North Carolina CPASS Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"NCCPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</EM></P> <H2 ALIGN=\"CENTER\">NORTH CAROLINA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Inadequate supply of persons willing and able to provide personal care and support.</LI> <LI>Regardless of funding source or program auspices, with few exceptions almost all personal assistance services are directed by provider agencies. North Carolina continues to be more heavily reliant than many states on models of service provision controlled by professionals.</LI> <LI>There is a waiting list of 4,600 older persons seeking personal assistance services not covered by Medicaid. Developmental Disabilities Services has a waiting list of over 7,000 people, 3,000 of whom receive no services.</LI> <LI>Multiple funding sources for personal assistant services have often conflicting requirements.</LI> <LI>Most funding sources do not allow for provision of service with maximum consumer control and almost none of them provide direction or guidance on how to use them in a way that promotes consumer direction.</LI> <LI>Reforms are needed to ensure that funding is flexible and can be directed by the consumer with adequate supports and safeguards. The system must learn how to balance consumer control and accountability for public funds.</LI> <LI>The state lacks a comprehensive Medicaid policy that establishes a clear and consistent approach for the use of Medicaid funding across the system.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>North Carolina is now one of the top five states in the percentage of Medicaid funding directed to home and community care.</LI> <LI>North Carolina has two consumer-directed personal assistance programs. One program under the Division of Vocational Rehabilitation, the Independent Living Program, serves approximately 360 persons per year. Since fiscal intermediary services are not currently used, counselors funded through this program provide considerable assistance to consumers to prepare them to become employers of record, to manage the fiscal aspects of this role, as well as to direct their own care. The other program, under the Division of Services for the Blind Independent Living Program, provides support for about 375 persons per year.</LI> <LI>The NC Council on Developmental Disabilities supported a group of people with developmental disabilities and family members to develop the Customer Leadership Initiative, which produced a document, <EM>Choice, Change, Community: Charting a New Course for Customer-Driven Long-Term Supports for North Carolinians with Developmental Disabilities</EM>. This movement grew and formed a new organization, the Self-Determination Leadership Network, which joined with other efforts to bring the issue of consumer abilities and control to the attention of policy makers.</LI> <LI>The state legislature has responded positively to continued advocacy efforts by the aging community to increase funding for home and community services.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Facilitate consumer direction of services and supports through regulatory reform.</LI> <LI>Increase consumer-directed options for personal assistance services and supports.</LI> <LI>Increase consumer leadership in local reform efforts.</LI> <LI>Develop improved quality assurance system.</LI> <LI>Improve training materials and develop technical assistance for all providers of services.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Create a new infrastructure to sustain the service and support system for the provision of consumer-directed home and community care to people with disabilities and long-term conditions.</P> <P><STRONG>Goal.</STRONG> Facilitate consumer direction of services and supports through regulatory state policy reform.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Assess North Carolina's current fiscal and regulatory policies to identify and remove barriers to consumer-directed services and supports, and identify current practices that promote systems change.</LI> <LI>Identify and assess statutes, rules, and policies that are intended to provide safeguards to consumers and formulate changes that will safeguard consumers while promoting consumer direction and autonomy.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Increase consumer directed options for personal assistance services and supports.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Work with provider agencies to assess existing policies and practices and determine barriers to consumer-directed care.</LI> <LI>Establish guidelines for matching consumer strengths, needs, and preferences with personal assistant qualifications, capabilities, and interests.</LI> <LI>Create/modify training and technical assistance protocols on agency-based practices to promote consumer-directed approaches.</LI> <LI>Develop information and training materials to prepare personal assistants to work in a consumer-directed system.</LI> <LI>Create training and technical assistance capacity statewide for agency-based and independent personal assistants.</LI> <LI>Create technical assistance team to work with pilot sites created by all three of North Carolina's Systems Change Grants.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Create community demonstration projects for collaborative approaches across populations to enable people with disabilities and long term conditions to direct their own supports, assume personal responsibility, manage risks, and exercise their rights.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG></P> <P>Establish three pilot projects to promote enduring consumer and local community leadership across the populations of people in need of personal assistance services. The pilot projects will model best practice in linking agencies and organizations to create inclusive communities for all its citizens.</P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Conduct an assessment of state fiscal and regulatory policies and initiate statutory and rule reform.</LI> <LI>Identify provider practices that interfere with consumer direction and make recommendations for change.</LI> <LI>Develop and conduct training and technical assistance with agency based and independent providers to encourage consumer-directed practices.</LI> <LI>Develop technical assistance team(s) to create and sustain statewide capacity to promote and facilitate consumer-directed options.</LI> <LI>Create three community demonstration models of consumer leadership in community resource development to support consumer direction.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The grant application development process brought together a broad group of consumers, family members, providers, state agency personnel and other allies to begin a coordinated approach to assessing the current system of delivery of personal assistance services.</LI> <LI>Consumers and family members will make up the majority (at least 60 percent) of the Community PASS Advisory Committee membership. The Committee will comprise people with disabilities and long-term conditions as well as state agencies and providers.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>Principles for Service Provision for the Consumer-Driven Long Term System were adopted jointly by the consumers and state staff members developing this application, to create an initial consumer-state partnership.</LI> <LI>The Community PASS Advisory Committee developed and approved all aspects of the grant application.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>The new system will be designed with leadership from consumers and families, as modeled by the grant application development effort.</LI> <LI>The Community PASS Advisory Committee will develop working relationships with advocacy and consumer groups to pursue external avenues for change, listen to feedback on issues related to grant activities, and provide information and consultation to promote the vision and principles of systems change.</LI> <LI>The Community PASS Advisory Committee will approve all work produced through grant-funded activities and will advise the Secretary and the Long Term Care Cabinet on actions necessary to implement administrative and legislative changes.</LI> <LI>In addition to their oversight role, consumers will be involved in all aspects of grant activities, including but not limited to these strategies:</LI> <UL> <LI>Consumers will be invited to join all of the CAC Work Teams to provide expertise and to model consumer leadership.</LI> <LI>All subcontractors will be required to report to the project's Community PASS Advisory Committee.</LI> <LI>Consumers and families will form the core of the Technical Assistance Team.</LI> <LI>Consumers will lead the local pilot efforts including any Local Leadership Teams established.</LI> <LI>Consumers will participate in selection of subcontractors for the evaluation process and for three pilot sites via request for application process.</LI> <LI>Consumers will be involved in all aspects of the internal and external evaluation activities of the grant. In addition, they will bring feedback from other consumers to the Advisory Board and provide information to consumers and families not involved in grant activities.</LI> </UL> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Division of Aging.</LI> <LI>Division of Facility Services (Home Care Licensure).</LI> <LI>Division of Medical Assistance (Medicaid agency).</LI> <LI>Division of Mental Health/Developmental Disabilities/ Substance Abuse Services.</LI> <LI>Division of Services for the Blind.</LI> <LI>Division of Social Services.</LI> <LI>Division of Vocational Rehabilitation.</LI> <LI>Division of Public Health.</LI> <LI>North Carolina Board of Nursing.</LI> <LI>NC Community College and state universities in North Carolina.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>NC Association on Aging.</LI> <LI>Association of Self-Advocates in North Carolina.</LI> <LI>Self-Determination Leadership Network.</LI> <LI>Arc Alternative (a self-determination initiative of the ARC/NC).</LI> <LI>First in Families of North Carolina.</LI> <LI>NC Council on Developmental Disabilities.</LI> <LI>Independent Living Centers Advocacy groups.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P> <UL> <LI>A large group participated in the development of this application, including state agencies, provider organizations and advocacy groups.</LI> <LI>Representatives of the Department of Health and Human Services Divisions of Aging, Mental Health/Developmental Disabilities/Substance Abuse Services, Social Services, Vocational Rehabilitation and Medical Assistance were on the grant writing/review committee for this application.</LI> <LI>Principles for Service Provision for the Consumer Driven Long Term System were adopted jointly by the consumers and state staff members developing this application, to create an initial consumer-state partnership.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>Representatives from the Divisions of Facility Services, Mental Health/Developmental Disabilities/Substance Abuse Services, Aging, Vocational Rehabilitation, the Office of Long Term Care, the NC Council on Developmental Disabilities, Legislative Research staff and possible University partners will create an alliance with the Community PASS Advisory Committee and the Beach Center to conduct the assessment of statutes and rules. This partnership will develop and implement strategies to create the changes needed in the regulatory framework.</LI> <LI>The Divisions of Vocational Rehabilitation and Services for the Blind will provide specific expertise from their current experience with consumer-directed services, particularly in the development of materials and in training for providers and consumers.</LI> <LI>NC Community College and state universities in North Carolina. The primary role of the educational sector partners may be in long-term implementation through training, technical assistance and evaluation efforts.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>Independent Living Centers Advocacy groups and NC Council on Developmental Disabilities will have representatives on the Community PASS Advisory Committee and will keep the Committee and staff advised of advocacy and community development efforts pertaining to its population.</LI> <LI>NC Association on Aging and the NC Chapters of the Alzheimer's Association are on the Real Choice Consumer Directed Workgroup with which this grant is partnering and will be invited to participate in local planning and implementation efforts as well.</LI> <LI>The Community PASS Advisory Committee will also call on the many groups in the state who are making progress in the move toward consumer-directed supports. These include the Association of Self-Advocates in North Carolina, the Self-Determination Leadership Network, the Arc Alternative (a self-determination initiative of the ARC/NC) and First in Families of North Carolina.</LI> <LI>This grant will also include persons performing the role of personal assistant (both those employed by agencies and those employed by consumers) in many aspects of the project, but particularly in the development of materials and training for the career of personal assistants.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>State Agency Partners (primarily Divisions of the Department of Health and Human Services) will bring individual expertise and provide a conduit for participation of their public and private networks. The Division of Vocational Rehabilitation and Division of Services for the Blind will provide specific expertise in disability areas, particularly in the development of materials and training for providers and consumers.</LI> <LI>Several associations of providers of personal assistance services are currently participating on the Real Choice Consumer Directed Workgroup that is coordinating with the CPASS Grant activities. Many of these participants have indicated an interest in being resource persons to the project and possibly participating in the pilot projects. They have already contributed significantly to the grant application development process.</LI> <LI>The Association for Home and Hospice Care of NC (a trade association for approximately 400 provider agencies) has been an active participant on the Real Choice Consumer Directed Workgroup. Many other organizations will also be instrumental in using their conferences and other communication vehicles to extend the discussion of the issues and to provide feedback regarding proposed changes.</LI> <LI>The CMS Systems Change Grants Coordinators will provide an arena for coordinating activities of all the grants for effective overall systems changes.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The Community PASS Advisory Committee will meet monthly and will be involved in all stages of problem analysis, planning, implementation, monitoring, and evaluation activities through a Quarterly Review Process.</LI> <LI>The Community PASS Advisory Committee will (1) meet quarterly with the Long Term Care Cabinet to review all evaluative reports and provide recommendations for changes; (2) will track implementation of recommendations; and (3) will work with the assistant secretary to implement administrative and legislative changes within the department.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The Community PASS Advisory Committee will meet monthly and will be involved in all stages of problem analysis, planning, implementation, monitoring, and evaluation activities through a Quarterly Review Process.</LI> <LI>The Community PASS Advisory Committee will meet quarterly with the Long-Term Care Cabinet to review all evaluative reports and provide recommendations for changes.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P>Grant activities are designed to produce significant changes in all aspects of the infrastructure currently supporting the system of personal assistance services and supports by effecting change in (1) state-level statutes and policy; (2) public and private provider practices; and (3) local community capacity for supporting people with disabilities throughout the state. <UL> <LI>In preparing the grant application, upper management DHHS divisional staffs throughout the Department have met with consumers, families and providers to agree on principles and strategies to support major system-wide changes. The principles will guide the policy reform activities of this grant and it is this reform that will ensure the sustainability of the change.</LI> <LI>Principles for Service Provision for the Consumer-Driven Long-Term System sets the standards for future community services provision in North Carolina.</LI> <LI>Grant activities will result in enduring change through: (1) policy reforms that address the current regulatory and fiscal bias favoring care directed by professionals; (2) the use of Model Practice Guidelines and other incentives to demonstrate how agency-based providers can modify practices to provide for more consumer choice and control; (3) the provision of consultation, education, and technical assistance to community service agencies and organizations to decrease reliance on specialized services and increase access to generic community supports; (4) the implementation of initiatives that increase the availability, skills and knowledge of personal assistance workers in local communities; (5) the creation of person-centered approaches to address quality of services, which will endure beyond the grant period.</LI> </UL> </P> <H3>Geographic Focus</H3> <P> <UL> <LI>The impact of the grant is intended to be statewide-statutes, rules and policies that change will affect the entire state, and materials that are developed would be available across the state in the future.</LI> <LI>The three pilot sites are yet to be determined and will be decided in coordination with other Systems Change Grants in order to have the most impact.</LI> </UL> </P> <P>&nbsp;</P>