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The State Perspective
Karol SwartzlanderCalifornia Health and Human Services Agency
STAKEHOLDER INPUT FORUMLe Rivage Hotel, Sacramento, September 27, 2012
Part 1: Overview Presentation Introductions Changes in Federal Aging and Disability
Agencies How Federal Changes Affect California History of ADRC Partnerships in California State and Local Systems Transformations in
California
Part 2: California’s ADRC Designation Criteria Review
Today’s AGENDA
"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
Federal HHS brings together the Administration on Aging (AoA), the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD)
ACL oversees federal policies and system improvements for consumers of any age; including seniors and people with disabilities.
Administration for Administration for Community LivingCommunity Living
“The vision is to have Resource Centers in every community serving as highly visible and trusted places where people of all ages and income levels can turn for information and options counseling on their long-term care needs.”
6
The ADRC Vision
ADRC Operational Model
7
Home and Community Based Services
Nursing Homes/Institutions
Options Counseling
HealthPromotion & Nutrition
Employment Services
Transportation &Housing
Private Services
Public Programs
StreamlinedAccess
to Information and Services
8
Bringing the Vision to Life
It’s all about building partnerships and making connections….
New Systems….NOT New Programs
1. Enhanced Information and Assistance
2. Options Counseling 3. Short-Term Service Coordination4. Care Transitions
CA ADRC Core Services
12 states,
8 sites, 2% of pop.
24 states,
42 sites, 8% of pop.
43 states,
81 sites,
13% of pop.
43 states,
147 sites,
30% of pop.
43 states,
201 sites,
39% of pop.
47 states,
300 sites,
49% of pop.
51 states,
344 sites,
54% of pop.
54 states & territori
es 467 sites,
70% of pop.
11
2012 ADRC Funding Opportunity
Just the Facts
o A final agreement (e.g., MoU, Contract, etc.) between the State Medicaid Agency and designated lead agency overseeing ADRC Options Counseling Program to utilize Medicaid funds for certain ADRC functions.
o Statewide coverage of a no wrong door ADRC system serving all LTSS populations and all LTSS payers.
o Statewide coverage of an Options Counseling Program that adheres to national Options Counseling Standards including training and certification.
o Statewide agreement and/or coverage for delivering Veterans services through ADRC.
o Continuous Quality Improvement Plan for its ADRC Options Counseling Program, consistent with the National Evaluation Framework.
13
Part A ADRC FundingPart A ADRC FundingKey Deliverables for 8 States (36 Months)Key Deliverables for 8 States (36 Months)
ACL Vision for Role of Options
Counseling
OC Roles
• Veterans Adminstration• Medicaid• Medicare• Money Follows Person• FFP•Balance Incentive Program•Managed Care
An ADRC partnership is a new service delivery model that provides a coordinated system of information, referral and assistance for anyone seeking long-term services and supports (LTSS), regardless of age, disability or income.
At the center of an ADRC model is a core partnership between an Area Agency on Aging (AAA) and Independent Living Centers (ILC), and then the broader LTSS network providers.
CA Definition of an ADRC
ADRC Development in CA
2010 – Affordable Care Act AoA/CMS ADRC Grants: Options Counseling and Care Transitions (CHHS) MFP/ADRC (DHCS)
2011 - ADRC Advisory Committee (CHHS & SILC) Participate in the development of a strategic plan
for statewide implementation of ADRCs Provide input on ADRC designation criteria and a
formal application process Serve as change agents to promote the ADRC
model Serve as key informants on stakeholder issues
ADRC Development in CA
2012 ADRC Funding Hospital Discharge Planning Grant ACL Part B ADRC Grant Collaboration with The Scan Foundation
Looking Forward – 2012/2013 Finalize ADRC designation criteria Formalize ADRC application process Expand ADRC partnerships and the options
counseling Developing sustainable ADRC business model(s) Support capacity-building of local organizations to
partner with managed care and other organizations
ADRC Development in CA
Budget Adjustments and Resource LimitationsBudget Adjustments and Resource Limitations
The Evolving Landscape of LTSS
Service Delivery ReformsService Delivery Reforms
Demographic Shifts in Service DemandDemographic Shifts in Service Demand
National Reforms Affordable Care Act, Medicaid Reform
State Reforms Mandatory enrollment of seniors and
persons with disabilities in managed care Community Based Adult Services (CBAS) Dual Demonstrations in 8 counties Medicaid Managed LTSS
Transformation of LTSS
Knowledge of the diverse and broadly defined LTSS population An established infrastructure that connects the broad array of
LTSS service providers in a community Call centers staffed with Information and Assistance experts Consumers streamlined access to the information they need Databases that include a wide array of provider referrals One-to-one Options Counseling that serves to empower
individuals and promote personal choice and responsibility. Expertise in transition services (hospital-to-home and nursing
facility-to-home) Access to skills training, assistive technology, nutrition
programs, care coordination Assistance with/ access to Medi-Cal eligibility application
processes
Strengths of ADRC Partnerships
Nexus of managed Medi-Cal managed LTSS and momentum for ADRC partnerships offers a unique opportunity and challenge
ADRC Partnerships could offer a gateway to support dual demonstration efforts and Medi-Cal Managed LTSS
ADRCs as the Gateway to LTSS
ADRC
Foundations
Private Insurance Employer
Assistance Programs
Employer Insurance
Plans
Medicare FFS/MAP/SNP
OAA
Medicaid
VA Medical Center
PACE
ADRC Advisory Committee deliberated and generated draft criteria
State planning team made changes 2 Public Forums will generate additional
modifications ADRC Advisory Committee will
recommend final criteria to CHHS ADRC application process will be
available to new ADRCs
ADRC Designation Criteria
26
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%
28
QUESTIONS???
Communitychoices.info (state) TAE-ADRC.org (federal) State ADRC Team
Karol Swartzlander, [email protected] Ed Ahern, [email protected] Paula Acosta, [email protected]
ADRC Resources
Dual Demonstration, www.calduals.org AARP, LTSS Scorecard,
http://www.aarp.org/relationships/caregiving/info-09-2011/ltss-scorecard.html
AARP New Report, On the Verge: The Transformation of LTSS, www.aarp.org/ppi
TheScanFoundation.org
Additional Resources
15 minutes Break
Review and Discuss California Draft ADRC Designation Criteria
Identify Technical Assistance Needs
Part II