Oklahoma RCSC Summary | advancingstates.org

<A NAME=\"OKRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">OKLAHOMA</H2> <H3>Identified Problems with Oklahoma's Long-Term Care System</H3> <P> <UL> <LI>Institutional bias for long-term care (LTC) service delivery, primarily from hospital discharge.</LI> <LI>Lack of experienced and capable providers and lack of manpower and tools for adequate quality oversight by program administrators.</LI> <LI>High turnover of personal assistance workers and difficulty recruiting staff in LTC service delivery settings.</LI> <LI>HCBS stakeholders lack expertise in Oklahoma's long-term care system and the nursing facility lobby is a powerful and influential force in Oklahoma government.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Significant increase in recent years of persons with nursing facility (NF) level of care needs being served in the community.</LI> <LI>The state contracted with the Long Term Care Authority (LTCA) of Tulsa to develop a HCBS delivery system and write the 1915(c) waiver for federal funding at a fraction of the amount being charged at the time by traditional public policy consultants for these products. Currently, Oklahoma contracts with LTCA of Tulsa and LTCA of Enid to provide HCBS waiver Administrative Agent services on behalf of the state. These public trust authorities are cooperatively being used to efficiently manage the statewide HCBS program for frail elders and for adults with physical disabilities.</LI> <LI>Reform of LTC infrastructure over a 10year period through collaboration between the Department of Human Services Aging Services Division (DHS/ASD), the Oklahoma Health Care Authority (OHCA), and the LTCA of Tulsa. This service delivery system that was begun in 1994, currently serves 11,000 persons with administrative costs of less than 7 percent of service costs. Since waiver program inception, the LTCAs have assisted the state to redefine and make more available personal care services and double the number of services covered in the waiver, including the development of a unique case management model that combines home care services with case management.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Develop improved quality assurance system.</LI> <LI>Improve the availability, reliability, adequacy and quality of Personal Assistance Services (PAS).</LI> <LI>Create supports for consumers transitioning from institutional settings into community living.</LI> <LI>Develop a new service delivery infrastructure to support a specialty managed care program model.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Develop an infrastructure that supports a service delivery system that is accountable to LTC stakeholders.</P> <P><STRONG>Goal.</STRONG> Develop and implement an infrastructure to support Continuous Quality Improvement (CQI) activities.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Review current contract, audit, and reimbursement structures and processes to guide infrastructure reforms that will achieve "consumer-valued" outcomes.</LI> <LI>Provide incentives for providers to meet defined service delivery performance goals such as higher reimbursement rates and/or a decrease in frequency or intensity of monitoring.</LI> <LI>Develop a contracting infrastructure that requires all Medicaid PAS and 1915(c) ADvantage Program waiver provider agencies to have an approved CQI Plan.</LI> <LI>Increase provider understanding of CQI requirements and concepts through training and technical assistance.</LI> <LI>Develop and install a model Quality Waiver Evaluation System Tracking/Case Management (QWEST/CM) software system.</LI> <LI>Conduct Quality Assurance/Quality Improvement (QA/QI) evaluations to increase Department of Human Services Aging Services Division staff involvement in QA/QI activities. This refers to approximately one hundred DHS LTC Nurses.</LI> <LI>Streamline the level-of-care assessment process and explore outsourcing of LTC assessments through evaluation recommendations.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Improve the availability, reliability, adequacy and quality of PAS.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Evaluate options to expand the PAS program to include services requiring nurse delegation of tasks.</LI> <LI>Secure transition services for 50 consumers to gain detailed knowledge of NF transition service requirements and cost.</LI> <LI>Develop a 1915(b)/(c) waiver to create Medicaid funding for a model specialty managed care program that will serve people with disabilities or long-term illnesses more effectively.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Develop and implement supports for CQI in the service delivery system through the involvement of consumers and their families in oversight of quality monitoring.</LI> <LI>Develop and deploy software tracking of quality indicators.</LI> <LI>Evaluate and make recommendations to expand the PAS program to include services which require nurse delegation of tasks and additional skilled nursing.</LI> <LI>Attain detailed knowledge of NF transition service requirements and costs by transitioning 50 consumers.</LI> <LI>Prepare a pilot integrated service delivery system built around the concept of using a section 1915(b)(c) waiver and a model specialty managed care program in a rural area of the state. The intention is to apply for an appropriate waiver to fund the designed integrated service delivery by the end of the grant period.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The Policy Consortium for Persons with Disabilities comprises advocacy organizations for persons with disabilities and two providers, BIOS and Effective Learning Center, which provide services to persons with disabilities and their family members. Most of the organizations have board members that have disabilities and all are non-profit organizations.</LI> <LI>The Olmstead Planning Group was a group of state agency staff, consumers and representatives from advocacy organizations convened by OHCA, the state Medicaid Agency, to begin the process of developing an Olmstead Plan for Oklahoma. No dedicated funding supported the activities of the group and the group became subsumed by the Oklahoma Olmstead Strategic Planning Committee that has subsequently been created by the Oklahoma Legislature.</LI> <LI>Ability Resources ILC and Progressive Independence ILC are Independent Living Center organizations whose staff comprises over 50 percent persons with disabilities.</LI> <LI>The Oklahoma Real Choice Systems Change Partnership is composed of Consumer Consultants and Grant Partners. The Consumer Consultants are Oklahoma citizens with disabilities that currently use personal assistive services and have committed to actively participate in the partnership for the duration of the grant. The 10 Consumer Consultants range in age from 30 to 65+, with approximately equal numbers of male and female and they come from both urban and rural areas of Oklahoma.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>The leadership of Ability Resources, Progressive Independence and the Oklahoma Policy Consortium for Persons with Disabilities reviewed and helped clarify grant concepts and goals. On separate occasions the proposed grant concepts and goals were presented to the membership of the Consortium and the Olmstead Planning Group for discussion and feedback.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P>Every aspect of grant product development and implementation will be discussed and reviewed for input and feedback by the Oklahoma Real Choice Systems Change Partnership.</P> <H3>Public Partners</H3> <P> <UL> <LI>Oklahoma Health Care Authority, the State Medicaid Agency.</LI> <LI>DHS Developmental Disabilities Services Division.</LI> <LI>Long Term Care Authority of Tulsa.</LI> <LI>Long Term Care Authority of Enid.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Ability Resources ILC.</LI> <LI>Progressive Independence ILC.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG> <UL> <LI>Representatives from Oklahoma Health Care Authority and DHS Developmental Disabilities Services Division, state entities responsible for LTC service delivery, reviewed and endorsed the grant concepts and activities.</LI> <LI>The LTCA of Tulsa in conjunction with DHS Aging Services Division (the Lead Agency), wrote the grant application.</LI> </UL> </P> <P><STRONG>Private</STRONG></P> <P>Ability Resources, Progressive Independence (Independent Living Centers) and the Oklahoma Policy Consortium for Persons with Disabilities reviewed application drafts and met to discuss grant concepts and offer suggestions for improvement.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>The LTCA of Tulsa and LTCA of Enid as Grant Partners with DHS provide staff, facility and material in support of grant activities. This includes support for Oklahoma Partnership meetings, development of technical support documents and information, and strategic planning leadership.</LI> <LI>The LTCA of Tulsa is responsible for delivery of grant products.</LI> </UL> </P> <P><STRONG>Private</STRONG></P> <P>Ability Resources and Progressive Independence actively participate in strategic planning meetings and in all Oklahoma Partnership meetings. Both of these Independent Living Centers will be subcontractors for the NF Transition Services Pilot Grant activity.</P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The Oklahoma Real Choice Systems Change Partnership, created under the Oklahoma CPASS Project Grant, will serve as the Advisory Committee for the Real Choice Project Grant, and will directly guide research, planning, development, implementation and evaluation of reforms of the service delivery system.</LI> <LI>The committee consists of 10 Grant Partners and 10 Consumer Consultants. Grant Partners are grant recipients or subcontractors and consumer consultants are people with disabilities that have used personal care services. Grant Partners gather information and facilitate meetings while consumer consultants develop expertise, offer advice and evaluate system development activities related to the two Oklahoma grants.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The project director and a member of the Oklahoma Partnership will participate in the LTC Systems Coordination meetings at which discussion of the Real Choice Systems Change activities and progress will be a standing agenda item through the duration of the grant.</LI> <LI>Feedback from these meetings regarding grant goals and strategies will be shared with the Oklahoma Partnership members and incorporated into grant activity planning. The whole design and interactive nature of the Oklahoma Partnership process promotes formative learning.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>Development of a provider CQI infrastructure.</LI> <LI>Implementation of a Medicaid contractual condition of participation for providers to have an approved CQI Plan.</LI> <LI>Required QA component for all PAS and waiver services and increased state QA/QI monitoring capacity.</LI> <LI>Medicaid State Plan PAS services will be redefined, including the roles of DHS nurses and nurse-delegated Advanced PAS.</LI> <LI>Improved wages/benefits and equity for institutional/community personal assistance staff.</LI> <LI>Legislative/administrative commitment of state and local government agencies.</LI> <LI>A model LTC specialty managed care service delivery system.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>