Embed Size (px)
Citation preview
CALIFORNIA COLLABORATIVEFOR LONG TERM SERVICES & SUPPORTS
June 1, 20189:00 – 10:30 am
Via GoToWebinar Platform
CCLTSS Staff Team:Laurel Mildred, Sue North,
Mariya Kalina and Crista Nicholas
Staffing for CCLTSS is provided by Mildred Consulting & Advocacy
Control Panel Features
The webinar will begin shortly…
• Please ensure you are connected to audio via the webinar platform. Connection options are listed under the “Audio Connection” drop-down on your right-hand side toolbar.
• We have found that “Phone Call” connection is more reliable. Please dial-in using information displayed in the “Audio Connection” drop-down. Remember to enter your unique audio PIN!
• For real-time technical assistance please use the “Questions” chat feature. A staff member is available to provide support.
NO WRONG DOOR:GAPS & OPPORTUNITIES IN CALIFORNIA
Eli GelardinExecutive Director Marin Center for
Independent Living
Ana ActonExecutive DirectorFREED Center for
Independent Living
Irene WalelaDeputy Director
California Department of Rehabilitation
Objectives
• Explore key elements of a high performing No Wrong Door (NWD) system of access for Long Term Services and Supports (LTSS).
• Understand local best practices and gaps to implementing comprehensive NWD approach to LTSS in California.
• Leverage the value of the California Independent Living Centers and the Aging & Disability Resource Centers to perform NWD functions in California.
• Engage with communities to develop policy proposals toward a NWD system for California LTSS.
Definitions:
No Wrong Door: If people contact anyorganization that is part of the NWD system, they are connected with the services and supports that they need, regardless of age, income or disability.
NWD systems are identified as a critical component of a high-performing LTSS system by the LTSS Scorecard.
Definitions:
Key Elements: Characteristics that shape a statewide system, embodying the NWD, person-centered practice to LTSS service delivery.
Based on cumulative experience of several years of federal partnership among ACL, CMS and the VHA to support States’ NWD development.
Key Elements of a NWD System to LTSS Access
State Leadership
Governance -Administration
Partnership of Key Referral Sources
Visible and Trusted Partners
Person and FamilyDirected
Shared Assessments and Data
Streamlined EligibilityPerson-Centered Planning
State Governance and Administration
Key Role of State Leadership:
• Design, implementation and oversight
• Full support of Governor, Cabinet and multiple state agencies
• Clear expectations for non-state organizations carrying out NWD
• Ensures ongoing, meaningful involvement of stakeholders
Public Outreach and Coordination
Visible and Trusted Partners :• Recognized by citizens and referral sources• Trusted source of unbiased and in-depth information • Formal relationships where major transitions occur • Proactive and planned statewide education and
marketing • Education of key referral sources • Transition and diversion services • Youth transition services
Person-Centered Counseling
Person and Family Directed: • Statewide point of entry into the LTSS system for
individuals and families • Ensures that the person with LTSS needs directs the
process • Includes screening, assessment, goals and methods • Inclusive of quality of life domains and attributes • Consistent skills and with CMS HCBS Settings Rule • Access to public and private services and supports
Streamlined Eligibility for Public Programs
Shared Assessments and Data: • Optimize efficiency and effectiveness of
eligibility determination processes across systems • Seamless for consumers • Minimize duplication and ensure priority
attention • Systematic and continuous improvement • Relies on Person-Centered Counseling
Six Other States
State Leadership and Person-Centered Counseling: • Connecticut – Current personnel competency exam • Michigan – Cross-Agency Body • New Hampshire – Statewide training and certification
and peer support model • Virginia – Expansion on Services for Persons with ID/DD
and Statewide Council (CILs, AAAs, PWD, and older adults)
• Washington – State network adopted standards of practice
• Wisconsin – Leader in transition and diversion through options counseling and tools to guide conversations
ADRC of Nevada County
VisionAll seniors and persons with disabilities in Nevada County have independence
and autonomy and live full and healthy lives.
MissionProvide easy access to a broad array of
services, a continuum of help in accessing services and advocacy for
individuals desiring long term support services and information.
Collaboration & PartnershipCore Partners:
• FREED
• Agency on Aging Area4
Extended Partners:
• Nevada County Social Services
• Alta Regional
• 211 Nevada County
• Nevada County Transit Services
• Community Beyond Violence
• Chapa-De Health Clinic
• Falls Prevention Coalition
• Hospice of the Foothills
• Western Sierra Medical Clinic
• Gold Country Community Services
• Community Legal
• Sierra Nevada Memorial Hospital
• Community Recovery Resources
Nevada County Elements of LTSS NWD System
State Leadership
Governance -Administration
Partnership of Key Referral Sources
Visible and Trusted Partners
Person and FamilyDirected
Shared Assessments and Data
Streamlined Eligibility
Person-Centered Planning
Nevada County No Wrong Door
Person Centered Planning & Shared Values• Prevention of Institutionalization• Honoring individual/consumer rights• Consumer-directed approach
Key Referral Sources • 211 Nevada County • FREED• Promotion of ADRC services and referrals• Warm Hand Offs
Participation on ADRC Advisory Committee• Community Living Implementation Council
Cross-trainingAnnual Aging & Disability Conference
ADRC Core Services
• Enhanced Information & Assistance – 211, FREED, other extended partner organizations• Person Centered Counseling – FREED, 211, Alta Regional• Hospital to Home – Care Transition Intervention, hospital
navigators• Institutional Transition – California Community Transition,
DOR Transition, MDS 3.0• Short-term Service Coordination
Where do we see additional NWD Systems needs in our local work?
• Homeless Coordinated Entry – HMIS System
• Whole Person Care Pilots
A NWD System for California, Independent Living and our LTSS partners?
Six months ago, the California Foundation for Independent Centers, in partnership with the Department of Rehabilitation and the State Independent Living Council began discussing a strategies to expand the capacity of Independent Living Centers to provide NWD services. The draft objectives are as follows: • Invest in the internal capacity necessary to position Independent Living
Centers to provide NWD services.• Position the Independent Living Network to be perceived as professional,
high performing, and high impact. • Create conditions where California’s health care system sees value and
invests in models of care that include Independent Living Centers and are integrated, person- centered, and cost effective NWD Services.• Secure at least one or more new funding stream or revenue generating
contract with a statewide healthcare/LTSS entity to provide NWD services.
Proposed Strategies and Timeframe
Years 1-2• Identify funders and partners to do this work• Present need and objectives to potential funders• Secure pilot funding and begin work.• Assess baseline readiness for cross-sector partnership development
(current status)• Develop plan to address capacity need(s)• Build understanding of healthcare trends, policies, and programs• Promote new ways of thinking and ideating with an initial focus on
service design
Proposed Strategies and Timeframe
Year 3-5
• Incorporate learning into planning and design
• Implement statewide pilot for person centered NWD Independent Living Services.
• Track measurable objectives and outcomes
• At the conclusion of the pilot/new program design:• Produce evidence-based report.• Distribute to potential payors.• Engage in a statewide campaign.
Next Steps
• Convene/participate in a workgroup to refine our strategy
• Secure support and buy-in for this initiative from the California Collaborative
• Roll up our sleeves and get to work!
Resources
• Key Elements of a NWD System of Access to LTSS for All Populations and Payers https://www.acl.gov/sites/default/files/programs/2016-10/NWD-National-Elements.pdf• AARP Public Policy Institute: Person- and Family-Centered
Checklist https://www.aarp.org/content/dam/aarp/ppi/2017-01/LTSS-Promising-Practices-No-Wrong-Door.pdf• CA State Independent Living Council https://www.calsilc.ca.gov/• CA Foundation of Independent Living Centers http://cfilc.org/• Aging and Disability Resource Centers Advisory Committee
https://www.aging.ca.gov/ProgramsProviders/ADRC/Meetings/
Thank you!Ana ActonExecutive Director FREED Center for Independent [email protected]
Irene WalelaDeputy DirectorCalifornia Department of [email protected]
Eli GelardinExecutive DirectorMarin Center for Independent [email protected]
Use the “Raise Your Hand”
Feature
OR
Use the “Questions”
Chat Box
QUESTIONS/ COMMENTS?
CALIFORNIA’S ASSISTED LIVING WAIVER
Eric CarlsonDirecting Attorney
Justice in Aging
Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources.
Since 1972 we’ve focused our efforts primarily on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.
Assisted Living Waiver
• Originally a pilot program in three counties, 2006-2009.
• Subsequently approved for two five-year terms, 2009-2014, and 2014-2019.
Limited Scope and Enrollment
• 15 counties§ Alameda, Contra Costa, Fresno, Kern, Los
Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara & Sonoma
• 3,744 participants§ Governor proposes to increase this to 5,744.
HCBS Provided in Congregate Residential Settings
• Residential Care Facilities for the Elderly, with services provided by facility staff.§ And, occasionally, Adult Residential Facilities; 18
ARFs are currently participating.
• Public subsidized housing, with services provided by home health agency.
Care Coordination Agencies
• CCA coordinates enrollment, develops service plan, and determines tier for provider reimbursement rate.§ RN assesses resident at least once every six
months.§ CCA staff must conduct in-person meeting with
resident each month.
Waiver Enrollees Are Generally 70+ Years Old
Age Range % of Age Group
20-29 .06%
30-39 .25%
40-49 1%
50-59 8%
60-69 22%
70-79 25%
80-89 28%
90-99 14%
100+ 1% (37 persons)
Room for Improvement in the
Assisted Living Waiver
Current Limits on Program
• Only 15 counties.• Only 3,744 participants.
§ Wait list is loooooong and mysterious; applicants don’t know where they stand on the list.
Single Occupancy and Kitchenettes, But …
• “[A]ll waiver residents must be offered a private unit.”
• Must have kitchenette (refrigerator, microwave, and storage space) if resident does not have 24/7 access to kitchen.
DHCS Has Produced Form for Waiver of “Amenities”
I, ________, prefer to:□ Waive my right to a private room.□ Waive my right to a refrigerator.□ Waive my right to a microwave.______________ ______Signature Date
Confusing Financial Eligibility Standards
• Waiver allows for eligibility under§ SSI/SSP§ Aged and Disabled Federal Poverty Level Program§ Medically Needy
• But DHCS fact sheet says: “Individuals with Medi-Cal benefits that include a share of cost may not be enrolled in the ALW.”
• But, but, DHCS explains that resident can have share of cost eliminated through eligibility determinations at county level.
Provider Reimbursement Rates
Level of Care $/Day
Tier 1 $58
Tier 2 $69
Tier 3 $80
Tier 4 $92
Tier 5 $200
Also, $320 per month for Care Coordination Agency
Renewal Timeline
Aug-Sept. 2018DHCS Releases
Waiver Draft for Comment
November 2018DHCS Submits
Waiver Application to CMS
March 1, 2019Effective Date of Renewed Waiver
Waiver Renewal
• ALW renewal is described by DHCS as Phase 1.
• In Phase 2, the ALW will be combined with the Home and Community-Based Alternatives (HCBA) waiver.§ Why?
• Simpler access for consumers.• Reduced administrative duties for DHCS.
Some Issues in Combining ALW with HCBA Waiver
• Need to incorporate the HCBA waiver agencies.
• HCBA is statewide, but currently limited to 7,150 participants at any one time.
AB 2233 (Kalra)
• Increase enrollment to 18,500.• Expand program beyond 15 counties.• Require DHCS, during waiver renewal, to
consider private occupancy, kitchenettes, and financial eligibility standards.
• Increase provider rates based on minimum wage increases.
• Make wait list process transparent.
Status of AB 2233
• Recently moved off suspense file.
• Under consideration by Assembly.
Use the “Raise Your Hand”
Feature
OR
Use the “Questions”
Chat Box
QUESTIONS/ COMMENTS?
MEDICARE ADVANTAGE REGULATION NARROWS ABILITY TO CHANGE PLANS:
DHCS Request for Stakeholder Input
Hilary HaycockPresident
Harbage Consulting
NEW MEMBER INTRODUCTIONS
Anne QuaintanceChief Government Affairs and Business Development Officer
Meals on Wheels California
Kristie Sepulveda-BurchitExecutive DirectorEducate. Advocate.
50 Member Agencies AND GROWING
NORTHERN CALIFORNIA CITYSeniors Council of Santa Cruz and San Benito Counties AptosMid-County Senior Center CapitolaChico Meals on Wheels ChicoSpectrum Community Services HaywardCommon Ground Senior Services JacksonContra Costa Senior Nutrition Program MartinezPeninsula Volunteers, Inc. Meals on Wheels Menlo ParkCommunity Action Napa Valley NapaAlameda County Meals on Wheels OaklandMeals on Wheels of Alameda County OaklandCoastal Seniors, Inc. Point ArenaAgency on Aging - Area 4 SacramentoMeals on Wheels by ACC SacramentoShasta Senior Nutrition (Dignity Health) Sacramento CtyMeals on Wheels San Francisco San FranciscoProject Open Hand San FranciscoSelf-Help for Elderly San FranciscoWhistlestop Meals On Wheels San RafaelCouncil on Aging Santa RosaCeres Project SebastopolMeals On Wheels Solano County SuisunTehama Co. Communtiy Action Agency Tehama CountySierra Senior Services TruckeeMeals on Wheels and Senior Outreach Services Walnut CreekMeals on Wheels Yolo County Yolo County
CENTRAL CALIFORNIA CITYKern County Aging & Adult Svcs BakersfieldKings County Commission on Aging HanfordCommunity Action Partnership of Madera County MaderaMeals on Wheels of the Salinas Valley, Inc. SalinasCommunity Services & Employmen Training, Inc. Visalia
SOUTHERN CALIFORNIA CITYSeniorServ AnaheimBarstow Senior Nutrition Center BarstowHuman Services Association Bell GardensThe Salvation Army GlendaleAIDS Services Foundation Orange County IrvineIrvine Meals On Wheels IrvineCity of LA, Department of Aging Los AngelesMeals On Wheels of West Los Angeles Los AngelesSan Fernando Valley Interfaith Council Los AngelesSt. Vincent Meals on Wheels Los AngelesYWCA of San Gabriel Valley Los AngelesRiverside Meals On Wheels, Inc. RiversideCatholic Charities, San Diego San DiegoJewish Family Service of San Diego San DiegoMeals On Wheels San Diego County San DiegoCommunity Action Commission of Santa Barbara Cty Santa BarbaraSoutheast Area Social Services Funding Authority Santa Fe SpringsMeals On Wheels West Santa MonicaTorrance-Lomita Meals On Wheels Torrance
Board of Directors
• Chris Baca, Executive Director Meals on Wheels West
• Debbie Case, President & CEO Meals on Wheels San Diego County
• Elaine Clark, Executive Director Meals on Wheels and Senior Outreach Services
• Darren Dunaway, Assoc. Director Human Services Association, LA
• Holly Hagler, President & CEO SeniorServ Orange County
• Eric Moxon, Board Member Chico Meals on Wheels
• Anne Quaintance, Chief Gov't Meals on Wheels San Francisco
Affairs and Business Dev. Officer
• Mark Ryle, CEO Project Open Hand
• Daryl Twerdahl, Exec. Dir. St. Vincent Meals on Wheels
• Bobbie Wartson, Exec. Dir. Kings County Commission On Aging
POLICY AGENDA 2018LEGISLATIVE FRAMEWORK AND BUDGET PRIORITIES
Meals On Wheels California (MOWCA) is a newly established association affiliated with Meals on Wheels America. Our mission is to create a unified voice of nutrition providers in California and broaden the impact of our programs that improve the lives of seniors, adults with disabilities and their families. We serve over 17 million meals a year statewide and the need is growing.
MOWCA advances legislation and policies that strengthen programs that provide home-delivered and group setting (congregate) meals, the volunteers who make them happen and the seniors they serve. We must ensure that California is able to meet the growing number of seniors who need the support that enables them to live more nourished lives with the independence and dignity they deserve.
MOWCA advocacy impacts senior poverty and hunger in these focus areas: Nutrition and Isolation
Healthcare System and Support Services State and Federal Funding for Nutrition Programs
Public Benefits and Self-SufficiencySafety Net and Food Security
STATE BUDGET AND LEGISLATIONVital health and human services programs that provide a safety net for low-income Californians werecut by $15 billion during the recession. SSI/SSP grant levels trap seniors and adults with disabilities at90% of the Federal Poverty Level, leaving no money to purchase food. SSI/SSP and IHSS recipients in California make up 25-30% of those in need of food and cannot receive CalFresh. Nutrition services promote wellness, improve health outcomes and reduce health care costs.
We support increasing the capacity of nutrition programs under the Older Californians and OlderAmericans Acts, including Congregate Meal Lunch Sites and Home-Delivered Meals.
We support reinstating the Cost of Living Adjustment (COLA) for the SSI/SSP program so that recipients receive a payment that is not below 100% of the Federal Poverty Line.
We support legislation that strengthens and protects critical services for seniors and adults with disabilities.
www.mealsonwheelsamerica.org/california
v. 11.1.17Page 51 of 2
v.11.1.17
Page52of 2
FEDERAL BUDGET AND LEGISLATIONThe public-private partnership supporting the Meals on Wheels movement is one of the most effectivemodels in America. However, federal funding has failed to keep pace with the escalating growth in thesenior population and the need for nutritious meals.
We support protecting and strengthening the Older Americans Act and Social Services, CommunityServices and Community Development Block Grants at funding levels to address increasing demand.
We support improving access to federal nutrition programs for seniors and adults with disabilities.
We support modifications to the tax code that can help encourage and increase the charitabledonations our programs rely on to serve seniors in need.
Older Americans ActThe Older Americans Act (OAA) has been the primary federal legislation supporting nutrition, social and preventative services for Americans 60 and older since 1965, and was reauthorized in 2016. OAAprograms are vital for seniors who are at significant risk of hunger or losing their ability to liveindependently. The Older Americans Act provides essential services every year to nearly 11 million seniors, including information and referral assistance, in-home supports, nutrition programs, transportation, caregiver support, job training, legal services and protection from abuse and financial exploitation. The OAA supported the provision of nearly 218 million meals that were delivered to more than 2.4 million seniors nationwide.
Social Services, Community Services and Community Development Block Grants (SSBG, CSBG, CDBG)Unless Congress acts, cuts to these block grants will lead to increased waiting times, reduced delivery days, layoffs, fewer meals and, in some cases, closing programs entirely. These programs are vital to enabling Meals on Wheels programs to serve more seniors in need, which in turn saves substantial taxpayer dollars by keeping seniors healthier and independent in their own homes, out of hospitals or nursing facilities.
Federal Nutrition ProgramsThere are more than 10 million seniors struggling with hunger today – that’s 1 in 6. In addition to Home-Delivered and Congregate Nutrition Programs, there are several federal programs that providefood/grocery assistance for low-income seniors. These include the Supplemental Nutrition AssistanceProgram (SNAP), the Commodity Supplemental Food Program (CFSP) and The Emergency Food Assistance Program (TEFAP).
Tax Code & Charitable DonationsMeals on Wheels programs could not operate without the generous charitable donations of volunteers. Whether donations take the form of donated goods and services, money or volunteering mileage and one’s own vehicle to deliver meals.
Contact Meals on Wheels California: Anne Quaintance, Chief Gov’t Affairs & Business Development Officer, Meals on Wheels San Francisco, [email protected].
www.mealsonwheelsamerica.org/california
C A L I F O R N I A2 0 17
ME A L S O N W H E E L S D E L IV E R S T H E S U P P O R T T H AT K E E P SS E N IO R S I N T H E I R O W N H O ME S , W H E R E T H E Y WA N T T O B E .
S E N IO R S R E MA I N I N G AT H O ME , O U T O F H O S P IT A L S A N D N U R S I N GH O M E S , S AV E S B I L L IO N S I N ME D I C A R E A N D ME D I C A I D C O S T S .
say it makesthem feel moresafe and secure
9 0 %say it enablesthem to remainliving at home
9 2 %8 1% say it improvestheir health
1 Y E A R 1 D AY
We can provide a senior Meals onWheels for 1 Y E A R for roughly thesamecost as 1 DAY in ahospital.
=
Meals on Wheels' clients report fewer falls, which cost our nation$ 3 1 B I L L I O N each year.
$31B I L L I O N
=
T O O MA N Y S E N IO R S I N C A L I F O R N IA A R E L E F T B E H I N D , A L O N E A N DH U N G R Y, S T R U G G L I N G T O S T AY I N D E P E N D E N T A N D H E A L T H Y.
1,4 7 5 ,8 17 are isolated, living alone
1,12 2 ,9 6 0 are threatened by hunger
Investing in Meals on Wheels is aW I N - W I N for our seniors, our communities and our nation.
Nationally, 1 I N 6 seniors struggles with hunger
T O G E T H E R , W E C A N D E L IV E R . T®M
The number of seniors in our country will grow exponentially over thecoming years. Meals on Wheels is a proven public-private partnershipthat effectively addresses the challenges of aging by promoting healthand improving quality of life for our nation’s most vulnerable seniors.By leveraging the existing Meals on Wheels network, we have theopportunity to not only keep seniors at home, but also save billions intax dollars by keeping them out of more costly healthcare settings.
Visit www.mealsonwheelsamerica.org/takeaction to learn more about how you can help in your state and community today.
2 , 0 12 ,0 6 5 are living in or near poverty
Announcements
Our Last Meeting was Rated 4.7 out of 5
Please Take a Minute When You Sign Out to Rate Today’s Meeting!
And please email suggestions for meeting topics or speakers to Mariya Kalina
CALIFORNIA COLLABORATIVEFOR LONG TERM SERVICES & SUPPORTS
• Friday, June 15 – Collaborative Meeting• Friday, July 6 – Collaborative Meeting• Friday, July 20 – Collaborative Meeting• Friday, August 3 – Collaborative Meeting
Upcoming Meetings
Staffing for CCLTSS is provided by Mildred Consulting & Advocacy
