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, 2003
43 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
Develop care plan 43
Authorize service 41
Monitor services
Reassess
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)