>> SLIDE 1 Logos: Administration for Community Living, US Department of Veterans Affairs, Centers for Medicare & Medicaid Services Transforming State LTSS Programs and Functions into A No Wrong Door System for All Populations and Payers: How To Build Successful Partnerships Across the ADRC Network July 2014 >> SLIDE 2 Our Learning Objectives 1. Understand the role of the CIL and AAA in the collaboration with the ADRC led agencies and community partners 2. Understand the benefits of a collaborative effort between the CILs, AAAs and the ADRC to strengthen the No Wrong Door System 3. Understand the potential challenges to establishing and sustaining successful partnerships 4. Understand effective strategic approaches to building and sustaining successful partnerships >> SLIDE 3 The Presenters - Elizabeth Leef, Project Officer, ACL: Co-Moderator - Lindsay Baran, Disability and Aging Specialist, NCIL: Co-Moderator - Mary Margaret Moore, CIL Director, North Shore MA - Valerie Parker-Callahan, Director of Planning and Development, Greater Lynn Senior Services, Inc. and Chair, Planning and Development Committee, Aging and Disability Resource Consortium of the Greater North Shore, Inc., MA - Eileen Healy, Executive Director, Independence Northwest CT - Sarah Launderville, CIL Director, VCIL >> SLIDE 4 The Vision for a NWD System In collaboration with states, develop a National NWD/ADRC System for all populations and all payers which is person centered, financially sustainable and high quality that supports individuals to achieve their goals for community living. >> SLIDE 5 The Administration for Community Living developed a high-level vision for the No Wrong Door System. The four primary components of the vision are: 1. Public Outreach and Links to Key Referral Sources. This includes schools, family members and friends, schools, individuals, local non-profits, LTSS providers, 800 numbers and local 211 lines, acute care systems, VA medical centers, and nursing homes. 2. Person Centered Counseling (PCC), which includes: confirming the need for and interest in PCC; conducting personal interviews to identify goals, strengths, and preferences as well as to support any immediate LTSS needs; a comprehensive review of private resources and informal supports; and the development and implementation of the Person Centered Plan. 3. Streamlined Access to Public Programs, which includes: a preliminary functional eligibility assessment for public programs in which data will be collected and the submission of applications will be supported; the final determination of functional eligibility for public program; linking individuals to private pay resources; and following up to ensure that the plan’s services are initiated, meet the needs of the individual, and is adjusted as needed. 4. Governance and Administration of the NWD System, which includes state oversight, management, and financing of the NWD System. This must include the State Medicaid Agency, State Agencies administering programs for aging, intellectual and developmental disabilities, physical disabilities, and mental/behavioral health needs. Administration includes input from external stakeholders, including consumers and their advocates, on the design, implementation, and ongoing operations of the system. The management system tracks clients, services, outcomes, expenditures, and organizational performance, enables information to flow with the client from initial person centered plan through follow-up, and supports ongoing evaluation and continuous quality improvement. >> SLIDE 6 Why Develop a NWD System? - Empowers individuals to make informed choices - Enables staff to provide wrap around services and work collaboratively with partner agencies. - Demand for services will increase. >> SLIDE 7 2014 Funding Opportunity - Builds upon the accomplishments of both the ADRC and Balancing Incentive Program initiatives, as well as the lessons learned from the experience of the participating Part A states. - Goal is to recognize the variation in functionality and capacity that exists across the states to create a fuller vision for a NWD system for all populations and all payers. - ACL, CMS and the VHA decided now is the time to draw upon these experiences in this new FOA. >> SLIDE 8 NWD Funding Opportunity Vision - At the end of the 12-month planning period a 3-Year Plan will be developed that includes a detailed strategy, work plan, and budget. - The following state agencies must be involved as full partners in co-leading this planning process: the State Medicaid Agency, the State Unit on Aging, and the state agencies that serve or represent the interests of individuals with all disabilities, including intellectual and developmental disabilities, as well as the state authorities administering mental health services. - The planning process must involve meaningful input from key stakeholders including AAAs, CILs, local disability advocacy groups and individuals who use LTSS. >> SLIDE 9 NWD Partnerships in CT, MA and VT >> SLIDE 10 CT ADRCs & The No Wrong Door: State of Connecticut >> SLIDE 11 History of ADRCs in Connecticut: - Early 2000s: CT applied for but did not receive the initial round of ADRC grants. - June 2007: SDA hosted an ADRC Planning Meeting. This included state stakeholders, ACL, and the Lewin Group. - September 2007: CT received an NHD grant and formed their first ADRC. - September 2009: CT received their first official ADRC grant, and the state’s third ADRC was formed. - September 2012: CT received an Enhanced Options Counseling grant and achieves statewide ADRC coverage. All five AAAs, CILs, and CCCI are partners, and the focus shifts from the ADRC program to the NWD System. >> SLIDE 12 Connecticut NWD Vision: CT residents have access to a full range of high-quality long-term care options that maximize autonomy, choice, and dignity. Connecticut Strategy: streamline access by maximizing information technology, standardizing assessments, and building NWD access points in each community. This strategy includes the use of Person Centered Options for telephonic or one-to-one assistance with private programs, public programs, and local programs. >> SLIDE 13 Strengths and Challenges: Strengths - 51% persons with disabilities and/or family members on Steering Committee - Organizational structure - Shared leadership Challenges - Finding the right people - Providing information in an actionable format - Strategic coordination with other groups working on similar goals - Assuring integrated approach - Communication - Diversion and serving non-Medicaid population >> SLIDE 14 Commitment to Strengthen CT NWD - Focus on strategic coordination with other groups working on similar goals -- Further define niche of ADRCs in CT’s NWD system (i.e. 1:1 assistance, PCP) -- Examine and define role of SDA: Where does aging population fit outside of CHCPE? OAA programs, Wellness/Prevention programs; ADRC - Examine and re-envision ADRCs in the context of a NWD system -- Maintaining existing ADRC partners while growing broader vision - More attention to Non-Medicaid population - Create Access Points in local communities >> SLIDE 15 The Massachusetts Experience The ADRC of the Greater North Shore, Inc.: - developing extensive infrastructure - hiring staff including the first Executive Officer - convening bi-monthly partner meetings with over 45 diverse agencies Expanded outreach and inclusion: this is being accomplished through programs such as Over the Rainbow and North Shore Pride, as well as through legislative advocacy and candidate forums. -Expanded contracts: -- Options Counseling -- the One Care LTSS pilot enhanced with capacity grant -- Money Follows the Person -- Housing Search Entity -Special initiatives: -- sponsorship of Transportation Regional Coordination Council -- sponsorship of regional Kiosks for Living Well -- sponsorship of the Safe Passages Discovery initiative -Trainings and conferences: -- Seventh Annual ADRCGNS Conference -- Sponsorship of Strengthening Mobility symposia -- Extensive internal cross-training -- Developing community trainings >> SLIDE 16 Lessons learned: -Challenges -- Shifting the paradigm -- Managing collaborative resources -- Navigating the bureaucratic systems - What we learned -- Importance of cross-training- large and small groups -- Importance of communications -- Importance of being at the table >> SLIDE 17 The Vermont Experience Vermont’s Aging and Disability Resource Connection >> SLIDE 18 Vermont’s ADRC History: - 2005- Vermont receives first ADRC grant -- Includes four key partners: AAAs, CIL, BIAVT, and I/DD in 2 regions of the state -- Assess readiness and capacity to perform key functions -- Need to build trust, collaboration, and commitment - 2009- Vermont received ADRC Strategic Planning Grant -- Move to one statewide ADRC comprised of 10 core partners -- ADRC grant funding shared among all partners -- I/DD partners not ready yet -- Develop 5-year ADRC strategic plan - 2010- Vermont receives Options Counseling Grant -- ADRC partners agree to implement its Options Counseling program statewide inclusive of all partners -- Draft Options Counseling Standards -- Identify the 5 AAAs and VCIL as the Local Contact Agencies for Section Q - 2012- Vermont receives Part A Enhanced Options Counseling/NWD Grant -- I/DD partners rejoin as core partners -- Articulate what functions each will play -- Focus on streamlining access and Medicaid match for Options Counseling -- VCIL, BIAVT, and AAAs pilot Care Transitions Program -- Focus on G=governance and administration, branding, and sustainability >> SLIDE 19 Vermont’s Partnerships - Strengths and Lessons Learned -- All partners equal voice and at table since inception -- Sharing of ADRC grant funds across all partners -- Embrace differences -- Seek understanding of varying philosophies -- Understand language and meaning behind it - Challenges and Opportunities -- Maintaining equal voice among larger partner networks -- Language and meaning behind it: coming to common understanding -- Varying capacities to perform key functions -- Valuing and respecting partner choices regarding which key functions will be performed as a core partner, e.g. Medicaid eligibility assistance >> SLIDE 20 Vermont’s ADRC Future - Expand Care Transitions Collaborative Model statewide, inclusive of other ADRC partners - If State leadership approves, identify ongoing Medicaid match for Enhanced Options Counseling and expand to other ADRC partners and statewide - Build sustainable ADRC Governance structure that supports the NWD vision inclusive of ADRC Leadership, State leadership, Consumers, and Key Stakeholders/Advocates - Formalize Protocols and Processes among ADRC Core Partners that clearly outlines roles and expectations, value, and commitment - Build necessary IT connections across various systems that ADRC Core Partners use to support Results-Based Accountability and Continuous Quality Improvement/ADRC Business Management Tool needs - Identify other partners necessary to support and sustain a true NWD for all persons with all disabilities and ages needing long term services and supports >> SLIDE 21 Open Discussion >> END PRESENTATION