CHARTING THE COURSE FOR WAIVER INDEPENDENCE

1. CHARTING THE COURSE FOR WAIVER INDEPENDENCE Moving Cash and Counseling from the Traditional Waiver Program to the New State Plan Option Alabama Department of Senior Services

2. Planning the Voyage • During Olmstead Planning, focus groups indicated strong desire to have self-direction in Alabama • Much discussion on how to accomplish • Possibly combine with efforts of other grants in Alabama – Real Choice, Medicaid Infrastructure, etc. • Application made for Cash and Counseling Project/RWJ Grant Alabama Department of Senior Services

3. The Launching • RWJ Grant received in 2004 • Alabama was in 2nd round of grant awards • Received $250,000 for assistance in start-up • Formulation of a plan • Coordination with Medicaid and other state agencies on workplan for project • Determination of need for consultant • New concept for Alabama • Uniqueness of program – no two states alike • Concept Paper developed • Recommendation to operate program as an 1115 Research and Development project Alabama Department of Senior Services

4. Complicated Course The 1115 vs. 1915c Amendment Route • Issues with the 1915c Elderly and Disabled Waiver • Concern over implementing a new concept in a large waiver • Ability for one agency to test as a pilot • Rationale for the 1115 • Could accomplish a small pilot program under the 1115 waiver • Could carve out certain services for the program • Wanted ability to give cash to participants • Wanted to include Independent Living Waiver participants from the Rehab department without having to do a separate waiver Alabama Department of Senior Services

5. Leaving The Port • Workgroups formed • Concept paper submitted • 1st goal to meet – achievement of budget neutrality Alabama Department of Senior Services

6. Sailing Along • National Program Office (NPO) Involvement • Attending Cash/Counseling meetings • Participating in conference calls • Consumer Directed Module Software Project • Selected as one of three states to participate • Involved in selection of vendor, development of software design, and testing Alabama Department of Senior Services

7. Rough Seas Ahead • Budget Neutrality • Ongoing nightmare • Lengthy work sessions with numerous state and NPO staff • Took over a year to resolve • Passage of 2005 Deficit Reduction Act • Potential impact for our program Alabama Department of Senior Services

8. The Calm Before the Storm • 1115 Waiver submitted – 4/06 • Initial questions of whether CMS would approve as an 1115 waiver because of the DRA • Numerous conversations with CMS • Were finally told by CMS that they would process as 1115 • Received list of questions – 9/06 Alabama Department of Senior Services

9. The Storm Approaches • Waiting for word on approval • CMS conference call – 11/06 • Question/Answer clarification • Told approval forthcoming Alabama Department of Senior Services

10. The Storm Hits • Received e-mail from CMS • Stated proposal could not be approved as program could be accomplished under the new state plan option of the DRA • Told to withdraw proposal and submit draft pre-print for 1915(j) or waiver would be disapproved. • Much concern - what to do? • No final regulations regarding the DRA • Too much work on project to just throw away Alabama Department of Senior Services

11. The Sun Peaks Out • After several agonizing weeks – decision made to move forward with SPA option under the 1915(j) section • 1915(j) would allow Alabama to operate program as designed under the 1115 plan Alabama Department of Senior Services

12. Approaching Land • Worked closely with CMS in completion of the State Plan Amendment • Had numerous conference calls to work through the application issues • Submitted in 3/07 – almost a year after the original waiver submitted Alabama Department of Senior Services

13. Docking Complete CMS final approval received on May 24, 2007!!! Alabama Department of Senior Services

14. Disembarking • Within a period of four months • Established Advisory Committees • Developed Operational Protocol • Developed an RFP and Selected a Financial Management Agency • Started planning for Implementation • Training • Enrolling clients Alabama Department of Senior Services

15. Journey on Land Begins • Start Date of August 2007 • 1st Clients enrolled in September • Started managing budgets in November Alabama Department of Senior Services

16. Trip Expectations • Goals of Program • Increase access to paid personal care • Increase satisfaction with services • Increase overall quality of life • Meet more day-to-day needs • Decrease stress of families and informal caregivers

17. Trip Status • Extension of RWJ Grant • October 2007 - March 2008 • Current Participants • Success reports • Same amount of services received • Money left over for special purchases/savings • Purchase Examples – lift chair, air conditioner, ceiling fan with remote, etc. Alabama Department of Senior Services

18. Last Leg of the Journey • Final CMS rules/regulations • Financial impact of program • Conduction of program evaluation Alabama Department of Senior Services

19. Contact Information Alabama Department of Senior Services770 Washington Avenue RSA Plaza Suite 470Montgomery, Alabama 36130(334) 242-5743 1-(877)-425-22431-800-AGELINE (1-800-243-5463)Fax (334) 242-5594 Irene B. Collins, Commissioner Irene.Collins@adss.alabama.gov Or Jean Stone, Division Chief Long Term Care Programs Jean.Stone@adss.alabama.gov