ALASKA DEPARTMENT OF HEALTH AND SOCIAL SERVICE
Development of Alaska’s 1915(k) Community First Choice Option
In 2017, HCBS Strategies began providing technical assistance and project mangement to the Division of Senior and Disabilities Services (SDS) around the planning of the State’s 1915(k) Community First Choice (CFC) Option. HCBS Strategies previously worked with SDS to determine that CFC was the best route to lessen the impact of the State’s fiscal crisis and allow the SDS to 1) continue providing quality supports to participants and 2) draw down enhanced federal dollars.
HCBS Strategies began supporting the planning effort by developing service cost models to establish the services that would best fit within the CFC option, developing a framework for how the program would be operationalized, and developing a detailed work plan through implementation. They then worked with SDS staff to review the approach with participants, providers, and other stakeholders through advisory committees and community forums. HCBS Strategies then heavily supported SDS with the development of a State Plan Amendment (SPA) and subsequent negotiations with the Centers for Medicare & Medicaid Services (CMS). SDS is now working to finalize the CFC regulatory package and implement the program.
Development of New Intake, Assessment, and Support Planning Processes
Since 2016, HCBS Strategies has been supporting the Division of Senior and Disabilities Services (SDS) with redesigning LTSS access processes. This has included:
- The development of a Person-Centered Intake (PCI) that will be used by the Aging and Disability Resource Centers (ADRC) and Short-Term Assistance & Referral Programs (STAR) access points. The PCI allows for a standardized process for all individuals looking to access LTSS, and contains screens for all of the Alaska waivers as well as options counseling for all individuals.
- Development of a Person-Centered Support Plan supplement that allows SDS to meet the HCBS Person-Centered Rules while developing a more comprehensive Support Planning process that aligns with the redesigned assessment.
- Comparison of SDS’ current assessment tool, the Consumer Assessment Tool (CAT), with the proposed new assessment tool, interRAI. This evaluation included a crosswalk of items that are included in the CAT but not in the interRAI suite, as well as items that are needed for level of care (LOC) that may need to be updated.
- Supporting the pilot of the interRAI and CAT tools to better understand the impact of a new assessment process on level of care (LOC).
- Drafting new tools that align the new interRAI-based assessment process across Intake, Assessment, and Support Planning and also allow SDS to comply with the HCBS Final Rule.
HCBS Strategies is now working with SDS to develop the draft access tools and design an implementation plan for the testing and rollout of the tools.
Conflict Free Case Management in Alaska
HCBS Strategies partnered with Agnew Beck Consulting to develop a draft plan for Alaska to come into compliance with CMS conflict free requirements contained in CMS HCBS rules.
As part of this project, HCBS Strategies and Agnew Beck facilitated interviews with a number of State agencies to gain a better understanding of the implications of the conflict free requirements on the processes of the State and local agencies. HCBS Strategies interviewed State staff in Colorado, Wyoming, Minnesota, and Hawaii about their efforts to comply with conflict free requirements.
HCBS Strategies and Agnew Beck then developed a report documenting the following:
- Rationale for CMS Rules and interpretation of the conflict free requirements
- Summary of the delivery of case management in Alaska and lessons from other states
- Draft plan to comply with the conflict free requirements in Alaska
- The vision for the case management system in Alaska
HCBS Strategies is now working with the State to pre-certify HCBS case management agencies as conflict free. HCBS Strategies has developed a solicitation that will be used by agencies in Alaska who wish to perform case management functions to provide assurances that they meet the conflict free requirements.
Development of Standard Tools
HCBS Strategies worked with Alaska to develop a standardized intake and screening tool. This tool will help clarify which programs individuals may be eligible for and who should be referred for an assessment. The tool should help reduce the number of people who are referred to programs that may not be the best fit and minimize the number of unnecessary assessments.
Development of Community First Choice Option
HCBS Strategies assisted the State of Alaska in exploring the development of the Community First Choice (CFC) option for attendant care services under the provisions of the Affordable Care Act. We reviewed Alaska’s current attendant care programs and facilitated discussions with the State on key design decisions that would be required in the implementation CFC. The design considerations included providing consultation of the program framework and participant access, quality assurances, support infrastructure, fiscal impact analysis, and proposed an implementation timeline.
As part of this scope of work and as a requirement under CFC we facilitated a participant advisory group designed to provide feedback and guidance to the State on the development of CFC. We also facilitated community forums to obtain additional feedback to the State on the proposed design of CFC. These design decisions and stakeholder feedback were integrated into our final report deliverable that advised the State on the implementation of CFC.
Developing a Long Term Care Plan for the State of Alaska
HCBS Strategies assisted the Alaska Department of Health and Social Services develop a plan for improving their long term care system. The purpose of this website is to facilitate the sharing of information among stakeholders and provide greater visibility to the project.
This report presents the following:
- A summary of the input received from stakeholders via focus groups, interviews and surveys.
- Our analyses of strengths and vulnerabilities of the operational infrastructure the State uses to deliver and monitor long term care services.
- Our analyses of expenditure trends.
- Recommended actions to be included in the LTCP.
- A summary of stakeholder reactions to these recommendations and modifications we made based upon this input.
- A three year action plan (3YAP) that translates the recommendations to be implemented within the first three years into discrete and interrelated tasks.
- The framework for an Ongoing Planning Process to oversee the implementation of these changes.