Transcript Slide 1

The Federal and State Perspectives
on ADRCs
Karol Swartzlander
California Health and Human Services Agency
February 16, 2012
ADRC Advisory Committee Meeting
Excerpts from presentations by Joseph Lugo (Administration on Aging),
Carrie Blakeway (Lewin Group) and the ADRC-TAE website
2
• The Aging and Disability Resource Center
Program (ADRC) is a collaborative effort of
the Administration on Aging (AoA) and the
Centers for Medicare & Medicaid Services
(CMS). ADRCs serve as single points of entry
into the long-term supports and services
system for older adults and people with
disabilities of all income levels
3
To have Aging and Disability Resource
Centers in every community serving as
highly visible and trusted organizations
where people of any incomes and ages
can turn for information on the full range
of long-term support options and a
single point of entry for access to public
long-term support programs and
benefits.
4
• Federal ADRC initiative began in 2003 with three core
functions
– Awareness, Assistance, and Access
• Set of core expectations has grown over time
– Information, referral, and awareness
– Options counseling, advice, and assistance
– Streamlined eligibility determinations for public programs
– Intervene in critical pathways to institutionalization
– Person-centered transitions
– Quality assurance and continuous improvement
5
CCTP and BIP
launched
4 SI grants awarded
Affordable Care Act
CT, OC and MFP
grants awarded
VD-HCBS launched
49 States awarded
new ADRC grants (5
year plans)
10 CMS Hospital
Discharge Planning
grants to ADRC
states
2007
2008
2010
2009
2012
2011
Lewin and AARP
Develop SEP Indicator
for LTSS Scorecard
FFC revised to better
address CT, OC and CQI
FFC revised to better address
NWD models
FFC released
6
47 states,
300 sites,
49% of
pop.
200
Number of People (in Millions)
180
160
140
120
24
states,
42 sites,
8% of
pop.
100
80
60
40
12
states,
8 sites,
2% of
pop.
43
states,
81 sites,
13% of
pop.
43
states,
147
sites,
30% of
pop.
43
states,
201
sites,
39% of
pop.
51
states,
344
sites,
54% of
pop.
51
states,
386
sites,
60% of
pop.
20
-
7
Across All 383 ADRCs:
►8 are operated at the state level by a state-level
organization, either an SUA University or other non-profit
►49% are operated by more than 1 entity, through networked
or “no wrong door” model
►81% have an Aging Network Organization serving as at least
1 operating entities
► 77% include an Area Agency on Aging
►29% percent have a Disability Network Organization serving
as at least 1 of their operating entities
► 24% include a Center for Independent Living
8
• ADRCs have an
average of:
• 14 formal
partnerships with
individual
organizations at
program/local level
• Formal partnerships
with 14 different
types of
organizations at the
state level
More a network
than a place or an
entity.
9
•
•
•
•
•
•
•
•
•
•
Funding shared
Written contract or agreement
Written referral protocols
Co-location of staff
Regular cross-training of staff
Routine collaboration to better serve individual
clients
Use of same or compatible IT systems
I&R resources are shared
Client data are shared
Joint marketing and outreach activities
10
Common Partners
Medicaid, State Units on Aging, ADRCs, Area Agencies on Aging,
Independent Living Centers, Alzheimer’s Associations, health care
providers, minority services associations and organizations, consumers
Examples of Unique Partners
AARP
Senior Services
Property Tax Levy Staff
State Coordinating Council for
Services Related to Alzheimer's
Disease and Related Dementias
Workforce
Wisdom Steps Health
Preventive Program for
Development Office
Native Elders
Governor's Office and
Lieutenant Governor’s
Office
Latin American
State Commission on
Association
Private Health Plans
SAGE (Services and Advocacy
for Gay, Lesbian, Bisexual &
Transgender Elders)
Center for Pan Asian
Community Services
Minority Health
11
ADRC Operational Model
Home and Community
Based Services
Options
Counseling
Private
Services
One-Stop
Access
to Information
and Services
Transportation
&Housing
Nursing Homes/
Institutions
Employment
Services
Public
Programs
Health
Promotion
& Nutrition
12
1. Information, Referral, and Awareness: Outreach and
marketing to all ages and income levels, web-based
searchable database, systematic I&R, follow-up
2. Options Counseling and Assistance: OC standards and
protocols, short-term crisis support to prevent
institutionalization, planning for future needs, follow-up
3. Streamlined Eligibility Determination for Public Programs:
Uniform intake and screening, coordinated elig. processes,
financial and functional elig. determined on-site or through
seamless referral, tracking an follow-up to all applicants
1
4. Person-Centered Transition Support: Formal agreements and
protocols with critical pathway providers to facilitate
transitions, serve as Local Contact Agency for MDS 3.0
Section Q
5. Target Populations and Partnerships: Capacity to serve all
ages and types of disabilities, formal partnerships with key
agencies, regular consumer input and involvement
6. Quality Assurance: Adequate staffing and IT to support all
program functions, CQI plan and procedures, state and local
level tracking of performance and outcomes
1
• Catalyze broader systems change
• Promote participant-direction
• Build stronger partnerships across siloed LTSS
system
• Intervene during care transitions from hospitals
and other care settings
• Assist with institutional transitions
• Implement new initiatives (e.g., VeteranDirected Home and Community Based Services,
MDS 3.0 Section Q)
15
Goals
- Improve ADRC capacity to provide care coordination and
reduce health care expenditures of people with disabilities
and/or chronic conditions
- Position ADRC and Aging Network for other funding
opportunities
Current Status
- 100 ADRCs are actively partnering with 156 hospitals across 36
states
- 34 states are partnering with QIO’s/21 states are partnering with
hospital associations
- Between 4/1/11-9/30/11, 66 sites served 9,115 consumers with
care transition following an acute care episode; 3,708
consumers received an EB Care Transition program
- Readmission rates
16
• Goal
– Develop National Standards for ADRC Options Counseling Program
– Credential network to provide a options counseling for a variety of funding
sources (e.g., CMS Care Transitions, VD-HCBS, Private Pay, MFP, etc.)
• Approach
– 19 grantee states funded in 2010
– Collaboratively develop and test draft National Standards for ADRC Options
Counseling Program
– Develop Performance/Evaluation Framework
– Implement and pilot test10 common measures agreed upon by states
• Current Status
– 19 states adopted and are implementing draft national standards with some
variation
– Approximately 30 non-grant states are developing or have draft standards based
on the draft national standards
17
 ADRCs play a critical role in
nursing facility transitions
under the Money Follows
the Person Demonstration
(MFP) in 37 of the MFP
states. ADRCs are involved
in nursing facility transitions
in another 4 states.
 Local Contact Agency for
MDS 3.0 Section Q
– ADRC is only LCA in 12
states
– ADRC has been
designated as one LCA
among many in 39
states
►ADRC role includes:
 Screening candidates
 Providing Options Counseling
 Facilitating access to HCBS
 Establishing/ strengthening
quality assurance and CQI
 Strengthening infrastructure to
facilitate transitions
 Educate/outreach to state
agencies and NFs about MDS
3.0 Section Q
18
Function
Progress
Resource database
37 states have statewide web-based directories
available to consumers and service providers
Functional eligibility
40% of ADRCs have co-located Funct. Elig. staff
Financial eligibility
25% of ADRCs have co-located Fin. Elig. staff
Medicaid application
34 states have applications available on-line
Medicaid application submission
7 states allow applications to be completed online and submitted electronically
Consumer decision tool
Available on-line in 16 states; 15 states
developing technology
Portable technology
8 states use laptops in the field; 3 include
portable document scanners and photography
19
► Embedded in Older Americans Act
Reauthorization 2006
► Embedded in Affordable Care Act 2010
► 33 states have passed ADRC legislation,
developed exec. guidance, and/or contributed state funds to
enhance and expand ADRCs
► Received approximately $43M in financial support from public
and private sectors for program development and expansion.
► Developed new partnerships to enhance program activities.
► Expanded to multiple pilot sites and statewide in many states.
20
• Older Americans Act Titles III-B, III-D, III-E and IV
•
Rehabilitation Services Act
•
Medicaid Administrative
•
State Health Insurance Assistance Program (SHIP)
•
Medicare Improvements for Patients and Providers Act
(MIPPA)
•
Senior Medicare Patrol
•
Money Follows the Person Demonstration (MFP)
•
AoA Grant Funding (e.g., ADRC, OC, CT, CDSMP, EBDP)
Great future potential: CMS Community Care Transitions
Program, CMS Balancing Incentive Payment Program,
Veterans Affairs VD-HCBS
21
22
• Leadership that is willing to break down bureaucratic
barriers
• Viewing the ADRC as a catalyst for positive systems
change
• Being sensitive to political climate
• Being open to spontaneous partnership opportunities
• Board members and consumers who are vocal champions
• State and local sites working collaboratively
• Designating organizations as ADRCS with functions,
missions, and priorities that match the federal vision
• Melding ADRC activities with ongoing
systems reform and related community
initiatives
23
Medicare
FFS/MAP/SNP
OAA
Medicaid
VA Medical
Foundations
Center
ADRC
Employer
Insurance
Plans
Private
Insurance
Employer
Assistance
Programs
PACE
24
• What are your state’s current LTC priorities? How/where
does the ADRC initiative fit?
• How are things going with your sustainability/expansion
efforts?
• What kinds of funding sources do you have? What are you
pursuing?
• What role have partnering organizations at state or local
level played in sustaining services?
• Which ADRC functions do you think will be sustained no
matter what (e.g. they are embedded or institutionalized)?
• Which may not be sustained (e.g. put on hold, reduced in
scope or service area)?
25
The State Perspective
ADRC Partnerships

Rethinking Service Delivery
AREA AGENCY ON
AGING
+
INDEPENDENT LIVING
CENTER
CA Definition of an ADRC

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 other LTSS network providers.
No Wrong Door Approach

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 reenvision how information and services can be
made more accessible to any consumer.
ADRC Development in CA
 2003 – AoA ADRC Grant to Department of Aging
(CDA): San Diego and Del Norte
 2006 – CMS Systems Transformation Grant to CHHS:
Riverside and Orange
 2007 – AoA ADRC Grant to CDA: San Francisco and
Passages
 2009 – ADRC Enhancement Grant to CHHS: San
Francisco and San Diego
 2009 – AoA ADRC Grant to SILC (Nevada)
ADRC Development in CA


2010 – Affordable Care Act ADRC Grants: Options
Counseling and Care Transitions (CHHS), and
MFP/ADRC grant (DHCS)
2012 - 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
New Vision Statement

Every community in California has a
highly visible, reliable, universal access
point that provides information to
facilitate access to long-term services
and supports.
CA ADRC Core Services
 Information
and Assistance
 Options Counseling
 Short-Term Service Coordination
 Care Transitions

hospital-to-home care transition

nursing facility transition services
Common Goals
 Improve
consumer Awareness
 Provide consumer Access to
information and services
 Provide Assistance through ADRC
core services
 Streamline consumer access to
Critical Pathways Providers
Fundamental Components of a
California ADRC
 Core
Partnership of AAA & ILC
 Local Leadership Advisory
Committee
 Capacity to serve all ages,
disabilities and income levels
 Provision of the four core ADRC
services
Why do we need ADRCs?
Service System Challenges
►Increase in demand
►Reduced service budgets
►Fragmented systems
►Hard to access
►Confusing
►Lacks focus on consumer
►Institutional bias
The Evolving Landscape of LTSS
Service Delivery Reforms
Budget Adjustments and Resource Limitations
Demographic Shifts in Service Demand
Transformation of LTSS in CA
 Mandatory
enrollment of seniors
and persons with disabilities in
managed care
 Community Based Adult Services
(CBAS) transition effort
 Dual Demonstration Pilots
 Coordinated Care Initiative
ADRCs Embedded in Reforms
 New
reform efforts lend urgency to
finalizing State ADRC designation
criteria and establishing criteria for:
A
fully functional ADRC
 An emerging ADRC
ADRC Partnerships Offer







Knowledge of the diverse and broadly defined LTSS population
Call centers staffed with Information and Assistance experts
Databases that include a wide array of provider referrals
Person-to-person Options Counseling that includes self-direction,
planning and personal responsibility (OC pilot testing is currently
in process, January – June, 2012)
Expertise in transition services (hospital-to-home and nursing
facility-to-home)
Access to skills training and assistive technology, some of which
could result in delaying or avoiding higher Medi-Cal costs, and
Assistance and access to Medi-Cal eligibility application
processes.
Q&A/Discussion

How can we leverage the state’s current
investment in ADRC Partnerships and
existing aging/disability service providers
in a fully integrated LTSS system?

How do you see ADRC partnerships
fitting into these reform efforts?
Q&A/Discussion
What are Managed Care Organizations
focusing on at the local level? Are they
engaging the LTSS network in
discussions?
 What kinds of technical assistance do
local organizations need to
explore/implement an ADRC
partnership?

ADRC Resources
 Communitychoices.info
(state)
 TAE-ADRC.org (federal)
 State ADRC Team
For More Information

Dual Demonstration


CBAS


www.calduals.org
www.dhcs.ca.gov/services/medi-cal/Pages/ADHC/ADHC.aspx
AARP New Report, On the Verge: The
Transformation of LTSS

www.aarp.org/ppi