Administration for Community LivingAging & Disability Resource Center Program

Options CounselingAugust 15, 2012

Q&A

Agenda for Today

Work GroupSessions

Vision Person Centered System

ADRC Options Counseling Program

IntroductionTo ACL

"For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

• This new HHS Operating Division brings together the Administration on Aging (AoA), the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD)

• This single agency is charged with developing policies and improving supports for seniors and people with disabilities.

Administration for Community Living

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WEB

www.aoa.gov

Person Centered System

Who Might Need Long Term Services and Supports?

Milton Friedman

4 Ways to Spend Money

Economize and seek highest value

Economize, but don’t seek highest value

Don’t economize, but seek highest value

Don’t economize and don’t seek highest

value

YourMoney

Someone Else’s Money

Yourself Someone Else

Management Information System

Personalinterview

DevelopAction Plan

Connect To Services

Follow-up

CDSMP/EBDP

Care Transitions

HCBS

Nutrition & SNAP

Housing & Energy

Transportation

Individual Rights Lifespan

ParticipantIn Control

&Directing Services

NWD/ADRCSystem

Key Characteristics High PerformingLong Term Service and Support System

Continuous QualityImprovement

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• An approach of providing services to assist an older individual with activities of daily living, in which:– (A) services are planned, budgeted and purchased under the

direction and control of the individual;– (B) individual is provided with I&A as necessary and appropriate to

enable individual to make informed decisions about care options;– (C) needs, capabilities and preferences of the individual are assessed;– (D) plan of service is developed together with the individual, family

caregiver or legal representative; and– (E) the AAA or SUA provides oversight to ensure quality of services

provided and appropriate use of funds

OAA Sec. 102(a)(46) – Definition of Self Directed – summary

National Vision for ADRCs

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

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ADRC Options Counseling Program

2012 ADRC Funding OpportunityJust the Facts

• 3 Yr Grant Awards• 56 States/Territories Eligible• Est. Award $2.3 Million• Up to 8 AwardsPart A

• 1 Yr Continuation• 48 States Eligible• Est. Award $200,000• Up to 48 AwardsPart B

2012 ADRC Funding Opportunity# 1 NWD Model

Strengthening the capacity of ADRC Options Counseling Program to serve people of all ages, income levels and disabilities by adopting a “No Wrong Door” approach that involves a wide variety of community partners

2012 ADRC Funding Opportunity#1 - NWD Model?

ADRCs are not about replacing existing organizations and networks.

It’s about building a better, more coordinated network.

Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica

September 2011

A State Scorecard on Long-Term Services and Supports for Older Adults,

People with Physical Disabilities, and Family Caregivers

http://www.longtermscorecard.org/

This Scorecard finds that generally states with the highest level of performance have enacted public policies designed to:

Improve access to services and choices in their delivery by directing state Medicaid programs to serve more people in need and offer alternatives to nursing homes that most consumers prefer.

Establish a single point of system entry to help people find needed information and more easily access services.

Improve support for family caregivers by offering legal protections as well as other services to address caregiver needs.

Rapidly diffusing trained and certified ADRC Options Counselors throughout the funded states, and building stronger partnerships between health and LTSS

2012 ADRC Funding Opportunity#2 Trained/Certified Options Counselors

ACL Vision for Role of Options Counseling

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Options Counselor Specific Requirements

Person-Centered PlanningParticipant DirectionCultural Competency

CommunicationDecision Support

Quality

VD-HCBSSupport Broker

Money Follows the

PersonCoordinator

Participant-Directed Counselor

Care TransitionsTransitions

Coach

*Options Counselors include case/care managers and service coordinators from AAAs, ADRCs, and other providers.

Stake h o ld e rs

• Centers for Medicare & Medicaid Services (CMS)• State Units on Aging• State Units on Disability• Council for Social Work Education (CSWE)• National Association of Area Agencies on Aging (n4a) • National Association for Social Workers (NASW)• National Association of State Directors of Developmental Disabilities Services

(NASDDDS) • National Association of State Mental Health Program Directors (NASMHPD)• National Association of States United for Aging and Disability (NASUAD) • National Autism Association (NAS)• National Council on Independent Living (NCIL) • Social Work Leadership Institute (SWLI) • Through grant – AAAs, CILs

2010 OC Grant Timeline

11/10 – 3/11 Met with grant states to discuss “strawman” draft standards

4/11 State draft standards were due to ACL

8/11 State draft OC evaluation plans were due to AoA

9/11 State draft OC evaluation plans were finalized

10/11 States began standards implementation

7-9/12 States write-up evaluation reports/final comments on standards

10/12 Options Counseling Standards finalized

Sales FactoidNational Sales Executive Association

• 80% of sales are made on 5th - 12th contact

• 10% of sales are made on 4th contact• 5% of sales are made on 3rd contact• 3% of sales are made on 2nd contact• 2 % of sales are made on 1st contact

80%10%

5%3%

2%

Developing financially sustainable ADRC models that include revenue from multiple programs to cover expenses associated with tasks such as:• Outreach• Screening/Assessing needs for LTSS• Service plan development• Assisting individuals in determining their eligibility for public

programs

2012 ADRC Funding Opportunity# 3 Financial Sustainability

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Current Status of ADRC FundingFebruary 17, 2012

Source: The Lewin Group Analysis of October 2011 ADRC Semi-Annual Reports

Sustaining ADRC ActivitiesSummary of Funding Pursuits Across 14 ADRC State Plans

OAA

ADRC Grant

Options Counsel

ing Gran

t

Care Tr

ansiti

ons Gran

t

CDSMP Gran

t0

3

6

9

SHIP

SMP

MFP Dem

o

MIPPA

Medica

id Administrati

ve0369

State

fundsRSA

SS Block

Grant

ACA Care Tr

ansiti

ons

VD-HCBS

Private

gran

ts/funding

Private

pay/co

st-sh

aring

Local

/orga

nizational

funds02468

101214

AoA Funding

CMS Funding

Other Sources

Possible Current

Possible Current

Possible Current

ADRC Grant, OAA

SHIP, MIPPA

State Funds, VD-HCBS

Section 10202: Balancing Incentive Program

Effective October 1, 2011

• Offers enhanced Federal match to States that make structural reforms to increase nursing home diversions and access to HCBS  – 2% if less than 50% LTSS spending in non-institutional

settings– 5% if less than 25% LTSS spending in non-institutional

settings

• States must implement structural changes including “no wrong door–single entry point system,” conflict-free case management, and core standardized assessments

Section 2403: Money Follows the Person

• Provides for the extension and expansion of Money Follows the Person through 2016

• Offers States substantial resources and additional program flexibilities to remove barriers

• More States have recently been awarded MFP grants

• CO, FL, ID, ME, MA, MN, MS, NV, NM, RI, TN, VT, WV received an additional $4.3B

• By April 2011, CMS expects to have at least 42 States and the District of Columbia participating

Managed LTSS

States with Managed LTSS:• Build on existing managed care experience

• Offers consumers more choice and better coordinated care

• Can provide more benefits & choice then FFS

• Better management of LTSS spending

• Can provide more cost effective system

• Improve quality of care measurement in each setting and across settings

• Move to full integration of Medicare and Medicaid services

2012 ADRC Funding OpportunityAttachments - Sustainability

Attachment G:Medicaid Support for ADRC Functions

Attachment H: Veterans Health Administration Opportunity for ADRCs

Attachment I:Person-Centered Assessment and Planning

Attachment J: Draft National Options Counseling Standards

Attachment K:Elder Abuse Detection and Prevention

Increasing ADRC Options Counseling Programs Role and Capacity

Attachment L: Proposed National Evaluation Framework

Attachment M: Other Federal Opportunities that May Align with ADRCs

2012 ADRC Funding Opportunity#4 National Performance/Outcome Standards

Adopting national performance and outcome standards and aligning data collection and reporting methods across LTSS payers within a state

ADRC Options Counseling Program Functions

BBB

reakfast

athroom

edroom

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Veteran-Directed Home & Community Based Services

The Veteran-Directed Home and Community-Based Services (VD-HCBS) program serves Veterans of any age who are at risk of institutional placement as well as their family caregivers.

VA Medical Centers (VAMCs) purchase these services on behalf of Veterans from: State Units on Aging, Area Agencies on Aging, and Aging and Disability Resource Centers

Veteran-Directed Home and Community-Based Services

Active

Near Completion

Early Planning

Program Status Map

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This is a shift in thinking…..

I don’t mind change…I just don’t want to be there when it happens.

Adrian MonkMonk, USA Network

An assessment and care planning assistance Decide for themselves, or with a participant

representative, what mix of goods and services will best meet their, and their family caregiver’s care needs

Manage a flexible, individual budget Hire and supervise their own workers, including

family or friends Purchase items or services needed to live

independently in the community Have financial management and support services

which facilitate service delivery

The Veteran Receives

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Question & Answers