Area Agencies on Aging Preparing for the Balancing Incentive Program (BIP) Association on Aging in New York 1

Balancing Incentive Overview Federal initiative authorizing grants to States to increase access to non-institutional community-based long-term services and supports. New Yorks BIP grant for $598.7 million requires the state to expand the NY Connects among them. NY Connects programs are currently operational in 54 counties NY Connects has been designated as the no wrong door/single point of entry as part of the restructuring plan. 3

Balancing Incentive Overview (cont.) New BIP funding will be used to strengthen and expand the NY Connects Network to be a one-stop shop for long term services and supports BIP requires three (3) structural changes: 1.A no wrong door/single entry point system (NWD/SEP) 2.Conflict-free case management services 3.Core standardized assessment instruments 5

Background on NY Connects NY Connects Current Role Most located within Area Agencies on Aging Aging-Long Term Care Services and Supports Information, Assistance, Screening, and Intake Resources Listings for consumers and caregivers Referrals for in home visits, assessments, and care plans Linkage to community based services and supports such as case management, home delivered meals, in home personal care, and social model day care. 6

Medicaid Restructuring & BIP Initiatives laying the groundwork for BIP NYS Medicaid rebalancing Olmstead Managed Long Term Care Transition Systems Integration Project NYSOFA; Oneida County: SUNY Albany Center of Excellence in Aging and Community Wellnesss Balancing Incentive Program BIP 7

No Wrong Door System NWD is a single statewide system of access to LTSS for all populations and all payers. The NWD System functions include: Public Outreach and Coordination with Key Referral Sources; Person Centered Counseling; Streamlined Access to Public LTSS Programs; State Governance and Administration. 8

NY Connects Expansion & Level 1 Screens With the expansion, NY Connects staff will Be trained to provide consistent information about available services Operate in accordance with Standards and Operating Protocols Conduct Level I screens* as appropriate *A preliminary functional and financial assessment of individuals with Long Term Care 11

NY Connects Expansion & Level 1 Screens (cont.) Provide application assistance for Medicaid and other publicly funded programs Provide linkages to available services for individuals not eligible for Medicaid and link those potentially eligible to a Level II assessment 12

Advertising New York comprehensive advertising strategy is expected to Create widespread awareness Significantly increase in the number of Medicaid recipients and Medicaid eligible individuals with the roll out of a toll free number 13

Long Term Care Councils An important component of the existing NY Connects design Charged with assessing the needs of the community, identifying priorities to address and developing an action plan. Comprised of local governmental partners, community- based organizations and service providers, hospitals and other institutional and community based medical providers, and consumers/caregivers. Under NWD, will expand to include: mental health and Intellectual Disability and/or Developmental Disability (ID/DD) networks. 14

Sustainability Beyond 9/30/2015 The BIP federal grant ends on September 30, 2015. The Governors Budget released on January 21, 2015 proposed funding to continue NWD functions from October 1 st and into the next State Fiscal Year: Budget Briefing Book - 2015 Opportunity Agenda - #8. Health Care, p. 108 New York Connects. NY Connects is a statewide, locally based point of entry system that provides one stop access to free, objective and comprehensive information and assistance on accessing long term care services and supports. The Budget provides additional State funding to maintain ongoing operational support to the New York Connects program and the "No Wrong Door" initiative as Federal Balancing Incentive Payments (BIP) funding is set to expire in October 2015. The Budget includes funding of $8.2 million in 2015-16 and $18.1 million in 2016-17. 15

AAAs Preparing for NWD Three (3) Counties models how area agencies on aging are preparing for the expansion of NY Connects and restructuring their organization for the No Wrong Door component of the Balancing Incentive Program Essex County Oneida County Erie County 16

Erie Oneida Essex 17 Three (3) Examples from Counties with Varied Populations and Geography NY Connects & NWD Implementation: Three (3) Examples from Counties with Varied Populations and Geography

Essex County Population of 39, 370 2 nd largest geographically in the State Three hospital divide the county naturally into 3 catchment areas 18

Essex County Why No Wrong Door? Increasing aging population which will increase need for services Increase disabled adults & children needing LTC We know our local resources and our local partners vs regionalizing services Opportunity to create more cost effective use of programs vs institutionalizing an individual Consumer satisfaction Who doesnt want to remain home? Opportunity to determine unmet needs 19

Essex County Essex County NY Connects (now) Strong partnerships DSS, area hospitals discharge planners, Mental Health, volunteer programs, local and regional Not-For Profits and other local governmental agencies such as Public Health and Emergency Services. Taking referrals for varies agencies Cares Transitions DSRIP Medical Home Long Term Care Council Understanding of all programs available Constantly a work in progress 20

Essex County Essex County NY Connects (future) Continues Intake and referral All staff are currently crossed trained Screening Expand relationships with local agencies Assist ER staff with discharge planning Formalize relationships with EMS Continue the discussion of PARAMedicine Increase Intake and Screening staff Continue Case Management 21

Essex County Add additional components Community Mental Health (subcontract) Mental Health Workers making home visits w/NYC Connects staff Transition when appropriate to Clinical Mental Health Services Volunteer Coordinator Handyman program Service dog Friendly Visitors & Telephone reassurance Transportation for Social functions Engage Baby Boomers Attach to the RHIO 22

Oneida County Goals and Objectives of local implementation NY Connects will expand to meet the requirements of No Wrong Door (NWD) under the Balancing Incentive Program. Restructuring and reassigning NY Connects; HIICAP to create a fully functioning Aging and Disabilities Center (ADRC). Retraining and reassigning various provider staff to perform telephone information and assistance, initial intake and screens and enter caller information into client data base at the time of the call instead of entering data completed by case managers from hard copy assessment forms. Designated HIICAP and NY Connects staff will be assigned, trained, and required to complete the Level one screen Designated NY Connects staff will also be trained to provide, information, assistance, and follow-up assistance for consumers who are enrolled into to MLTC plans. 23

Oneida County Planning and progress to date Planning sessions with HIICAP/NY Connects staff and supervisors Laptops for Program Coordinators; Case Managers; Supervisors Communication system upgrades are under consideration Care transitions Program is being developed and ready for implementation Chronic Disease Self-Management Program (CDSMP) is being expanded and available in many areas of Oneida County On-site training for client data management from PeerPlace Networks 24

Oneida County Implementation Timeline Laptop training for field staff (6/14 to 3/15) PeerPlace Training for Case Aide/Data Entry and Supervisors (6/14 to 3/15) Upgrades to Telephone System to support Enhanced NY Connects/HIICAP Unit (5/15) Case Managers Begin Using Laptops Infield (3/15) Provider Revised staffing to include (3) LTC Associates;(1) Program Coordinator (CDSMP); (1) NY Connects Supervisor (1/15) 25

Oneida County Implementation Timeline (cont.) Implement staff training to provide technical support and guidance during the transition to BIP (6/14-9/15) Transition (3) Case Aide Positions to perform telephone I&A, Live Screening - Reduce Data entry tasks as case managers begin using laptops in the field (1/15-9/15) Enhanced NY Connects/ADRC unit becomes fully Operational (12/15) 26

Erie County BIP Innovations Grant Ready, Set, Home BIP grant separate from NWD - $738,000 Ready, Set, Home Not specifically NWD Growth opportunity

Erie County Changing the View Ready, Set, Home An Extroverted ADRC model Establish a community presence Strengthen NY Connects name recognition NY Connects Staff are working in and with local rehab and nursing facilities Working to get patients home sooner Part of the fabric of the facility Not a place to refer patients

Erie County Building relationships with MLTC plans providing service in Erie and surrounding counties. Engaging plans on behalf of clients to develop appropriate care plans Working with caregivers Establishing and strengthening vendor relationships to facilitate services and home modifications Starting services early Relationships with contractors and vendors for home modifications

Erie County Challenges Past Changing the view within the facilities Partner agreements Purchasing goods Ahead Changing the view within the facilities Getting to the right clients Providing adequate modifications- managing expectations

Erie County Successes First client transitioned home days before Christmas MLTC plans knowing about RSH. Calling us! Housing Connections Relief to Families

Erie County Positive Results Erie County known as a quality provider Meeting the need Greater Understanding of LTSS Pilot Project Medicaid savings estimated at $1,109,724. Administrative Support

Documents

Area Agencies on Aging Preparing for the Balancing Incentive Program (BIP) Association on Aging in New York 1