Tennessee CPASS Summary | advancingstates.org

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"TNCPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</EM></P> <H2 ALIGN=\"CENTER\">TENNESSEE</H2> <H3>Identified Problems with the States' Long-Term Care System</H3> <P> <UL> <LI>Personal assistance services in Tennessee are both fragmented and very limited.</LI> <LI>The waiting list for waiver services exceeds 2,300 persons for persons with mental retardation.</LI> <LI>Consumer-directed services are not available through the waivers.</LI> <LI>Consumers, advocates, providers, and professionals all lack information and experience in consumer-directed personal assistance.</LI> <LI>Limited training for individual or agency providers of personal assistance.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>In 2000, the state enacted a statute codifying a philosophy of community services to support people with mental illness, serious emotional disturbance and developmental disabilities in the most appropriate settings that enhance each person's dignity and ability to thrive. The statue also established principles for services, including consumer responsiveness, consumer/citizen-based planning and policy development, and basic quality standards.</LI> <LI>The Developmental Disabilities Council collaborated with the Tennessee Housing Development agency, the Division of Mental Retardation Services, disability organizations, and community housing development agencies to establish a <EM>Home of Your Own</EM> project to promote safe, affordable, accessible housing options for persons with disabilities to enable them to remain in integrated settings.</LI> <LI>The name of the Commission on Aging was changed to the Commission on Aging and Disability to reflect its new commitment to home and community long-term care services in the most integrated settings for all adults with disabilities.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Increase the use of consumer-directed options for personal assistance services.</LI> <LI>Develop tools and resources for people who want to direct their own services and supports in community settings.</LI> <LI>Implement a pilot program for people with disabilities to test and use the tools and resources.</LI> <LI>Support consumers and providers through a mentoring and technical assistance program.</LI> <LI>Construct and test policies, procedures, and infrastructure needed to establish a new and workable long-term care system for the state.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Develop an enduring system of accessible, quality responsive, consumer-designed and -directed PASS and develop both consumer and provider confidence and competence.</P> <P><STRONG>Goal.</STRONG> Develop and provide education and support to consumers.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Identify the knowledge, skills and tools required to exercise effective consumer-directed personal assistance through feedback at regional meetings and best practices from other states.</LI> <LI>Provide training and information through the <EM>PASS Users Guide</EM>.</LI> <LI>Conduct individual and small group training sessions to prepare individuals who will be hiring their Personal Assistants (PAs).</LI> <LI>Support individuals who have already hired their PAs by developing and providing practice-based training, technical assistance and resource tools.</LI> <LI>Develop a self-assessment tool and process designed to provide guidance for consumers to identify what is needed from a PA.</LI> <LI>Develop a checklist of elements about consumer expectations of a PA.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Provide mentoring and training for consumers, PA workers, advocates, providers and professionals.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop core competencies for individuals providing Personal Assistance Services (PASS).</LI> <LI>Develop a recruitment, screening, selection and management strategy with useful tools for individuals providing or using PASS.</LI> <LI>Develop a consumer-led mentoring and technical assistance program available to support both individuals who use PASS, as well as agency and individual providers.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop and pilot a consumer-directed personal assistance program.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Identify individuals who would be interested in the consumer-directed option, as well as individuals who are already self-directing. If possible, they will come from a variety of settings, including persons living in their own home and in institutions.</LI> <LI>Include individuals in the pilot who currently utilize a variety of funding sources to enable the establishment of flexibility in the system.</LI> <LI>Elicit from consumers their preferences regarding consumer direction through regional meetings and review best practices from other states.</LI> <LI>Implement a consumer-directed pilot program in the Mid-Cumberland region of the state and ensure that necessary supports are available and assessable.</LI> <LI>Develop a fiscal intermediary function that will allow consumers to focus on managing their personal assistants while not being encumbered with the technical and financial details of employing a personal assistant.</LI> <LI>Develop and utilize Consumer Satisfaction Surveys to give feedback on the delivery of high quality and consistent person-centered supports, as identified by the consumer.</LI> <LI>Incorporate feedback gained locally to modify curriculum to meet the specific needs of each given geographic location within Tennessee.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Detailed checklist regarding agreement between consumer and PA or agency.</LI> <LI>A list of core competencies and performance expectations for individual and agency providers of personal assistance.</LI> <LI>A guide for consumers on how to recruit, screen, select and manage personal assistants.</LI> <LI>Develop and provide practice-based training and resource tools for consumer-directed personal assistance.</LI> <LI>Develop and pilot a system of consumer-directed personal assistance.</LI> <LI>Develop and implement a program of consumer-led mentoring and technical assistance for individuals who use PA and agencies and staff who provide personal assistance.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The Consumer Task Force includes consumers, family members and self-advocates from the aging and disability communities, and representatives of the Tennessee Disability Coalition, an advocacy alliance of approximately 50 disability groups. Additionally, the Consumer Task Force includes representatives from the state legislature, the Area Agencies on Aging, the Long-Term Care Planning and Advisory Council, the Family Support Council, The Arc of Tennessee, IAM Cares, the AARP, the Middle Tennessee Council on Independent Living, the Home and Community-Based Services Planning Commission, and the Tennessee Technology Access Project.</LI> <LI>The majority of the membership of the Project Oversight Committee will be consumers and consumer surrogates representing the physical disability community, people receiving services through the Department of Rehabilitation Services personal assistance program, and additional members from the aging community.</LI> <LI>To insure continuity, four members from the Consumer Task Force will serve on the Project Oversight Committee.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>The Consumer Task Force developed concept papers for two grants. The Task Force then broke into two subcommittees: one that focused on the CPASS Grant application, and the other on the Real Choice Grant application.</LI> <LI>The Consumer Task Force led the planning and development of the application that included a consensus and commitment of stakeholders to move toward a system for consumer-directed personal care assistance. The task force included a number of consumers who serve as gubernatorial appointees to disability related boards and commissions.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Project implementation will be led and directed by the Project Oversight Committee.</LI> <LI>Consumers will provide input on, test, and evaluate the grant products.</LI> <LI>The Consumer Task Force will be utilized in all phases of the development, training, implementation and evaluation of the pilot project.</LI> </UL> </P> <H3>Public Partners</H3> <P>The Multi-Agency Coordinating Council comprises the following public agencies: <UL> <LI>Area Agencies on Aging.</LI> <LI>Commission on Aging and Disability.</LI> <LI>Council on Developmental Disabilities.</LI> <LI>Department of Mental Health and Developmental Disabilities.</LI> <LI>Division of Mental Retardation Services.</LI> <LI>Division of Rehabilitation Services.</LI> <LI>Tennessee Technology Access Project.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Tennessee Council on Independent Living.</LI> <LI>Tennessee Disability Coalition.</LI> <LI>Family Support Council.</LI> <LI>The ARC of Tennessee.</LI> <LI>IAM Cares.</LI> <LI>The AARP.</LI> <LI>Middle Tennessee Council on Independent Living.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P>The public and private partners listed above participated in the development and planning phase of the CPASS Grant project. They provided input, technical assistance and guidance via meetings and discussions with the Consumer Task Force, during the project development and the application process, and also provided ideas for implementation.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>The Multi-Agency Coordinating Council will act as a partner to the Project Oversight Committee as they assist each other to problem-solve issues that arise, resolve systems barriers, develop or revise policies, and implement a statewide systems strategy that will promote and sustain the grant activities.</LI> <LI>Both the Coordinating Council and Oversight Committee will partner with TennCare, the lead agency, and The ARC of Tennessee in all grant activities.</LI> <LI>The Commission on Aging's Options Program, and the personal assistance program available through the Division of Rehabilitation Services, will work closely with the subcontractor to ensure that people supported through the pilot will be able to access their services and that these initiatives will be able to incorporate changes into their systems to accommodate a "self-determination" model.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>The Arc of Tennessee is the sole subcontractor and will carry out the grant activities as directed by Tennessee Long Term Care Division of TennCare (the lead agency) and under the guidance of the Project Oversight Committee.</LI> <LI>The Arc of Tennessee will lead the multi-year team effort to provide training/technical assistance in the implementation of this grant, through a combination of regional meetings, hands-on support in the Mid-Cumberland region, and working with providers, people with disabilities, parents, and advocates.</LI> <LI>The Arc of Tennessee will perform the fiscal intermediary function and be responsible for the actual payroll for personal assistance workers.</LI> <LI>The Family Support Program will work closely with the Arc of Tennessee to ensure that people supported through the pilot will be able to access its services.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>The Project Oversight Committee, comprising consumers, representatives of consumer organizations, consumer advocacy organizations and other key stakeholders, will set direction for the grant, approve products and processes, make recommendations for systems change, and evaluate progress. The Committee will conduct quarterly reviews of the project and, as determined by evaluations, make needed changes to project activities.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>Each product will, as a component of its development, include at least one evaluation cycle, during which consumers for whom the product is intended will evaluate it, provide feedback and make suggestions for improvement.</LI> <LI>The project director and staff will submit quarterly reports to the Oversight Committee. These reports will be used to make adjustments to refine the system for PASS that is being developed and tested within the pilot. Flexibility among partners will be an essential part of the refinement loop.</LI> <LI>Ongoing evaluation, analysis, and refinement of all grant products will be reviewed within the quarterly project status reporting mechanisms. The Project Oversight Committee, based on the quarterly reviews and the timely feedback from the consumer, personal assistant, and agency perspectives, will make needed changes to project activities.</LI> <LI>Feedback from all regional meetings, and review of systems that are operating already both within Tennessee and outside the state will be studied prior to implementation of the pilot.</LI> <LI>Every aspect of the new system will be scrutinized during Year 3 and refinements and fine tuning will take place before system wide changes are implemented.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>During the last two years of the grant, The Arc of Tennessee, in conjunction with TennCare and the multi-agency Coordinating Council, will identify changes needed in the current waiver-funded programs across the state to support "self-directed" models. In addition, TennCare will evaluate the need for additional Medicaid-funded waivers that can support the activities of the CPASS Grant.</LI> <LI>A number of products developed with grant funds will be used after the grant ends. For example, user guides for recruiting, screening, selecting and managing personal assistants, a guide for mentors, a list of consultants available to provide consumer to agency mentoring and technical assistance, and a boilerplate agreement/checklist.</LI> <LI>A video lending library will be maintained for all training developed under the grant and will include materials on employment and supervision related topics that will be purchased through commercial sources.</LI> <LI>A system for continuation of the fiscal intermediary function after the grant ends will be developed during the grant period with appropriate policy and systems as deemed necessary.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>The initial focus of the pilot project will be in the Mid-Cumberland district of the state, to include Davidson, Sumner, Robertson, Wilson, Williamson, Cheatham, and Montgomery Counties.</P>