The Federal and State Perspectives on ADRCs

Karol Swartzlander

California Health and Human Services Agency

February 16, 2012

ADRC Advisory Committee Meeting

THE FEDERAL PERSPECTIVE

Excerpts from presentations by Joseph Lugo (Administration on Aging), Carrie Blakeway (Lewin Group) and the ADRC-TAE website

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• The Aging and Disability Resource Center Program (ADRC) is a collaborative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS). ADRCs serve as single points of entry into the long-term supports and services system for older adults and people with disabilities of all income levels

What are ADRCs?

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National Vision for ADRCs

To have Aging and Disability Resource Centers in every community serving as highly visible and trusted organizations where people of any incomes and ages can turn for information on the full range of long-term support options and a single point of entry for access to public long-term support programs and benefits.

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• Federal ADRC initiative began in 2003 with three core functions– Awareness, Assistance, and Access

• Set of core expectations has grown over time– Information, referral, and awareness– Options counseling, advice, and assistance– Streamlined eligibility determinations for public

programs– Intervene in critical pathways to

institutionalization– Person-centered transitions– Quality assurance and continuous improvement

Maturity, Growth, and Expansion of ADRCs

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Milestones of ADRC Development

FFC released

VD-HCBS launched49 States awarded new ADRC grants (5 year plans)

2007

2008

2009

2010

2011

FFC revised to better address NWD models

2012

10 CMS Hospital Discharge Planning grants to ADRC states

Affordable Care ActCT, OC and MFP grants awarded

FFC revised to better address CT, OC and CQI

Lewin and AARP Develop SEP Indicator for LTSS Scorecard

CCTP and BIP launched4 SI grants awarded

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Sep-04 Mar-05 Sep-05 Mar-06 Sep-06 Mar-07 Sep-07 Mar-08 Sep-08 Mar-09 Sep-09 Mar-10 Sep-10 Mar-11 Sep-11 -

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

180,000,000

200,000,000

12 states,

8 sites, 2% of pop.

24 states,

42 sites, 8% of pop.

43 states,

81 sites,

13% of pop.

43 states,

147 sites,

30% of pop.

43 states,

201 sites,

39% of pop.

47 states,

300 sites,

49% of pop.

51 states,

344 sites,

54% of pop.

51 states, 386 sites, 60% of

pop.

Growth in ADRC Coverage

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Across All 383 ADRCs: ►8 are operated at the state level by a state-level

organization, either an SUA University or other non-profit►49% are operated by more than 1 entity, through networked

or “no wrong door” model►81% have an Aging Network Organization serving as at least

1 operating entities ► 77% include an Area Agency on Aging

►29% percent have a Disability Network Organization serving as at least 1 of their operating entities

► 24% include a Center for Independent Living

ADRC Operational ModelTypes of entities operating ADRCs:

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More a network than a place or an entity.

ADRC Partnerships• ADRCs have an

average of:• 14 formal

partnerships with individual organizations at program/local level

• Formal partnerships with 14 different types of organizations at the state level

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• Funding shared• Written contract or agreement• Written referral protocols• Co-location of staff• Regular cross-training of staff• Routine collaboration to better serve

individual clients• Use of same or compatible IT systems• I&R resources are shared• Client data are shared• Joint marketing and outreach activities

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What does Formal Partnership Mean?

PartnershipsCommon Partners

Medicaid, State Units on Aging, ADRCs, Area Agencies on Aging, Independent Living Centers, Alzheimer’s Associations, health care providers, minority services associations and organizations, consumers

Examples of Unique Partners

State Commission on Minority Health

Latin American Association

Center for Pan Asian Community Services

SAGE (Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders)

Wisdom Steps Health Preventive Program for Native Elders

Governor's Office and Lieutenant Governor’s Office

State Coordinating Council for Services Related to Alzheimer's Disease and Related Dementias

Senior Services Property Tax Levy Staff

AARP

Workforce Development Office

Private Health Plans

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One-stop access from the Consumer’s perspective

ADRC Operational Model

Home and Community Based Services

Nursing Homes/Institutions

Options Counseling

HealthPromotion & Nutrition

Employment Services

Transportation &Housing

Private Services

Public Programs

One-Stop Access

to Information and Services

ADRC Operational Model

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1. Information, Referral, and Awareness: Outreach and marketing to all ages and income levels, web-based searchable database, systematic I&R, follow-up

2. Options Counseling and Assistance: OC standards and protocols, short-term crisis support to prevent institutionalization, planning for future needs, follow-up

3. Streamlined Eligibility Determination for Public Programs: Uniform intake and screening, coordinated elig. processes, financial and functional elig. determined on-site or through seamless referral, tracking an follow-up to all applicants

Criteria of Fully Functional ADRCs – 6 DomainsADRC Functional Components

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Criteria of Fully Functional ADRCs – 6 Domains (cont.)ADRC Functional Components

4. Person-Centered Transition Support: Formal agreements and protocols with critical pathway providers to facilitate transitions, serve as Local Contact Agency for MDS 3.0 Section Q

5. Target Populations and Partnerships: Capacity to serve all ages and types of disabilities, formal partnerships with key agencies, regular consumer input and involvement

6. Quality Assurance: Adequate staffing and IT to support all program functions, CQI plan and procedures, state and local level tracking of performance and outcomes

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• Catalyze broader systems change • Promote participant-direction• Build stronger partnerships across siloed

LTSS system• Intervene during care transitions from

hospitals and other care settings• Assist with institutional transitions• Implement new initiatives (e.g., Veteran-

Directed Home and Community Based Services, MDS 3.0 Section Q)

AoA and CMS view ADRCs as the platform to:

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Aging and Disability Resource Center Role in Care Transitions

Goals- Improve ADRC capacity to provide care coordination and

reduce health care expenditures of people with disabilities and/or chronic conditions

- Position ADRC and Aging Network for other funding opportunities

Current Status- 100 ADRCs are actively partnering with 156 hospitals across

36 states- 34 states are partnering with QIO’s/21 states are partnering

with hospital associations- Between 4/1/11-9/30/11, 66 sites served 9,115 consumers

with care transition following an acute care episode; 3,708 consumers received an EB Care Transition program

- Readmission rates

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Establishing National Standards and Core Competencies for Options Counseling

• Goal– Develop National Standards for ADRC Options Counseling Program– Credential network to provide a options counseling for a variety of funding

sources (e.g., CMS Care Transitions, VD-HCBS, Private Pay, MFP, etc.)

• Approach– 19 grantee states funded in 2010– Collaboratively develop and test draft National Standards for ADRC Options

Counseling Program– Develop Performance/Evaluation Framework– Implement and pilot test10 common measures agreed upon by states

• Current Status– 19 states adopted and are implementing draft national standards with some

variation – Approximately 30 non-grant states are developing or have draft standards

based on the draft national standards

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►ADRC role includes: Screening candidates Providing Options Counseling Facilitating access to HCBS Establishing/ strengthening

quality assurance and CQI Strengthening infrastructure to

facilitate transitions Educate/outreach to state

agencies and NFs about MDS 3.0 Section Q

Person-Centered Transition Support (Institutional Transitions):

ADRCs play a critical role in nursing facility transitions under the Money Follows the Person Demonstration (MFP) in 37 of the MFP states. ADRCs are involved in nursing facility transitions in another 4 states.

Local Contact Agency for MDS 3.0 Section Q– ADRC is only LCA in 12

states– ADRC has been

designated as one LCA among many in 39 states

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Function Progress

Resource database 37 states have statewide web-based directories available to consumers and service providers

Functional eligibility 40% of ADRCs have co-located Funct. Elig. staff

Financial eligibility 25% of ADRCs have co-located Fin. Elig. staff

Medicaid application 34 states have applications available on-line

Medicaid application submission 7 states allow applications to be completed on-line and submitted electronically

Consumer decision tool Available on-line in 16 states; 15 states developing technology

Portable technology 8 states use laptops in the field; 3 include portable document scanners and photography

Key strategies for streamlining access and eligibility determinationADRC Functional Components

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Sustainability

► Embedded in Older Americans Act Reauthorization 2006

► Embedded in Affordable Care Act 2010

► 33 states have passed ADRC legislation, developed exec. guidance, and/or contributed state funds to enhance and expand ADRCs

► Received approximately $43M in financial support from public and private sectors for program development and expansion.

► Developed new partnerships to enhance program activities.

► Expanded to multiple pilot sites and statewide in many states.

Signs of ADRC Sustainability

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• Older Americans Act Titles III-B, III-D, III-E and IV

• Rehabilitation Services Act

• Medicaid Administrative

• State Health Insurance Assistance Program (SHIP)

• Medicare Improvements for Patients and Providers Act (MIPPA)

• Senior Medicare Patrol

• Money Follows the Person Demonstration (MFP)

• AoA Grant Funding (e.g., ADRC, OC, CT, CDSMP, EBDP)

Great future potential: CMS Community Care Transitions Program, CMS Balancing Incentive Payment Program, Veterans Affairs VD-HCBS

Common Federal Funding Sources Supporting ADRC FunctionsSustainability

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Diversity of funding: Average Annual ADRC Budget Revenue Sources, 2011

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Lessons Learned: What facilitates Local ADRC sustainability?

Sustainability

• Leadership that is willing to break down bureaucratic barriers

• Viewing the ADRC as a catalyst for positive systems change

• Being sensitive to political climate• Being open to spontaneous partnership opportunities• Board members and consumers who are vocal

champions• State and local sites working collaboratively • Designating organizations as ADRCS with functions,

missions, and priorities that match the federal vision

• Melding ADRC activities with ongoing systems reform and related community initiatives

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Community Scan – Potential Buyers

ADRC

Foundations

Private Insurance Employer

Assistance Programs

Employer Insurance

Plans

Medicare FFS/MAP/SNP

OAA

Medicaid

VA Medical Center

PACE

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• What are your state’s current LTC priorities? How/where does the ADRC initiative fit?

• How are things going with your sustainability/expansion efforts?

• What kinds of funding sources do you have? What are you pursuing?

• What role have partnering organizations at state or local level played in sustaining services?

• Which ADRC functions do you think will be sustained no matter what (e.g. they are embedded or institutionalized)?

• Which may not be sustained (e.g. put on hold, reduced in scope or service area)?

SustainabilityKey Decision Points

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The State Perspective

ADRC Partnerships

Rethinking Service Delivery

AREA AGENCY ON AGING

+

INDEPENDENT LIVING CENTER

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 other LTSS network providers.

No Wrong Door Approach

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 how information and services can be made more accessible to any consumer.

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 SILC (Nevada)

ADRC Development in CA

2010 – Affordable Care Act ADRC Grants: Options Counseling and Care Transitions (CHHS), and MFP/ADRC grant (DHCS)

2012 - 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

New Vision Statement

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

CA ADRC Core Services

Information and AssistanceOptions Counseling Short-Term Service Coordination Care Transitions

hospital-to-home care transition nursing facility transition services

Common Goals

Improve consumer AwarenessProvide consumer Access to

information and services Provide Assistance through ADRC

core servicesStreamline consumer access to

Critical Pathways Providers

Fundamental Components of a California ADRC

Core Partnership of AAA & ILC Local Leadership Advisory

Committee Capacity to serve all ages,

disabilities and income levels Provision of the four core ADRC

services

Why do we need ADRCs?

Service System Challenges►Increase in demand►Reduced service budgets►Fragmented systems►Hard to access►Confusing►Lacks focus on consumer►Institutional bias

The Evolving Landscape of LTSS

Service Delivery Reforms

Budget Adjustments and Resource Limitations

Demographic Shifts in Service Demand

Transformation of LTSS in CA

Mandatory enrollment of seniors and persons with disabilities in managed care

Community Based Adult Services (CBAS) transition effort 

Dual Demonstration PilotsCoordinated Care Initiative

ADRCs Embedded in Reforms

New reform efforts lend urgency to finalizing State ADRC designation criteria and establishing criteria for: A fully functional ADRCAn emerging ADRC

ADRC Partnerships Offer

Knowledge of the diverse and broadly defined LTSS population Call centers staffed with Information and Assistance experts Databases that include a wide array of provider referrals Person-to-person Options Counseling that includes self-direction,

planning and personal responsibility (OC pilot testing is currently in process, January – June, 2012)

Expertise in transition services (hospital-to-home and nursing facility-to-home)

Access to skills training and assistive technology, some of which could result in delaying or avoiding higher Medi-Cal costs, and

Assistance and access to Medi-Cal eligibility application processes.

Q&A/Discussion

How can we leverage the state’s current investment in ADRC Partnerships and existing aging/disability service providers in a fully integrated LTSS system?

How do you see ADRC partnerships fitting into these reform efforts?

Q&A/Discussion

What are Managed Care Organizations focusing on at the local level? Are they engaging the LTSS network in discussions?

What kinds of technical assistance do local organizations need to explore/implement an ADRC partnership?

ADRC Resources

Communitychoices.info (state)TAE-ADRC.org (federal)State ADRC Team

For More Information

Dual Demonstrationwww.calduals.org

CBAS www.dhcs.ca.gov/services/medi-cal/Pages/ADHC/ADHC.aspx

AARP New Report, On the Verge: The Transformation of LTSS www.aarp.org/ppi