From NACDD's 2014 Annual Conference

1. 1A non-profit service and advocacy organization © 2011 National Council on Aging
State Activity and Opportunities to
Advance Home and Community-Based
Services
Joe Caldwell
Director of LTSS Policy
National Council on Aging
Rachel Patterson
Policy Analyst
Association of University Centers on Disabilities

2. 2A non-profit service and advocacy organization © 2011 National Council on Aging
Overview
1. Managed Long-Term Services and Supports
(MLTSS)
2. Opportunities for DD Councils in LTSS
– Community First Choice Option
– Aging and Disability Resource Centers
3. Implementation of HCBS Settings Rule

3. 3A non-profit service and advocacy organization © 2011 National Council on Aging
Half of States Could Have
MLTSS Programs Within Next Year
NASUAD State Medicaid Tracker, July 2013

4. 4A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS Programs Adults with ID/DD, 2012

5. 5A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS Programs Adults with ID/DD, 2012
State Statewide Mandatory
Enrollment
Private for-
profit
Surveys and
Advisory
Council
Survey
Arizona X X X
Delaware X X X
Hawaii X X X X
Michigan X X X
North Carolina X (2013) X X
Pennsylvania X
Washington X
Wisconsin X

6. 6A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS Programs Adults with ID/DD, 2012
Program Primary/A
cute
ID/DD
HCBS
Institutional Behavioral Rx
AZ Long Term Care System X X X X X
DE Diamond State Health Plan-Plus X X X
HI QUEST Expanded Access
MI Managed Specialty Support &
Services
X X X
NC MH/DD/SAS Health Plan Waiver X X X
PA Adult Community Autism
Program
X X X
WA Medicaid Integration Partnership X X X X
WI Family Care Partnership X X X X X
WI Family Care X X X

7. 7A non-profit service and advocacy organization © 2011 National Council on Aging
MLTSS for Adults with ID/DD: 2014 Update
• Six new states are planning or are in the
process of implementing MLTSS for adults
with ID/DD
– Kansas
– Texas
– Illinois
– New Hampshire
– New York
– Florida
Source: NASUAD State Medicaid Integration Tracker, April 2014. Retrieved from
http://www.nasuad.org/sites/nasuad/files/Edited%20Final%20Tracker%20-%204.14.14.pdf

8. 8A non-profit service and advocacy organization © 2011 National Council on Aging
What is Managed Care?
Traditional Medicaid Managed Care

9. 9A non-profit service and advocacy organization © 2011 National Council on Aging
Powerful Tool
• Managed care is neither inherently “good” or
“evil”
• It is a powerful tool: If it is used correctly it
can do a lot of good, but if not it can do a lot
of harm.
• Engagement of individuals with disabilities
and families in the design and implementation
is critical

10. 10A non-profit service and advocacy organization © 2011 National Council on Aging
Pros and Cons

11. 11A non-profit service and advocacy organization © 2011 National Council on Aging
Key Issues and Potential Roles
of DD Councils
1) Disability Stakeholder Engagement
2) Choice and Self-Determination
3) Consumer Protections and Rights
4) Quality Measurement, Data Collection, and Research

12. 12A non-profit service and advocacy organization © 2011 National Council on Aging
Disability Stakeholder Engagement
• The Issues:
– MLTSS is very complicated
– New terms, tools, and ways to advocate
– No trainings have been developed for self-advocates
• Potential Role of DD Councils:
– Develop trainings for self-advocates
– Support consumer-based aging and disability coalitions in
states to influence programs and ensure consumer
protections

13. 13A non-profit service and advocacy organization © 2011 National Council on Aging
Choice and Self-Determination
• The Issues:
– Opportunities to design programs that promote self-
direction, rebalancing, unmet needs and addressing
waiting lists
• Potential Role of DD Councils:
– Not allow states to “carve out” institutional services
– Promote person-centered planning and options for self-
direction in programs
– Ensure savings are reinvested to help address unmet needs
and waiting lists

14. 14A non-profit service and advocacy organization © 2011 National Council on Aging
Consumer Protections and Rights
• The Issues:
– Some states are moving too quickly and not ready to
implement MLTSS programs
– Need independent ombudsman programs
• Potential role of DD Councils:
– Strong involvement in all phases of design and
implementation
– Possible state legislation to ensure consumer protections
– Require ombudsman programs

15. 15A non-profit service and advocacy organization © 2011 National Council on Aging
Quality, Data Collection, Research
• The Issues:
– Quality measures are powerful tools that advocates and
states can use to make systems change
• Possible Role of DD Councils:
– Support development and use of HCBS measures (e.g.
National Core Indicators and Council on Quality and
Leadership)
– Support independent, external research on
implementation and outcomes for people with I/DD

16. 16A non-profit service and advocacy organization © 2011 National Council on Aging
Community First Choice Option 1915(k)
• State plan option to provide personal attendant services and
supports to individuals who meet an institutional level of care
– Hands-on, supervision, and cueing assistance with
activities of daily living and health-related tasks
– Also includes some other services and transition costs
• Requires person-centered planning and options for self-
direction
• Provides a 6% enhanced federal match for services that
continues indefinitely

17. 17A non-profit service and advocacy organization © 2011 National Council on Aging
Community First Choice Option 1915(k)
• Two states have been approved (CA, OR)
• Many states are applying or seriously considering
– AR, CO, MD, MN, MT, NY, TX
Possible Role of DD Councils:
• Forming Community First Choice Council
• Commission or contract for a study
• Work with state on analyses
• Think about next state legislative session

18. 18A non-profit service and advocacy organization © 2011 National Council on Aging
Aging and Disability Resource Centers
• No Wrong Door
– ADRCs are intended to be trusted community sources
where people of all ages, incomes and disabilities go to get
information and one-on-one person-centered counseling
on the full range of LTSS options
• ACL’s new vision for ADRCs
– Much more inclusive of disability
– Emphasizes Person-centered planning

19. 19
VD-HCBS launched
49 States awarded
new ADRC grants
(5 year plans)
2007
2008
2009
2010
2011
2012
10 CMS Hospital
Discharge
Planning grants to
ADRC states
Affordable Care Act
Money Follows the
Person
CCTP and Balance
Incentive Program
launched
19
Milestones of ADRC Development
2003 12 states, 8 sites, 2% of pop.
24 states, 42 sites, 8% of pop.
43 states, 147 sites, 30% of pop.
47 states, 300 sites, 49% of pop.
53 states, 525 sites, 77% of pop.
ACL, CMS, VHA
NWD System
FOA

20. 20A non-profit service and advocacy organization © 2011 National Council on Aging
Aging and Disability Resource Centers
• Potential Role of DD Councils
– ACL, CMS, VA issued an funding opportunity for state
planning grants
– Deadline for applications in July 15
– Main “deliverable” is a 3-year plan
– States eligible include all states and territories, except the
8 states currently receiving Part A ADRC Grants (CT, MD,
MA, NH, OR, VT, WA, WI).
– Need to make sure the DD Council is at the table
– Promote greater involvement of self-advocates and
families

21. 21A non-profit service and advocacy organization © 2011 National Council on Aging
Friday Morning Collaborative
• American Association on Health and Disability
• American Association of People with
Disabilities
• AARP
• Alliance for Retired Americans
• American Federation of State, County and
Municipal Employees (AFSCME)
• American Network of Community Options and
Resources
• The Arc of the United States
• Association of University Centers on
Disabilities
• Alzheimer’s Association
• Bazelon Center for Mental Health Law
• Center for Medicare Advocacy
• Community Catalyst
• Direct Care Alliance
• Disability Rights Education & Defense Fund
• Easter Seals
• Families USA
• Health and Disability Advocates
• Leading Age
• Lutheran Services in America
• National Association of Area Agencies on Aging
• National Association of Councils on
Developmental Disabilties
• National Association for Home Care and Hospice
• National Committee to Preserve Social Security
and Medicare
• National Council on Aging
• National Council on Independent Living
• National Consumer Voice for Quality Long-Term
Care
• National Disability Rights Network
• National Domestic Workers Alliance and Caring
Across Generations
• National Health Law Program
• National PACE Association
• National Senior Citizens Law Center
• Paralyzed Veterans of America
• Paraprofessional Healthcare Institute
• Service Employees International Union
• United Spinal Association

22. 22A non-profit service and advocacy organization © 2011 National Council on Aging
FMC Webinars
• Way to connect with state advocates and build
capacity
• Many on MLTSS and ACA Opportunities
• All archived: www.ncoa.org/HCBSwebinars