MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Aging and Disability Resource Center (ADRC) Liaison for the Money Follows the Person (MFP) Demonstration

HCBS Strategies worked with the Maryland Department of Health and Mental Hygiene (DHMH) to assist in the integration of key parts of Maryland’s MFP effort into the ADRC effort known as the Maryland Access Point (MAP) program. The scope of work was expanded to assist the MAPs in meeting ACL criteria for full-functioning ADRCs and the Balancing Incentives Program (BIP). This included conducting operational reviews on each of the 20 MAP sites to develop an inventory of each site’s structure, strengths, and challenges. We worked with DHMH, MDoA and other stakeholders to identify the key infrastructure requirements for each MAP site and identify infrastructure that the state was to develop. These requirements and tasks were incorporated into a State Action Plan. We collaborated with each of the MAP sites to develop Individual Action Plans that guided their planning for meeting the new State requirements.

HCBS Waiver Quality Management Evaluation

HCBS Strategies collaborated with the Delmarva Foundation to assess strengths and weaknesses of three 1915(c) Home and Community-Based Waivers for the Maryland Department of Health and Mental Hygiene. The scope of work included the provision of a roadmap for redesigning a quality improvement system and some initial quality management tools.

HENNEPIN COUNTY, MINNESOTA

DD System Evaluation

The objective of the project was to review of Hennepin’s programmatic operations that support individuals with developmental disabilities. This effort included an evaluation of key business processes, consumer and provider stakeholder focus groups, and developing recommendations for improving County operations. We also facilitated a one day stakeholder summit meeting. HCBS Strategies developed three reports: an operational review, a summary of stakeholder input, and a findings and recommendations report.

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

Illinois MFTD Waiver Assessment and Resource Allocation Development

HCBS Strategies worked with Health Systems of Illinois (HSI (now eqHealth)) to assist the state of Illinois in building an assessment tool and resource allocation methodology for its 1915(c) waiver targeting medically fragile technology dependent (MFTD) children. The scope of this work also included developing a more objective and valid Level of Care Screening tool to determine eligibility for MFTD waiver services.

Illinois Medicaid Waiver Quality Management Review

HCBS Strategies conducted a project for HFS to review and make recommendations for improving systems for managing quality in Medicaid funded HCBS. We reviewed quality management infrastructure across nine different 1915(c) waivers and summarized the strengths and challenges for each in complying with CMS requirements and best practices. We also convened a working group of representatives from all of the waivers to review recommendations for improvements.

DC DEPARTMENT OF MENTAL HEALTH

Strategic Planning Retreat

HCBS Strategies contracted with Illinois Department of Aging (IDoA) to lead a cross-agency strategic planning retreat. A major goal of the retreat was to develop a plan for integrating new initiatives into IDoA’s current Strategic Plan. As the discussion progressed, it became apparent that it was important to clarify how both the Strategic Plan and the new initiatives potentially impacted current operations. During the retreat, we developed a draft analytic structure for integrating the new initiatives with IDoA’s operations and Strategic Plan. After the retreat, we developed a more detailed spreadsheet builds off this analytic structure. The more detailed spreadsheet could help IDoA develop a more detailed understanding of these issues.

CMS Compliant 1915(c) Waiver Quality Management Strategy

HCBS Strategies assisted the Illinois Department on Aging in building a quality management structure for the State of Illinois Community Care Program (CCP) that complies with CMS requirements for 1915(c) waiver is under application version 3.5. CCP is an entitlement program serving individuals needing long term supports, who are over age 60, and who live in the community. Many of the people served are Medicaid eligible under the 1915(c) waiver that includes CCP services.

The project included an operational analysis of the existing quality management structure, comprehensive research of national practices, development of performance indicators, methodologies for discovery and remediation, and recommendations for operational implementation for the new quality management system (including technology tools). The project provided the State with the information needed for their waiver renewal. It also included the development and delivery of training to staff and providers on the requirements of the new system.

ILLINOIS DEPARTMENT ON AGING

Strategic Planning Retreat

HCBS Strategies contracted with Illinois Department of Aging (IDoA) to lead a cross-agency strategic planning retreat. A major goal of the retreat was to develop a plan for integrating new initiatives into IDoA’s current Strategic Plan. As the discussion progressed, it became apparent that it was important to clarify how both the Strategic Plan and the new initiatives potentially impacted current operations. During the retreat, we developed a draft analytic structure for integrating the new initiatives with IDoA’s operations and Strategic Plan. After the retreat, we developed a more detailed spreadsheet builds off this analytic structure. The more detailed spreadsheet could help IDoA develop a more detailed understanding of these issues.

CMS Compliant 1915(c) Waiver Quality Management Strategy

HCBS Strategies assisted the Illinois Department on Aging in building a quality management structure for the State of Illinois Community Care Program (CCP) that complies with CMS requirements for 1915(c) waiver is under application version 3.5. CCP is an entitlement program serving individuals needing long term supports, who are over age 60, and who live in the community. Many of the people served are Medicaid eligible under the 1915(c) waiver that includes CCP services.

The project included an operational analysis of the existing quality management structure, comprehensive research of national practices, development of performance indicators, methodologies for discovery and remediation, and recommendations for operational implementation for the new quality management system (including technology tools). The project provided the State with the information needed for their waiver renewal. It also included the development and delivery of training to staff and providers on the requirements of the new system.

ALASKA DEPARTMENT OF HEALTH AND SOCIAL SERVICES

HCBS Technical Assistance for Alaska’s Division of Senior and Disabilities Services

From November 2015 to June 2016, HCBS Strategies provided technical assistance to the Division of Senior and Disabilities Services (SDS) and the Alaska Mental Health Trust Authority around a variety of HCBS topics. HCBS Strategies provided guidance to SDS about national trends in Federal Financial Participation (FFP) claiming and how FFP may be implemented in Alaska. More recently, we coordinated with the current 1915(i) and (k) contractor and SDS to review deliverables, provide guidance on relevant national trends, and establish the next steps for implementing and sustaining the effort.

HCBS Strategies was awarded a second Technical Assistance contract in June 2016 to support the Division of Senior and Disability Services with the ongoing planning and implementation of the 1915(i) and (k) efforts.

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.

COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING

LTSS Assessment Redesign

The Colorado Department of Health Care Policy and Financing (HCPF) has contracted with HCBS Strategies to develop a new process for assessing the need for long term supports and services (LTSS).

The project has the following stages:

  1. Understanding how Colorado’s current LTSS assessment processes work, including a review of the tools used across the State and local departments and meetings with these entities.
  2. Develop a document that identifies how the new assessment process can support Colorado’s home and community-based services (HCBS) systems change efforts (formerly the white paper).
  3. Selecting the tool or tools that will serve as the basis of the new assessment process.
  4. Customizing the tool or tools to meet Colorado’s unique needs.
  5. Piloting the tool to understand the impact on eligibility determinations.
  6. Developing a plan for implementing the new tool and related processes.

The operational review mentioned in Step 1 has been complete, and during this process it was found that there are far more initiatives working towards systems change across the State than originally anticipated. As a result, the timing of the white paper (Step 2) was moved forward and refocused to discuss how the new assessment process might support proposed systems change efforts. As a result, the Department has decided on the tools that they will be using as models to develop their own tool (Step 3), and the draft assessment tool has been developed (Step 4). This modular assessment tool has been customized to meet the specific needs of Colorado and requirements from the HCBS Final Rule, and includes elements from the federal FASI (formerly CARE) tool and Minnesota’s MnCHOICES, which HCBS Strategies helped develop. The tool has gone through rigorous review with the State and stakeholders over the course of dozens of meetings. The pilot (Step 5) will occur when a final iteration of the FASI tool is available (anticipated date of late 2016).

For more information, please visit the blog at:  http://coassessment.blogspot.com/

Developing an Integrated Implementation Plan for Statewide Long Term Services and Supports

HCBS Strategies is currently working with the Department of Health Care Policy and Financing (HCPF) on the development and execution of an integrated plan for statewide LTSS. Currently, Colorado has over 15 LTSS enhancement and expansion projects that are co-occurring, many of which overlap. There has been little coordination across these projects, and Colorado has contracted with HCBS Strategies to develop an integrated implementation plan. This plan has been proposed to include descriptions of each of the efforts, a detailed implementation timeline, steps for coordinating the implementation of these efforts to minimize duplication, and the establishment of several workgroups to coordinate ongoing efforts.

HAWAII DEPARTMENT OF HEALTH, EXECUTIVE OFFICE ON AGING

Hawaii Executive Office on Aging’s No Wrong Door (NWD) Initiative

In 2014, HCBS Strategies worked with Hawaii on its proposal and fulfillment of the objectives under a one-year planning grant from the Administration for Community Living (ACL) to develop a plan and vision for how the No Wrong Door effort, referred to as the ADRC Network in Hawaii, would be implemented. As a result of this planning effort, HCBS Strategies worked with the Executive Office on Aging (EOA) and the Office of the Governor to develop a successful application for a highly competitive ACL grant that funds the implementation of the ADRC Network. HCBS Strategies is now working with EOA and the other State partners on the three-year plan to implement the ADRC Network.

Under the ADRC Network effort, HCBS Strategies has led the development and implementation of a comprehensive implementation plan that includes six State agencies, four local agencies, and two contracting partners. Agencies involved in this effort include:

  • Adult Mental Health Division (AMHD)
  • Adult Protective Services (APS)
  • Assistive Technology Resource Center (ATRC)
  • Center for Independent Living (CIL)- Access to Independence
  • Center for Independent Living (CIL)- Aloha Independent Living Hawaii
  • Children with Special Health Needs Branch (CSHNB)
  • Developmental Disabilities Division (DDD)
  • Division of Vocational Rehabilitation (DVR)
  • Med-QUEST Division (MQD) with links to all Health Plans
  • Office of Veterans Services (OVS)
  • Veterans Health Administration (VHA)
  • The four county Area Agencies on Aging (AAA) which operate the Aging and Disability Resource Centers (ADRCs).

Thus far in implementation, HCBS Strategies has worked with EOA and the other agencies to develop:

  • An automated referral tool that allows the agencies (Doors) to send common referral information across Doors to reduce 1) the need for the participant to tell their story multiple times and 2) the number of individuals who are not contacted after being referred to another agency. The referral tool includes the ability to “close the feedback loop”, which requires the agency receiving the referral to mark that they are acting on the referral, after which the system sends a notification to the agency who generated the referral to let them know the referral has been acted upon. HCBS Strategies is currently leading the pilot effort of this tool within the City and County of Honolulu.
  • An advisory group that consists of individuals with disabilities, providers, family members, and advocates;
  • A framework and plan for the initiatives that will continue or begin after the initial three year grant period;
  • Draft person-centered standards to meet the CMS rules;
  • FFP claiming methodology, including the completion of two time studies;
  • Interviews with five states on potential methods for implementing managed LTSS in Hawaii; and
  • Interviews with each of the State agencies and other partners to collect information on organization structure, service offerings, intake and assessment procedures, and training efforts. This information will be translated into living documents to improve the understanding of the functions of each agency across partners.

To monitor progress of the initiative and allow stakeholders to review documents and provide additional feedback, we have developed a website. It can be found at http://hinwd.blogspot.com/

Supporting Systems Change in Hawaii

HCBS Strategies is currently working with EOA and its partners in order to realize the goals and objectives laid forth in the 5-year plan for implementing ADRCs. HCBS Strategies is working with EOA to implement core pieces of the ADRC operational infrastructure that includes:

  • Automating protocols for referrals, intake, assessment, and support planning
  • Developing Options Counseling competencies and protocols
  • Creating procedure, approval, and documentation requirements for drawing down Medicaid administrative federal financial participation (FFP) to support core ADRC functions
  • Establishing memorandum of understandings (MoUs) with other partner agencies
  • Determining policies and procedures that incorporate evidence-based approaches for targeting services, determining whether case management is needed, and establishing support plans (utilizing the interRAI framework)
  • Developing provider agreements between Veterans Health Administration Medical Center and the ADRCs

Systems Change Developer

HCBS Strategies was contracted to fulfill the role of the Systems Change Developer (SCD). The objective was to create a five year strategic plan that guided the development of a streamlined operations infrastructure for Hawaii’s ADRC, Community Living Program, and Person-Centered Hospital Discharge Planning efforts. The SCD effort built an infrastructure that streamlined access to HCBS, helped target scarce resources to individuals at greatest risk of institutionalization and Medicaid spend down, and provided a participant-directed option under the state-funded Kupuna Care program.

While the main thrust of the effort was to develop the five year plan, we also engaged in building infrastructure to develop and sustain collaboration among the stakeholders. As part of this effort, we facilitated the two ADRC recharge conferences.

Hawaii Strategic Five-Year Plan

Download the strategic plan:

ADRC Recharge Conference

Download the strategic plan:

NEBRASKA STATE UNIT ON AGING

ADRC Pilot Evaluation

HCBS Strategies worked with the Nebraska State Unit on Aging (SUA) as the evaluator for the State’s ADRC pilot. The State contracted with three Area Agencies on Aging (AAAs) teams, seven AAAs in total, to develop and pilot ADRCs in Nebraska. HCBS Strategies worked with these sites to determine the qualities of the program activities implemented and the effectiveness in meeting or addressing the program goals and objectives. As a result of the pilot efforts, the Nebraska State Legislature has agreed to fund the statewide ADRC effort on an ongoing basis.  HCBS Strategies produced three evaluation reports that can be found below:

November 29, 2016
November 30, 2017
November 30, 2018
Year 1
Year 2
Year 3

ADRC and AAA Medicaid Administrative Claiming

The Nebraska SUA has contracted with HCBS Strategies to develop and implement infrastructure to support drawing down federal financial participation (FFP) through Medicaid administrative claiming.  In addition to developing the infrastructure, HCBS Strategies will conducting training and overseeing all aspects of the ongoing administrative claiming.

OREGON OFFICE OF DEVELOPMENTAL DISABILITY SERVICES

Establishing a Valid and Reliable Assessment Tool

The Oregon Office of Developmental Disability Services (ODDS) contracted with HCBS Strategies, Mission Analytics Group, and Barbara Gage of the Post-Acute Care Center for Research (PACCR) to redesign their assessment tool for individuals accessing services for intellectual and developmental disabilities. The primary goal under this effort was to update the current assessment tool to utilize nationally recognized valid and reliable items from tools including CMS’ FASI tool, MnCHOICES, and the Colorado Assessment Tool.

Under this effort, HCBS Strategies performed a comprehensive review of the five current tools used by the State for assessing individuals with intellectual and developmental disabilities. The items within these tools were evaluated for face validity and reliability, and then cross-walked with the FASI, MnCHOICES, and the Colorado Assessment Tool to identify areas were updates were needed. Throughout the effort, FASI item experts were consulted to ensure optimal reliability and validity. Realizing that an overhaul would be required to develop a valid and reliable tool, HCBS Strategies led the effort to design a paper version of the tool that incorporated items from the five current State tools, and coordinated with the State during the automation phase. The Tool was piloted throughout the state in late 2016, and has been implemented statewide.