District of Columbia CPASS Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"DCCPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</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 between decision-makers and community 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 such as adequate and available housing, information dissemination about available services, and eligibility streamlining.</LI> <LI>Lack of agency oversight of personal care services.</LI> <LI>Lack of consumer-directed systems of support.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>The District has been supportive of the creation of a cross-disability consumer advocacy group to strengthen and streamline input into policy development.</LI> <LI>Consolidation of long-term care responsibilities in the Office on Disabilities and Aging.</LI> <LI>Increased services and expanded eligibility through HCBS waivers.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Create a PASS program for the delivery of cost-effective services with a consumer direction component.</LI> <LI>Reduce institutional services and increase availability of HCBS services by allowing individuals who are desirous of leaving institutions to be served in HCBS programs.</LI> <LI>Create quality assurance/improvement mechanism for monitoring services.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Construct a cost-effective personal assistance service infrastructure.</P> <P><STRONG>Goal.</STRONG> Create mechanisms to ensure the full community participation of elderly people and individuals with disabilities and to coordinate policy decision-making across District government agencies.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Convene an advisory committee composed primarily of consumers, provider representatives and representatives of District agencies to work with stakeholder groups to prioritize needs and to develop strategic action plans. The committee will recommend changes in policies, such as the eligibility determination process, and provide decision-making regarding policies and procedures, training, and quality assurance.</LI> <LI>Set up a Resource Center to serve as a single point of entry and to provide counseling about long-term care options and self-determination.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Improve the availability of HCBS information to consumers and streamline the eligibility determination process.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Coordinate referrals and service options with the Resource Center to determine the consumer's eligibility for publicly funded programs and to channel the consumer to the most effective care management setting.</LI> <LI>Assist consumers in expediting the application process for financial eligibility determinations.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Create a consumer-directed personal assistance service system under the elderly and physical disabilities waiver program.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>The Medical Assistance Administration will develop the rate structure and methodology for determining the amount of services and supports that the consumer will receive and will set appropriate rates for the CPASS program under the elderly and physical disabilities waiver program.</LI> <LI>Develop fiscal intermediary services.</LI> <LI>Develop a database to track individual PASS budgets and expenses.</LI> <LI>Train waiver recipients and their representatives in care management responsibilities, including the areas of hiring, firing, training, directing, supervising, and retaining personal assistants, risk management procedures, contingency planning for planned and unplanned provider absences, and budget management and bookkeeping services. Consumers will initially be those that serve on committees or represent organizations that will have heard about the training opportunities offered by the grant.</LI> <LI>Provide training and technical assistance to personal assistants in the care delivery process to improve the quality of service delivery and to assist the consumer with administrative functions such as work-related tasks. Personal assistants will initially be identified through current provider agencies or recommended by consumers.</LI> <LI>Develop an urgent response system through which consumers can access providers in an emergency situation.</LI> <LI>Recruit, train, and support mentors (individuals with disabilities) to provide encouragement to other individuals with disabilities who trying to &quot;make it&quot; in the community and to assist in conflict resolution training.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Convene an Advisory Committee composed primarily of consumers, but also including provider representatives and representatives of District agencies 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; to institute and maintain innovation; and to ensure that goals and objectives are met.</LI> <LI>Coordinate referrals for services with the Resource Center to include counseling of consumers regarding options, eligibility determination, the selection of providers and services, and timeframes for initiation of services.</LI> <LI>Assist consumers in expediting eligibility determinations and payment methods.</LI> <LI>Develop a fiscal intermediary for management of funds and payment to workers and tasks related to human resources, such as personnel actions, employment benefits, and federal and state employment-related taxes.</LI> <LI>Determine appropriate rates for the CPASS program.</LI> <LI>Develop a database to track individual PASS budget and expenses.</LI> <LI>Train consumers in the areas of hiring, firing, training, directing, supervising, and retaining personal assistants, risk management procedures, contingency planning and urgent response system, administration of services, and improving the quality of services.</LI> <LI>Recruit, train, and support personal assistants and mentors to improve service quality.</LI> <LI>Develop a QA/QI plan for internal, routine evaluation of services received by consumers.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <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> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>The consumer partner organizations were involved in the following planning activities: <UL> <LI>Participated in meetings, conducted needs assessment of individuals with disabilities, worked with national and local disability rights organizations, and assisted in the development and prioritization of goals and action plans.</LI> <LI>Reviewed draft policies and regulations and recommended changes in policies and regulations to institute and sustain innovations.</LI> <LI>Assisted in mapping a work plan for achieving the goals and objectives of the grant.</LI> <LI>Advised the Office on Disabilities and Aging (ODA) and the consultants who assisted in the development of the CPASS program on issues pertaining to (1) the amount of personal assistance and support services an individual will receive; (2) the reimbursement structure; (3) outcomes and consumer satisfaction measures; (4) refinements needed to provide consumers with the opportunity to self-direct or maximize control over their personal assistance services; (5) ways to streamline the financial eligibility process for qualifying individual provider applicants; and (6) simplifying the payment process.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Consumers will partner with the lead agency to develop recommendations and implement strategies to address unnecessary barriers to continued implementation of the program; to identify service needs; to organize and participate in community forums in educating the public on the CPASS program; to develop Medicaid policies supporting consumer direction; to review reports and make recommendations, and to design, implement, evaluate, and refine a new consumer-controlled personal assistance services support system that will be available for the first time to District residents.</LI> <LI>ODA has created a PASS Advisory Committee (PAC) with a majority membership of individuals with disabilities and their representatives/advocates, which will provide oversight of the full Real Choice Systems Change Initiative.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Rehabilitation Services Administration (RSA).</LI> <LI>Mental Retardation/Developmental Disabilities Administration (MRDDA).</LI> <LI>Adult Protective Services (APS).</LI> <LI>Income Maintenance Administration (IMA).</LI> <LI>Health Regulations Administration (HRA).</LI> <LI>Office of Policy Management (OPM).</LI> <LI>Office on Aging (OOA).</LI> <LI>DC Housing Authority (DCHA).</LI> <LI>Office of General Counsel (OGC).</LI> <LI>Office of Chief Technology Officer (OCTO).</LI> <LI>Center for Health Program Development and Management (Center) at the University of Maryland, Baltimore County.</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&#151;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> <UL> <LI>All key District government agencies involved in the delivery of long-term care services have been included in the development of the CPASS program.</LI> <LI>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 Elderly and Physically Disabled (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.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <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 the consumer's 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 to 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> <LI>ODA staff involved the three (3*) provider associations affected by the District's long-term care delivery system to ensure that the District's plan efforts were synchronized with the provider's strategic plans. In addition, ODA has been meeting individually with the leadership of central providers to discuss the changes for which they should be planning.</LI> <LI>ODA has entered into arrangements with consultants to help with the development and implementation of specific aspects of the proposed PASS system.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG></P> <P>All key District government agencies involved in the delivery of long-term care services will be integral to the implementation of program components based on their areas of specialty and service delivery. <UL> <LI>Key public partners (RSA, MRDDA, DCHA, IMA, MAA, and HRA) will convene special topic forums on issues such as community-based inclusion and supports and services, Medicaid eligibility determinations, affordable and accessible housing, access to care givers, workforce employment, and transition issues.</LI> <LI>The Center for Health Program Development and Management (The Center) at the University of Maryland, Baltimore County, will develop the consumer network and train mentors.</LI> </UL> </P> <P><STRONG>Private</STRONG></P> <P>Key private partners and 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 offer to the consumers preferences and choices in the selection 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>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>Long-term Care Coalitions and organizations to facilitate access to services and supports; to provide training and education to the direct care and professional workforce; and to identify and examine barriers to accessing services and the delivery of services.</LI> <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>Medicaid Infrastructure grant project to facilitate the development of an expanded workforce to meet the needs of individuals with physical disabilities.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>ODA has created a PASS Advisory Committee (PAC) with a majority membership of individuals with disabilities and their representatives/advocates. PAC will be a working group of the Systems Change Advisory Committee and will provide oversight of the Real Choice Systems Change Initiative.</LI> <LI>PAC and project staff will be responsible for reviewing, revising, and approving/disapproving all recommendations that are submitted from the subcommittee. The PAC will then submit the recommendations to ODA for final review and approval.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>ODA proposes to retain the services of a consultant to provide real-time feedback about the growth and development process in place for planning, implementing, monitoring, evaluating, and revising the goals and activities; prioritizing recommendations for the implementation process and progress; drafting an action plan for implementation of the program inclusive of strategies for resolution of identified service and support gaps; and presenting an annual assessment of the progress in implementation phase of the program.</LI> <LI>The contractor will advise members of the PAC in the evaluation of their periodic planning assessment to include 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 under both formal District regulation and the 1915(c) Home and Community-Based Waiver for the EPD. The initiative is financially sustainable because it is built on a platform of continuous funding streams as developed within the CPASS grant. The bulk of the funding for the systems design, including the resource center, will be through District funds and matching federal funds under the Medicaid program.</LI> <LI>The PASS Project is expected to become a permanent operation for which ODA will maintain oversight. At the end of the grant period, District funds will be used to support the positions of the PASS Project Coordinator, Communications Assistant, and Administrative support.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Districtwide.</P>