The State Perspective Karol Swartzlander and Ed Ahern California Health and Human Services Agency STAKEHOLDER INPUT FORUM East Los Angeles Community College,

The State Perspective

Karol Swartzlander and Ed AhernCalifornia Health and Human Services Agency

STAKEHOLDER INPUT FORUMEast Los Angeles Community College, LA, September 25, 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

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL [email protected] | WEB www.aoa.gov

Administration for Community 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.”

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The ADRC Vision

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Bringing the Vision to Life

It’s all about building partnerships and making connections….

New Systems….NOT New Programs

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.

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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

Each county has a unique mix of health care and social service supports.

California’s No Wrong Door approach allows local ADRC partnerships to build on existing expertise and infrastructure.

Rather than creating new services, ADRCs re-envision and redefine how information and services can be made more accessible to any consumer.

No Wrong Door ADRC Model

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

Every community in California has a highly visible, reliable, universal access point that provides objective information to facilitate access to long-term services and supports.

California Vision Statement

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

1. Enhanced Information and Assistance Call center staff utilize a broader array of

information and provider resources across the aging and disability provider networks; warm transfers.

2. Options Counseling A person-centered, interactive, decision-support

process whereby individuals are supported in their deliberations to make informed long-term support choices in the context of their own preferences, strengths and values.

CA ADRC Core Services

3. Short-Term Service Coordination Coordination assistance for consumers who

urgently need help with multiple services and programs, generally for 90 days or less and until a longer term plan is in place.

4. Care Transitions hospital-to-home care transition nursing facility transition services

CA ADRC Core Services

California ADRC Relational Chart Staff, Advisors, Contractors

ADRC Advisory Committee

CA Health & Human Services Agency (CHHS)

2010 Options Counseling & Care Transitions Grants

State ADRC Planning Team

CHHS + Departments of Aging, Rehabilitation

State Independent Living Council (SILC)

2009 ADRC Grant

Mission Analytics

Input From Stakeholders

Public ADRCs Subject Matter

Experts LTSS Industry Legislative &

Policy Analysts

Nevada County ADRC

ADRC Project Director

San Diego State University/Interwork Project Evaluation

Orange, Riverside Passages (5 county)

San Diego & San Francisco

ADRCs

ADRC Operational Model

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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

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 Knowledge of the diverse and broadly defined LTSS population 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

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

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

Imperative to create consistency of:

Message to the Public About LTSS Four Core ADRC Services Options Counseling Standards Broad Outreach Facilitated Access to Public Programs

California’s ADRC Partnerships

How can the local organizations work together to:

Leverage multiple service networks Embrace a person and family-centered approach

to service delivery Understand and support consumers of any age,

any disability and any source/level of income Support effective and efficient transitions back

home from hospital and nursing facilities Coordinate with and market services to

managed care and other potential funders

Considerations for the Future

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 and existing ADRCs

ADRC Designation Criteria

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In Conclusion

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%

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

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QUESTIONS???

15 minutes Break

Review and Discuss California Draft ADRC Designation Criteria

Identify Technical Assistance Needs

Part II