The State Perspective

1. The State Perspective Karol Swartzlander and Ed Ahern California Health and Human Services Agency STAKEHOLDER INPUT FORUM East Los Angeles Community College, LA, September 25, 2012

2. Today’s AGENDA Part 1: Overview Presentation • Introductions • Changes in Federal Aging and Disability Agencies • How Federal Changes Affect California • History of ADRC Partnerships in California • State and Local Systems Transformations in California Part 2: • California’s ADRC Designation Criteria Review

4. "For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

5. Administration for Community Living Federal HHS brings together the Administration on Aging (AoA), the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD) ACL oversees federal policies and system improvements for consumers of any age; including seniors and people with disabilities.

6. Administration for Community Living U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WEB www.aoa.gov

7. The ADRC Vision “The vision is to have Resource Centers in every community serving as highly visible and trusted places where people of all ages and income levels can turn for information and options counseling on their long-term care needs.”

8. Bringing the Vision to Life It’s all about building partnerships and making connections…. New Systems….NOT New Programs

9. 2012 ADRC Funding OpportunityJust the Facts

10. Part A ADRC FundingKey Deliverables for 8 States (36 Months) • A final agreement (e.g., MoU, Contract, etc.) between the State Medicaid Agency and designated lead agency overseeing ADRC Options Counseling Program to utilize Medicaid funds for certain ADRC functions. • Statewide coverage of a no wrong door ADRC system serving all LTSS populations and all LTSS payers. • Statewide coverage of an Options Counseling Program that adheres to national Options Counseling Standards including training and certification. • Statewide agreement and/or coverage for delivering Veterans services through ADRC. • Continuous Quality Improvement Plan for its ADRC Options Counseling Program, consistent with the National Evaluation Framework.

11. ACL Vision for Role of Options Counseling OC Roles • Veterans Adminstration • Medicaid • Medicare • Money Follows Person • FFP • Balance Incentive Program • Managed Care

12. Person Centered System

13. CA Definition of an ADRC An ADRC partnership is a new service delivery model that provides a coordinated system of information, referral and assistance for anyone seeking long-term services and supports (LTSS), regardless of age, disability or income. At the center of an ADRC model is a core partnership between an Area Agency on Aging (AAA) and Independent Living Centers (ILC), and then the broader LTSS network providers.

14. No Wrong Door ADRC Model Each county has a unique mix of health care and social service supports. California’s No Wrong Door approach allows local ADRC partnerships to build on existing expertise and infrastructure. Rather than creating new services, ADRCs re-envision and redefine how information and services can be made more accessible to any consumer.

15. ADRC Development in CA • 2003 – AoA ADRC Grant to Department of Aging (CDA): San Diego and Del Norte • 2006 – CMS Systems Transformation Grant to CHHS: Riverside and Orange • 2007 – AoA ADRC Grant to CDA: San Francisco and Passages • 2009 – ADRC Enhancement Grant to CHHS: San Francisco and San Diego • 2009 – AoA ADRC Grant to State Independent Living Council (Nevada)

16. ADRC Development in CA • 2010 – Affordable Care Act AoA/CMS ADRC Grants: Options Counseling and Care Transitions (CHHS) MFP/ADRC (DHCS) • 2011 - ADRC Advisory Committee (CHHS & SILC) • Participate in the development of a strategic plan for statewide implementation of ADRCs • Provide input on ADRC designation criteria and a formal application process • Serve as change agents to promote the ADRC model • Serve as key informants on stakeholder issues

17. California Vision Statement Every community in California has a highly visible, reliable, universal access point that provides objective information to facilitate access to long-term services and supports.

18. ADRC Development in CA • 2012 ADRC Funding • Hospital Discharge Planning Grant • ACL Part B ADRC Grant • Collaboration with The Scan Foundation • Looking Forward – 2012/2013 • Finalize ADRC designation criteria • Formalize ADRC application process • Expand ADRC partnerships and the options counseling • Developing sustainable ADRC business model(s) • Support capacity-building of local organizations to partner with managed care and other organizations

19. CA ADRC Core Services • Enhanced Information and Assistance • Call center staff utilize a broader array of information and provider resources across the aging and disability provider networks; warm transfers. • Options Counseling • A person-centered, interactive, decision-support process whereby individuals are supported in their deliberations to make informed long-term support choices in the context of their own preferences, strengths and values.

20. CA ADRC Core Services • Short-Term Service Coordination • Coordination assistance for consumers who urgently need help with multiple services and programs, generally for 90 days or less and until a longer term plan is in place. • Care Transitions • hospital-to-home care transition • nursing facility transition services

21. California ADRC Relational Chart Staff, Advisors, Contractors

22. ADRC No Wrong Door Model ADRC Operational Model One-stop access from the Consumer’s perspective Home and Community Based Services Employment Services Streamlined Access to Information and Services Options Counseling Public Programs Private Services Health Promotion & Nutrition Transportation &Housing Nursing Homes/ Institutions

23. Strengths of ADRC Partnerships An established infrastructure that connects the broad array of LTSS service providers in a community Call centers staffed with Information and Assistance experts Consumers streamlined access to the information they need Knowledge of the diverse and broadly defined LTSS population Databases that include a wide array of provider referrals One-to-one Options Counseling that serves to empower individuals and promote personal choice and responsibility. Expertise in transition services (hospital-to-home and nursing facility-to-home) Access to skills training, assistive technology, nutrition programs, care coordination Assistance with/ access to Medi-Cal eligibility application processes

24. The Evolving Landscape of LTSS Service Delivery Reforms Demographic Shifts in Service Demand Budget Adjustments and Resource Limitations

25. Transformation of LTSS • National Reforms • Affordable Care Act, Medicaid Reform • State Reforms • Mandatory enrollment of seniors and persons with disabilities in managed care • Community Based Adult Services (CBAS) • Dual Demonstrations in 8 counties • Medicaid Managed LTSS

26. ADRCs as the Gateway to LTSS Nexus of managed Medi-Cal managed LTSS and momentum for ADRC partnerships offers a unique opportunity and challenge ADRC Partnerships could offer a gateway to support dual demonstration efforts and Medi-Cal Managed LTSS

27. Community Scan – Potential Buyers Medicare FFS/MAP/SNP OAA Medicaid VA Medical Center Foundations ADRC Employer Insurance Plans Private Insurance Employer Assistance Programs PACE

28. California’s ADRC Partnerships Imperative to create consistency of: Message to the Public About LTSS Four Core ADRC Services Options Counseling Standards Broad Outreach Facilitated Access to Public Programs

29. Considerations for the Future How can the local organizations work together to: • Leverage multiple service networks • Embrace a person and family-centered approach to service delivery • Understand and support consumers of any age, any disability and any source/level of income • Support effective and efficient transitions back home from hospital and nursing facilities • Coordinate with and market services to managed care and other potential funders

30. ADRC Designation Criteria ADRC Advisory Committee deliberated and generated draft criteria State planning team made changes 2 Public Forums will generate additional modifications ADRC Advisory Committee will recommend final criteria to CHHS ADRC application process will be available to new and existing ADRCs

31. In Conclusion Relationships Matters

32. Sales FactoidNational Sales Executive Association 80% 2% 10% 3% 5% • 80% of sales are made on 5th - 12th contact • 10% of sales are made on 4th contact • 5% of sales are made on 3rd contact • 3% of sales are made on 2nd contact • 2 % of sales are made on 1st contact

33. ADRC Resources • Communitychoices.info (state) • TAE-ADRC.org (federal) • State ADRC Team • Karol Swartzlander, kswartz2@chhs.ca.gov • Ed Ahern, eahern@chhs.ca.gov • Paula Acosta, pacosta@chhs.ca.gov

34. Additional Resources • Dual Demonstration, www.calduals.org • AARP, LTSS Scorecard, http://www.aarp.org/relationships/caregiving/info-09-2011/ltss-scorecard.html • AARP New Report, On the Verge: The Transformation of LTSS, www.aarp.org/ppi • TheScanFoundation.org

35. QUESTIONS???

36. Part II 15 minutes Break Review and Discuss California Draft ADRC Designation Criteria Identify Technical Assistance Needs