Alaska RCSC Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"AKRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">ALASKA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>The criteria for assessing the need for long-term services are unclear, leading to inconsistency across regions and confusion among both providers and consumers. CMS recently gave Alaska 90 days to improve its LOC determination process.</LI> <LI>Lack of community awareness and understanding of Alaska's LTC system, and lack of a Website or manual to provide information.</LI> <LI>Alaska's Service Principles lists self-determination as a value, but there is minimal effort to maximize individual control over services. Alaska has no mechanism for consumers to personally direct their own services under the MRDD, CCMC, Senior, and Adults with Physical Disabilities Waivers.</LI> <LI>Lack of training and technical assistance for providers, personal assistants, and consumers, regarding recent changes to the state's Consumer-Directed Personal Assistance Services (CDPAS) program.</LI> <LI>Difficulty recruiting and retaining qualified and committed personal care workers due to low compensation and a lack of opportunity for career advancement.</LI> <LI>Lack of locally available and culturally competent community services. There are 1,149 people with developmental disabilities on waiting lists, and the average wait is 2 years.</LI> <LI>Most care coordinators in the DD system are ill trained, often unresponsive to consumer needs, and employed by providers, which creates a potential conflict of interest.</LI> <LI>There is no process for continually improving the quality of service across providers or at all levels of the service delivery system, including the state agency level. There is also a lack of consumer participation in quality review activities, and under-representation of consumers in the state's decision and policy-making process.</LI> <LI>There has been little statewide systemic effort to develop housing, transportation, and assistive technology resources.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Alaska has worked hard to establish a cohesive and comprehensive system that meets the LTC community support needs of Alaskans and some of its efforts are nationally recognized.</LI> <LI>Alaska is leading all but one state in successfully utilizing waivers to depopulate and close its Medicaid-funded intermediate care facilities. Alaska is one of only two states to have no public or private ICF/MR facilities. In 2000, 98 percent of those receiving residential services in Alaska were served in settings for six or fewer persons.</LI> <LI>Alaska remains one of the top 10 states in terms of per capita placement in supported employment. Recent employment statistics indicate that Alaska has the highest rate of competitive job closures for people receiving supported employment.</LI> <LI>Personal Care has always been part of Alaska's Medicaid Program. In October 2001, the state implemented a CDPAS program whereby consumers receiving PAS are now able to employ their care providers using private agencies as fiscal intermediaries and employers of record. The total number of people in Alaska receiving personal assistance is 2,157. Of these 79 percent use CDPAS.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Increase consumer participation in systems change efforts.</LI> <LI>Develop policy and advocacy strategies to assure that desired systems change occurs.</LI> <LI>Integrate self-determination service approaches into current service delivery systems.</LI> <LI>Improve access to services through new consumer-driven care coordination and case management systems.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> To put in place a planning, capacity building, monitoring and advocacy structure that will enable enduring systems change.</P> <P><STRONG>Goal.</STRONG> Ensure that people with disabilities, including people with mental illness and persons age 65 and older, participate in systems change efforts.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Expand the Consumer Task Force to adequately represent all regions, ethnicities, ages, and disabilities, and develop mechanisms to involve primary and secondary consumers in systems change activities.</LI> <LI>Secure input from primary and secondary consumers, advocacy groups, consumer organizations, service providers and state agencies.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop strategies to implement desired policies and system changes.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Determine and prioritize policy options and develop plan to implement high priority options.</LI> <LI>Coordinate Grant activities with related projects and initiatives, including the state's Nursing Facility Transition and CPASS Grants.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Use project evaluation findings to inform systems change activities and advance the systems change agenda.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop the capacity to collect and maintain relevant data, and design and conduct formative and summative evaluations.</LI> <LI>Identify key issues affecting systems change efforts and develop recommendation for removing barriers and using resources more effectively to effect real choice systems change.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Advocate for real choice systems change with the Governor, the executive branch and the legislature.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Determine strategies to favorably influence policymakers, and hold Disability Summit to promote the real choice systems change agenda.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Integrate self-determined service delivery into current service delivery systems.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Pilot and evaluate an Alaskan self-determined model of service within the two DD waiver programs.</LI> <LI>Create a policy environment favorable to self-determination while eliminating current system barriers to self-determination.</LI> <LI>Build on what was learned to align relevant administrative, fiscal and service practices of self-determination into the DD service delivery system; develop recommendations for change to Alaska's self-determined service system, and integrate self-determination within the DD service delivery system.</LI> <LI>Determine to what extent current Medicaid policy sanctions self-determination; advocate for clear policy guidelines from CMS regarding the use of waiver funds for self-determined services; develop a plan to phase in self-determination services statewide; and prepare and negotiate changes to the state Medicaid Plan and Medicaid waiver programs to integrate self-determination services into service systems.</LI> <LI>Based on findings of the evaluation of the DD pilot program, develop a plan to include self-determination within the Older Alaskans and Adults with Physical Disabilities waivers, as well as the mental health system.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Improve access to services through new consumer-driven care coordination/case management systems. The activities listed under this goal are not funded with CMS grant funds but with the required state match funds.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop and implement mechanisms to streamline access to services and supports, and standardize the eligibility determination process for DD waivers.</LI> <LI>Develop a system of technical support information and assistance for DD providers.</LI> <LI>Implement reforms within the DD system and determine the applicability of these reforms to the Adults with Physical Disabilities, the Older Alaskan waiver programs, and the mental health system, and make changes as indicated.</LI> <LI>Design, implement and evaluate a consumer-driven care coordination system to be used as a single integrated system in the state's four waiver programs.</LI> <LI>Develop consumer-driven care coordination standards, certification and outcome measures; review and revise care coordination training curricula; and train care coordinators, provider and state agency staff, and primary and secondary consumers.</LI> <LI>Develop a Web-based system of ongoing technical assistance for care coordinators.</LI> <LI>Design, implement and evaluate consumer-driven mental health case management system.</LI> <LI>Review and revise current case management training curricula; train care coordinators, provider and state agency staff, and primary and secondary consumers; and update current Web-based system of ongoing technical assistance for case managers.</LI> <LI>Change Medicaid regulations, including waiver regulations, to ensure the continuance of a consumer-driven case management system and phase-in statewide.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Conduct formative and summative evaluations.</LI> <LI>Pilot and evaluate a self-determined model of service within the two DD waiver programs.</LI> <LI>Design, implement and evaluate a consumer-driven care coordination system to be used as a single integrated system in the state's four waiver programs.</LI> <LI>Develop a Web-based system of ongoing technical assistance and information.</LI> <LI>Develop consumer-driven care coordination standards, certification and outcome measures.</LI> <LI>Provide revised care coordination training and case management training.</LI> <LI>Prepare and negotiate changes to the state Medicaid plan and Medicaid waiver programs.</LI> </UL> </P> <H3>Consumer Partners</H3> <P>Consumers are actively involved in the Consumer Task Force<STRONG>,</STRONG> which includes consumers and family members selected by the State Independent Living Council (SILC), the Governor's Council on Disabilities and Special Education, and the Alaska Commission on Aging. The Consumer Task Force (CTF) also includes state and private agency representatives who actively participate in the state's long-term care plan.</P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>The state's starter grant was used to pull together a CTF. The CTF had three meetings to support and participate in the development and writing of the grant application. CTF members provided input on grant goals and activities.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P>Consumers and their families will be actively involved in developing, implementing and evaluating grant activities.</P> <H3>Public Partners</H3> <P> <UL> <LI>Alaska Commission on Aging.</LI> <LI>Alaska Mental Health Board.</LI> <LI>Developmental Disabilities Subcommittee of the GCDSE.</LI> <LI>The Governor's Council on Disabilities and Special Education (GCDSE).</LI> <LI>The Center for Human Development (CHD) at the University of Alaska Anchorage.</LI> <LI>The Division of Senior Services (DSS).</LI> <LI>The Division of Medical Assistance (DMA).</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P>State Independent Living Council.</P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG> <UL> <LI>The Governor's Council on Disabilities and Special Education (GCDSE) received the starter grant and applied the funds to sponsoring the original Consumer Task Force and facilitating the subsequent RCSC Grant planning sessions. The Council played a key role in the development of the grant application, coordinating input and writing the application.</LI> <LI>Staff from the University of Alaska Anchorage partnered with the GCDSE to prepare the grant application.</LI> </UL> </P> <P><STRONG>Private</STRONG></P> <P>The SILC was an active participant in developing the grant application to address systems change across all beneficiary groups rather then being limited to the developmental disability community.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>The GCDSE will play a key role in supporting the Consumer Task Force and helping coordinate the Disability Summits. GCDSE will also coordinate the Council's input regarding HCBS waivers systems change activities.</LI> <LI>The DSS will play a key role in project goals and objectives by assuring coordination between Alaska's three Real Choice Systems Change Grants. DSS will use the results of the pilot within the Developmental Disabilities service delivery system to inform the inclusion of self-determination within the Older Alaskans and Adults with Physical Disabilities waivers operated by DSS. DSS will also be involved in implementing reforms within the other two waiver programs and the mental health system.</LI> <LI>The Center for Human Development's (CHD) Evaluation Unit will perform evaluation activities and provide technical assistance for the development and implementation of Web-based data programs and services to support day-to-day tracking of project activities. CHD staff will coordinate the design and implementation of the training curriculum for consumers, parents, and other family members.</LI> <LI>The Department of Medical Assistance will provide technical assistance in planning for the implementation of self-determined/consumer driven services that will be feasible within Alaska's agreements for Medicaid billing, and will cooperate in making necessary regulatory or methodology changes.</LI> <LI>The Alaska Commission on Aging, the Alaska Mental Health Board, and the Developmental Disabilities Subcommittee will support the consumer task force in developing, implementing and evaluating grant activities and will be involved throughout all activities to provide guidance and public commentary for effective systems change.</LI> </UL> </P> <P><STRONG>Private</STRONG></P> <P>The SILC will support the consumer task force in developing, implementing and evaluating grant activities and will be involved throughout all activities to provide guidance and public commentary for effective systems change.</P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>Currently the Developmental Disability Program and the DSS are being realigned as one organization, the Division of Senior and Disability Services. This will strengthen the relationship among the grant's partners in that all four waivers, the NFT Grant, and the Personal Assistance Program will be under the same management and use compatible management data systems. Under consideration is a legislative proposal to include the CIL and the SILC in this realignment. The realignment has been established in the FY 04 state operation budget that begins July 1, 2003. Integration of staff functions, waiver procedures, and oversight will coordinate, support and create opportunities to implement grant activities.</LI> <LI>There are multiple projects in progress around the state related to self-advocacy, deinstitutionalization, and other various systems change activities. The key partners of the Real Choice Grant program will work with these other projects to utilize as many components as possible so that grant resources are maximized.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>The CTF will coordinate policy development for all three of the state's Systems Change Grants. The CTF will meet quarterly to ensure that project activities support the design and implementation of effective and enduring improvements in community long-term support systems.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>Mechanisms for tracking program goals, objectives and outcomes and incorporating feedback in the project will be accomplished through summative and formative evaluations to determine the impact and effectiveness of the project on systems change efforts.</LI> <UL> <LI>Formative evaluations will be conducted to assess timelines and progress, and to facilitate continuous improvement in project activities.</LI> <LI>An annual summative evaluation will be conducted to: (1) determine accomplishments and the impact of those accomplishments on policies, procedures and practices; (2) determine the extent to which systems change is occurring; and (3) make recommendations for change in the following years. A final comprehensive report will examine the type and extent of systems change and capacity building in Alaska at the state and community level over the life of the project.</LI> <LI>Evaluation findings will be used to advance the systems change agenda by determining whether modifications in project activities are needed. They will also assist in the identification of key issues affecting systems change efforts and the development of recommendations for removing barriers and using resources more effectively.</LI> <LI>Position papers will be developed to outline critical issues and proposed strategies for dealing with them. These papers will be disseminated widely to stakeholders.</LI> </UL> <LI>Research and evaluation activities will also include data extraction, labeling and storage methodologies to combine necessary data elements from a variety of sources (e.g., state DMA data, local agency data, and satisfaction data). The combined integrated data set will be utilized to continuously evaluate the project.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The legislative and executive support for Alaska's successful systems change efforts has created an environment receptive to making enduring systems change to its community long-term support systems. Individuals with disabilities and their families, advocates, service providers and state agencies are committed to bring about systems change. A major impediment to implementation has been a lack of resources, which this project will provide.</LI> <LI>Many grant activities are designed to ensure the sustainability of systems changes initiated under the grant, such as securing commitment from policymakers to incorporate desired changes into short-term and long-range plans and resource allocations, as well as assessing needed statutory and regulatory changes and working to bring them about.</LI> <LI>Additionally, all grant activities aimed at change will modify or expand current processes and systems and will link to existing capacity building initiatives. Grant activities will themselves bring about much needed systems changes including:</LI> <UL> <LI>The implementation of consumer-driven care coordination/case management systems.</LI> <LI>More timely eligibility determination and assessment processes.</LI> <LI>Consumer-directed service options will be integrated into the service delivery system following the demonstration.</LI> <LI>Two Disability Summits will provide key stakeholders with access to key policymakers, including legislators, who can help implement recommended changes.</LI> <LI>Training curricula will be packaged in accessible formats to increase sustainability (distance education, Internet and train-the-trainer formats). The systems change coordinator and the self-determination coordinator will work with university programs to include the curricula into their course offerings.</LI> <LI>Finally, Alaska's strong tradition of pooling resources across a number of different public and private groups and organizations to leverage funding will help ensure the development of an enduring resource infrastructure to support community LTC systems.</LI> </UL> </UL> <H3>Geographic Focus</H3> <P>Statewide.</P>