Nevada’s Long Term Support Services

1. Nevada’s Long Term Support Services DHHS Vision March 2013

2. The Vision • One Integrated DHHS Home and Community Based Long Term Support System.

3. Critical Components • No Wrong Door to Services • Simplified Access to Services • Coordinated Quality Management

4. No Wrong Door • Entry to Integrated System through • Aging and Disability Resource Centers (ADRC) • Money Follows the Person (MFP) • Division of Health Care Financing and Policy (DHCFP) • Aging and Disability Services Division (ADSD) • Division of Welfare and Supportive Services (DWSS) • One system where referral and recipient information resides, preventing duplication.

5. No Wrong Door - SAMS • Social Assistance Management System (SAMS) case management software. Functionality includes: • Intake • Integrated case management • Assessments and reassessments • Care planning • Electronic service ordering • Service tracking • Invoicing • Provider contract management • Security access roles

6. No Wrong Door - SAMS • Recipient/Consumer Maintains all client-related information and offers hundreds of data elements, including auto-assignment of a unique client/caller identifier, client demographics, contact information, care plan enrollment, case managers, authorized providers, service plans, third-party payer identifiers and other vital information as identified and chosen by the state. • Case Manager Define goals, needs, objectives, and planned services per program. Care plans can be triggered for review and treatment team members are alert via automated alerts on the Dashboard to complete assigned tasks such as reviews or reassessments. • Provider Securely access a consumer’s record to track movement through all of the organization’s programs, providing a single, integrated system that will link all demographics, assessments, care plans, service plans, service deliveries and re-assessments.

7. No Wrong Door - SAMS Comprehensive reports on client and service information. Build reports based on templates. Create reports without having to rely on technical staff. Security and administrative features ensure that the users have access to the right data, can extract data specific to them and create reports to analyze client and provider activity. Report Examples include: • Wait list and wait times • Care enrollments • Unduplicated census • Consumer’s by care managers/office/program

8. Simplified Access To Services • Two 1915(c) waiver programs • One serving recipients with nursing facility Level of Care. • One serving recipients with ICF/MR Level of Care. • Integrated suite of services allowing recipient ease of service access without program transition, wait times, and/or duplicative processes, such as LOC. • Improved access to providers - providers have limited provider types, with ease of enrollment, prior authorizations, and billing.

9. Coordinated Quality Management • Improved Quality Management • Larger sample sizes provide for integrated data and better issue identification (versus small, splinter reports). • Samples will be drawn from all HCBS programs, including State Plan and Waivers. • Decreased Administrative Burden to State, allowing more funds to transition to services. • Only two annual waiver reports and reviews versus four. • Increased ability to access new opportunities, including: • 1915(i) • Community First Choice • Balancing Incentive Payment Program. • Allows great opportunities to recipients and helps shift funding currently expended on institutional services to home and community based services.

10. Coordinated Quality Management (Continued) • Quality Process Simplification • Rather than 4 or 5 HCBS quality reviews a year, providers will have one large review annually. (there will still be licensure processes and program financial and billing audits) • This will provide better data, allow one comprehensive improvement plan, and allow time to implement the plan before the next review. • Provide quarterly reports on progress. • This will help identify policy, program, or system issues that can be improved.

11. Operations • Transition all WIN Waiver Operations to ADSD (January 2016) • Combine Waivers into one NF waiver and one ICF/MR waiver (July 2016)

12. Action Steps • January – February 2013 • Initial high level planning. • February 2013 • Vision Communicated to Legislative Committees in ADSD budget presentations. • February 2013 • Initial out reach to staff to present vision and develop work groups. • March - April 2013 • Continued outreach to internal DHHS staff, Medicaid Medical Care Advisory Committee, Long Term Support Service Quality Assurance Committee. • Add DWSS and DHCFP/ADSD IT staff to Core development committee

13. Action Steps (Continued) • June/Summer 2013: • Development of stakeholder communication, focus statements, workgroups. (Commission on Aging, Nevada Commission on Services for Persons with Disabilities) • Gather input and concerns. • August 2013: • Contact CMS for technical assistance for combined waiver development • May 2014 • Budget Concept for WIN operations integration into ADSD completed for 2015 legislative session. • May 2014 • Budget Concept - if needed -to complete WIN integration into combined case management system. • July 2015 – January 2016 • WIN operations transferred from DHCFP to ADSD.

14. Action Steps Continued • April 2013 – March 2015 • Development of combined HCBS quality assurance system (CHCS assistance in two year action plan development). • January – July 2016 • WIN/CHIP/AL combination into one waiver.