Indiana CPASS Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"INCPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</EM></P> <H2 ALIGN=\"CENTER\">INDIANA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Lack of a unified vision across state agencies to support community integration.</LI> <LI>Limited funding for community services.</LI> <LI>Lack of focus on consumer choice and control.</LI> <LI>Inadequate quality assurance mechanisms, prompting the need for improvements in licensure and certification, ongoing monitoring, system-wide oversight, and consumer access to ombudsman services and complaint procedures.</LI> <LI>Inconsistencies among agencies in their ability to serve non-elderly consumers in need of long-term care services.</LI> <LI>Inconsistencies in availability of consumer-directed care between waiver-funded services and 100 percent state-funded services.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>A well-designed community services program that includes the CHOICE program, a nationally recognized program.</LI> <LI>Experience using multiple funding streams to support persons at risk of losing their independence.</LI> <LI>Seven Home and Community-Based Services (HCBS) waiver programs.</LI> <LI>Data management system has a tracking system that incorporates demographic and other pertinent information about individuals in programs.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Plan, develop, pilot and evaluate an infrastructure for consumer-directed attendant care through three local coalitions across the state.</LI> <LI>Create a workforce development system to support a stable resource of providers and personal assistance staff.</LI> <LI>Develop a methodology to illustrate the value of consumer-directed care.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Create an enduring infrastructure to support consumer-directed personal assistance services.</P> <P><STRONG>Goal.</STRONG> Design a consumer-directed attendant care model, education and outreach programs, and develop informational materials.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop a pilot model of self-directed care based on the work of three local coalitions. Those coalitions will include an Area Agency on Aging (AAA), an Independent Living Center (ILC), a nursing home(s), and other pertinent support providers and advocacy groups.</LI> <LI>Collaborate with community entities to (1) plan and implement outreach events and dissemination activities, and (2) to develop further networks and coalitions with participants in the education/outreach effort.</LI> <LI>Provide nursing home facilities and hospital discharge planners with information and training on the pilot model consumer-directed attendant care program.</LI> <LI>Contact all potential local providers with information about the consumer-directed attendant care program.</LI> <LI>Develop a training curriculum for case managers who will work on the consumer-directed attendant care project.</LI> <LI>Disseminate information about consumer-directed attendant care options through the pilot model program to residents in nursing facilities, group homes, and large private ICF/MR facilities.</LI> <LI>Identify potential Medicaid Waiver participants to participate in the pilot model program based on functional status, with self-selection of remaining participants</LI> <LI>Case managers, ILCs, ombudsman and other local collaborators will provide participants with necessary information and support, including how to hire, train or dismiss personal attendants and how to use emergency back-up systems.</LI> <LI>Include consumers from the Medically Fragile Children's Waiver or the Traumatic Brain Injury Waiver in the pilot model program in the third year of the grant.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop a system where self-directed personal attendant care is a realistic and accessible service for any individual who chooses to live in the community.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Encourage families and advocates to actively participate in systems development, person-centered planning, education, and caregiver support initiatives through representation on the project's work groups.</LI> <LI>Strengthen quality assurance, monitoring systems, complaint systems and advocacy efforts through the Bureau of Quality Improvement Services (BQIS), an independent Bureau charged with oversight of incident reports, complaints, and surveys of services.</LI> <LI>Enhance consumer advocacy programs, assure oversight and accountability for quality assurance activities, and ensure that conflicts of interest do not exist by engaging consumers in all phases of the design and implementation of the pilot for consumer-directed care.</LI> <LI>Partner with the Division of Disability, Aging, and Rehabilitative Services and the Office of Medicaid Policy and Planning to address transportation, employment, and housing needs, and provide more consumer direction and choice for these community supports.</LI> <LI>Examine barriers to recruiting and maintaining quality workers and coordinate with the Department of Workforce Development and the Department of Labor to ensure realistic approaches to the development of a dedicated workforce. These efforts are being coordinated through a workgroup of consumer representatives, provider representatives, and state officials.</LI> <LI>Identify a way to provide services to persons with a sole diagnosis of mental illness not included in Medicaid waiver programs.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop a methodology to illustrate that Consumer-Directed Care leads to enhanced consumer satisfaction and an improvement in the quality of life for participants.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop a data collection tool to record the cost and units of personal attendant services, costs and time to manage the fiscal activities for consumers, demographics of participants, ICD-9 codes of participants, number of providers utilized, and total costs of services.</LI> <LI>Develop outcome-based reports on quality of care, quality of life, and consumer need for additional assistance from AAAs to manage their personal attendants.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Develop a model for consumer-directed attendant care to be piloted in three communities.</LI> <LI>Develop training curriculum for case managers who will work on the consumer-directed attendant care project.</LI> <LI>Plan and design education and outreach programs for all stakeholders, and provide nursing home facilities and hospital discharge planners with information and training about the pilot model consumer-directed attendant care program.</LI> <LI>Provide participants in the pilot model program with information and support on all aspects of consumer-directed care.</LI> <LI>Work with state agencies to provide community supports such as housing, transportation and employment.</LI> <LI>Create a coordinated workforce development system that recruits and supports a stable resource of providers or personal assistance staff.</LI> <LI>Develop a data collection tool and produce outcome-based reports.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The Governor's Commission on Long Term Care, formerly the Community Choice Commission, comprises consumers, advocates, state agencies and provider representatives, and is the overarching steering committee for all the Systems Change grants. The Governor's Commission will establish a Project Advisory Council to oversee grant activities, whose members will include consumers and representatives from public, private, and state organizations.</LI> <LI>The Governor's Planning Council for People with Disabilities, comprising consumers, advocates, state agencies, and provider representatives, is a strong advocate for quality of life issues and the rights of persons with disabilities.</LI> <LI>An integral component of the Community Personal Assistance and Support Services Grant (CPASS) is the appointment of a task force to guide the work of Indiana's Family and Social Services Administration (FSSA) staff and consultants as they develop the policies and procedures necessary to implement consumer-directed care. The CPASS Task Force is lead by a consumer representative and a former FSSA Secretary, both leaders in the development of home and community services in Indiana. Members of the Task Force include consumers and their representatives and providers of home and community services.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>The Governor's Commission on Long Term Care and the Governor's Planning Council for People with Disabilities were involved in the concept development of the grant application, attending meetings and providing input.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Consumers will be involved in the three local coalition pilot projects as peer mentors and as advocates for consumer placement, providing outreach to institutions.</LI> <LI>Because the materials, by definition, will need to be accessible to a variety of consumers with varying levels of sophistication, all program materials will be reviewed by consumers and their representatives for approval.</LI> <LI>The CPASS Task Force will be reviewing reports and making recommendations for uniform policies and information needed under the waivers.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>The Community Home Options to Institutional Care for the Elderly and Disabled (CHOICE) Board.</LI> <LI>The Governor's Planning Council for People with Disabilities.</LI> <LI>Commission on Aging.</LI> <LI>Division of Disability, Aging, and Rehabilitative Services.</LI> <LI>Bureau of Aging and IN-Home Services.</LI> <LI>Bureau of Quality Improvement Services.</LI> <LI>Office of Medicaid Policy and Planning.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>ARC of Indiana.</LI> <LI>Indiana Association of Rehabilitation Facilities.</LI> <LI>Indiana Assisted Living Federation of America.</LI> <LI>Indiana Association for Home and Hospice Care.</LI> <LI>Indiana Association of Homes and Services for the Aging.</LI> <LI>Indiana Council on Independent Living.</LI> <LI>Indiana Health Care Association.</LI> <LI>The Indiana Association of Area Agencies on Aging.</LI> <LI>AARP.</LI> <LI>The Indiana Home Care Task Force United Senior Action.</LI> <LI>Malone Consulting (subcontractor).</LI> <LI>Capitol Health Strategies (subcontractor).</LI> <LI>Health Evolutions (subcontractor).</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public Partners</STRONG> <UL> <LI>The CHOICE Board, the Governor's Planning Council for People with Disabilities, and the Commission on Aging provided input, guidance and feedback throughout the application process, including invaluable insight into barriers and how to overcome them.</LI> <LI>The Bureau of Aging and IN-Home Services and the Office of Medicaid Policy and Planning were the architects of the grant application, and were involved in all planning meetings. The lead agency wrote the grant application.</LI> </UL> </P> <P><STRONG>Private Partners</STRONG></P> <P>The private partners have had varying levels of involvement. <UL> <LI>Advocacy groups listed above have had a strong voice in terms of developing the independent fiscal intermediary model and strategies for self directed care.</LI> <LI>Provider groups listed above, such as the Indiana Association of Rehabilitation Facilities and the Indiana Assisted Living Federation of America, have been involved in the meetings to discuss the project and provide guidance on what the self-directed care model will look like.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public Partners</STRONG> <UL> <LI>The Office of Medicaid Policy and Planning (OMPP) is the Medicaid Single State Agency and will be a major partner in this grant effort. They will provide oversight to grant activities, administrative activities, and will help develop and authorize the amendments to the Medicaid Waivers. The amendments will be enhancements/additions to current services recommended by the CPASS work group to enable consumer-directed care to be an integral part of all community services.</LI> <LI>The other public partners will be involved in implementation through their roles as advocates, their ability to influence legislation, and as technical experts in promoting the changes in the system as they occur.</LI> </UL> </P> <P><STRONG>Private Partners</STRONG> <UL> <LI>The subcontractors identified above will deliver the finished work products on which the systems changes will be based, such as a statewide uniform fiscal intermediary policy, an information guide to consumer-directed care, and recommendations for training curricula for personal assistance workers.</LI> <LI>The private partners will be involved in the three pilot coalitions and will provide the medium through which changes are implemented and will generate reports for state monitoring of success and identified barriers.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG></P> <P>The Bureau of Aging and In-Home Services is in the process of developing incident and complaint reporting policies, as well as drafting rules for those services supplied in the community through BAIHS. One of the grant activities will be to strengthen quality assurance, monitoring systems, complaint systems and advocacy efforts through BQIS, an independent bureau charged with oversight of incident reports, complaints, and surveys of services. These two entities will build on their existing initiatives to support the grant's quality assurance activity. In addition, the BQIS has offered to perform consumer satisfaction surveys for participants in the pilots.</P> <H3>Oversight/Advisory Committee</H3> <P>The Governor's Commission on Long-Term Care will establish a Project Advisory Council to oversee the project. Membership will include consumers and representatives from public, private, and state organizations. The Council will review the subcontractors' work, provide feedback, and make recommendations for RFPs for the three coalition projects. Sites will be selected using a standard scoring system.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The grant managers and project consultant will visit project sites on a regular basis throughout the grant period to ensure implementation of initiatives and to provide informal opportunities for participants to express satisfaction/dissatisfaction with the process as it evolves.</LI> <LI>The BQIS will gather information/feedback about individuals who transitioned to community services using consumer-directed care from all those involved, including the facilities, the AAA's, ILCs, case mangers, personal care attendants, and most importantly, the consumers themselves. Since these will be pilot projects, information will be used to refine and strengthen the system before it is rolled out on a statewide basis.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>A coordinated workforce development system will be created using Home Health Care Agencies as training centers to recruit and support a stable resource of personal assistance staff.</LI> <LI>The FSSA will submit a plan to the CPASS Task Force to assure that services provided to elderly persons and persons with disabilities match the needs of these persons as closely as possible. The plan will include specific options available to these populations, costs, availability of waivers through the Medicaid program, and the effects on the quality of life for the consumers and their families. This plan will change current practices as the first of many steps towards having a well-informed consumer population in Indiana that has enough information to make decisions based on their own wants and needs, not the service category they fit into.</LI> <LI>Funding for personal attendant care services will continue to be provided to individuals through the Medicaid waivers.</LI> <LI>The IN-Home Services program will use blended funding after grant funds are expended to sustain the ongoing grant projects, including the establishment of independent fiscal intermediaries to act on behalf of consumers utilizing self-directed care, maintaining the availability of self-directed care on all waivers, and training and certification of personal care attendants. The blended funding method will enable individuals to have access to funds from the Aged and Disabled Waiver, the CHOICE program, and funds that may be available from other local sources. AAA's will be able to draw upon resources available through funding under the IN-Home Services Program. This will enable consumer-directed personal care to become an accepted and enduring service after the grant period is complete.</LI> <LI>The pilot model, which will require a local coalition of partners that do not traditionally work together, will allow a transformation of the support network to move in parallel with the increase in consumer options.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide. An RFP will be forthcoming for three pilot sites. Once those geographic locations have been identified, a geographic listing will be included.</P>