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
2A non-profit service and advocacy organization © 2011 National Council on Aging
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
3A non-profit service and advocacy organization © 2011 National Council on Aging
Half of States Could Have MLTSS Programs Within Next Year
NASUAD State Medicaid Tracker, July 2013
4A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS Programs Adults with ID/DD, 2012
5A non-profit service and advocacy organization © 2011 National Council on Aging
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
6A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS Programs Adults with ID/DD, 2012
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
7A non-profit service and advocacy organization © 2011 National Council on Aging
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
8A non-profit service and advocacy organization © 2011 National Council on Aging
What is Managed Care?
Traditional Medicaid Managed Care
9A non-profit service and advocacy organization © 2011 National Council on Aging
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
10A non-profit service and advocacy organization © 2011 National Council on Aging
Pros and Cons
11A non-profit service and advocacy organization © 2011 National Council on Aging
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
12A non-profit service and advocacy organization © 2011 National Council on Aging
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
13A non-profit service and advocacy organization © 2011 National Council on Aging
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
14A non-profit service and advocacy organization © 2011 National Council on Aging
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
15A non-profit service and advocacy organization © 2011 National Council on Aging
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
16A non-profit service and advocacy organization © 2011 National Council on Aging
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
17A non-profit service and advocacy organization © 2011 National Council on Aging
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
18A non-profit service and advocacy organization © 2011 National Council on Aging
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.
43 states, 147 sites, 30% of pop.
47 states, 300 sites, 49% of pop.
53 states, 525 sites, 77% of pop.
ACL, CMS, VHA NWD System FOA
20A non-profit service and advocacy organization © 2011 National Council on Aging
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
21A non-profit service and advocacy organization © 2011 National Council on Aging
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
22A non-profit service and advocacy organization © 2011 National Council on Aging
FMC Webinars
• Way to connect with state advocates and build capacity
• Many on MLTSS and ACA Opportunities• All archived: www.ncoa.org/HCBSwebinars
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