August 15, 2012
Introduction
To ACL
Work Group
Sessions
Vision Person
Centered
System
ADRC Options
Counseling
Program
Q&A
"For too long, too many Americans have faced
the impossible choice between moving to an
institution or living at home without the longterm 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
4 Ways to Spend Money
Milton Friedman
Yourself
Someone Else
Your
Money
Economize and seek
highest value
Economize, but don’t
seek highest value
Someone
Else’s
Money
Don’t economize, but
seek highest value
Don’t economize and
don’t seek highest
value
CDSMP/EBDP
Continuous Quality
Improvement
Care Transitions
Personal
interview
NWD/ADRC
System
Develop
Action Plan
Connect
To Services
Participant
In Control
&
Directing
Services
HCBS
Nutrition & SNAP
Housing & Energy
Follow-up
Management
Information System
Transportation
Individual Rights Lifespan
9
• 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
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
11
2012 ADRC Funding Opportunity
Just the Facts
Part A
• 3 Yr Grant Awards
• 56 States/Territories Eligible
• Est. Award $2.3 Million
• Up to 8 Awards
Part B
• 1 Yr Continuation
• 48 States Eligible
• Est. Award $200,000
• Up to 48 Awards
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.
A State Scorecard on Long-Term Services and Supports for Older Adults,
People with Physical Disabilities, and Family Caregivers
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.
Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica
September 2011
http://www.longtermscorecard.org/
2012 ADRC Funding Opportunity
#2 Trained/Certified Options Counselors
Rapidly diffusing trained and certified ADRC
Options Counselors throughout the funded
states, and building stronger partnerships
between health and LTSS
ACL Vision for Role of Options Counseling
Options Counselor Specific Requirements
Person-Centered Planning
Participant Direction
Cultural Competency
Communication
Decision Support
Quality
VD-HCBS
Support Broker
Care Transitions
Transitions
Coach
ParticipantDirected
Counselor
Money Follows
the Person
Coordinator
18
*Options Counselors include case/care managers and service coordinators from AAAs, ADRCs, and other providers.
Stakeholders
•
•
•
•
•
•
•
•
•
•
•
•
•
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 Factoid
National Sales Executive Association
• 80% of sales are made on
5th - 12th contact
80%
10%
5%
3%
2%
•
•
•
•
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
2012 ADRC Funding Opportunity
# 3 Financial Sustainability
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
Current Status of ADRC Funding
February 17, 2012
Source: The Lewin Group Analysis of October 2011 ADRC Semi-Annual Reports
23
Sustaining ADRC Activities
Summary of Funding Pursuits Across 14 ADRC State Plans
10
8
6
AoA Funding
4
2
ADRC Grant, OAA
0
OAA
ADRC Grant
Options
Counseling
Grant
Care
Transitions
Grant
CDSMP Grant
Possible
Current
10
8
6
CMS Funding
4
SHIP, MIPPA
2
0
SHIP
14
12
10
8
6
4
2
0
SMP
MFP Demo
MIPPA
Medicaid
Administrative
Possible
Current
Other Sources
Possible
Current
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 Opportunity
Attachments - 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
B
B
B
reakfast
athroom
edroom
Veteran-Directed Home & Community Based Services
 The Veteran-Directed Home and CommunityBased 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
32
Program Status Map
33
I don’t mind change…I just
don’t want to be there when it happens.
Adrian Monk
Monk, USA Network
The Veteran Receives
 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
35
Question & Answers