Serving Older Adults and Individuals with Disabilities through No Wrong Door

1. Serving Older Adults and Individuals with Disabilities through No Wrong Door Blueprint for Livable Communities July 17, 2015

2. No Wrong Door Mission Statement Virginia will provide a high-quality, sustainable, person-centered, single statewide No Wrong Door system of long-term services and supports. No Wrong Door will support individuals of all ages and disabilities in achieving their unique goals for community living; streamline access to community supports; and promote efficiencies.

3. Multiple Entry Points into HCBS CILs AAAs CSBs LDSSs LHDs Local I&R Agencies (211) Faith-Based Community Family Members & Supporters VA Medical Centers (VDHCBS) LTC Facilities (Section Q; MFP) Other LTSS Providers CCC MCOs Acute Care Systems (Hospitals) Local Government Agencies State Government Agencies

4. Challenges to Multiple Entry Points • People fall through the cracks between the referral point and the access/enrollment into a service • People must provide same information to each provider (often details are left out) • Duplication of information collected • Referrals are often based on Coordinator’s knowledge, not on individual choice • No common community record to track what supports an individual may have • Most providers have their own Case Management system

5. Virtual Single Point of Entryfor Accessing HCBS across Virginia • Older Adults • Individuals with Disabilities • Family Caregivers • Public and Private • Statewide Initiative

6. No Wrong Door Network • A virtual statewide network of long-term care providers, connected by a web-based system that enables partners to: • 1. Share individual data in a secure web-based system • 2. Make electronic automated referrals between providers • 3. Track individual progress • 4. Access reports related to referrals

7. Communication, Referral, Information, and Assistance (CRIA) CRIA HCBS

8. Automates and Tracks Referrals CRIA Interfaces with VirginiaNavigator Provider Database of 26,000+ Programs/Services Customized dependent drop-downs for region, service, and funding source Interfaces with statewide “Client Profile” Database Shares individual-level data within secure web-based environment between partners Tracks “real-time” status of referrals: pending, accepted, rejected Automates reports on individual, staff, agency, and state levels

9. Enhances Person-Centered Decision Support CRIA Data fields align with statewide standards for Options Counseling Tracks individual progress and shares progress notes Prompts follow-up with dates and details Populates automated report for state reimbursement Integrates with automated referrals

10. Supports Transitions CRIA Integrates with Care Transition Module Automates reports for CMS Reimbursement Tracks quality assurance measures related to readmission Tracks MDS 3.0 Section Q protocol and response rates Integrates with automated referrals to MFP Transition Coordination Providers (TCPs)

11. Provides Universal Assessment CRIA Integrates with Virginia’s Uniform Assessment Instrument Expedites eligibility process Can be downloaded to laptops and used in remote areas of the state Assessment areas include: Current formal services; Financial resources; Physical environment; ADLs/IADLs; Medical Admissions; Diagnoses; Medications List; Sensory functions; Nutrition; Cognitive Function; Behavior Patterns and Emotional Status

12. NWD/ADRC: Evaluating Outcomes • Integrating evaluation into process using Technology to Document and Demonstrate • Tracking Community Tenure via Living Environment • Successfully supporting individuals in the environment of their choice • Increased understanding of individual options • Increased knowledge of caregiver supports • Identifying and tracking gaps and unmet needs in HCBS

13. Virginia receives four grants requiring coordination with ADRC (OC, MFP, VICAP, Alz). • DMAS/VDH/ VDA establish LCA network for Section Q. • DARS expands to include AS/APS. • Two of Virginia’s Care Transitions programs receive approval for reimbursement by CMS. • Legislation establishes new agency, DARS (DRS & VDA). • Virginia develops online training and Reimbursement Model for OC, open to all CILs and AAAs. • Virginia receives one-year planning grant to form Resource Advisory Council; develop a • three-year plan. Virginia’s No Wrong Door Milestones • Virginia standardizes • OC training certification . • AAAs written into Code of Virginia as “Lead Agency in Respective area” for the NWD System. • VDA receives Virginia’s first ADRC Grant from AoA, to launch a No Wrong Door System. • DMAS receives STG tied to NWD. 2014 2013 2012 • Legislative Study on the benefits of establishing a “No Wrong Door” approach to coordinate Virginia’s LTC supports. 2011 2010 • Independent Living moves from Rehab Services Administration to ACL. 2009 • Administration for Community Living established (Admin on Aging, Office on Disability, Admin on DD. 2006 • National Association for CILs (NCIL) hires ADRC coordinator to identify opportunities for collaborating with local ADRC network. • ACL defines ADRC core components: I,R&A; OC; Person-Centered Transitions. 2005 • SeniorNavigator launched. • AoA partners with Veterans Administration and encourages states to serve Vets through ADRC. 2003 Federal “Systems Change” Milestones • AoA awards first ADRC Grants to pilot states. 2001 • “Systems Change” Grants begin to address deinstitutionalization and remove barriers to community living for individuals with disabilities. 1999 • Olmstead Decision affirms right of individuals with disabilities to live in community.

14. ADRC Coverage (October 2009) Approximately 50% of State AAAs only (13) Current communities in which the AAA is using full NWD/ADRC technology 8D 8B 7 8A (12) NWD/ADRC technology not yet being utilized 8C 8E 9 16 6 17/18 10 22 15 5 11 14 21 2 4 19 12 3 20 1 13

15. Five-Year No Wrong Door Progress 2010 - 2015 NWD Partners 13 61 Providers currently using CRIA CIL Home Health (2) Home Modification Client Database 31,566 160,281 unique individuals in system 8D 8A PACE Meals on Wheels Home Modification Adult Day(2) Family Services Home Health; YMCA Home Health Provider Database 22,000 26,300+ services/programs 7 8C 8B CIL CRIA (Communication, Referral, Information and Assistance) 0 41,500+ unique served last year 8E Community Action Agency 9 16 6 PACE MFP TCP Hospital Affiliate Home Health 17/18 10 22 DSS (3) Hospitals (2) Home Health 15 5 Transportation 14 11 Adult Day Meals on Wheels Mental Health Home Health CIL; ARC; DSS CSB 21 2 19 CIL CIL 4 CIL 12 3 20 1 13 Care Transitions Using NWD System Options Counseling Using NWD System

16. “All-Med Express” (Assistive Technology) “Help with Housing” (Home Modification) “Comfort Keepers” (Help with Chores) “Access Chesterfield” (Transportation) DHP VFHY CSA VBPD DARS/AAAs D ARS/CILs “Circle Center” (Adult Day Care) “Meals on Wheels” (Home Delivered Meals) VDDHH “Care Advantage” (Medication Management) DBVI VDSS/LDSS VDH/Local HDs DMAS DBHDS/CSBs No Wrong Door and HHR Portal ENERGY ASSIST MEDICATION MANAGEMENT TANF MEDICAID ADULT DAY CARE Portal ASSISTIVE TECHNOLOGY PORTAL HELP WITH COOKING HOME DELIVERED MEALS HOME MODIFICATION SNAP FAMIS TRANSPORTATION WIC

17. Planning Grant • One-year Planning Process • Strategic Leadership Group – Office of the Secretary of Health and Human Resources (OSHHR), Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS) • No Wrong Door - Resource Advisory Council (NWD-RAC) State agencies, statewide associations, self and family advocates • Advocacy Group – Individual Providers, Health Plans, Medical Community, Advocacy Organizations, Other Stakeholders

18. Resource Advisory Council Workgroups • Workgroups focused on cross-cutting areas: • Assessment • Common Language • Education and Awareness • Person Centered Tools • Quality • Sustainability

19. NWD 3-Year Implementation Grant • Increase public and private partner participation in the NWD System • Replace the case management system currently used by Local Departments of Social Services Adult Protective Services/Adult Services (LDSS-APS/AS) with the NWD System • Integrate person-centered practices into the Uniform Assessment Instrument (UAI), related assessment tools, curriculum, training materials, and policies • Increase citizen-centric access, consumer direction and self referrals and capture data entered by consumers in the NWD System through the NWD Virtual Provider Directory • Develop and implement “Best Practices” for NWD that promote systems interchange and interoperability

20. Serving Older Adults and Individuals with Disabilities through No Wrong Door Kathleen A. VaughanNo Wrong Door CoordinatorDARS (804) 662-9153Kathleen.Vaughan@DARS.Virginia.gov Blueprint for Livable Communities July 17, 2015 Katie Roeper Assistant Commissioner, Aging DARS (804) 662-7047 Katie.Roeper@DARS.Virginia.gov