SC Access Plus Planning Retreat: Developing a Shared Vision for ADRC Design and Operation

1. South Carolina Access Plus Planning Retreat January 14-15, 2004 Karen Linkins and Sharon Zeruld, The Lewin GroupSusan Reinhard, Rutgers Center for State Health Policy

2. SC Access Plus Planning Retreat Introductions

3. Goals To develop a shared vision and values to guide ADRC design and operation To identify, evaluate and decide on different design options Outcomes Partnership between the Aging and Disability communities Common understanding about federal requirements and expectations Shared expectations about ADRC outcomes Identification of strengths and resources of all partners Foundation for the local advisory board Identification of next steps toward pilot implementation Overview of SC Access Plus Planning Retreat

4. Agenda Day 1 Historical and current perspective of South Carolina’s system Overview of AoA/CMS vision and expectations for ADRCs Small group session: SC Values and Principles Small group session: SC Vision Development Day 2 Synthesis of SC’s shared visions and values ADRC design options Small group session: evaluation of design options, identification of resources, opportunities and challenges Next steps toward implementation Expectations of Small Group Discussion Overview of SC Access Plus Planning Retreat, continued

5. SC Access Plus Planning Retreat Where We’ve Been and Where We Are

6. SC Access Plus Planning Retreat Overview of National Vision and Expectations

7. Context of Aging and Disability Resource Center (ADRC) Program Background of collaborative initiative Functions of an ADRC National vision for ADRC program National expectations Overview: National Vision & Expectations

8. DHHS Systems Framework Coherent Systems Management Access Comprehensive information, simplified eligibility, and single access points Person Philosophy of self-direction and individual control in legislation, policies, and practices Community Life Financing A seamless funding system supporting individual choice Services Responsive supports across settings and provider types Quality Improvement Comprehensive systems that assure quality of life and services Context of ADRC Program

9. ADRC Activities Within AoA and CMS Initiatives and Goals Initiatives Systems ChangeGoals/Impacts CMS • Real Choice System Change Grants • Systems Change Conference • Other CMS Programs/Initiatives • Community Living Exchange Collaborative • Access • Efficiency • Effectiveness • Consumer Focus • Visibility/Awareness Activities by CMS & AoA (websites, town forums, conferences) • Aging & Disability Resource Center Grants • Aging & Disability Resource Center Technical Assistance Exchange • Projects with the National Governor’s Association/National Conference of State Legislatures • NASUA I&R Support Center • AoA Prevention Initiative • RTI Case Studies AoA Context of ADRC Program, continued

10. Background of Collaborative Initiative • ADRC Program announced March 2003 • Grants issued as cooperative agreements by AoA and CMS • Joint effort that provides states with an opportunity to effectively integrate their long term support resources for consumers into a single coordinated system

11. FY 2003 ADRC Grantees Aging & Disability Resource Center Grantees FY 03 Awardees: LA, ME, MD, MA, MN, MT, NH, NJ, PA, RI, SC, WV

12. Definition of an ADRC An ADRC is a visible and trusted place at the community level where people can turn for information and counseling on all available long term support options and a single point of entry to public long term support services. The ADRC program enables people to make informed decisions, provide streamlined access to long term supports, and organize the long term support system.

13. Functions of an ADRC • Awareness & Information • Public Education • Information on Options • Assistance • Options Counseling • Benefits Counseling • Employment Options Counseling • Referral • Crisis Intervention • Planning for Future Needs • Access • Eligibility Screening • Private Pay Services • Comprehensive Assessment • Programmatic Eligibility Determination • Medicaid Financial Eligibility Determination • One-Stop Access to all public programs

14. National Vision for ADRC Program • To truly embrace the vision of the Americans with Disabilities Act (ADA) – serve all ages & income levels • To continue the vision of President Bush’s New Freedom Initiative • To create synergies between the Aging Network and CMS to implement consumer-directed care • To increase visibility of long term support within state government • To offer a variety of different models for other states to replicate

15. National Expectations for ADRC Program • Broad mandate • Information & Awareness, Assistance and Access • Serve people of all ages and income levels of identified target groups • Specific expectations • Seamless system for consumers • Integrated access – streamlined eligibility • Shift of institutional bias – critical pathways • Meaningful involvement of consumers & other stakeholders • Partnership between Aging Network and Medicaid • Investment in MIS that supports goals of ADRC • Performance measurement – CQI, outcomes • Sustainability

16. Common Elements of Success • Adopt a civic process and develop state & local partnerships • Public and private sector integration • Leverage other grants • Real Choice Systems Change, AoA Family Caregiver, HUD, Medicaid Infrastructure Grants, etc. • Develop program based on shared, underlying values • Need to develop a disability expertise • Foster good relationship with Medicaid • Emphasize performance management & flexibility

17. Common Elements of Success, continued • Plan for sustainability • Need for cultural competence in both outreach and options counseling • Decide information needs from the beginning • Establish attainable short term goals and objectives but keep sight of the long term goals

18. Common Elements of Success: Lessons Learned from Wisconsin RC Experience • 9 pilot Resource Centers in WI • 3 – county Departments on Aging • 1 – combination of county Public Health Department & Department on Aging • 2 – county Social Service agencies • 2 – county Human Service agencies • 1 – split between county Social Service agency & agency for Developmental Disabilities Services

19. Lessons Learned from Wisconsin RC Experience: RC Contact Needs, 2002 RC Contact Needs, 2002 Referral to private LTC services 1% Referral to APS 2% Follow up contact from staff 4% Referral to Emergency Services 0.3% Basic Info on Medicaid 15% Short term CM 9% Referrals to other public services 7% LTC related services 29% Referrals to functional Screen 14% Basic Info on Other Services 19%

20. Common Elements of Success: Lessons Learned from Wisconsin RC Experience • Be willing to give up organizational turf to work as team and to put people first • Focus on streamlining eligibility determination • Completed in 2-4 days, < 24 hrs. when needed • Protocols on sharing eligibility information with consumers and other providers • Recognize needed skills and training of ADRC staff • ADRC is a business that serves customers/customer satisfaction • Ability to serve different target groups - “disability specialists” • Public image of “aging” services or “welfare agency”

21. Common Elements of Success: Lessons Learned from Wisconsin RC Experience • Invest in comprehensive IT systems that support ADRC • Treat options counseling as process, not as event • Leverage experience from agencies that serve individuals who can private pay

22. SC Access Plus Planning Retreat Underlying Values & Vision Development

23. Karen Linkins Vice President The Lewin Group 3130 Fairview Park Dr. Suite 800 Falls Church, VA 22042 Karen.Linkins@lewin.com (703) 269-5681 Sharon Zeruld Senior Manager The Lewin Group 3130 Fairview Park Dr. Suite 800 Falls Church, VA 22042 Sharon.Zeruld@lewin.com (703) 269-5967 Contact Information