nacdd: making sense of ltss policy. joe caldwell

1A non-profit service and advocacy organization © 2011 National Council on Aging

State Activity and Opportunities to Advance Home and Community-Based Services

Joe CaldwellDirector of LTSS PolicyNational Council on Aging

Rachel PattersonPolicy Analyst Association of University Centers on Disabilities


Overview

1. Managed Long-Term Services and Supports (MLTSS)

2. Opportunities for DD Councils in LTSS– Community First Choice Option– Aging and Disability Resource Centers

3. Implementation of HCBS Settings Rule


Half of States Could Have MLTSS Programs Within Next Year

NASUAD State Medicaid Tracker, July 2013


MLTSS Programs Adults with ID/DD, 2012



State Statewide Mandatory Enrollment

Private for-profit

Surveys and Advisory Council

Survey

Arizona X X X

Delaware X X X

Hawaii X X X X

Michigan X X X

North Carolina X (2013) X X

Pennsylvania X

Washington X

Wisconsin X



Program Primary/Acute

ID/DD HCBS

Institutional Behavioral Rx

AZ Long Term Care System X X X X X

DE Diamond State Health Plan-Plus X X X

HI QUEST Expanded Access

MI Managed Specialty Support & Services

X X X

NC MH/DD/SAS Health Plan Waiver X X X

PA Adult Community Autism Program

X X X

WA Medicaid Integration Partnership

X X X X

WI Family Care Partnership X X X X X

WI Family Care X X X


MLTSS for Adults with ID/DD: 2014 Update

• Six new states are planning or are in the process of implementing MLTSS for adults with ID/DD– Kansas– Texas– Illinois – New Hampshire– New York– Florida Source: NASUAD State Medicaid Integration Tracker, April 2014. Retrieved from

http://www.nasuad.org/sites/nasuad/files/Edited%20Final%20Tracker%20-%204.14.14.pdf


What is Managed Care?

Traditional Medicaid Managed Care


Powerful Tool

• Managed care is neither inherently “good” or “evil”

• It is a powerful tool: If it is used correctly it can do a lot of good, but if not it can do a lot of harm.

• Engagement of individuals with disabilities and families in the design and implementation is critical


Pros and Cons


Key Issues and Potential Roles of DD Councils

1) Disability Stakeholder Engagement2) Choice and Self-Determination3) Consumer Protections and Rights4) Quality Measurement, Data Collection, and Research


Disability Stakeholder Engagement

• The Issues:– MLTSS is very complicated– New terms, tools, and ways to advocate– No trainings have been developed for self-advocates

• Potential Role of DD Councils:– Develop trainings for self-advocates– Support consumer-based aging and disability coalitions in

states to influence programs and ensure consumer protections


Choice and Self-Determination• The Issues:

– Opportunities to design programs that promote self-direction, rebalancing, unmet needs and addressing waiting lists

• Potential Role of DD Councils:– Not allow states to “carve out” institutional services– Promote person-centered planning and options for self-

direction in programs– Ensure savings are reinvested to help address unmet needs

and waiting lists


Consumer Protections and Rights

• The Issues:– Some states are moving too quickly and not ready to

implement MLTSS programs– Need independent ombudsman programs

• Potential role of DD Councils:– Strong involvement in all phases of design and

implementation– Possible state legislation to ensure consumer protections – Require ombudsman programs


Quality, Data Collection, Research

• The Issues:– Quality measures are powerful tools that advocates and

states can use to make systems change• Possible Role of DD Councils:

– Support development and use of HCBS measures (e.g. National Core Indicators and Council on Quality and Leadership)

– Support independent, external research on implementation and outcomes for people with I/DD


Community First Choice Option 1915(k)

• State plan option to provide personal attendant services and supports to individuals who meet an institutional level of care– Hands-on, supervision, and cueing assistance with

activities of daily living and health-related tasks– Also includes some other services and transition costs

• Requires person-centered planning and options for self-direction

• Provides a 6% enhanced federal match for services that continues indefinitely


Community First Choice Option 1915(k)

• Two states have been approved (CA, OR)• Many states are applying or seriously considering

– AR, CO, MD, MN, MT, NY, TX

Possible Role of DD Councils:• Forming Community First Choice Council • Commission or contract for a study• Work with state on analyses• Think about next state legislative session


Aging and Disability Resource Centers

• No Wrong Door– ADRCs are intended to be trusted community sources

where people of all ages, incomes and disabilities go to get information and one-on-one person-centered counseling on the full range of LTSS options

• ACL’s new vision for ADRCs – Much more inclusive of disability– Emphasizes Person-centered planning

19

VD-HCBS launched 49 States awarded new ADRC grants (5 year plans)

2007

2008

2009

2010

20112012

10 CMS Hospital Discharge Planning grants to ADRC states

Affordable Care Act Money Follows the Person

CCTP and Balance Incentive Program launched

19

Milestones of ADRC Development

2003 12 states, 8 sites, 2% of pop.

24 states, 42 sites, 8% of pop.




ACL, CMS, VHA NWD System FOA


Aging and Disability Resource Centers

• Potential Role of DD Councils– ACL, CMS, VA issued an funding opportunity for state

planning grants– Deadline for applications in July 15– Main “deliverable” is a 3-year plan– States eligible include all states and territories, except the

8 states currently receiving Part A ADRC Grants (CT, MD, MA, NH, OR, VT, WA, WI).

– Need to make sure the DD Council is at the table– Promote greater involvement of self-advocates and

families


Friday Morning Collaborative

• American Association on Health and Disability

• American Association of People with Disabilities

• AARP• Alliance for Retired Americans• American Federation of State, County

and Municipal Employees (AFSCME)• American Network of Community Options

and Resources • The Arc of the United States • Association of University Centers on

Disabilities • Alzheimer’s Association• Bazelon Center for Mental Health Law• Center for Medicare Advocacy• Community Catalyst• Direct Care Alliance• Disability Rights Education & Defense

Fund• Easter Seals• Families USA• Health and Disability Advocates

• Leading Age• Lutheran Services in America• National Association of Area Agencies on

Aging • National Association of Councils on

Developmental Disabilties• National Association for Home Care and

Hospice• National Committee to Preserve Social

Security and Medicare• National Council on Aging • National Council on Independent Living• National Consumer Voice for Quality Long-

Term Care• National Disability Rights Network • National Domestic Workers Alliance and

Caring Across Generations• National Health Law Program• National PACE Association• National Senior Citizens Law Center• Paralyzed Veterans of America • Paraprofessional Healthcare Institute• Service Employees International Union • United Spinal Association• VNAA –Visiting Nurse Associations of

America


FMC Webinars

• Way to connect with state advocates and build capacity

• Many on MLTSS and ACA Opportunities• All archived: www.ncoa.org/HCBSwebinars

nacdd: making sense of ltss policy. joe caldwell

Government & Nonprofit