supports goals of ADRC
Performance measurement – CQI, outcomes
Sustainability
#2- Centralized LOC determination
#3 - Critical Pathways – create formal linkages among major pathways to long term support
#7 - Feds ask that grantees concentrate on both the formative (make adjustments along the way because grant is part of larger systems change) and impact (collect data related to performance outcomes) evaluations
Work plan needs to reflect goal to be fully operational with all identified target populations by Year 3

15. Common Elements of Success
Adopt a civic process and develop state & local partnerships
Public and private sector integration
Leverage other grants
Real Choice Systems Change, AoA Family Caregiver, HUD, Medicaid Infrastructure Grants, etc.
Develop program based on shared, underlying values
Need to develop a disability expertise
Foster good relationship with Medicaid
Emphasize performance management & flexibility
Leverage other grants – SC is already doing this by building upon earlier CMS Real Choice grant
Performance Measurement – be flexible, learn along the way – measure outcomes

16. Common Elements of Success, continued
Plan for sustainability
Need for cultural competence in both outreach and options counseling
Decide information needs from the beginning
Establish attainable short term goals and objectives but keep sight of the long term goals

17. Common Elements of Success: Lessons Learned from Wisconsin RC Experience
9 pilot Resource Centers in WI
3 – county Departments on Aging
1 – combination of county Public Health Department & Department on Aging
2 – county Social Service agencies
2 – county Human Service agencies
1 – split between county Social Service agency & agency for Developmental Disabilities Services

18. Lessons Learned from Wisconsin RC Experience: RC Contact Needs, 2002
Referral to private LTC services 1%
Referral to APS 2%
Follow up contact from staff 4%
Referral to Emergency Services 0.3%
Basic Info on Medicaid 15%
Short term CM 9%
Referrals to other
public services 7%
LTC related services
29%
Referrals to functional
Screen 14%
Basic Info on Other Services 19%

19. Common Elements of Success: Lessons Learned from Wisconsin RC Experience
Be willing to give up organizational turf to work as team and to put people first
Focus on streamlining eligibility determination
Completed in 2-4 days, < 24 hrs. when needed
Protocols on sharing eligibility information with consumers and other providers
Recognize needed skills and training of ADRC staff
ADRC is a business that serves customers/customer satisfaction
Ability to serve different target groups - “disability specialists”
Public image of “aging” services or “welfare agency”
Eligibility- Communication and collaboration between all local entities involved in eligibility is vital to make process work for consumers. Having written access plans or MOUs between parties is helpful in having common ground to refer back to.
IT – takes a lot of time and resources to keep the resource database updated

20. Common Elements of Success: Lessons Learned from Wisconsin RC Experience
Invest in comprehensive IT systems that support ADRC
Treat options counseling as process, not as event
Leverage experience from agencies that serve individuals who can private pay

21. SC Access Plus Planning Retreat
Underlying Values & Vision Development

22. Contact Information
Karen Linkins
Vice President
The Lewin Group
3130 Fairview Park Dr.
Suite 800
Falls Church, VA 22042
(703)
Sharon Zeruld
Senior Manager
The Lewin Group
3130 Fairview Park Dr.
Suite 800
Falls Church, VA 22042
(703)