EVALUATION OF VIRGINIA S SYSTEM TRANSFORMATION GRANT: YEAR TWO INTERIM REPORT

1. EVALUATION OF VIRGINIA’S SYSTEM TRANSFORMATION GRANT: YEAR TWO INTERIM REPORT PRESENTED TO THE VIRGINIA TRANSFORMATION LEADERSHIP TEAM BETH JACKSON, SUZANNE CRISP, STEVE EIKEN JUNE 10, 2009

2. 2 PRESENTATION OUTLINE APPROACH OBSERVATIONS & RECOMMENDATIONS: GOAL 1 OBSERVATIONS & RECOMMENDATIONS: GOAL 2 OBSERVATIONS & RECOMMENDATIONS: GOAL 4 OBSERVATIONS & RECOMMENDATIONS: TLT

3. 3 YEAR 2 EVALUATION FOCUS Assessing the Commonwealth’s accomplishments against the CMS-approved Strategic Plan; Identifying areas Virginia has faced difficulty or barriers in accomplishing grant objectives and activities; and Offering recommendations to facilitate the ultimate attainment of the goals specified in its System Transformation initiative.

4. 4 EVALUATION ACTIVITIES Periodic teleconferences throughout the year with the Commonwealth’s grants management team Periodic teleconferences with staff working on each goal Review of minutes from Resource Teams for each goal, the State Workgroup, and the TLT Three-day site visit November 5 – 7, 2008 Follow-up conversations with the grants management team, Resource Teams, and TLT chairs

5. 5 REPORTING PERIOD FOR YEAR 2 REPORT Covers more than one year, from November 2007 through February 2009. Report was delayed until the state could reassess its initial STG commitments in light of budget constraints.

6. 6 PRESENTATION OUTLINE APPROACH OBSERVATIONS & RECOMMENDATIONS: GOAL 1 OBSERVATIONS & RECOMMENDATIONS: GOAL 2 OBSERVATIONS & RECOMMENDATIONS: GOAL 4 OBSERVATIONS & RECOMMENDATIONS: TLT

7. 7 INTERVENTIONS IDENTIFIED IN GOAL 1 Connect 2-1-1 Virginia callers to the No Wrong Door (NWD) pilot sites and the NWD Web portal (Virginia Easy Access). Establishment of the pilots and Virginia Easy Access were funded under a separate ADRC grant. Train community professionals on the purpose and services of the one-stop NWD system and Virginia Easy Access Add a preliminary eligibility determination tool and an online Medicaid application to Virginia Easy Access Improve information and assistance for people with ID, DD, and MH needs

8. 8 2-1-1 VIRGINIA When Virginia Easy Access was implemented, 2-1-1 Virginia deployed a protocol to connect callers to organizations that specialize in serving older adults and people with disabilities (AAA, CSB, CIL) and to Virginia Easy Access The protocol was implemented later than planned in order to coincide with the rollout of Virginia Easy Access In Year 3, Thomson Reuters is working with VDA and the Goal 1 Resource Team to evaluate the degree to which 2-1-1 call center staff follow the protocol

9. 9 TRAIN COMMUNITY PROFESSIONALS Several efforts to promote Virginia Easy Access after August 2008 release (press release, presentations, panel cards, magnifiers, PSA) Virginia Easy Access usage was especially high in the first month NWD pilot sites will start using new software in first half of 2009. No outcome measures related to pilots were available because of need to change vendors.

10. 10 MEDICAID APPLICATION AND PRELIMINARY ELIGIBILITY TOOL A printable Medicaid application for older adults and people with disabilities is available on Virginia Easy Access. An interactive version, where people can enter information online and send it electronically to their local DSS office, is planned for 2009. A preliminary eligibility screening tool is also planned for 2009. A planned initiative to streamline program eligibility determination by transferring data between systems will not be implemented because of limited funding.

11. 11 INFORMATION AND ASSISTANCE FOR PEOPLE WITH ID, DD, AND MH Implementation is different from original grant, with all NWD sites able to establish partnerships using the NWD tools (PeerPlace) with other agencies (CIL, CSB, DSS). Access to NWD Tools has been delayed because a new vendor was necessary. For Virginia Easy Access, content for people with ID, DD, and MH is almost complete except for the provider database (11% complete). There are few mechanisms to measure participant satisfaction with NWD sites and Virginia Easy Access

12. 12 PRESENTATION OUTLINE APPROACH OBSERVATIONS & RECOMMENDATIONS: GOAL 1 OBSERVATIONS & RECOMMENDATIONS: GOAL 2 OBSERVATIONS & RECOMMENDATIONS: GOAL 4 OBSERVATIONS & RECOMMENDATIONS: TLT

13. 13 INTERVENTIONS IDENTIFIED IN GOAL 2 Obtain active input from the Resource Team whose members should be particularly attuned to Medicaid services and self-direction Promote recently-developed Person-Centered Practice (PCP) products Continue training of case managers, support coordinators, and transition coordinators in PCP philosophies Develop individual budgets for ID/DD and EDCD populations Update agency regulations, policies, and legislation to reflect PCP terminology Increase Medicaid waiver beneficiaries electing self-direction option Develop and test the Individual Support Plan (ISP)

14. 14 RESOURCE TEAM & PCP GUIDELINES / PRINCIPLES Resource team has a broad-based and diverse membership, but we continue to encourage adding participants who use Medicaid services Person Centered Planning (PCP) products include: Person-Centered Principles and Guidelines Glossary of PCP Terms “I Want a Good Life” (workbook) “What Does Person-Centered Mean?” (brochure) Need to develop clear website links to the PCP information and resolve any confusion associated with the STG website Recommend staff for older adults and people with physical disabilities consider a renewed commitment to PCP

15. 15 PCP TRAINING & INDIVIDUAL BUDGETING Roughly 200 case managers, support coordinators, and transition coordinators have been trained While progress has been achieved to develop cross-disability PCP standards and practices, the Commonwealth should develop a training curriculum using common principles across populations DMAS staff recommended separate methodologies for ID/DD and EDCD populations, and to start with pilot implementation. Budget shortfalls may delay development, but continued work in a budget neutral manner is recommended

16. 16 PCP LANGUAGE IN POLICY, REGULATIONS & LEGISLATION Resource Team reviewing agency regulations and policies to identify areas where PCP language should be included; will meet with OAG and Legislative Services in July. The 2008 General Assembly passed legislation to change the term “Mental Retardation” to “Intellectual Disabilities;” could not be implemented due to concerns re: loss of funding MFP Operational Protocol developed and written from perspective of service users and participants

17. 17 INCREASE SELF-DIRECTION SELECTION & DEVELOP / TEST ISP Individuals selecting the self-directed option continues to increase in all Medicaid waivers Development and testing of ISP continues. Initial pilots will be in specific regions of the ID/DD community. It is unclear whether the ISP will apply to older adults and people with physical disabilities, and the extent to which ISP coincides with Uniform Assessment Instrument (UAI) Recommend engaging staff and participants from the aging and disability communities in ISP development

18. 18 PRESENTATION OUTLINE APPROACH OBSERVATIONS & RECOMMENDATIONS: GOAL 1 OBSERVATIONS & RECOMMENDATIONS: GOAL 2 OBSERVATIONS & RECOMMENDATIONS: GOAL 4 OBSERVATIONS & RECOMMENDATIONS: TLT

19. 19 INTERVENTIONS IDENTIFIED IN GOAL 4 Development of an automated individual budgeting system (IBS) for self-directed program participants Enhancements to Office of Developmental Services IT capabilities Developing a Critical Incident Management and Reporting System (CIMRS)

20. 20 INDIVIDUAL BUDGETING SYSTEM (IBS) DMAS staff developed a report on individual budgeting that recommended separate methodologies for people with DD and people on the EDCD waiver. State plans to pilot methodologies for each population before implementation Automation of an IBS is at risk because of funding constraints

21. 21 ENHANCEMENTS TO OMR/ID IT CAPABILITIES Plan is to automate some critical functions associated with day-to-day operations: Submission of applications via the Internet Tracking of waiver openings Electronic data sharing with the Community Support Boards (CSB) Approving prior authorizations Providing program participants and providers instant access to a participant’s status Generating management reports Programming to be done internally

22. 22 ENHANCEMENTS TO OMR/ID IT CAPABILITIES, CONTINUED Projected deployment is Spring of 2011 with linking to CSBs in Summer of 2011 This is last year of the grant, which precludes measurement of outcomes Commonwealth plans to investigate additional resources to implement by October 2010 Data for original baseline measures did not yield reliable information, and the state has proposed new baseline measures

23. 23 CRITICAL INCIDENT MANAGEMENT AND REPORTING SYSTEM (CIMRS) Original grant budget did not provide sufficient resources The Commonwealth has identified funds from other grant tasks that can be reallocated to CIMRS. Commonwealth is deciding whether build upon systems in Virginia or import Ohio’s system Possible deployment in 2011. This is last year of the grant, which precludes measurement of outcomes

24. 24 PRESENTATION OUTLINE APPROACH OBSERVATIONS & RECOMMENDATIONS: GOAL 1 OBSERVATIONS & RECOMMENDATIONS: GOAL 2 OBSERVATIONS & RECOMMENDATIONS: GOAL 4 OBSERVATIONS & RECOMMENDATIONS: TLT

25. 25 ROLE OF TLT In our site visit in November 2007, some TLT members voiced interest in strengthening the role of the TLT in rebalancing Virginia’s long-term care system Concurrently, the State expanded the TLT’s advisory role to include the Money Follows the Person Demonstration and the State Profile Tool TLT formed Communications subcommittee and developed a communications strategy TLT formed Sustainability subcommittee, which struggled to identify strategies

26. 26 ROLE OF TLT During and after the November 2008 site visit, TLT representatives and state staff explored mechanisms to provide information in advance to decrease the amount of meeting time spent on reports Since the November 2008 site visit, the TLT co-chairs contacted its members to discuss their desired role in the TLT committees

27. 27 RECOMMENDATIONS FOR TLT The TLT should consider identifying one specific project to develop and implement in the next six months related to communications and/or sustainability While we applaud the TLT turning its attention to the long-term sustainability of the grant initiatives, we recommend that it maintain its focus on grant monitoring as well

28. 28 FOR MORE INFORMATION, PLEASE CONTACT Beth Jackson Director, HCBS Quality Community Living Systems Thomson Reuters beth.jackson@thomsonreuters.com (617) 492-9326 Steve Eiken, Senior Analyst Community Living Systems Thomson Reuters steve.eiken@thomsonreuters.com (651) 687-1136