District of Columbia RCSC Summary

<A NAME=\"DCRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">DISTRICT OF COLUMBIA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Lack of coordination among decision-makers and stakeholders.</LI> <LI>Reliance on institutional care for individuals with disabilities and long-term illness.</LI> <LI>Barriers to accessing the LTC system include the lack of a coordinated system of services and supports and the lack of a streamlined eligibility determination process.</LI> <LI>The current HCBS and Medicaid state plan service delivery models are agency-based and do not foster consumer control over the recruitment, delivery, and management of services, nor do they allow for an integrated system change effort covering the range of needs across the life span from institutionalization to self-sufficiency.</LI> <LI>Insufficient HCBS infrastructure.</LI> <LI>Lack of flexibility in &quot;family-centered&quot; service delivery.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Consolidation of long-term care responsibilities in the Office on Disabilities and Aging.</LI> <LI>Increased services and expanded eligibility through amended HCBS waivers.</LI> <LI>Improved long-term care service system through system changes and the development and implementation of a Quality Assurance (QA) and Continuous Quality Improvement (CQI) Plans. The QA and CQI efforts assist in identifying the educational needs of consumers and service providers, areas of service delivery needing improvement, and the strategies and educational programs to be implemented for resolving the problems.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Develop a single point of entry for home and community services.</LI> <LI>Establish a care coordination system that incorporates financial incentives, improves quality of life and care, and controls costs.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Create the necessary infrastructure to build a cost-effective HCBS system.</P> <P><STRONG>Goal.</STRONG> Coordinate policy decision-making across government agencies.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Convene an Advisory Committee comprising consumer, provider, and various government agency representatives to work with stakeholder groups to prioritize needs, and to develop strategic action plans for addressing the identified needs; to provide decision-making regarding policies and procedures, training, and quality assurance; to recommend changes in policies, including the eligibility determination process, to institute and maintain innovation; and to ensure that goals and objectives are met.</LI> <LI>The Committee will also develop a coordinated system of information regarding services and supports to increase public awareness of inclusion in the community.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Improve the dissemination of HCBS information to consumers and streamline the eligibility determination process.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Create a Resource Center to provide counseling about long-term care options and to determine eligibility for publicly funded programs.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop an accessible continuum of services that will allow for an integrated system change effort covering the range of needs and services across the life span from institutionalization to self-sufficiency.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Amend the elderly waiver to include non-elderly persons with physical disabilities ages 18 to 64 years.</LI> <LI>Amend the elderly waiver to expand services to include an independent provider/consumer-directed attendant care option.</LI> <LI>Expand the elderly waiver services to include assisted living, targeted case management for particular populations and provide broader coverage for assistive technology under the Medicaid state plan coverage.</LI> <LI>Hire a recruitment specialist for the new HCBS Elderly and Physical Disabilities (EPD) waiver case management and personal assistance providers and continue rate-setting analyses to ensure that the rates are adequate to attract sufficient providers.</LI> <LI>Rates will be quantitatively and qualitatively compared to those in contiguous states to determine their adequacy and fiscal impact on the district's budget for implementation thereof. Grant funds will be used to expand existing initiatives.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Construct the infrastructure to ensure an adequate pool of qualified providers, a menu of services for meeting the consumer's needs, and measurement of performance outcomes to determine the quality and utilization of services.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop a long-term care information systems software package with the capability to determine levels of service utilization, and to measure performance outcomes and service costs.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Coordinate policy decision-making across government agencies through a Real Choice Systems Change Advisory Committee that is composed of consumers, providers, and various representatives of district government agencies.</LI> <LI>Develop and implement a resource center or single point of entry for home and community services that provides long-term care options counseling, self-determination, Medicaid and other publicly-funded eligibility assessment, channeling of individuals to the most effective and medically appropriate setting, and effective management of cost of services.</LI> <LI>Expand services to include assisted living, targeted case management for particular populations, an independent provider/consumer directed form of attendant care services, and expanded coverage of assistive technology.</LI> <LI>Recruit new waiver providers, include non-elderly persons with physical disabilities in the waiver, and continue current rate-setting analyses.</LI> <LI>Develop a long-term care information systems software package that also has the capability to determine the levels of service utilization and to measure performance outcomes and service costs to assist in improving the quality of care.</LI> </UL> </P> <H3>Consumer Partners</H3> <P>The Advisory Committee will comprise consumers, providers, advocates and various government agency representatives. Consumer partners are: <UL> <LI>University Legal Services (ULS), the District's advocacy group that represents consumers.</LI> <LI>DC Coalition on Long-Term Care.</LI> <LI>Alzheimer's Association.</LI> <LI>Paralyzed Veterans of America.</LI> <LI>District of Columbia Center for Independent Living.</LI> <LI>ADAPT.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>The consumer partner organizations participated in meetings; conducted needs assessment of individuals with disabilities; worked with national and local disability rights organizations; assisted in the development and prioritization of goals and action plans; reviewed draft policies and regulations; recommended changes in policies and regulations to institute and sustain innovations; and assisted in mapping a work plan for achieving the goals and objectives of the grant.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>The Advisory Committee will develop and oversee the planned Resource Center.</LI> <LI>A subset of the Advisory Committee, known as the Governing Council, will oversee the operations of the Resource Center. Responsibilities of the Governing Council include reviewing and refining the operations model of the Resource Center, approving policies and procedures, reviewing reports and making recommendations, and monitoring and maintaining quality control of the Resource Center's operations.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Medical Assistance Administration.</LI> <LI>Health Regulation Administration.</LI> <LI>Office of the General Counsel.</LI> <LI>Office of Policy Management.</LI> <LI>Office on Aging.</LI> <LI>Rehabilitation Services Administration.</LI> <LI>Mental Retardation/Developmental Disabilities Administration.</LI> <LI>Adult Protective Services.</LI> <LI>Income Maintenance Administration.</LI> <LI>DC Housing Authority.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>DC Health Care Association.</LI> <LI>St. John's Community Services.</LI> <LI>Howard University Hospital-Geriatrics Department.</LI> <LI>District of Columbia Hospital Association.</LI> <LI>DC Primary Care Association.</LI> <LI>The ARC of DC, Inc.</LI> <LI>Home Care Partners.</LI> <LI>Long-Term Care Coalition.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG></P> <P>Representatives from all of the above public partners contributed substantially to the planning process and are members of the Advisory Committee. The public partners attended meetings and provided input and technical support for the grant application. Input included history of the long-term care and HCBS systems and data concerning the long-term care and HCBS systems and enrolled consumers; current and projected funding levels and expenditures of HCBS and long-term care services; statutes and rules authorizing the EPD waiver and Medicaid state plan services; Medicaid eligibility standards and processes; long-term care service and HCBS limitations; capacity and barriers to access to HCBS and long-term care services; plan of care development and oversight; recommendations on the goals and activities of the grant applications; and review of the grant application.</P> <P><STRONG>Private</STRONG> <UL> <LI>Office on Disabilities and Aging staff involved three provider associations affected by the long-term care delivery system to ensure that the District's plan effort was synchronized with providers' strategic plans. They are St. John's Community Services, The ARC of DC, Inc., and Home Care Partners.</LI> <LI>The private partners attended meetings and provided input and technical assistance for the grant application. Input included data concerning long-term care and waiver programs and enrolled consumers; analysis of the existing system of consumer inclusion and consumer education regarding sources of services and supports; analysis of the adequacy of gatekeeper functions for individuals currently residing in the community and in institutions who are seeking waiver services; analysis of provider supply, the factors contributing to provider shortages, and the options available for increasing the supply of qualified providers; capacity and barriers to access HCBS and long-term care services; plan of care development and oversight; recommendations on the goals and activities of the grant application; and review of the grant application.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P>The public and private partners listed above will be members of the Advisory Committee, which will develop and oversee the Resource Center.</P> <P><STRONG>Public</STRONG></P> <P>Major public partners will convene special topic forums on issues such as community inclusion and supports and services, Medicaid eligibility determinations, affordable and accessible housing, access to care givers, workforce employment, and transition issues.</P> <P><STRONG>Private</STRONG></P> <P>Key private partners and potential subcontractors will participate in special topic forums and community fairs to display their array of services and supports; to provide education to the consumers on the definition of the services and supports; and to accommodate consumers' preferences and choices in the selections of services and supports and providers.</P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG></P> <P>Partnerships have been formed with the following state and local agencies and private organizations to create linkages among key stakeholders that will result in coordination of services: <UL> <LI>Department of Mental Health to promote and coordinate long-term care changes and services that enhance the inclusion of all persons into the community and education of the community regarding informed decision-making and independent living.</LI> <LI>Department of Housing to oversee the creation of safe, affordable, appropriate, and accessible housing options in partnership with local communities to allow individuals to be integrated into community settings of their choice.</LI> <LI>Rehabilitation Services Administration to provide vocational rehabilitation to individuals with physical disabilities; to assist in matching consumer needs with existing services; and to assist in identifying consumer needs and services for transitioning individuals into community life.</LI> <LI>Medicaid Infrastructure grant project to facilitate the development of an expanded workforce to meet the needs of individuals with physical disabilities.</LI> <LI>Long-term Care Coalitions and organizations to facilitate access to services and supports; to provide training and education of the personal assistance and professional workforce; and to identify and examine barriers to access to services and delivery of services.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>The Advisory Committee or its subcommittees will oversee all Grant activities. The following subcommittees were formed: (1) Case Management; (2) Resource Center Oversight; (3) Consumer-directed Services; (4) Coordination; (5) Mentoring and Community Support; and (6) Peer Mentoring Support.</P> <P>The Advisory Committee is responsible for reviewing, revising, and approving all subcommittee recommendations. The Advisory Committee will then submit the recommendations to the Office on Disabilities and Aging (ODA) for final review and approval.</P> <H3>Formative Learning and Evaluation Activities</H3> <P>ODA proposes to retain the services of a consultant to: <UL> <LI>Provide real-time feedback about the growth and development process in place for planning, implementing, monitoring, evaluating, and revising the goals and activities.</LI> <LI>Present an annual assessment of the implementation phase of the program.</LI> <LI>Advise members of the Advisory Committee in their periodic planning assessment on the advantages and disadvantages of pursuing or modifying the established activities, the specific features and processes that present a barrier or disincentive to program success, and the District's capacity to remove the barriers and streamline the program.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>Services will be maintained by funding key components of the infrastructure through District funds and matching federal funds under the Medicaid program.</LI> <LI>ODA will use grant funds to hire staff and consultants and to supply resources to facilitate community advocacy and involvement in the redesign of the long-term care system. Once the grant period ends, the District will fund these positions as Medicaid administrative costs in the 2005 budget and onward.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Districtwide.</P>