MARYLAND DEPARTMENT ON AGING

HCBS Strategies worked with MDoA in implementing its Enhanced Aging and Disability Resource Center (ADRC) grant. HCBS Strategies collaborated with MDoA on the successful application in a highly competitive procurement process. The grant allowed MDoA to make substantial enhancements to the Maryland Access Point (MAP) program (Maryland’s version of the ADRC). We provided assistance with tasks including:

  • Administrative start-up and project management
  • Development of an ADRC CQI plan
  • Development of a sustainability plan
  • Expansion of MAP to provide statewide coverage serving all required disability populations.

Administrative FFP

In addition to the above tasks, another core component of these efforts was to develop infrastructure for drawing down Medicaid administrative federal financial participation (FFP) funding for Medicaid LTSS for the MAP program. We helped the MDoA team establish what method they would like to use for time studies for this program, either random moment time study or continuous daily log. We developed online surveys for both of these methods and piloted each with participants at entities throughout Maryland and analyzed the results to determine which method provided the best results for MDoA. This was then translated into a white paper.

Options Counseling Grant Support

In previous efforts, HCBS Strategies assisted MDoA with the development and implementation of a grant from ACL to build Options Counseling Infrastructure in Maryland’s ADRC program.

Key tasks in this effort included:

  • The establishment of infrastructure to facilitate collaboration among the state and local ADRC sites.
  • Background research and presentation of proposed models for options counseling
  • The development of options counseling protocols for the initial intake, support planning, and ongoing case management business operations.
  • The development of staff qualifications, training requirements, and performance indicators.

NH Diversion Modernization Grant

HCBS Strategies assisted MDoA with implementing a NH Diversion grant it received from AoA. HCBS Strategies assisted in a variety of efforts, including the development of targeting criteria in order to identify individuals at high risk of institutional placement and developing reimbursement approaches.

MINNESOTA DEPARTMENT OF HUMAN SERVICES

The State of Minnesota worked with HCBS Strategies to refine its assessment processes to ensure greater consistency across the counties and across all populations with disabilities under age 65. This project developed standards and protocols, a common data collection tool, and recommendations to best utilize these tools to improve the reliability and equity of service provision, with careful regard given to the possible impact on service funding structures. The State’s vision was to have a comprehensive assessment process that supports improvements to the quality and efficiency of supports.

 

This effort resulted in the MnCHOICES Comprehensive Assessment (formerly known as the Universal Assessment, and COMPASS). Development of the tool was completed in August 2007, and the tool has now been implemented.

The purpose of this project page was to facilitate the sharing of information across the stakeholders involved in the development of this effort. This work was overseen by the Comprehensive Assessment Steering Committee. Thus, this site contains documents that were developed as a part of the effort to make sure that all the stakeholders were full and active participants.

To receive home and community-based service programs an initial screen is required to establish eligibility and determine a person’s need for services. An annual screen is required thereafter to determine continued functional eligibility. The screening and assessment process prior to MnCHOICES was at times challenging and time consuming. First, there were multiple forms to complete, sign, and process. This made the intake process confusing and cumbersome for families and for some county staff. In addition, individuals and their families or caregivers did not feel that the present data collection instruments captured what their true needs were, yielding a service plan that was often not responsive to the actual needs of the individual and their situation.

Based upon input of numerous stakeholder groups, we heard the following as reasons for the need to change the current approach:

  • Assessments are performed at a period of time and reflect a “snapshot” versus the overall needs of the person. Parents tend to want to base the assessment of their children on their worst days. The new tool will allow for some clarity in how to address this.
  • People may switch from waiver to waiver, which is hard for staff at the local level. Having a single assessment process will help to determine what services fit a persons’ needs best.
  • One of the greatest concerns of county-level providers is the inability to meet the timeframes, e.g., 10 days for assessment. Factors contributing to this are:
    • Obtaining medical necessity approval for primary care provider/medical provider.
    • Numerous forms to sign.
    • The time it takes to perform the assessments for mental health, especially for the CADI waiver.
    • Obtaining all of the necessary eligibility requirements for DD in particular, such as psychological evaluations, and disability certifications.
  • Services cannot start without a service agreement, which is driven by assessment and service eligibility determination.
  • Multiple forms are confusing and cumbersome for families and for some county staff.
  • Staff at the county level do not want to be forced by the design, to complete all form fields if they are not relevant.
  • Current tools are not specific enough to capture the Active Treatment requirement of the DD waiver.
  • Currently the LTCC is too focused on the aged and not on youth or children.
  • DD does not satisfactorily screen for level of complexity and intensity of the needs of the DD population.
  • The issue of having two screening tools, one for DD and one for LTC, not only limits the ability to screen true levels of intensity for the DD populations, it also creates a separation at the county level of separate service provision units.
  • Tools do not adequately screen for mental health needs to help plan for services.
  • Consumers do not feel that the present design captures what their true needs and therefore staff are not responsive to actual needs.
  • Assure assessment for services and supports to individuals with disabilities are driven less by the funding stream (i.e., waiver or state plan) and more by the needs and preferences of the individual. A key starting point for this reform will be the ability to accurately assess what individuals need and prefer.
  • Allow intake and assessment staff at the county level to gather additional information on specific populations, such as individuals with greater medical needs or mental health concerns.
  • Streamline the process to reduce use of duplicative forms across waiver populations.
  • More accurately reflect the true needs of the individual and family/support system.
  • Capture more relevant information to address vocation, habilitation, skills adaptation and other needs for which the State currently does not offer tools.
  • Enhance the ability to conduct initial behavioral health screens for CADI and MR/RC by providing more definitions for screening.
  • Move toward an automated intake and screening process that is less cumbersome for the consumer and will capture more accurate data about the individual for service planning.

The MnCHOICES Comprehensive Assessment, formerly known as the Universal Assessment and COMPASS, is designed as an automated, modular tool that only prompts for information that is relevant to a particular individual. Thus, it includes higher level trigger questions that determine whether a particular section, or subset of questions within a section, is addressed.

These sections can be classified into the following three phases: (1) the “initial contact” screening call that captures the reason for referral, the urgency of the person’s needs, and whether a full assessment is needed; (2) the assessment of preferences, strengths, and needs; and (3) the development of the support plan.

We have described the structure of this process as resembling a “tree.” At the base of the tree, there is a trunk, consisting of information we discover through a person-centered interview about the person’s life goals and strengths. This information is used to direct the assessment into those areas of most importance to the person.

The state intends that the MnCHOICES Comprehensive Assessment will ultimately be automated and linked directly to the Medicaid Management Information System (MMIS). Below we provide links to mock-up versions designed to reflect what the automated version should look like.

A. First Contact Triage Intake– Updated November 5, 2010

B1. Person-Centered Interview – Ages 14-64  – Updated November 4, 2010

B2. Person-Centered Interview-Over 65- Updated November 4, 2010

B3. Person-Centered Interview for Birth to 13- Updated November 5, 2010

C. Capacity for Self Direction- Updated June 8, 2010

D. Initial Trigger Questions- Updated February 20, 2010

E. Adult Health Assessment- Updated February 24, 2010

F. Substitute Decision-Making – Updated June 1, 2010

G. Functional Memory and Cognition- Updated October 30, 2010

H. Children’s Health and Functioning- Updated October 20, 2010

I. Sensory Channels and Communication Skills- Updated June 7, 2010

J. Social Communication and Friendships- Updated July 7, 2010

K. Living Arrangements Environmental Screening- Updated May 28, 2010

L. Caregiver Assessment- Updated November 3, 2010

M. Activities of Daily Living- Updated September 20, 2010

N. Instrumental Activities of Daily Living- Updated July 6, 2010

O. Employment Module- Updated May 27, 2010

P. Support Planning Module- Updated March 4, 2010

Q. Demographic-Administrative- Updated July 15, 2010

S. Assessment Conclusions Iteration- Updated July 2, 2010

ILLINOIS GOVERNORS’ OFFICE ON HEALTH INNOVATION AND TRANSFORMATION (GOHIT)

1115 Demonstration Waiver Support

In 2014, HCBS Strategies assisted GOHIT with designing policy and operations for its ambitious 1115 Demonstration Waiver that combined nine waivers into a single program. Dr. Lutzky acted as the Subject Matter Expert for the LTSS Workgroup. Under this scope, he reviewed current program operations, proposed approaches for integrating these operations, and worked with a workgroup of State agency representatives and workgroups of stakeholders to review these changes.

TEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES

Information Technology Development

The Texas Department of Aging and Disability Services (DADS) contracted with HCBS Strategies and the Center for Information Management (CIM) to assist in the development of information technology (IT) that would support the implementation of a No Wrong Door (NWD) system for all community-based long term services and supports (LTSS) as part of the State’s Balancing Incentives Program (BIP) effort.

Under this effort, HCBS Strategies conducted a thorough review of the State’s current business operations for facilitating access to LTSS. We analyzed the ability of Texas BIP work plan to meet the core BIP related requirements and made recommendations for refinements and additions. We also developed a roadmap document to help the State establish the architecture for the IT solution to automate many of these core requirements.

Throughout this process we conducted research on models used by other states, focusing on LTSS standardized screen and assessment, inter-communicative IT systems, and other processes around “information follows the person”.

Business Operations Development

After assisting in the development of the IT structure, DADS contracted with HCBS Strategies to formalize business operations that would be automated within the new system. This included development of a standardized intake tool, guidance on options counseling and FFP, and the development of a managed long term services and supports white paper.